Cataract surgery – Is it really necessary?
10 April 2020
Cataract is characterized by the progressive decrease of vision due to opacification of the lens and without treatment leads to loss of vision. The only effective and curative treatment is cataract surgery, whereby the surgeon replaces the opacified lens with an artificial one. The implanted artificial lens does not require another replacement and retains its proprieties for the rest of the life, regardless of age. Perhaps lately you have often heard the term cataract surgery and you should not be scared if you or one of your loved ones have received this diagnosis, because it is a simple procedure which will save your sight.
When should cataract surgery be performed?
Nowadays, cataract surgery is performed when visual comfort decreases. The longer the procedure is delayed, the longer the patient will struggle with low vision, the actual surgery will be more difficult and risky and the visual recovery will be slower. Also, a series of complications can occur when the cataract is very advanced: among the most common is secondary glaucoma. It should be noted that there are rare cases in which cataract surgery is a surgical emergency, but in such a case, it is very important that the procedure be performed as soon as possible.
Preparation for cataract surgery
Before cataract surgery, you need to do some blood tests, conjunctival secretion analysis, cardiological consultation and EKG (you can check their list here: https://www.amaoptimex.ro/servicii/analize-necesare/) . Also, 2 days before surgery, you must start an antibiotic treatment, with drops and pills. On the day of the procedure, you are not allowed to consume coffee, as it may influence the effects of anesthesia, but you may eat a light meal and drink fluids. It is important to be accompanied to the surgery, because the operated eye will be bandaged until the next day’s check.
What happens during cataract surgery?
Fortunately, nowadays, due to the continuous evolution of technology, cataract surgery is very easily supported by patients:
- It has a short duration;
- Requires only local anesthesia;
- without hospitalization;
- last but not least, it has a very high success rate.The most modern and safe surgical technique for cataract surgery is phacoemulsification with ultrasound followed by implantation of a foldable artificial intraocular lens. This technique is achieved by a microincision of only 2 mm.In recent years there is talk of LASER cataract surgery. At the moment, this type of surgery is generally addressed to less experienced doctors, helping them to perform incisions and pre-fragmentation of the lens. What should be kept in mind is that, even in the case of LASER cataract surgery, the extraction of the lens is also done by the ultrasonic phacoemulsification technique. The LASER technique is not very popular among experienced cataract surgeons, because of the increased duration of the procedure, of greater potential trauma, accompanied by an increase of intraocular pressure during the procedure and not in the least, because of the increase in cataract surgery costs.
What happens after cataract surgery?
Following cataract surgery, after the lens has been replaced, a healthy eye regains sight within a short time.
If there are conditions affecting the eye behind the opacified lens, the postoperative vision will be influenced by them. These diseases can be of the vitreous body: vitreous disorders (floaters); of the retina: various types of retinal degeneration, strokes; diseases of the optic nerve etc.
There are situations in which the doctor cannot make a complete diagnosis until after replacing the lens, that is, after surgery. The opacification of the lens prevents the patient from seeing well, but also deters the doctor form examining properly the structures of the eye, behind the opacified lens (retina, vitreous body, etc.), that is, establishing the presence of other conditions. This happens because many of the existing ophthalmological investigations cannot be performed through the opacified lens.
After cataract surgery, the patient will follow the treatment prescribed by the doctor and it is important to comply with the recommendations, to submit to the mandatory checks and to inform the medical staff urgently, in case he/she considers that the evolution is not normal!
In the period immediately following surgery, the patient can experience phenomena such as:
- dry eye or foreign body sensation
- These phenomena will gradually disappear, depending on the healing capacity of each person. Cataract surgery, even if it is easily tolerated, is still a trauma.A normal phenomenon, which occurs in all cataract patients, after a variable interval of time, is represented by the secondary cataract, that is, the opacification of the layer in which the artificial lens was inserted. However, this does not require a second surgery to replace the lens, but only a minimally invasive LASER treatment that does not hurt and which allows in most cases the immediate restoration of postoperative visual acuity.Artificial lensesEstablishing the power of the artificial lens to be implanted is done by means of an investigation called ocular biometry. The result of the final diopter depends on the anatomy of the eye and on the accuracy of the biometrics which, in turn, is influenced by the type and degree of maturation of the cataract. Also, the healing process and the presence of other conditions can influence the result of the patients postoperative refraction.
The type of artificial lens is chosen by the patient, together with the doctor, after carrying out the necessary investigations.Artificial intraocular lenses are divided into monofocal and multifocal.
Monofocal lenses can be rigid or foldable.Foldable intraocular lenses are the most commonly used, as they are made of a soft material which can be compressed and inserted by micro-incisions of approximately 2 mm;
Rigid intraocular lenses are made of a hard material, being used less often, in special situations, because they require large incisions and sutures.Monofocal intraocular lenses have a single focal center, that is, they offer a good vision at a single distance. If a monofocal lens is chosen, after surgery, the patient will need glasses. The patient can choose the distance he wants to see without glasses postoperatively, ie without distance glasses and with near glasses or with distance glasses and without glasses for reading. However, there are situations when the patient will need glasses for all distances.
Foldable monofocal intraocular lenses can be spherical, aspherical and hydrophobic aspherical ones. The differences consist mainly in the contrast sensitivity and the depth of the visual field.
In case of monofocal artificial lenses, glasses will be required after surgery. Depending on the healing process, the doctor will determine when glasses can be prescribed.
The multifocal intraocular lenses offer independence from glasses, as they can be BI-focal and TRI-focal.
The bi-focal ones offer an independence from glasses in 85% of daily activities, that is to say, the vision is good at a distance and near, but at intermediate activities, glasses may be needed; TRI-focal intraocular lenses offer 95% independence in daily activities, covering all distances: distance, intermediate and close range of vision.
For patients with astigmatism there are monofocal and multifocal toric intraocular lenses available, which compensate for the cylindrical diopters. For patients with extreme diopters, there are custom made multifocal intraocular lenses.
Regardless of the type of lens used, it is important that cataract surgery be performed at short intervals between the two eyes. Such a procedure changes the visual system, and the brain needs to be readjusted, this process is known as neuroadaptation, which can take between 3 and 6 months. In this interval, rarely, the patient may encounter various disturbances such as halos, increased light sensitivity, changes in color perception etc.
Costs of cataract surgery. The price of cataract surgery differs depending on the type of artificial lens chosen, the price list for cataract surgery in our clinic can be consulted here.
On our dedicated website, www.cataracta.ro , you can find all the details about the preparation for surgery, the recovery process and the postoperative conduct.