Cataract

A cataract is a clouding of the lens inside the eye. Inside the eye behind the colored part (iris) is the lens. In a normal eye, this lens is clear. It helps focus light onto the back of the eye (the retina), which sends signals to the brain that allow us to see. When a cataract develops, the lens becomes cloudy and blocks light rays from passing through.

What symptoms does cataract cause?

Cataracts usually form slowly over time, causing a gradual blurring of vision that is ultimately not corrected by glasses. In some people, vision can deteriorate relatively quickly. Cataract development can also cause glare, difficulty driving at night, and multiple images in one eye, which can affect the quality of vision.

Does cataract spread from eye to eye?

No. But it often develops in both eyes either at the same time or one after the other.

Is there a link between diabetes and cataracts?

Yes. Cataracts are more common in people who have certain diseases such as diabetes.

Δεν ήξερα ότι είχα καταρράκτη έως ότου μου το είπε ο οπτικός μου - είναι αυτό συχνό?

At first, you may not notice that a cataract is developing and may not cause any problems with your vision. Generally, as a cataract develops over time, you will begin to notice blurred vision. In most cases, eyes with cataracts look normal on the outside, but if the cataract is advanced, your pupil may appear cloudy or white.

You may need to get new eyeglass prescriptions more often as your cataracts develop. Eventually, when your cataracts get worse, your glasses may no longer improve your vision, and you may have difficulty seeing things even with your glasses.

Treatment

When should I treat my cataract?

In many cases, cataracts are harmless and can remain in your eye. When cataracts progress to the point that they interfere with daily activities or lifestyle, even when you use proper glasses, then cataract surgery may be the next step. Modern surgery has excellent results for the majority of patients, but, as with all surgeries, there is a risk of complications.

Cataract surgery is performed when you have a problem with your vision and want to do something about it.

Can anything be done to stop my cataract from getting worse?

There is no known method of preventing cataracts.

Έχω καταρράκτη και στα δύο μάτια - θα χειρουργηθούν ταυτόχρονα;

It is common for cataracts to develop more quickly in one eye than the other. The eye with the most advanced cataract is usually operated on first. Although it is possible to have surgery on both eyes on the same day, this is not common.

Will I need special testing before surgery?

Yes. Special tests are required to determine the power of the lens that will be inserted into the eye. These measurements are taken before the day of surgery. Before your special tests, if you wear contact lenses, you should not use them:

1 week for soft contact lenses

2 week for hard contact lenses

I had previous laser corrective surgery. Does that play a role?

Refractive lasers (e.g. LASIK and PRK) are used to correct refractive errors (myopia, hyperopia, astigmatism)

If you have had laser treatment, it is very important to inform the surgeon during the preoperative check-up.

Excimer laser treatment affects the calculation of the power of the intraocular lens to be used. 

What happens during cataract surgery?

Your eye is never removed during the procedure. The most common cataract surgery is performed through small incisions and a procedure called “phacoemulsification.” This technique uses ultrasound to soften the lens, which is then dissolved and suctioned out with special instruments. An artificial lens (intraocular lens), made of synthetic material, is placed inside the eye. The lens shell remains in the eye and holds the artificial lens in place.

The incision is very small and most patients do not need stitches, although very fine stitches are sometimes used to close the incision securely. This may occasionally cause some mild temporary post-operative irritation.

Depending on the type used, the stitches may need to be removed. Removing the stitches is usually done in the clinic and is a quick and painless procedure.

Can cataract be removed with laser?

The new technology is available using a specially designed laser for part of the procedure. However, a surgeon still needs to intervene to complete the surgery. It is currently not possible to remove a cataract with laser alone. 

What takes place during surgery?

The procedure is performed while you are lying on the operating table. Your face is partially covered by a sterile drape. If you have difficulty lying flat or are claustrophobic, we will do our best to make you comfortable before the procedure begins, but it is recommended that you inform the surgeon during your preoperative examination.

During the operation, the surgeon uses a microscope and the bright light from the microscope and cover means that you cannot see the organs working, but you may see shadows and moving shapes. You will usually be awake during the operation and will see white light and often colorful lights and shadows. You may feel the surgeon's hands resting gently on your cheek or forehead.

A lot of fluids are used during the procedure. Sometimes, the fluid can leak out from under the drape and run down your face, into your ear, or up your neck, which can be uncomfortable.

You may hear conversations during the operation. Please do not participate as it is important to remain still during the operation.

What kind of anaesthesia is necessary?

Most cataract surgeries are done under local anesthesia, where you are awake but your eye is numb. This is usually achieved with drops or an injection around your eye.

Sedation may be administered if deemed necessary

Will I need to stay in the clinic?

Cataract surgery is day surgery. That means you don't have to stay in the clinic.

Which are my choices in terms of needing glasses after surgery?

Monofocal intraocular lenses

Your lens, which helps you focus, is removed during the surgery and replaced with an artificial lens, the intraocular lens. There are a variety of lenses that can be used and they affect how you will see at a distance or when reading after the surgery.

During your initial assessment, the surgeon will discuss with you whether you want better focus for near vision or distance vision.

Most people choose to see well at a distance after surgery. If you choose this option, you will usually need reading glasses and may also need glasses for good distance focus.

Some people choose to see well at close range, especially if they like to read without glasses. If you choose this option, you will need glasses for distance vision (e.g. driving).

-Monovision

By combining distance vision in one eye with near vision in the other, you may be less dependent on glasses after surgery. Dividing focus between the eyes in this way does not prevent the eyes from working together or disrupt your balance. You will likely need glasses for at least some activities after surgery, and it may take a few days for you to get used to your new vision. 

-Multifocal intraocular lenses

Multifocal lenses are lenses that aim to correct vision for both near and far distances. Multifocal lenses do not work for all patients and may reduce contrast vision.

Toric intraocular lenses (for astigmatism correction)

Toric lenses are available for patients with moderate to high astigmatism. A toric lens is made from the same material as a standard non-toric lens but also includes correction for astigmatism. The goal is to improve your vision so that the need for glasses is minimized, but, as with standard lenses, you may still need glasses for some activities.

There are a few potential issues with toric lenses:

• Astigmatism may not be fully corrected and glasses may still be needed postoperatively.
• If complications occur during cataract surgery, it may not be possible to insert a toric lens.
• The lens may rotate after surgery and may need to be placed in the original position with a second surgery.
• Alternative options to toric lenses for patients with high astigmatism are glasses or contact lenses. Laser refractive surgery can also be used postoperatively.

What is the cost for cataract surgery?

Preoperative measurements usually allow your surgeon to select an IOL that provides the desired visual outcome, but each patient's response is different and absolute accuracy cannot be guaranteed. Sometimes, patients may require glasses after surgery despite accurate measurements and a smooth procedure.

Color vision

A cataract selectively scatters and absorbs blue light. After surgery, your intraocular lens is transparent and a change in color perception is common. This can be dramatic, especially in the early period after surgery, and can make colors appear brighter or grayer than usual.

Most intraocular lenses have built-in filters for ultraviolet (UV) radiation, but you can use sunglasses when you are in bright areas.

Are there any possible complications?

Yes. Serious complications are uncommon but, if they occur, they can permanently damage your eye. 

• 1 in a 1000 risk of serious complications
• About 1 in 100 problems requiring additional surgery to correct
• 1 in 20 procedures has less serious complications, which may require additional time in the operating room or after surgery.
• 1 in 10 patients will need laser at some point in the future for opacity of the sheath behind the intraocular lens

What is important after surgery?

• Increased redness, pain, cloudy yellow/green discharge. This may indicate a serious infection or inflammation.
• Disturbance of central vision. This may indicate macular edema.
• The red, painful eye after the drops may be due to a recurrence of postoperative inflammation.
• The implanted lens can move from its original position, causing a distortion, although this is uncommon. If this happens you may need further surgery to reposition the displaced lens.
• A shadow, flashes, or floaters in your vision. The most common cause of a shadow or flashes in your peripheral vision is the different way light is focused on the retina by the new intraocular lens. You may be aware of a shadow on the side of your vision, often described as a “crescent.” This is usually temporary as your eye quickly adjusts to the new lens.

How soon after surgery can I return home?

You can return home right after surgery

How will my eye feel after surgery?

As the anesthetic wears off, there may be some mild pain. Your eye will also likely be red, watery, and your vision may be blurry for the first few hours after surgery. You may wish to use your usual painkillers when you get home and for the first 24 hours.

A mild sensation as if there is sand or a foreign body in your eye may last for some time after surgery, especially if you already suffer from dry eye.

You should contact us if the pain, redness, or blurred vision gets worse rather than better.

Is there anything else I need to do to take care of my eye?

You should avoid rubbing or putting pressure on your eye. This is extremely important in the first one to two weeks after surgery. You may find that you are sensitive to light, so it is helpful to have a pair of simple dark glasses in case you need them. Your surgeon will advise you if there are any

The majority of patients can resume normal physical activity within a day or two. 

When can I wash my face and hair after surgery?

We advise you to be careful when washing: Do not pour water directly on your face in the shower or immerse your head in the bath for one week after surgery.

When can I see my optician for my glasses?

You can usually have your eyes checked by your optician 4-6 weeks after surgery.

Until you have your new glasses or between the first and second surgeries, you may experience some vision difficulties, especially if there is a large difference between the two eyes.

During this period, you can choose to use or not use your old glasses. Your optician may remove the lens on one side of the glasses until your final pair of glasses is ready.

Can I get a cataract again?

No, but you may develop a thickening or clouding of the membrane behind your new lens in the months or years after your surgery, which occurs in about one in 10 patients who have the surgery. This is called posterior capsule fibrosis and can cause blurred vision.

This can be treated on an outpatient basis with a laser procedure known as YAG capsulotomy.