L: Vision before cataracts (simulated) |R: vision after cataracts (simulated)
L: Vision before cataracts (simulated) |R: Vision after cataracts & halo effect (simulated)
A cataract is the clouding of the crystalline lens in the eye that may cause the blurring of vision.
“In Singapore, the percentage of elderly patients affected by cataracts is about 78.6%. The number of people affected by cataracts also increases as they get older (It affects 63.6% of people between 60 and 64 years, and 94.6% of people 75 years and older.)”*
A cataract surgery is a 2-step process.
Firstly, the cloudy lens is removed using ultrasound.
Next, an intraocular lens (IOL) is implanted.
Comparatively, cataract removal is one of the safest and most effective surgical procedures. In addition, IOL implants are able to treat myopia, astigmatism, and presbyopia. As a result, cataract surgery is often called a ‘4-in-1 surgery’
People with systemic health conditions such as diabetes, high blood pressure, high cholesterol and heart diseases are usually suitable to undergo a cataract surgery. However, it is important to inform the surgeon of the medications that the patient is taking as certain medications may affect the surgery.
In addition, people who have undergone previous eye surgeries (LASIK, retinal detachment, glaucoma treatment, eyelid surgeries) are usually also suitable. Still, the patient should inform the doctor of all pre-existing eye conditions during the initial consultation session.
The older methods of cataract removal are extracapsular cataract extraction (ECCE) and intracapsular cataract extraction (ICCE).
In contrast, the new phacoemulsification with intraocular lens implantation has become a popular choice for surgeons. This is due to faster healing and less incidences of complications. In this process, the corneal incision can be made as small as 2.2-1.8mm which will heal without any stitching.
The video above shows the cataract surgery
Lens with one focal point. Some patients may require glasses for certain activities. Provides comparatively sharper vision.
Suitable for people who:
– Are particular about visual clarity
– Are particular about glares & halos (eg. for night driving)
– Require sharp near vision (reading, art & craft, sewing, etc.)
Lens with two focal points – near and far. Generally, patients will not require reading glasses after surgery. Possible side effects include halos & glares, and loss of contrast.
Lens with three focal points – near, intermediate and far. Generally, patients will not require reading glasses after surgery. Possible side effects include halos & glares, but less than multifocal IOLs.
Lens with two focal points – intermediate and far. Generally, patients will not require reading glasses after surgery. Possible side effects include halos & glares, but less than multifocal & trifocal IOLs.
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Most notably, cataract surgeries can potentially be 95-99% successful under the hands of a competent and experienced surgeon. However, some rare occurrences of complications are cystoid macular oedema, bleeding at the back of the eye, posterior capsule rupture, endophthalmitis, retinal detachment and glaucoma.
Incidentally, a cataract surgery may not be able to eyes with pre-existing diseases to perfect (6/6) vision.Some examples of these eye diseases are macular degeneration, retinal hole, glaucoma, corneal scarring and ambylopia. That is, a cataract surgery only removes the clouded lens. That being said, the irreversible damage initially done by the preexisting disease will not be rectified. Nevertheless, a cataract surgery can still improve vision, just not to 6/6.
Morever, about 30% of patients may develop a posterior capsular opacity (PCO) after a cataract surgery. As such, PCOs are also called secondary cataracts. A PCO may appear after a month or after many years following the surgery.However, some cataract patients enjoy clear vision for many years without encountering a PCO.
It is important to note that a cataract does not grow again after an initial cataract surgery.
PCO causes hazy vision with occasional glare effects. It occurs due to protein deposition on the posterior surface of the capsular bag which contains the intraocular lens. As a result, clarity of vision can is reduced. However, PCOs can be easily removed via a YAG-laser capsulotomy. This laser needs to be applied for only one session and is rather quick and painless.
Currently, there are no alternative treatments that can cause a cataract to disappear once it has formed. It is important to note that neither diet nor lasers can make a cataract go away.