What is cataract ?

What is

Cataract refers to the clouding of the normally clear lens of the eye. It is not always a disease as such, but rather an aging process of the lens. Cataracts can also be congenital, traumatic or secondary due to for example steroids or diabetes. Cataract surgery is the most common eye surgery since practically every person will at some stage develop a cataract.

When should a
cataract be operated?

Cataract can be operated at any time after diagnosis, whether it already impairs vision or not. Ideally, a cataract should be operated sooner than later, making the procedure safer for the patient. Highly mature cataracts not only impair vision but can lead to an increased surgical risk and complication rate and may even leave other conditions undiagnosed (especially retinal conditions).
In certain cases, such as high eye pressure (glaucoma), over-mature cataract or congenital cataract, prompt surgical intervention is necessary.

How is the surgery done?

Cataract surgery is a routinely performed eye surgery around the world and also at Finland Eye Center. Different techniques can be used for cataract surgery, depending on the patient’s needs and the surgeon’s decision. At FEC, the most common method is “phacoemulsification”, which involves a small incision through which the surgeon accesses the cataract. Alternatively, a larger “ECCE” incision can be made (sometimes for very mature cataracts). The cataract/lens is then removed by breaking it down into smaller pieces or extracted as one piece. A clear, plastic lens called an intraocular lens, or IOL, is then inserted. Sutures may be used to close the incision. Different types of anesthesia are available, including topical, local, and general.

Which type of
intraocular lens (IOL) is best?

There are several types IOLs available; monofocal, multifocal, monofocal toric, multifocal toric, and the newest trifocal IOLs. The IOL of choice is a carefully considered decision to be made for each patient depending on the patient’s age, lifestyle, needs etc. With a regular IOL, you will need to wear glasses for either near or distance vision, or both, because the plastic lens will not be able to adapt or focus. Patients at FEC are introduced to multifocal IOL’s, with which patients can become glass-independent to see near and far after the surgery due to the IOL’s built-in alternating zones. Toric IOL’s are used for patients with astigmatism. Multifocal toric IOL’s will be recommended for patients wishing to see near and far, who previously had a certain degree of astigmatism. The latest addition is the accommodating IOL, which mimics the natural lens’ ability to focus.

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What happens
after cataract surgery?

At the end of the operation, a protective eye shield will be placed, which will be removed at your next day follow-up. You will need to use eye drops as advised, usually antibiotic and steroid drops for 1 month. You will need at least a week of sick leave, possibly more if necessary. After that you should be able to return to work, depending on the nature of your work (e.g. patients with outdoor work, dusty environments, heavy manual labour etc. are advised for longer sick leave). Showering is fine after the 2nd post-operative day but praying must be done sitting for one week and the eyes/eye area should only be cleaned gently with a clean cloth or cotton wool for the first week. No swimming/sauna/steam room for 1 month. Driving permission will be given by your doctor when appropriate.
You will be given a detailed post-operative advice sheet with all the information you need regarding drops, follow-ups and practical advice!

What are the
risks and side-effects?

As with any surgery, also cataract surgery carries risks and side-effects. Studies suggest less than 2% of patients experience complications that require further surgical procedures.

Nearly everyone will have mild foreign body sensation and redness (redness can vary and often looks alarming to the patient/relatives but is actually harmless) for the first few days or weeks. Depending on the type of IOL used, the patient may need to continue using glasses or a laser “touch-up” treatment may be recommended. Post-operative glare, haloes or glistening is also possible.

During operation, in case of residual cataract fragment(s), a second surgical session might be required usually within a week (arranged by FEC). In the unlikely event of endophthalmitis (intraocular infection), admission may be required or daily visits to the clinic for treatment. The usual sources for infections are dirty eyelids/lashes. With very mature cataracts, due to the required large amount of energy and manipulation leading to a long operation time, the cornea may become decompensated and a corneal graft may be needed later if prolonged topical treatment does not help. Around 30% of patients, despite removing the cataract, experience clouding of the capsule (from which the cataract was extracted and the artificial lens inserted) within 5 years of surgery. In such cases, a quick out-patient laser procedure, called YAG-capsulotomy, can be done at FEC few months after surgery if needed. You can resume with your daily activities usually within an hour, although some blurriness may remain due to eye drops and dilated pupils.

In some cases, patients with other conditions (such as glaucoma, corneal scarring/haze, retinal problems, lazy eye etc.) may be disappointed with the results of a cataract surgery. We try our best to explain this to those patients before the surgery. It is also possible that secondary conditions may be revealed during or after the cataract surgery that could not be detected before removing the cataract (especially if the cataract was very dense/advanced). Cystoid macular oedema can appear post-operatively but it usually resolves within 6 months by itself.

Since all of us will develop a cataract sooner or later, it should be noted that the sooner it is operated, the lower the risks and side-effects are. The longer you wait, the more difficult the surgery becomes and the higher the risk of complications and additional/secondary issues.

Note:Cataract surgery involves many steps from pre-operative examination to anaesthesia, and cataract surgery itself to post-operative care and follow-up. Each of these steps requires care and co-operation from all involved. While all effort is made to ensure successful surgery, it is important to make an informed decision, before signing the consent form.