The only known effective treatment for a developed cataract is cataract surgery, which involves the almost complete removal of the lens of the eye and implanting an artificial lens in its place.
The technique of cataract surgery is constantly evolving, which provides better outcomes while rendering the healing time shorter. Today we perform the surgery through small corneal wounds. We make a round opening on the capsular bag after which we break the lens into smaller pieces with an ultrasound device and remove them while keeping most of the lens capsule in place. After that we implant an intraocular artificial lens (IOL) in this bag.
We determine the power of the IOL during the biometry, which consists of a set of very accurate measurements and individualized calculations. The use of a modern biometer, the experience of the examiner and the use of modern calculation formulas are important, as this is the only way to reduce the acceptable margin of error close to zero.
Traditionally, the opening on the capsular bag is made by hand, but newly it’s possible to do it a laser. The femtosecond laser assist cataract surgery (FLACS) the lens wound is made with high precision and atraumatically. The femto-laser also breakes the lens into smallert pieces, making the cataract removal easier and less stressful for the eye. This procedure can slightly further increase the safety of the surgery and reduce the complications.
Types of intraocular lenses
The basic, monofocal lenses can only correct the spherical diopter. Usually this is calculated to correct the distant vision and a working, reading glass is still needed. Additionally, in case of cylindrical refractive error of the eye a toric lens is used to correct that part of the refraction. This also requires a special technique of lens implantation, which is not available everywhere.
Post-operative spectacle-free vision can be achieved with multifocal lenses, which can provide sharp vision at distance, intermediate distance and near. Unfortunately these lenses are not suitable for everyone (e.g. certain retinal disease). We must note also, that there might be some trade-offs in becoming spectacle-free. By design multifocal lenses will provide a slightly lower contrast sensitivity, meaning slightly lower vision in very dim lighting conditions. Light scattering around conventional light sources (halo, glare, starbust) can also occur in some situations (e.g. driving at night) . These phenomena, although is most of the cases imperceptible, can be very disturbing for some people. Because of this it’s important to decide carefully when choosing this premium lens. Discuss your concerns with your surgeon before the operation, as this lens cannot be changed like glasses.
The enhanced depth of field (EDOF) lenses are situated between the monofocal and multifocal lenses. These offer the most glass-free option with the least compromise. One can expect a good vision with these lenses from about 70cm to distance without glasses. Up close, reading large characters won’t be a problem, but you’ll need reading glasses for the small ones. Nevertheless, you will be able to see the text on the monitor and television. Objects in the room could be seen clearly and you will not need glasses for driving or the dashboard.
Regardless of the lens you choose, bare in mind that there are some limitations of the surgery. The biometry, the manufacturing of the lens and the surgery itself have a margin of error. In unfurtunate cases, these combined can result in a significant residual diopter after surgery. Still, in the vast majority of cases this deviation is negligible (less then 0.5 diopters) and doesn’t require glass correction.
Before cataract surgery
We will perform a full ophthalmic examination before the cataract surgery appointment. This includes the biometry, which is the measurement and calculation of the power of the IOL implant. The pupil dilation will make your vision blurred for a few hours, during which driving is not recommended. If other eye disease is suspected or present, further testing may be required.
Prior to cataract surgery a laboratory testing, an ECG and a medical evaluation and opinion must be performed. This can be done by your primary care physician, internal medicine doctor or anesthesiologist. The opinion should contain that there is no internal medical contraindication of performing the cataract surgery under local anesthesia. Also, please make a list of your regularly taken medications and bring it with you.
On the day of cataract surgery you should eat, drink and take your medication as usually, except in rare cases when the procedure is performed under general anesthesia. Please do not use eye make-up or any cream on the eyelids or around the eyes on the day of surgery.
After cataract surgery
You should use one or more eye drops after cataract surgery, usually for 2 weeks, but sometimes for up to 4-6 weeks (e.g. in diabetes). You will usually need to instill it several times a day for the first week and less often afterwards. Always use it as instructed by your operating doctor.
For a few days after cataract surgery:
- do not rub, squeeze or wipe your eyes,
- water or dirt should not go into the eye,
- do not force or do strenuous physical work or sports.
In the first week, your vision may not be perfect yet, your eyes might be a little redder and a stinging sensation can occur. Tearing and light sensitivity can occur during the first days too. However, if after the first day of surgery your vision deteriorates or your eyes becomes redder and painful, an examination is recommended sooner than planed.
A follow-up examination is performed at day one, at first week and at six weeks after cataract surgery. Usually the vision will became good during the first week, after which the majority of the restrictions will be lifted. However, from a medical point of view the complete recovery takes 4-6 weeks.