Cataracts are related to age and the clouding of the cornea and is the most common of all eye diseases. Lenses grow throughout life but can only become larger and thicker in a limited range. The result is that the inner lenses coalesces, which leads to its blurriness. Another cause for this is the change in metabolism with the advancing of age in the organism, as well as previous injuries.

This process arises at a certain time for everyone. Cataracts often begin to negatively affect vision after the age of 60. The disease is characterized by the impression of cloudy vision. This is accompanied by greater sensitivity to night blindness and often prompts the purchase of stronger glasses.

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Cataract surgery is one of the most often performed and successful eye surgeries – annually over 1.5 million such procedures. During the operation, the cloudy lens is removed and an artificial lens is implanted (the lenses are changed). Replacing the lens also provides the opportunity for vision correction, like nearsightedness, farsightedness, astigmatism or presbyopia!

During the consultation with the initial optical examination, we check for cataracts and inform the patient of possible surgery. The patient will receive from us a modern implant – we will do our best so that he will not need to wear glasses. The operation is usually scheduled without a lengthy delay.

Description of cataract surgery

The most important equipment – besides the steady hand of the surgeon- is the microscope. The eyelids are immobilized so that they cannot blink during the procedure. So the eye does not dry out, moisturizing drops are added throughout the procedure. The eyeball remains slightly open with a small incision, next a similar one is made in the corneal sac. Next is the removal of the deficient lens with the help of an ultrasound vibrating device (which also extracts the particles of the lens at the same time). To the empty exposed lens is placed an artificial lens.

Course of the operation

  • Preparation – the patient receives a local anesthesia in the form of eye drops or an injection next to the eye.
  • The lens is removed – during the first stage on the edge of the cornea is made a small incision, allowing the floating and suction of the natural lens.
  • An implanted artificial multifocal lens is put in the place of the removed lens. The new multifocal lens provides vision with differing strength. Thanks to this, following the procedure, the patient can see both near and far. Multifocal lenses allow for a sharper vision both near and far.
  • Post operation – following the procedure the eye is protected by a band against external factors, like dirt and dust, also allowing the incision to heal over the coming days.
  • Preparation
    To the patient’s eye, we will apply anesthesia by using eye drops or a local spray.
  • Suction of the lenses
    In the first step of the operation for cataract removal, we will make a small incision on the side of the lens, which allows for the natural aspiration of the cloudy lens.
  • Insertion of artificial lenses
    Implanting the artificial lens allows a good vision match for the lens. Thanks to this, the patient can enjoy good vision both for seeing far and seeing near.
  • Post-surgery phase
    Following the eye surgery, the patient is protected from outside factors, like dirt and dust, with the use of a special flap. Thanks to this, healing takes place in just a few days.

Preparation for the operation

Prior to the surgery is an eye examination, where the pupils are dilated (which prohibits the driving of a car for a certain time). Next the eye is measured so that the appropriate artificial lens can be prepared. The family doctor will send a special report with the description of the patient’s general health. The patient will also present information that no health factors would prohibit the operation at that time. If such factors arise, the operation will be postponed. Sometimes it happens that the surgeon has to use a general anesthetic but this is very rare- almost always a local anesthetic will be used. The operation itself is not a difficult venture.

Prior to the procedure, a checklist is given. This includes also a request for the family doctor to fill out a survey with a description of any illnesses. It is important to set a time for a follow-up visit the day after the operation. In the day of the operation, the patient will take medicine like always, which will be coordinated with the local anesthesia. The patient should bring a referral and insurance card.

It is advisable that after the procedure, the patient will be picked up by a trusted companion. On that day, you should wear comfortable clothing without jewelry and make-up. For the operation, you should also bring documents from your family doctor and the basic results from your blood test and EKG.

Local anesthesia

The pain is moderated by eye drops or a shot. In the case of drops, the patient will notice a slight pressure on the eye. Related to this, the eye can still move, so the patient must concentrate and not allow it to move but keep the eye open and gaze upon the overhead light. After the operation, the eye can move, the anesthesia will wear off. In the case of an eye spray, during the procedure, the eye is completely numb and immobile. For some patients, having an injection near the eye is very unpleasant, and the numbness remains for several hours after the operation.

Directly before the operation

Each patient will receive a hospital gown. First the doctor will dilate the patient’s pupils with drops, and according to his expressed wishes will give a calming substance (in this case it is important to establish ahead of time that someone will be available to transport the patient from the clinic). A local anesthesia is given in the preparatory room, and then the patient is moved to the operating room, where he is covered with sterile sheets to protect from germs. During the procedure the oxygen level is monitored.

Most frequently asked questions

The corneal lens is responsible for the entering light to be bent and focused. The lens is very efficient, and makes possible both a sharp vision from up close, and a sharp clarity at a great distance. It is like the working of a camera. Unfortunately, the ability to accommodate lessens throughout life, because the lens simply age. This is why many people after the age of forty need reading glasses.

In the beginning, often in darkness, a blurriness of sight becomes apparent. Sometimes there is an oversensitivity to light than before. The patient often says that they think that they are looking through dirty glasses or an unclean glass, yet each one experiences this a little differently. Cloudy lenses in one case advances quickly, while in another person develops very slowly. Often the lens becomes like a blur, more often with nearsightedness- and wearing glasses can worsen the vision, or the opposite: without glasses the vision is better. Either way, one should quickly go to the ophthalmologist. He will examine the whole eye and give a vision test. With the help of a special lamp, he can check the blurry eye, especially checking for cataracts. Generally, the eyes are dilated. Doctors can quickly and accurately assess whether cataracts are present- and advise the immediate removal.

If artificial lenses are selected for weak sight, glasses will almost be unnecessary. This relates to vision at a distance, because artificial lenses create a focus up close, that means, that it cannot eliminate “farsightedness.” This also works in the opposite way- artificial lenses may be selected in such a way, that the focal point is a close distance. Then of course glasses for distance will be necessary. The decision always depends upon the patient. Most patients consent to the implants of artificial lenses, which help with seeing at a distance. Additionally, those who were nearsighted before the operation often decide to get an artificial lens for the second eye. With laser vision correction related to cataracts, there are no guarantees that the desired strength of light refraction will be achieved. Many unexpected factors will influence this. The measurements that are taken may be inexact which can lead to irregularities in producing the lenses, and in some circumstances the eye itself may not be able to adjust to 100%- all of these are unpredictable elements. Therefore, there is always a risk of residual vision defect. However, this can be counteracted with low power glasses.

 

The solution is “multifocal” lenses, which have been designed to enlarge the field of vision without optical assistance. They are ideal for patients who do not wish to wear glasses; however, these lenses also have some visual impairments- in some areas the optical perception is worse. In addition, there are special lenses, which can align the curvature of the cornea.

Cataract surgery is completely safe, however like every operation, there are some risks. 95% of all of this type of operation are completed without complications. It is possible that some complications can be treated immediately by the doctor, which completely eliminates the problem. Possible problems and ways of countermeasures:

 

  • Fluctuations of pressure in the eye are always treated with tablets and drops.
  • Corneal swelling with the result that vision after the operation is not immediately clear with take care of itself with time.
  • In very few cases, it may be necessary for a corneal transplant.
  • If the fibrous capsules are loose, it may be necessary to remove them, so they will not weaken the vision to any degree.
  • If during the procedure, the sac is damaged, the ophthalmologist will choose another place in the eye, where he can place the artificial lens.
  • Swelling of the retina is eliminated with the help of appropriate medicine.
  • In unusual and infrequent cases, it leads to a detached retina.

All of the above potential complications are reversible, if necessary even with surgery. The doctors remain powerless only when there is a choroidal hemorrhage or when the operated eye is infected. This can mean serious and irreversible vision loss or blindness of the eye. However, the risk is smaller than one in a thousand.

A special dressing is used to protect the eye. During the first night after the operation, the eye can itch- the dressing protects through the unintended wiping of the eye. The dressing is removed on the next day during the follow-up visit, and it may occur, that the patient is not yet able to see 100% clearly. The reason may be a slight edema or harmless inflammation. Both of these will disappear fairly quickly. At the latest, after two months the patient will not feel as though he had an operation.

 

During this period, it is important to remember several things. Some of them relate to the time immediately following the operation, others relate more to the long-term condition:

 

  • A prescription for eye drops should be followed exactly as prescribed by the doctor. You cannot exceed the prescribed dosage because if the eye is sufficiently moist, additional drops will simply run off. In the case of uncertainty, it is better to use one drop too many than too few.
  • The normal practice is for the follow-up visit to be scheduled the day after the operation. Afterward with time, more follow-up exams are conducted. They are individually scheduled together with the doctor.
  • A slight touch of the eye in the first period after surgery does not mean anything bad. Avoid heavy rubbing and pressure on the eye.
  • Just a few days after the surgery, you can carefully wash your hair and face. Avoid eye contact with soap and shampoo. A visit to the sauna or pool is only recommended after complete recovery, i.e. after eight weeks at latest.
  • In the first month after the procedure, the use of facial cosmetics, e.g. makeup, should be avoided completely. Driving is possible much earlier, however, it must be admitted in advance by a doctor.
  • You should refrain from sports and other physical activities for about the first week after the operation. It is acceptable to carry basic things like a juice box or water bottle, but do not lift heavy items. It is also acceptable to bend down. If there is pressure or pain that occurs in the eye, stop the activity immediately (and complete it later). For those who play ball sports, you should wear sport goggles for the first few weeks following the surgery.
  • If the image is shaky or flickering, there is no need to worry. Initially, the loosely placed artificial lens slowly adjusts in its new surroundings. At this time, it is also possible that the light entering the edge of the lens will be refracted in such a way that reflections will be seen as sickle-shaped objects. The normal phenomenon is the itching of the eye or the feeling of a foreign substance in the eye, which is also normal. This is because the incisions in the eye are healing or that the surface of the eye is drying more quickly than normal (eye drops contain cortisone). You can counteract this with the aid of artificial tears (gel or drops). After some time, these ailments disappear completely.

During the two months following the procedure, your vision will change slightly because the new lens must first coalesce with the surrounding tissue. Only then the new lens, regardless of whether the lens is for distance or up close, it fully adapts to the eye. If necessary, the patients will receive temporary glasses for this period, but they often only help for a few days, until the sharpness of vision again adjusts. Wearing glasses will not be necessary.

In the case of occurring pain, loss of vision, flash of light or the eye becomes extremely red, the patient should immediately go to the ophthalmologist or to the emergency room.

After the operation, the vision may get worse and suffer a setback. This results from the fact that following the operation sometimes remains partial cells from the lens (not every cell can be removed during the operation), and may try to reform the lens on the eye. This however is not possible- the result is a cellular layer resembling a light matted glass- so called secondary cataract. This is not a damaged eye, but only blurry vision. This happens when the layer grows over the central areas of the lens. This can be removed easily and risk-free with a laser.

 

In the short-term a few complications may arise, like an edema on the retina or increased pressure on the inner eye. After treatment of the reoccurring cataract, the patient must schedule intermittent follow-up visits. The return of cataracts after laser surgery is almost impossible.