What are cataracts?
The eye is similar to a camera. Light is focused by a lens on to a light sensor. If the camera lens is dirty, the picture will be blurred. A cataract is a clouding of the lens inside the eye. There are a number of types of cataracts – each of which causes different changes to vision.
Posterior subcapsular cataracts occur centrally and cause a significant reduction in vision. Cortical cataracts occur in the periphery of the crystalline lens. Vision is therefore affected later, as the cataract progresses. Nuclear cataracts cause the lens to become a yellow, murky brown colour. Vision is usually blurred and colours are less vibrant. Factors such as UV light exposure, smoking, prolonged use of steroids, and diabetes increase the risk of cataracts. Protect your eyes with quality sunglasses. Certain eye supplements and a balanced diet of fruits and leafy green vegetables can delay the onset of cataracts.
A technological breakthrough in cataract surgery has resulted in improved visual outcomes and blade-free surgery. In traditional cataract surgery, a blade is used to create incisions.
These incisions can sometimes be irregular. Now, using the femtosecond laser, perfect incisions are made, removing the need for all blades. This leads to greater accuracy in creating self-healing incisions so that stitches are not required. The second major step in cataract surgery involves creating a circular opening in the membrane covering the lens.
This “opening” should ideally be round and central. Using the femtosecond laser, the tear in the membrane is always circular and positioned in the centre of the lens to ensure optimised centration of the artificial lens. The cloudy cataract then needs to be fragmented and removed. In some patients undergoing conventional cataract surgery, this process can damage some of the structures in the eye.
With laser cataract surgery, the lens is broken up into tiny pieces with the femto laser. This process does not cause damage to any of the eye’s structures and is less time-consuming.
The final step of cataract surgery is the same for conventional and laser cataract surgery where the artificial lens is implanted into the eye.
Laser nano-second cataract surgery is the latest enhancement to cataract removal. Unlike conventional surgery, where a mechanical ultrasound probe vibrates to breakdown the cataract, nano-laser cataract surgery uses a laser to emulsify the cataract into tiny pieces without any moving parts.
The main advantage of cataract surgery performed using the nano-second laser is that the energy dispersion within the eye is only 5% compared to when ultrasound is used to break down the lens. This improves the rate of healing and has less impact on the endothelial cells. These cells are essential to guarantee the clarity of the cornea for the rest of the patient’s life.
The final stage of surgery is the same as conventional surgery, where an artificial lens, or IOL, is gently placed into the eye. Laser nano-cataract surgery offers improved safety and faster visual recovery.
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Cataracts cause clouding and light scatter in the crystalline lens. Surgery involves replacing the cloudy lens with a clear artificial lens.
Cataract surgery is very safe; over 95% of people have an improvement in vision. Most surgery is performed with a local anaesthetic using either drops or an injection. Throughout surgery, the eye is in its natural place.
Surgery begins with a small incision to the front of the eye. A thin membrane on the front of the crystalline lens is carefully removed. The process of making a continuous circular opening is called a Capsulorrhexis. A special tool is used to break-up the cloudy cataract and remove it from the eye.
Your surgeon will take care to remove any tiny fragments of the cataract. Once removed, an artificial lens is implanted in the eye and carefully centred. Stitches are not required during the majority of procedures, as incisions are self-healing.
Cataract surgery risks
When you and your doctor have determined that cataract surgery is required, you will be asked to complete an informed consent form.
The aim of the cataract operation is to improve the quality of your vision. Surgery may also improve the doctor’s view of the back of your eye. Cataract surgery involves the removal of the natural crystalline lens in the eye and replacing it with an artificial lens using a surgical technique.
Cataract surgery is usually very successful, with over 95% of operations occurring without any complications. However, it is important to realise that there is always a risk of complications associated with any operation. Some of the complications that may occur during the operation include internal bleeding, damage to other structures of the eye, including the capsule surrounding the lens, incomplete removal of the cataract, or part of the cataract falling into the back of the eye.
Some of these complications can be dealt with at the time of the surgery or just after surgery. Potential complications occurring after the operation include severe infection, fluid accumulating in the retina, which is the light-sensitive layer at the back of the eye, or detachment of the retina. You may require distance glasses to optimise vision and will probably need reading glasses.
Your glasses prescription will change after the operation. These complications can sometimes occur even if the operation itself is carried out perfectly. The most serious consequence of all the complications is the risk of loss of vision, which may be temporary or permanent.
These risk of severe or complete permanent loss of vision in the operated eye is less than 1 in 1,000. In approximately 1 in 10 cases, the membrane behind the artificial lens can become cloudy making your vision blurred again. If this happens, YAG laser treatment may be needed some time after the surgery.
Over 95% of operations occur without any complications. If you have any pre-existing conditions that may increase your risk, your doctor will discuss these with you.