Cataract is clouding of the lens of the eye that cause loss of vision.
In the young eye, the clear natural lens helps to focus light rays onto the retina so that a clear image can be formed .When the lens become cloudy or opacified , light rays will be scattered and vision will be affected
What causes cataract?
The vast majority of cataract is age related. By the time we are in our sixties, many of us would have developed cataract. Vision gradually gets foggy, and daily visual task like reading, driving and seeing at night becomes more difficult. Some describe it as similar to seeing through frosted glass .Colours do not appear as bright as they used to be. Glasses need to be changed more frequently and they become less effective in enabling the person to see clearly.
Symptoms are usually gradual and generally they are not painful. Smoking, prolonged exposure to sunlight and medical conditions like diabetes may increase the risk of getting cataract earlier. When the symptoms become more and more troublesome, it’s time to visit your ophthalmologist for a comprehensive eye examination.
Apart from age related, there are also other causes of cataract such as ocular trauma, previous eye inflammation, drug induced, nutritional disorders, congenital, developmental, metabolic disorders, excessive radiation etc.
What can you do?
· Eat a healthy diet.
· Wear sunglasses when going out under hot sun or wear a hat.
· Don’t smoke.
·Glasses: Changing your glasses for distance and reading may to a certain extend improve your vision, but the effect may be temporary.
·Better lighting conditions: This certainly will help improve your visual task.
·Surgery: Once all of the above measures have been exhausted, and your vision or daily visual task gets worst, it’s time to consider surgery.
With modern tools and machinery and Surgeon expertise, cataract surgery nowadays is very safe and effective and the results are remarkable.
Therefore do not be disheartened when you are told that you have cataract; in fact it is the beginning of a pleasant journey to a much anticipated wonderful eyesight once it is done!
What do I expect in my visit to the Eye Clinic?
When you suspect that you may have a cataract, make an appointment with your trusted Ophthalmologist to have a comprehensive eye examination.
In the initial visit, a brief ocular history and a history about your general health status will be asked.
Next, you will be subject to a few eye tests and examination that includes calculation of the intraocular lens (IOL) lens power. Dilating drops will be instilled into your eye to get the pupil dilated, so that the Surgeon would be able to do a comprehensive eye check. The Eye surgeon has to ensure that the other parts of the eye are healthy before a decision can be made to embark on the cataract operation.
A walk through the cataract surgery process.
Prior to the surgery, you will be escorted to the waiting area of the operating theatre. Here the attending nurse will check your vital signs ( blood pressure, pulse rate ) and do a minor blood test. You will also be asked about the medications that you usually take.
After that you will be brought to the preparation room ; eye drops will be instilled onto your eye to be operated on to dilate the pupil. You may also be given a tablet to calm you down if you are very anxious or apprehensive. Your attire will be changed to operating room attire .
You will then be escorted to the operating room and made to lie down flat and comfortably. Vital signs are monitored with a monitoring machine to ensure that your vital status are stable. As the operating room is cold, a warmer will be used as a blanket.
Your eye to be operated on and surrounding part of the face will be cleaned with a mild antiseptic solution; a sticky drape is then covered over the eye to be operated and part of the face to keep the area to be operated on sterile.
The procedure is usually done under topical anaesthesia whereby only topical anaesthetic drops are instilled onto the eye ; very rarely, local anaesthetic injection is necessary .You are awake throughout the operation, but may feel a bit sleepy or drowsy due to the sedative given to you.
Nowadays most cataract is removed by a procedure called phacoemulsification surgery.It is a procedure whereby the eye surgeon introduces an ultrasonic probe into the eye through a very small incision( as small as 2.0mm incision )to break and mesh up the cloudy cataract; this is then vacuumed out.
After cleaning and vacuuming the anterior chamber space, an IOL is inserted to restore the eyesight .
The whole process usually takes between 10 to 15 minutes.
At the end of the surgery , your operated eye will be covered with a shield to protect the eye. Eye pads are usually not necessary.
What happens after the surgery ?
Immediately after the surgery, you will be escorted out from the operating room to the recovery area .Your OR attire will be changed back to your own attire.; you will then be required to rest for a few minutes and your vital status checked.
If stable you will be guided out from the recovery room. You will also be instructed on how to instill your eye drops and the frequency of application. Pamplets with instructions will also be given to you on how to instill the eye drops and also on the “Do’s and Don’ts” of after eye surgery .(please go to the section on Do’s and Don’ts of post cataract surgery )
With rising affluence and improved quality of life, patients nowadays have higher visual expectations and many of them have opted for spectacle independence.
With better instrumentations and improve IOL technology, there are now many choices of lenses available to also correct presbyopia and existing astigmatism apart from the cataract.
Options of IOLs available:
·Monofocal IOL- this corrects distant vision only ( the most commonly used IOL) for patients with cataract but with no pre-existing astigmatism.
·Monofocal toric IOL- this corrects astigmatism and distant vision for patients with cataract and with pre-existing astigmatism.
·Multifocal IOL – this corrects near and distant vision for patients with cataract only.
·Multifocal toric IOL- this corrects astigmatism , near and distant vision for patients with cataract and pre- existing astigmatism.
·Trifocal IOL – this corrects near , intermediate( computer users) and distant vision.
Do not worry over which type of lenses are suitable for you. Our team of experienced and dedicated counsellors will be available to guide and advise you on your visual needs and expectations, so that you will have the ideal IOL implanted into your eye.
Can I do both my cataracts at the same sitting.?
For safety and avoidance of unforeseen very rare complication like infection, cataract is generally done one eye at a time in each sitting.
However, technology is very advance nowadays that performing a cataract surgery takes a mere 10 minutes that surgery in both eyes can be completed within 30minutes.; therefore sometimes the surgeon or the patient may according to their convenience may opt for bilateral simultaneous cataract surgery. The other advantage is that by doing bilateral simultaneous cataract surgery , patients, especially elderly patients avoid the inconvenience of making multiple visits to the eye centre.
Can I avoid cataract operation?
Initially when the cataract is not so mature and the symptoms are quite tolerable, one can delay his or her cataract operation. In the meantime, vision can be enhanced by glasses or change of glasses or doing task under better lighting conditions.
Eventually , as the cataract becomes more mature, the symptoms will become more disturbing and when your usual daily activities are being affected, you would have to consider surgery. Surgery is the only effective way of curing your cataract.
Must I continue my usual medication ?
Yes please do continue your usual medication ( heart, hypertension , DM etc ) ;However, if you are on blood thinning medications, you may opt to stop the medication about 4-5 days prior to the intended day of surgery. However, as most cataract operation is performed through the avascular cornea, this temporary stopping of medication is not absolutely necessary.
How often must I come for my eye check up after surgery?
Usually post cataract review is done at Day 1 post operation ,1 week post operation and subsequently at 6 weeks. However, the frequency of post operation visit depends entirely on the Surgeon. You may be asked to come for a review more frequently or less frequently, depending on the Surgeon’s instructions.
Do I need glasses after cataract surgery?
In certain cases, there might be some residual refractive power after cataract operation.
You may need glasses to enhance your already clear vision for distance and near.Usually the Surgeon would suggest refraction to be done and glasses prescribed about 1 month after the cataract operation when the wound has become more stable.
Do I need to be warded ?
Cataract surgery nowadays is very safe, effective and fast. It is usually done as a day care procedure or even as an outpatient procedure, meaning that you can go home a few hours later on the same day.
Therefore, one need not be admitted overnight. Only in certain circumstances will a patient need to be admitted for observation and close monitoring post surgery.
My vision initially after cataract surgery is very clear, but it becomes blur a few months later. Why is that?
During cataract surgery, the IOL is placed in front of a layer of membrane to support it. This membrane is initially very transparent. However in certain cases, the membrane becomes transluscent or opaque months or even years later. This is called posterior capsular opacification.It happens more in younger patients. It causes mild blurring of vision, glare or a feeling of something blocking the eyesight.
However, do not be worried over it. This opacity can be cleared by a minor laser procedure called YAG laser capsulotomy. The procedure is painless and it takes only a few minutes to do the procedure.
I experience something moving about across my field of view after cataract surgery. It disturbs my otherwise clear vision.Why is that ?
Sometimes after cataract surgery, one experiences something floating across one’s field of vision. This condition termed ‘floaters” is due to vitreous degeneration at the back of the eye ( the vitreous ). Most of the time , the condition is harmless ; however it is good to have your eyes checked by an Ophthalmologist to exclude more sinister causes like retinal tear.
If it is harmless, the floaters may get less over a period of time.
I develop tearing in my eyes after cataract surgery. Why is that?
After a routine cataract operation , one may sometimes experience tearing of the eyes. Most of the time, this symptom is quite tolerable and harmless and is likely due to dry eyes. However do have a check by your Ophthalmologist to exclude other local causes of tearing.