Cataract unit

What is cataract?

Cataract is the clouding of the natural lens located in the eye. Normally, the lens is transparent and its role is to focus light rays onto the retina, which is the part of the eye that enables us to see shapes, colors, and light. The most common reason for cataract formation in the eye is the natural aging process of the lens. Other reasons that can lead to cataract formation include injury, congenital or acquired diseases, and the use of certain medications, such as steroids.

In the early stages, cataracts in the eyes may only cause a change in the prescription of glasses, but later on, additional symptoms may appear. These symptoms may include constant blurred vision, monocular double vision, distorted colors, and sensitivity to glare, as well as a decline in the quality of night vision.

Currently, the most effective treatment for cataracts is surgery, where the clouded lens is removed from the eye and replaced with an artificial lens. This surgery is considered to have very high success rates, with around 97% of patients undergoing cataract surgery without complications or special problems. In about 3% of cases, there may be complications such as drooping eyelid, clouding of the cornea, retinal detachment, infection, tear duct leakage, and incorrect positioning of the implanted lens. These complications can usually be treated, but in rare cases, vision loss may occur.

Several types of intraocular lenses (IOLs) can be implanted during cataract surgery: standard lenses with a single focal point, and advanced lenses, including multifocal lenses and toric lenses for astigmatism correction. The standard single focal point lens is the most common type used. This lens is designed to correct near or distant vision. Typically, an intraocular lens is implanted monocularly to provide clear vision for distant objects, and reading glasses are required for close-up tasks. If the patient prefers a different approach, they should inform the ophthalmologist.

Advanced lenses:

Multifocal lenses - These lenses involve some compromise on the quality of vision in exchange for reducing the need for glasses. They require adaptation and are not suitable for individuals seeking perfect vision. It is important to note that multifocal lenses are not covered by the national health system, and there may still be a need for glasses even after their implantation.

Toric lenses - These lenses are suitable for patients with corneal astigmatism (a condition in which the cornea is elliptical, causing distortion and interference in vision). Toric lenses have a cylindrical correction (similar to glasses) to compensate for this distortion and reduce dependence on glasses after surgery. Today, there are combined multifocal and toric lenses available as well. Like multifocal lenses, toric lenses are not covered by the national health system.

Before undergoing cataract surgery, the patient will be examined at the preoperative ophthalmology clinic, where the different types of lenses and their advantages and disadvantages will be explained. The ophthalmologist will assess the patient's suitability for advanced intraocular lenses. If the patient is interested in these lenses and found suitable during the examination, they will be scheduled for an additional examination at the advanced lens clinic. It is important to understand that the preoperative examination is aimed at preparing the patient for cataract surgery and includes unique tests that require the doctor's time, patience, and cooperation from the patient. The stay at the eye institute on the day of the preoperative examination may be long, and the patient should be prepared for that.

What to expect on the day of the surgery?

Most cataract surgeries are performed on an outpatient basis under local anesthesia. If you are a candidate for cataract surgery under local anesthesia in the morning, you should take your regular medications as usual. You should arrive at the Ambulatory Day Surgery department 2 hours before the scheduled time given in your surgery invitation to complete administrative procedures. Upon arrival, you will be greeted by a nurse who will perform general tests such as blood pressure and pulse measurements. Subsequently, the nurse will instill drops in the eye scheduled for surgery to dilate the pupil, and you will be asked to change into a hospital gown in the dressing room designated for this purpose.

In the admission room, you will meet the operating surgeon, who will examine you before the surgery begins and briefly explain the procedure and answer any questions you may have. After the examination, the surgeon will mark the eye to be operated on with a special pen, and then you will be taken into the operating room. After receiving local anesthesia, the surgeon will clean your face, eyelids, and the eye itself to ensure a sterile surgical field. You do not need to worry about keeping your eyes open during the surgery. A small device will be placed between your eyelids to hold them open. The surgeon will ask you not to speak or move your head during the surgery.

During the procedure, the operating surgeon will create small incisions in the cornea of about 2 mm in size and will use a phacoemulsification device. This device operates at a high frequency and is used to emulsify and remove the cataract. After removing the cataract, the surgeon will implant the selected intraocular lens that was determined based on the measurements taken during the preoperative examination. At the end of the surgery, the surgeon will close the incisions, usually without the need for stitches. The nurse will instill antibiotic and anti-inflammatory eye drops, and your eye will be dressed, completing the surgery.

After cataract surgery, you will be transferred to the recovery room outside the operating room. The operating surgeon will prescribe antibiotic and anti-inflammatory drops and explain how to use them. It is essential that you fully understand how to instill the eye drops after the surgery. After receiving the discharge letter, the prescription for eye drops, and an explanation of how to use them, you will be discharged to your home. It is recommended to avoid swimming and strenuous physical activity during the immediate period after the surgery. There are no restrictions on reading, watching television, and working on a computer. You may cook and bend. You may be asked to protect your eye at night for about a week after the surgery using a plastic shield that will be provided to you on the day of the surgery.

It may take several days or weeks for your vision to fully return to clarity. The prescription for glasses will be given after the healing process, which typically takes between two to eight weeks after the surgery.