Cataract
A cataract is a painless clouding of the lens of the eye. Cataracts generally develop over a long period of time, gradually worsening the eyesight. They can eventually lead to blindness
Cataracts develop from a variety of reasons, including long-term ultraviolet exposure, exposure to radiation, secondary effects of diseases such as diabetes, and advanced age. Cataracts may also be produced by eye injury or physical trauma..
Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers who suffer from "exfoliation syndrome". Exposure to microwave radiation can cause cataracts.
What causes cataracts?
Most cataracts develop as people get older, and usually they are first noticed around the age of 50-60. The reason why is not yet known. One theory is that it is caused by a disturbance in the fluids and nutrients in the lens
In younger people certain factors that can increase your risk of getting cataracts can include:
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- diabetes - this can cause a secondary cataract to develope
- an injury to the eye
- exposure to ultraviolet light from sunlight
- medication use such as long-term use of steroid tablets
- smoking
- heavy drinking
- a family history of cataracts
The most effective and common treatment is to surgically remove the cloudy lens. There are two types of surgery that can be used to remove cataracts: extra-capsular (extracapsular cataract extraction, or ECCE) and intra-capsular (intracapsular cataract extraction, or ICCE).
How is it performed?
You may have a cataract in one or both eyes. If you have cataracts in both eyes and they both need removing, this is carried out as two separate operations a few months apart. This is to allow the first eye to recover and vision to return.
Phacoemulsification
A cataract is normally removed using a procedure known as phacoemulsification. Using a microscope with a light on the end, the surgeon makes a tiny cut (incision) of about 3mm in the surface (cornea) of the eye. This is usually just under the upper eyelid at the edge of the iris (the coloured part of the eye).
The cataract is then dissolved painlessly using a special instrument called a phacoemulsification needle. This gives off high-energy ultrasound waves, which break down the cataract into small soft pieces so they can be sucked out through the centre of the needle. A new plastic (artificial) lens called an intraocular lens (IOL) is folded in half, squeezed through the cut that has been made and unfolded inside the eye. The incision seals up itself and doesn't need stitches.
Phacoemulsification is usually carried out under local anaesthetic, which means you stay awake during the procedure but you won't feel any pain. A nurse will ensure that you are comfortable throughout the procedure. To help you relax and feel sleepy, you can choose to have a sedative before the operation. A local anaesthetic is normally used for cataract surgery because it has fewer risks than general anaesthetic, and you will also recover more quickly after the operation.
Before the operation, eye drops are given to open up (dilate) the pupil. You won't be able to see out of the eye while it is being treated, but you may be able to see some light. The operation is performed in an operating theatre while you are lying down on your back. Lightweight drapes (special sheets) will be placed over your face (with a space for you to breathe through) so that germs are kept out of your eye. Your eyelids will be opened up using a small instrument called a speculum. The operation usually takes between 15 and 20 minutes and you will normally be able to go home the same day.
Manual extracapsular extraction
Occasionally, an operation called manual extracapsular extraction may be carried out. This involves a larger incision into the eye being made and the removal of the lens, in one piece. An artificial lens is put in and the cut on the eyeball is closed with dissolvable stitches. If you have this procedure, you may need to stay in hospital a little longer.
After surgery, a pad or clear piece of surgical tape may be put across your eye to protect it. It can usually be removed after a few hours.
An eye examination or pre-operative evaluation by an eye surgeon is necessary to confirm the presence of a cataract and to determine if the patient is a suitable candidate for surgery. The patient must fulfill certain requirements, such as:
The eyes should have a normal pressure, or any pre-existing glaucoma should be adequately controlled on medications. In cases of uncontrolled glaucoma, a combined cataract-glaucoma procedure (Phaco-trabeculectomy) can be planned and performed.
The pupil should be adequately dilated using eyedrops; if pharmacologic pupil dilation is inadequate, procedures for mechanical pupillary dilatation may be needed during the surgery.
In addition, it has recently been shown that patients taking tamsulosin (Flomax), a common drug for enlarged prostate, are prone to developing a surgical complication known as floppy iris syndrome, which must be correctly managed to avoid the complication posterior capsule rupture; however, prospective studies have shown that the risk is greatly reduced if the surgeon is informed of the patient's history with the drug beforehand, and has appropriate alternative techniques prepared
Recovery
Following surgery, you can usually go home as soon as you have recovered from the operation. However, it is a good idea to have somebody with you for the first 24 hours after the operation as you won't be able to drive home from the hospital.
Your sight should return a few hours after the operation and your vision should improve quickly over the next week or two. Following surgery, the area around your eye will probably be swollen and your doctor or surgeon will give you anti-inflammatory eye drops to treat this. You may also need antibiotic eye drops on your eye for a few weeks to prevent infection (although infection is quite rare following cataract surgery).
In general, following cataract surgery you should:
- take it easy for the first two or three days after the operation,
be careful when moving around because it can be difficult to judge distances with one eye covered,
- try not to touch or rub your eye,
take care if it is windy, in case anything blows into your eye, although you don't need to stay indoors,
- keep soap and shampoo out of the eyes (you may want to avoid washing your hair for the first few days),
- avoid heavy lifting for the first few weeks after the operation as it can increase the pressure in the eye and cause the scar to take longer to heal,
- contact your doctor if you have pain, loss of vision or increasing redness in the eye, and
wear sunglasses or a shaded hat to keep the sun out of your eyes, if you find that you are sensitive to bright light.
If you experience pain, have an unusual discharge from the eye, or a sudden change in your vision, you should contact the hospital straight away.
Possible Side Effects
As with all types of surgery, there are some possible side effects. However, most side effects are temporary.
They include:
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-your vision may be blurry for a few days after the operation,
-the white part of your eye may appear red and feel itchy,
-your eye may ache, but this usually settles down within 10-14 days, and
-your eyelid or eye may be bruised.
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