Dr Dylan Joseph, a cataract surgeon of the Garden Route, gives expert advice on everything you need to know about cataract surgery, cataract surgery costs, treatments, causes, and recovery. Read this guide to find out more about the cataract surgery procedure.
As we get older the lens inside our eye gradually changes and becomes less transparent (clear). If you have a lens that has turned misty/cloudy, you may have a cataract. Over time a cataract can worsen, gradually making your vision mistier. A brief operation to remove cataracts is usually successful in removing the misty lens and replacing it with an artificial lens to enable you to see clearly again.
This information is about cataracts in the eye of adults. Some children develop cataracts, called congenital cataracts, before or just after birth. They can also be related to a number of infective and inflammatory conditions, but these are usually dealt with in a different way to cataracts in adults.
When looking at an image or object, light passes through the front of the eye and is focused by the cornea and then the lens onto the retina. The lens is normally clear so that light can pass directly through to focus on your retina (the lens is clear because of the way the cells in the lens are arranged). It focuses light onto the retina, which converts the light into electrical signals. A network of nerves delivers these signals from the different parts of the retina to the optic nerve and then on to the brain. The brain interprets these signals to “see” the world around us.
This lens can change shape, allowing us to focus on objects at different distances, called “accommodation of vision.” As we get older, the lens isn’t able to change shape as well as it used to. Even people who can see clearly in the distance without glasses will need to have reading glasses to see things up close. This process is not caused by cataracts.
What Causes Eye Cataracts?
Cataracts can be caused by several things, but by far the most common reason is growing older.
Most people over the age of 65 have some changes in their lens and most of us will develop a cataract in time. Apart from getting older, the other common causes of cataract include:
• Medications such as steroids
• Eye surgery for other eye conditions
• Miscellaneous eye conditions
In general, the reason why you have developed cataracts will not affect the way they are removed. Most cataracts are caused by natural changes in the lens, which happen as you get older.
However, the following factors may be involved in the development of a cataract (please note that these are only suggested causes, which are the subject of ongoing research):
• Tobacco smoking
• Lifelong exposure to sunlight
• Having a poor diet, lacking antioxidant vitamins
Eye Cataract Surgery
Cataract surgery is the only effective treatment to have cataracts removed. Your cloudy lens is removed and replaced by an artificial lens implant. This is done by an ophthalmologist in a day clinic.
There is no evidence to suggest that changing your diet, taking vitamins or using eye drops can remove cataracts.
The operation to remove cataracts can be performed at any stage of their development. There is no longer a reason to wait until your cataract is “ripe” before removing it. However, because any surgery involves some risk, it is usually worth waiting until there is some change in your vision before removing the cataract. This is something you may want to discuss with your optometrist, as the “right” time to be referred varies from person to person.
Most people choose to have their cataracts removed when the change in their vision starts to cause them difficulties in everyday life. The timing of this varies from person to person. If you have problems in bright light, find reading, getting out and about, cooking or looking after yourself increasingly difficult then it may be time to consider having the cataract removed. When you attend your appointment in the eye clinic you need to make clear to the specialists any everyday problems you are having.
Many people with cataracts are still legally able to drive. If you have any concerns about whether you should be driving, your optometrist should be able to tell you whether your sight is within the legal limits for driving. Sometimes people may be legally able to drive but might find driving difficult in bright sunlight or at night.
If this is the case, then you may think it is a good time to consider having your cataracts removed. Cataract surgery is ultimately the solution.
Before Cataract Surgery and Treatment
Before undergoing any cataract surgeries, your eye health and general health will be checked carefully in what is often called an advanced eye assessment.
Your vision and your eye will be assessed very carefully. This is usually done by a machine which measures the length of your eyeball and the shape of the front of your eye. These tests help the ophthalmologist decide which lens to implant when they perform your operation, to make sure your vision is as good as possible after the cataract surgery procedure.
If you have a cataract in both eyes the ophthalmologist will use these tests to decide which cataract to remove during the first operation. In most cases, this is the eye with the worst cataract.
Cataract Treatment Procedure
Cataract removal surgery usually takes about 30 to 40 minutes and most of the patients go home from the day clinic a few hours later. It is usually done with a local anaesthetic, which means you will be awake during the operation but you won’t feel any pain. You can talk to the operating team if you need any assurance. The local anaesthetic takes the form of eye drops.
For your cataract surgery procedure, you will be given drops to dilate your pupil. Your face will be covered by a sheet, which helps to keep the area around your eye clean during the operation. You will have no shortage of oxygen whilst under the cover.
To remove a cataract, the ophthalmologist needs to remove the natural lens in your eye and replace it with an acrylic lens implant. The most common way to remove cataracts is called phacoemulsification. This technique uses high-frequency sound energy to break up your natural lens with the cataract. Only really small cuts are used, so you don’t need any stitches, and this helps to speed up your recovery from the surgery. Usually, the ophthalmologist uses a machine which acts as a microscope to get the best possible view of the eye during surgery.
The lens in your eye is made up of different layers and the outside layer is called the lens capsule. During the operation, the ophthalmologist makes a circular tear in the anterior part of the lens capsule so they can reach the lens inside. Using another instrument, the ophthalmologist can break up your lens and the cataract inside your eye, and remove it using ultrasound and suction. Your lens capsule is kept in place so that the artificial lens implant can be placed inside of the pocket. The tiny implant is folded so that it can be put into the eye through the same incision that was created to remove cataracts. Once it reaches the right position, the ophthalmologist unfolds the artificial lens so that it sits in the right place inside the capsular bag.
As you are awake during the operation, you will be able to hear what is happening in the operating room. You can also communicate with the ophthalmologist and the nurses who are on hand to reassure you. Because the eye is anaesthetised and your pupil is dilated, you may be able to see some lights and movement but not the details of the instruments used.
Your cataract is easily removed during surgery. No pain is felt by almost any of cataract surgery patients.
Cataract Treatment Recovery
A day after surgery your eye is examined in Dr Joseph’s refractive suite.
Your eye will be covered with a clear shield, allowing you to see through it. This shield will stay in place when you go home, normally a few hours after surgery. Eyes may begin to feel uncomfortable once the local anaesthetic starts wearing off. The discomfort usually isn’t too bad and you can take a painkiller tablet, such as paracetamol, to help. The shield, which is put on in the day clinic, usually needs to stay on overnight, but you should be able to take it off the following morning. Your eye may look red but this will improve over the next few days.
Some people can tell that their sight has improved straight after surgery. If your cataract was quite mild you might not notice a big change in your vision but if your cataract was quite bad you may be able to notice a bigger improvement. Either way, your sight may not be as good as you expect for the first week after surgery, as the eye is still recovering from the cataract surgery procedure and will probably be a little swollen.
Immediately after the cataract surgery, you will be given an antibiotic and steroid eye drop combination to prevent infection and reduce inflammation simultaneously. It is important to take these drops as the ophthalmologist recommends and to complete the course. If you have problems using the drops you should let Dr Joseph know as he may be able to arrange some help for you or alternative drops. You will be given a chart to take home with a timed schedule for your drops to make the post-op period as straightforward as possible.
Cataract Surgery Complications
Most people have no problems after the surgery and they are up and about as normal the next day.
If your eye is very painful or your vision suddenly gets a lot worse after surgery, then you should let Dr Joseph know as soon as possible. This may mean he needs to see you again.
Cataract Removal Cost
Cataract surgery is sometimes (partially) covered by medical aid. Contact us to find out more about the cost of cataract eye surgery.
Ophthalmologist and Eye Specialist in Knysna focuses on Cataract Removal, LASIK, LASEK, PRK Laser Eye Surgery.
Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear. A cataract causes the lens to become cloudy, which eventually affects your vision.