“Cataract” can be a scary word for some. For many people the first thought that comes to mind is wondering whether they’re about to go blind. The next thought is typically wondering what happens next, and what they can expect during eye cataract treatment.
What is a Cataract?
A cataract refers to an opacity in the crystalline lens of the eye. This lens is located just behind the coloured iris and is usually clear and transparent to allow light to pass through. However, with time and age this lens gradually loses its transparency, becoming hazy or developing a discrete opacity – this is then considered a cataract. While advancing age is the most common cause of cataracts, other conditions or factors can cause a cataract or increase your risk of developing one, including:
- Trauma to the eye
- Metabolic diseases such as diabetes
- Certain systemic medications, such as steroids
- As a complication of eye surgery, such as a retinal detachment repair
There are three types of age-related cataracts. Nuclear sclerosis appears as a yellowish-brownish haze in the centre of the lens, a section known as the nucleus. Cortical cataracts grow as spoke-like opacities in the cortex of the lens, which surrounds the nucleus. A posterior capsular cataract is an opacity at the back surface of the lens, further into the eye. Cataract symptoms will vary depending on the type and location of the opacity, though often there can be more than one type present in the eye simultaneously. Symptoms include glare sensitivity, blurred vision, altered colour perception, and increased difficulty with night vision. Nuclear sclerotic cataracts also have the potential to cause what’s known as a “myopic shift”, meaning that your contact lens or spectacle prescription becomes more short-sighted, or a higher minus script. Interestingly, this means that some patients find their reading vision improves without corrective lenses.
As a cataract tends to form very slowly in the eye, cataract symptoms may not become noticeable for years. This also depends on a person’s visual demands and daily activities as to how bothersome their eye cataract symptoms become. For example, a painter who requires very fine colour vision discrimination will likely be more affected by a milder cataract compared to an accountant who works on a computer and can easily enlarge their screen. A person’s visual demands and health of their eye guides cataract treatment timing. This leads us to the next question – what is the best treatment for cataract?
Eye Cataract Treatment
The only definitive treatment of a cataract in current medicine is surgical removal of the cataract. Your local optometrist will usually be the first to detect a cataract in the eye; cataract treatment is generally only recommended if the symptoms bother you enough to warrant intervention. Many early cataracts, and even moderate opacities, can simply be monitored. In most cases it’s not harmful to defer cataract surgery. There will be some instances where you may be advised to undergo treatment even if you’re still content with your vision – this includes situations where your vision no longer meets the legal visual requirements for holding a driver’s licence or if the presence of the cataract is affecting the pressure in your eye by blocking the drainage of fluid from the eyeball.
Once it’s decided that your cataracts are ready for surgery, your optometrist will refer you to an ophthalmologist for the operation. Cataract surgery is typically a quick and uncomplicated procedure with very high success rates in Australia.
The procedure is conducted under local anaesthesia; very rarely is a general anaesthetic used though many surgeons will offer a sedative if you’re feeling anxious or restless. A small incision is made at the edge of your cornea, which is the clear bubble of tissue at the front of the eye, to allow the necessary instruments to access the cataract inside. The cataract is then broken into fragments small enough to be suctioned out, leaving behind the capsular bag that used to hold this cataract. Different ophthalmologists will have a preference on the method of fragmenting the cataract, either with a technique known as phacoemulsification or a combination of phacoemulsification and the use of a femtosecond laser.
Once the cataract has been removed from the capsular bag, an artificial lens implant known as an intraocular lens (IOL) is then inserted in its place, which is designed to refract, or bend, the passage of light rays such that they focus clearly on the retina at the back of the eye. The power of this IOL is calculated before you undergo surgery and can reduce your dependency on glasses and contact lenses after the operation by accounting for your existing prescription, basically like having corrective lens implanted in the eye. Your surgeon will discuss your options of IOLs, which include:
- Monofocal: correcting for one viewing distance, either near or far sight. Some patients may choose to have one monofocal IOL designed for long distance in one eye and a monofocal IOL for reading vision in the other, an arrangement known as monovision
- Multifocal: these provide clear vision for multiple distances
- Accommodative: designed to provide some degree of flexible focus to mimic your own eye’s ability to change focus
- Toric: correct astigmatic prescriptions
If you’re concerned about cataracts, speak to Armadale Eye Clinic by calling us at (03) 9070 5753 for advice tailored to your situation.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.