What is a Cataract?
A cataract is a clouding of the normally clear lens inside the eye just behind the pupil. When the lens becomes cloudy, the light rays cannot pass easily through it and vision becomes blurred, both for near and distance objects. Sensitivity to light or glare in bright sunlight, and distortion or ghosting of images may also occur.
Cataract is the commonest cause of failing vision over the age of 60 in Malaysia. They are a normal part of the aging process in both eyes but usually develop at different times. Less commonly, cataracts can occur in babies, children and young adults. Other causes include eye and systemic diseases, eye trauma and as side effects of medication, such as Prednisolone therapy for severe bronchitis, SLE, eczema etc. Cataracts are not a growth or film over the eye and are not caused as a result of overusing the eye or eyestrain. You generally can’t see your cataract in the mirror, unless of course, it is very mature.
When do Cataracts need treatment?
Cataract may need no treatment at all if the vision is only a little blurry and often a change in glasses will help. It’s when a cataract interferes with the things you like to do that surgery should be considered. Surgery is the only way to remove a cataract. Provided you do not have any other eye problems, there is a 95-98% chance that you will see better after cataract surgery.
Complications although rare, can occur. This is why you should wait until the symptoms frustrate your enjoyment of life. The benefits of properly timed cataract surgery greatly out weight the risks, making cataract surgery so popular today. If you have any concerns, you can call and make an appointment to see our consultant
Micro-Incision Cataract Surgery
What is available?
At Ranu Eye Specialist, we are equipped with the latest technology in MODERN DAY CARE CATARACT SURGERY. Surgery is routinely performed through a very small incision of 2.5 mm or smaller. Patients are educated on the different types of ‘foldable’ MONOFOCAL, TORIC, MULTIFOCAL IOL’s and the most appropriate one are selected for you.
Ranu Eye Specialist is equipped two machines, Sovereign Phacoemulsification System from Advance Medical Optics and Stellaris Phacoemulsification System from Bausch & Lomb.
CATARACT SURGERY is fast evolving. Newer surgical techniques and better understanding of the procedure makes cataract surgery a simple procedure.
Just like every eye, every cataract is different. Each eye is unique and Dr Ranu has been performing the same procedure since 1996, maturing in his skills, mastering newer procedures and staying current in his techniques. There is no substitute for experience.
NO INJECTION, NO PAIN, NO STITCH.
Extracapsular Cataract Extraction (Traditional Cataract Surgery)
A less common method of cataract surgery is extracapsular cataract extraction (ECCE). This procedure, which was developed before phaco, is often used for removal of very advanced cataracts that may be too hard to break up using phaco or in patients who have multiple eye conditions that render phaco a less desirable surgical option. Today, with modern technology we are able to remove the hardest of cataracts with phacoemulsification.
ECCE requires a larger incision that phaco, perhaps 8 to 12 millimeters long, at the side of the cornea so the cataract can be removed in a single piece. Visual recovery may be slower after ECCE than phaco and there may be more discomfort because of the larger incision and sutures that are required to close it.
Once the cataract is removed, an IOL is implanted in the eye. Given that a larger incision has been made to remove the cataract-damaged natural lens, the surgeon has the option of inserting a non-foldable IOL made from a medical-grade Plexiglass like material or a foldable material as discussed above.
|TRADITIONAL CATARACT OPERATION ECCE||Micro Incision Cataract Surgery|
|Incision||8 – 12 mm||1.5 – 1.8mm|
|Lens (IOL)||HARD PMMA||SOFT Foldable|
|Healing||Slow 1 – 3 months||Less than 1 week|
|No wound burn|
|Clearer cornea the next day|
|Faster visual recovery|
Cataract Surgery Procedure
Before The Operation (Consultation and examination)
On your visit before the operation, the doctor will take a detailed history from you and perform a complete eye examination. He will also do a comprehensive systemic examination and examine your blood sugars and blood pressure. Eye tests such as visual acuity both uncorrected and best corrected for far and near, intraocular pressure examination and dilated funduscopy if required.
Biometry (Measurements of IOL)
Once cataract surgery has been decided, your eye will be measured with ultrasound to determine the power of the intraocular lens (IOL) that will be permanently implanted in your eye during surgery. The IOL has been a major advance of medical science that has freed post cataract patients of the need for “coke bottle” glasses without which they used to be functionally blind. Virtually everyone having cataract surgery received an IOL. A little appreciated but important feature of IOL implantation is that the power of the IOL can be chosen so that pre-existing long, short sightedness or astigmatism can be corrected as well. Glasses will still be necessary for some activities, particularly reading and possibly night driving. However, a new generation of IOL’s called toric can reduce astigmatism. Multifocal IOL’s are designed to reduce dependence or eliminate the need for reading glasses after cataract surgery.
Adult eye surgery is done under topical anesthesia. Some eye drops will be put into numb your eye and you may also have a mild “twilight anesthetic” if you are very nervous or tense. You can talk and answer questions throughout the procedure. You may be asked to see your local doctor prior to surgery so that we may be alerted to any special medical risks before undertaking cataract surgery. When you make a booking for surgery you will be given detailed information about the planned surgery and sometimes some antibiotic drops to use during the 3 days prior to surgery. Occasionally, the best choice of anesthesia may be General Anaesthesia. If General Anaesthesia is required, we will arrange for the procedure to be done in the nearest hospital by our Surgeon.
The Operation (Modern Day Care Cataract Surgery)
Surgery is performed under topical anesthetic in our center and your total stay is usually 1 -2 hours.
Cataracts are removed by “NO INJECTION, NO PAIN, SMALL INCISION, NO STITCH TECHNIQUE”, using a “Phaco” machine. At Ranu Eye Specialist, we are proud to have the latest “WHITE STAR COOL PHACO MACHINE” from AMO & “The Stellaris” Phaco Machine from Bausch & Lomb. It is the most advanced surgical procedure for removing cataracts, with the entire procedure taking place through a small tunnel incision in the eye. A small incision is much gentler to the eye and usually requires no stitches. Occasionally, a stitch may be necessary for safety reasons.
Rarely, cataracts may be removed by the ‘extracapsular’ technique. This is also a very safe and longstanding procedure suitable for advanced or dense cataracts where the “phaco” technique is considered more hazardous. A longer incision is made which is closed by multiple sutures. Post-operative comfort is the same as in ‘phaco’ surgery but vision return is delayed for up to two months.
When you come to Ranu Eye Specialist you will be given eye drops to dilate the pupil. No injections are given, so you need not be afraid. You need not worry about keeping your eye open or still during surgery. Typical concerns such as the need to cough or inability to lie completely flat are rarely a problem. Please alert the doctor before the surgery of any special needs.
Aftercare (Post Surgery Counselling)
You will stay in our recovery area for half an hour’s observation prior to going home. You will be advised by our medical team and given some refreshments. You will be advised by our experienced staff on the Do’s and Don’ts and how to instill your eye drops and care for your eye.
Most of the time NO EYE PATCH is required. You will be given an appointment to come the next day and allowed to go home. YOU MUST BE ACCOMPANIED HOME. DO NOT DRIVE YOURSELF.
The old much quoted advice of not bending down or lifting does not apply to modern ‘phaco’ cataract surgery. Simply avoid strenuous or violent activity and keep the eye and lids clean.
If the eye is healthy the chances are excellent that you will have good vision following cataract surgery. Even if the surgery itself is successful the eye may not see as well as you would like if there are other problems such as macular degeneration (aging of the back of the eye), glaucoma or diabetic retinal changes.
It is important to remember that cataract surgery will not correct poor vision caused by other eye problems. However, even with such problems, cataract surgery may still be worthwhile to improve overall vision.
Normally, your eyes are checked at 1 day, 7 days, 1 month, 3 months and 6 months. Glasses for reading may be prescribed after 1 month. You will be given another information brochure after your surgery with detailed post-op instructions.
Possible Late Complications
Over 98% of patients will have improved vision after cataract surgery. A very small number may have vision related problems. Infection is very rare , 1 in 100000 , bleeding and detachment of the retina are also rare serious complications. Uncommonly, moderate blurring of central vision between 3 and 12 weeks post-operatively may develop even with uncomplicated operations. This condition, cystoids macula edema, usually recovers over many weeks and necessitates additional treatment. It is more common in those with a history of retinal inflammatory conditions.
Any sudden change in the nature of your sight or eye should be reported to us immediately. Please don’t wait until your next scheduled appointment.