Cataract surgery

Cataract is the name used to describe opacity of the formerly clear lens of the eye. You notice that you appear to be looking through a thin veil (like dirty glasses for example), which becomes thicker with the passing of time. In addition your sensitivity to glare increases.

Cataracts have many causes, the most frequent by far is advancing age and is due to the slow-down in the metabolism. This form is therefore known as senile cataract. It generally appears after age 60 and is not dangerous for the eye.

Most frequent causes

• Mostly affects persons aged around 60 and older (senile cataract); the cause is not known.
• As a complication with diabetes.
• Congenital cataract in newborn babies as a consequence of the mother suffering a virus infection (e.g. German measles, chicken-pox, mumps, measles) in the first three months of pregnancy.
• As a consequence of prolonged exposure to heat (workers in steel works, glass blowers) or X-rays.
• As a consequence of high-voltage current lesions or being struck by lightning.
• As a consequence of eye injuries.

Prevention

• When reading or carrying out other work with the eyes, ensure adequate, non-glare illumination.
• Wear safety goggles when carrying out any type of hazardous work (heat in the eye region).
• Senile cataract is not preventable.
• Eye drops are of no help against cataracts.
• You should consult an ophthalmologist regularly after around age 45.

Treatment

Do not expect any help from "eye drops to cure cataracts". Although some magazines regularly carry reports of miracles, it has been scientifically proven that none of these medications can check the progress of cataracts or heal them.

Up to now the only truly effective treatment is an operation; it has a high probability of success and is totally painless.

Operation

By and large, you determine the time of your operation yourself. You must decide when your sight has deteriorated to the point that it is no longer adequate for your daily requirements, and when you are ready to be operated on. If you want to drive a car, your ophthalmologist must set an earlier date for the operation than for patients who do not place this especially high requirement on their eyes.

With the present procedure, the complication rate for cataract operations is very low. A significant improvement in sight can be achieved with over 90% of all patients. However, the success rate cannot be expected if a patient suffers from another serious eye disease in addition to a cataract. Before the operation your ophthalmologist will discuss with you the result to be expected and endeavor to answer all your questions.

As your clouded lens is being removed, you will need an optical correction to compensate: either cataract glasses with very powerful lenses or contact lenses or an intraocular (i.e. implanted in the eye) artificial lens.

This patient information is limited to explaining the most advanced of the three possibilities, the intraocular lens - in more detail.

Intraocular lenses

Intraocular lenses are pressed from plastic and only slightly heavier than the fluid with which the eye chambers are filled. The fluid washes around the implanted plastic lens. Its optically effective part has a diameter of 6 to 8 millimeters. Elastic arms are attached to its periphery, ensuring stable fixation of the lens.

Side effects

Every year 30,000 to 35,000 patients in Switzerland undergo operations for senile cataract. Today the majority of them can be fitted with intraocular lenses and get along with them extremely well. It is extremely rare for an ophthalmologist to advise against a lens implantation.

Preparation for the operation

First your family doctor examines your general state of health. His findings go to the anesthetist, who will monitor you during the operation.

Before the operation an ultrasound measurement of your eye will be made in order to determine the refractive power of your artificial lens and the procedure for the operation will be discussed with you in detail.

2-3 days before the operation you must administer the eye drops supplied by the ophthalmologist in accordance with his instructions.

Here the operation is carried out on an outpatient basis.

Only one eye is ever operated on at a time. Only when you can see well again with this eye and you are satisfied, your ophthalmologist will discuss the time of the operation on your other eye, should this be necessary.

On the morning of the operation you should come to the clinic with an empty stomach (do not eat solid food after midnight). A glass of water is permitted at any time and you may (even should) also take the medication which you normally take in the mornings with a glass of water.

Before the operation the eye will be treated with further eye drops at the clinic.

The eye will be made totally numb by means of a local anesthetic in the form of eye drops or, less commonly, an injection next to the eye. The anesthetist is responsible for continuous monitoring of your circulation by means of ECG, blood pressure, pulse and oxygen measurement. If your eye is to be made numb by means of an injection he will give you a short general anaesthetic to ensure you feel nothing.

During the operation

The lens consists of several parts. In the center is the nucleus which grows hard in the course of life and surrounding it, the softer cortex. The whole lens is enclosed in the lens capsule, which is attached to the ciliary body of the eye with elastic fibers – the zonular fibers. The most common cataract operation today is the "extracapsular extraction" of the opaque lens with implantation of a posterior chamber lens in the capsule sac.

That more or less describes the entire operation procedure. At the beginning of the operation an incision is made in the anterior lens capsule which is then removed from the eye with surgical forceps. Next the nucleus and cortex are removed with the aid of ultrasonic waves so that only the intact posterior lens capsule and lateral parts of the anterior remain. They form a loose “capsule sac” which is open to the front. The operator can now insert the artificial lens and anchor its fixation arms in the capsule sac. The intraocular lens is thus securely attached in the posterior eye chamber.

"Phacoemulsification" is the name of this procedure.

The intracapsular extraction - removal of the opaque lens together with the entire capsule sac – was formerly the standard method, when only cataract glasses and contact lenses were available for optical correction. A lens implantation is also possible in this operational technique, however it must be a anterior chamber lens which is not anchored behind the iris in the capsule sac but in the chamber angle of the cornea or on the iris.

Anterior chamber lenses are now only implanted in special circumstances, especially when in elderly patients the often very soft posterior capsule tears with the result that a posterior chamber lens implantation is no longer possible. Patients who have already been operated on some time ago using the intracapsular extraction technique often express the wish to have a subsequent operation to implant intraocular lenses. However, a secondary anterior chamber lens implantation of this type is not always possible and must first be discussed with an ophthalmologist.

Treatment following the operation

Your operated eye is covered with an eye dressing, and you will be taken to the recovery room where a light snack (coffee and croissants) awaits you. You have the opportunity to rest a little before starting on your way home. As you have a dressing over the eye and you may be somewhat tired and unsteady after the operation, we recommend that you have someone accompany you home and that you do not spend the first night completely alone.

Even though you may be home, your treatment is not yet complete.

Your contribution to a swift and safe healing process:

1. Do not press on or rub your operated eye in the first three weeks under any circumstances. At first there is unquestionably a great temptation to do so. Since the eye often itches as the irritation subsides, there is strong urge to rub it.
2. At night for the first 2-3 weeks you should wear an eye cover that we will supply for you to take home with you after the operation - above all so that you will be reminded of the need to take care of your eye when you are half awake.
3. You must not allow soap to get into your eye, therefore do not wash your own hair for the first two to three weeks; have someone wash it for you with your head tilted backwards.
4. You may wash the eye gently with clean lukewarm water.
5. Watching television and reading is permitted.
6. If you find bright sunlight dazzling, wear sunglasses.
7. Avoid strenuous physical activity. You may lift up to 10 kg and may also bend over (e.g. to put on stockings or socks, or tie shoelaces...).
   During the regular check-ups your ophthalmologist will tell you when you are allowed to swim, dive and take part in other sports.
8. You can only drive a car when your ophthalmologist has confirmed that your sight complies with the driving regulations.
9. It is extremely important that you administer the medication (eye drops) prescribed by your ophthalmologist at the correct time and that you keep the check-up appointments. After all, the medication changes in the on-going healing process, and furthermore, you want to resume your normal way of life as soon as possible. Your ophthalmologist will help you here too.

Sight after the lens implantation

As early as the day following the operation you will probably notice a significant improvement in your sight. However you will not yet have achieved the best possible sight for a number of reasons. Although your ophthalmologist will have endeavored to determine the strength of your intraocular lens as accurately as possible, this is only possible to a limited extent. Therefore a small correction for distance vision is usually still required by means of glasses.

For reading and other close-up work you will in any case require glasses but normal thin, light lenses will be sufficient.

First, however, the slight irritations in the eye have to subside. Punctual administration of your medication will help to achieve this. During the scar formation, the refractive power of your eye will still change slightly for which reason your ophthalmologist is only able to prescribe your new spectacle lenses after around 6-12 weeks. If necessary, he will prescribe temporary reading glasses for you.

Sometimes a gradual deterioration in vision can set in after a number of weeks - caused by a fine tissue membrane which forms as an "aftercataract" on the rear lens capsule. A short outpatient laser treatment will normalize vision once again.