Currently, the only treatment for cataract is surgery. But, if your doctor finds a cataract, you may not need cataract surgery for several years.
It’s important to have your vision tested regularly. When a cataract interferes with normal activities, you should consider surgery.
Many people with cataracts are able to use vision aids, such as spectacles, to avoid or delay surgery. People who depend greatly on their eyes for work and leisure activities may want their cataracts removed earlier than others.
Cataract surgery is safe, fast, virtually painless, and one of the most common surgeries performed. Improvement in vision after surgery depends on the initial health of the eye and the operative result. Certain diseases of the retina can limit the final visual result.
What to expect from surgery
Surgery involves replacing the clouded lens with an implanted clear plastic, acrylic or silicone intraocular lens (IOL).
The implant is placed in or near the original position of the removed natural lens, so that vision is restored with good peripheral vision and depth perception, yet with minimal magnification and distortion.
IOLs remain permanently in place, require no maintenance or handling, and are neither felt by the recipient nor noticed by others. Spectacles with thin lenses for near or distant viewing may still be required.
One of the disadvantages of IOLs is the fixed focus of the lens – you can only see far or only near. New developments in IOLs are the development of multifocal IOLs that provide refractive correction for close vision and distance, so that individuals don’t lose their accommodative ability.
There are some disadvantages to multifocal IOLs, like reduction in contrast sensitivity and the presence of glare and halos, especially at night. Your ophthalmologist will discuss these pros and cons with you before deciding to implant a multifocal IOL.
Preparation for surgery
Once you and your ophthalmologist have decided on cataract surgery, you’ll be measured for the appropriate lens implant (this is specific to each individual) and the surgery date will be set.
Procedure for implantation of an IOL
The procedure is carried out under general or local anaesthetic.
Looking through an operating microscope, the surgeon makes a minute incision in the surface of the eye. The clouded lens is emulsified with an ultrasonic probe and suctioned out of the eye, usually leaving intact the rear wall of the transparent capsule that encloses the lens.
The new lens – a clear, plastic disc – is placed behind the iris and up against the back wall of the capsule. Two tiny C-shaped arms attached to the lens hold the lens firmly in place.
In most cases, no suturing (stitching up) of the incisions are required.
The whole operation usually takes less than an hour.
- You should be able to start using the eye the morning after surgery. Vision is usually remarkably clear the day after the procedure and improves over the following weeks. You can resume most of your normal activities, but will be asked to minimise lifting, bending and straining for the month after surgery.
- Avoid getting water in the operated eye for 1-2 weeks.
- Following surgery, it’s important to wear a protective eye shield at night for at least two weeks after surgery to prevent rubbing of the eye during sleep.
- Being able to return to work and start driving varies from one individual to another. Many people are back at work a few days after the operation.
- During the first 6-8 weeks after surgery, your doctor will check for infections or other complications.
- To prevent infection and reduce inflammation, your doctor may recommend that you apply antibiotic and steroid ointments or drops to your eye.
- Risks associated with cataract surgery include complications such as bleeding, infection, swelling of the cornea, glaucoma, swelling of the retina and retinal detachment, which occur during or after surgery in a small percentage of people.
- Once the cataract has been removed, it doesn’t recur. Some people develop thickening of the capsule behind the new lens implant, which causes blurred vision.
However, this thin film can easily be treated with a laser and doesn’t require repeat surgery. This painless procedure takes a few minutes and improvement is usually immediate.
A lens implant will not wear out and should last a lifetime. Leaving a cataract in the eye isn’t dangerous but, with time, cataracts do increase in size and hardness and cause progressively worsening vision.
Reviewed by ophthalmologist Dr Viresh Dullabh, MBBCh (Wits) FC Ophth SA (CMSA) MMED (UKZN). September 2018.
South African Optometric Association
Tel: 011 805 4517
South African National Council for the Blind
Tel: 012 452 3811
Retina South Africa
Tel: 011 622 4904