Surgical Services
Conventional Cataract Surgery
What is a cataract
A cataract is a progressive clouding of the human lens inside the eye. It’s like looking through a steamed shower door. Glare becomes a problem especially in bright sunlight and when driving at night.
The human lens consists of a mixture of water and protein which is inside a capsular bag. As the lens ages, the proteins in the lens start to break down and clump together, eventually causing the cloudy vision.
During cataract surgery the capsular bag is cleaned by removing the hardened water and protein layers, and then an artificial lens is implanted into the empty capsular bag. The cataract procedure is fast, safe and successful.
Cataract surgery is the most common surgery of all other surgical disciplines performed over the world. It is also the most frequently performed surgical procedure at Visiomed Eye and Laser Clinic. It is thanks to advanced technology that cataract surgery has become so fast, effective and successful. Cataract procedures are performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.
What are the causes of cataracts?
Most cataracts start to develop at any age from 40 years and older and it is almost guaranteed to have them if you live long enough. Cataracts are formed with age and oxidation due to sun exposure, smoking, alcohol, cortisone treatment, diabetes, injuries to the eye, etcetera. These factors change the cellular composition of your lens and discolour and cloud the lens and distort the light passing through. Symptoms of cataracts include impaired vision which is evident during driving, poor night vision, cloudy/blurry vision, double vision and glare/halo around lights.
In order to treat cataracts effectively the ophthalmologists at Visiomed Eye and Laser Clinic suggest regular eye examinations. If you are diagnosed with a cataract, the ophthalmologist is able to replace your lens, of which there are various options, including Premium lenses to suit your specific needs. As cataracts are irreversible, surgery is the only proven way to get back to enjoying your life style and all the adventures life brings without blurred, cloudy vision.
First consultation
What to expect at your first consultation
- A refraction and ocular examination to determine the state and strength of your eyes and quality of your vision.
- Biometry tests to measure your eyeballs and determine the right power for your artificial intraocular lenses which are implanted into your eyes after your cataracts have been removed.
- A corneal topography test may provide additional details that the biometry tests can’t, such as the presence of keratoconus.
- The overall health of your retina, the nerve layer in the back of your eye and your optic nerve will be checked with an optical coherence test (OCT). You will also be checked for glaucoma, aged related macular degeneration, signs of diabetes and many other eye diseases.
- Should you have any eye infections, hypertension, undiagnosed diabetes with blood sugar levels and other systemic diseases that need immediate attention, this will first be treated, or you be referred to your GP or other specialists for treatment before surgery is done.
- High blood pressure and sugar levels can mean a higher risk of bleeding at the back of the eye during surgery. High blood sugar levels can also put you at a higher risk of infection after surgery.
- So understandably, the surgeon needs to ensure you’re in relatively good health to get the best possible outcomes of your surgery, hence he may require further eye tests if needed.
Admission to our clinic and theatre reception
On the day of surgery you need to provide us with your personal and medical information again, as given at the doctor’s rooms during your first consultation. The clinic and the doctor’s rooms are two different entities. It will help if you bring someone with you to help you with the forms as your eyes will be dilated and become blurred, which makes it difficult to read and write. You will be admitted into our pre-and post-operative ward where we will provide you with a comfortable theatre top and trousers. Your vital statistics will be checked. It will take around one and a half hour to instil various eye drops like anti-inflammatory, antibiotic- and eye dilatation drops into your eye to prepare your eye for surgery. This all happens while sitting on a comfortable recliner chair. Be ensured that our sisters will pamper you!
What happens once you’re in theatre and during surgery
If you have two cataracts, we will only do one at a time. The second cataract will be removed a week later. The cataract surgery only takes 15 – 20 minutes per eye, however the preparation for surgery and entire process may take a little bit longer. You will not be able to drive after the procedure is completed, as you may feel a bit sedated and disorientated for a while, so please arrange for someone to fetch you afterwards.
Cataract surgery normally requires no general anaesthesia where you need to be intubated. Your anaesthetist will administer intravenous sedation which leaves you in a blissful dream-like state, or even make you sleep. You may experience very little or no discomfort during your cataract procedure. The best technology is used to remove your cataract either with Phaco Emulsification or with our new AI Femto Laser Assisted Technology. Your surgeon will discuss which option of the two will benefit you the most.
Your ophthalmologist will make a small incision on your cornea – the outer dome shaped transparent window of your eye, through which the cataract will be removed. To remove the cataract, your doctor will break up the hardened protein layers inside your capsular bag and extract it with a technique called phacoemulsification and suction, or he/she will use low impact AI Femto Laser Assisted Cataract removal technique to break up your lens. An intraocular lens (IOL) will then be inserted through the same tiny incision into the cleaned and empty lens capsule to replace your natural lens.
The lens is made of a material that is flexible, which allows the ophthalmologist to fold and insert it through the small incision on your cornea with a special introducer or injector/syringe.
Once the cataract is removed, and the IOL is positioned in the clear capsular bag and light can once again travel unimpeded to the retina at the back of your eye. The retina is the nerve layer of your eye and receiver of the light images from outside. It changes them into electric impulses, which travel to your brain via the optic nerve, from where the brain interprets what you see.
After the procedure, you will receive an eye patch or transparent goggles in theatre to protect your eye, and after being wheeled back to the ward, your vital statistics will be taken again. You will receive some tea or coffee with a biscuit or two and rest for a short period before going home.
You will begin to notice an immediate improvement in your vision. Patients are typically able to heal very quickly with little to no discomfort as the cataract procedure is done with sophisticated technology causing minimal impact in the eye. (Click on the next section ‘restoring vision’ to explain the steps of cataract surgery)
Cross-section of the eye
A cataract is a clouding of the lens of your eye that causes blurred or distorted vision. If left untreated it can cause blindness.
Step 1
The pupil is dilated and the lens behind the iris is now exposed. A 1.8 – 2.3mm incision is manually made into the cornea with a precision blade or with low impact AI Femto Laser Assisted technology. Due to the small size of the incision, the opening is generally self-sealing.
Step 2
A circular tear is manually made on the lens capsule or can also be made by low impact AI Femto Laser Assisted technology to create an opening from where the cataract can be removed.
Step 3
With conventional cataract surgery ultrasonic vibrations are used to break the cataract into smaller fragments that are then aspirated from the eye with a customized suction device. With low impact AI Femto Laser Assisted Cataract technology the cataract is divided into smaller wedge shaped sections for easy and less invasive removal.
Step 4
After the cataract has been removed, a new lens is implanted. In most cases, a foldable lens is placed into a specialised injector or introducer and inserted through the circular opening previously made.
Step 5
As the foldable lens is inserted, it will automatically expand, open up inside the lens capsule, attach and secure itself to the lens capsule wall with specially designed hooks, resulting in……..
…….good, clear vision!
Depending on the type of intra ocular lens inserted, you might only need a pair of spectacles either for distance or near vision, or no spectacles at all!
Lens Options
- Visiomed Eye and Laser Clinic offers a wide range of cataract replacement lenses, of which also include Premium Lenses to correct your vision. These lenses can address anything from nearsightedness, farsightedness, presbyopia and astigmatism.
Some of the most common lenses include:
- Monofocal Intraocular Lens
This lens will correct vision at a set distance but does not correct pre-existing corneal astigmatism. Patients with astigmatism will therefore wear glasses to correct distance and close up vision problems. Patients without pre-existing astigmatism require reading glasses.
- Toric Intraocular Lens
This advanced technology lens corrects both distance and astigmatic problems. Patients will require reading glasses to see up close.
- Multifocal Intraocular Lens
This advanced technological lens corrects both distance and close up vision problems which will assist in correcting overall dependence on glasses.
Should any corneal surface conditions need to be addressed after cataract surgery, you will still be able to receive laser and corneal surgery and other surgery necessitated to optimise your vision.
The day after surgery
- The day after surgery your surgeon will examine your eye in the consultation room and you will proceed with eye drops as prescribed to you. It is of utmost importance that you always wash your hands before instilling your eye drops to prevent infection in your operated eye.
- Your vision will be improved, although you may experience some inflammation and swelling as healing takes place, but healing is fast and you may proceed with your daily tasks as long as there is no unnecessary bending, no heavy objects are lifted and you do not partake in strenuous activity/exercise for at least 2 weeks.
- You may read, use the computer and watch TV, but keep your eyes well lubricated and rest them if they feel strained.
- Be sure to keep sweat out of your eyes and avoid all lotions, creams and eye makeup for seven days.
Your eye surgeon will schedule a few routine post-op visits to ensure your treatment is a success and you are 100% satisfied.
- The artificial tears provided or suggested by your doctor will help ease any irritation you may experience after the Cataract surgery.
- If you experience any irritation it is important not to rub, poke or touch your eyes, especially if your hands are not washed.
- Follow your doctor’s instructions on using your steroid and antibiotic eye drops.
- Use this time to rest and relax.
- Do not strain your eyes through reading, computer work or watching TV.
One month after the cataract surgery
Your eye will be close to fully healed and you will notice continued improvement to eyesight.
Three months after cataract surgery
- Typically, your ophthalmologist will request that you attend a post-op appointment between one and three months after your cataract surgery.
- In some cases, after three months, your doctor may request an additional 90-day post-op check.
- Vision stability will be realised in most patients at approximately three months.
- Your surgeon will tell you when you can visit your referring optometrist for a refined eye test and have new glasses made for you should it be necessary. This happens at around 6 weeks post-surgery or after your eye has completely healed.
