Cataracts: How does the surgery work?

Everything you need to know about surgery, treatment and preventative measures

Our vision continues to fade and a patch appears in front of our eyes until we can only see through a thick fog: Although cataracts are a serious eye disease (in the absence of treatment), they can be safely treated with routine surgery to restore your sight. BETTER VISION EXPLAINS: What operative methods and treatments are used for cataracts, and what is the best way to prevent cataracts?

To date, no drugs have been developed for the conservative treatment of cataracts. However, a viable solution is surgery: the clouded lens is replaced by an artificial lens (the so-called intraocular lens) made of acrylic or silicone.

Although it sounds like a serious operation, it is actually one of the safest operations ever. According to the data, it is the most frequently performed operation in the world. The date of the operation is usually agreed by the patient with the doctor. The main factor is how much the foggy lens affects the patient’s life. The first symptoms of cataracts are visual disturbances that look like fog and increased sensitivity to light. As the disease progresses, typical symptoms include fading of color and contrast, difficulty seeing at dusk or in low light, increased glare, and reduced ability to adapt to light and dark. Lens fogging occurs slowly and usually takes several years. This is precisely why patients only go to the doctor when it is too late. If the cataract is hereditary, surgery to restore the patient’s vision as quickly as possible is recommended without delay to avoid permanent damage to the patient’s vision. Congenital cataracts also require immediate surgery. If left untreated, cataracts can lead to blindness. Read on to learn more about cataract surgery and prevention.

Cataracts: How does the surgery work?

 

What operations are performed?

 

After surgery

 

Prevention

Cataracts: How does the surgery work?

Cataract surgery is usually performed on an outpatient basis. First, the patient is given local anesthetics in the form of eye drops or injections. General anesthesia is exceptional and is given to children or in special cases, such as when the patient has a severe cough. Once the anesthesia takes effect, the doctor removes the clouded intraocular lens and “anchors” a new, artificial lens into the eye. The operation of the second eye is performed later – once the first eye has healed and begins to function properly. In order to prescribe a suitable artificial lens, the doctor must accurately measure the affected eye. This is the only way to ensure that the operation goes smoothly and that the patient will see the best possible outcome with the new lens. To achieve an optimal result, over 75% of all cataract surgeries are performed using ZEISS medical equipment. Cataract treatment consists of several different steps and uses a variety of devices, from diagnosis to follow-up care. ZEISS offers the right products and solutions to help doctors treat cataracts.

What operations are performed?

 

Read on to learn all about standard cataract surgery.For more information on the composition and functions of the eyes, click here.

Two surgical procedures are currently available to treat this disease: extracapsular cataract extraction (ECCE) and intracapsular cataract extraction . Extracapsular extraction is more common. The “natural attachment” of the lens remains intact. The lens is removed, but the lens housing remains intact. The advantage of this method is that the new artificial lens can be anchored more firmly in the eye. Extracapsular cataract extraction can be performed in three possible ways: phacoemulsification, using a femtosecond laser, or manually.

Intracapsular cataract extraction

Intracapsular cataract extraction is now obsolete. This method was performed until the sixties of the last century, when it was replaced by extracapsular cataract extraction. During intracapsular cataract extraction, the clouded lens and its capsule are completely removed from the eye. This method is usually quite risky and is only performed in exceptional cases, eg when other methods are not possible for health reasons.

Phacoemulsification

Phacoemulsification is the most common treatment for cataracts. After anesthesia, a small incision (two to three millimeters) is made and an ultrasound probe is inserted into the eye. The probe uses ultrasound waves to break up the fogged lens. Pieces of the lens are then aspirated. The surgeon then carefully inserts a custom-made collapsible artificial lens into the eye through a small incision. The cut does not need to be sutured: it is so small that it will heal on its own.

Cataract surgery using a femtosecond laser

Cataract surgery using a femtosecond laser is considered the most precise and gentlest method available today. The cut, dissection and removal of the lens are performed by a computer controlled laser, specifically a femtosecond laser. The name of this laser is derived from the light pulses it emits, the length of which falls into the femtosecond scale. Femtoseconds are very short – one femtosecond is equal to 0.00000000000001 of a regular second. The laser comes into contact with the tissue only for a fraction of a second, which is a guarantee of the gentlest operation. Femtosecond laser cataract surgery is not suitable for patients whose lens is very hard due to the advanced stage of the disease.

Manual ECCE

As the name implies, manual extracapsular cataract extraction is performed manually, i.e. without the use of laser or ultrasound. The surgeon makes an incision, which is then sutured. The stitches then cause a non-standard curvature of the cornea. The healing process takes longer with manual ECCE and is associated with a higher risk of inflammation. This type of surgery is therefore only performed in rare cases, such as in patients with advanced cataracts to protect the cornea or when the lens is so hard that it cannot be liquefied.

After surgery: What should I keep in mind?

After cataract surgery, the patient is usually sent home straight away. If the surgery is performed as an inpatient, patients usually stay in the hospital for two to three days for observation. As with most other eye conditions, good follow-up care is absolutely essential after the procedure. After surgery, the patient must wear an ointment bandage for at least 24 hours to protect the eye and help with healing. The patient is also prescribed anti-inflammatory eye drops for up to four weeks. The ophthalmologist then regularly monitors the healing process. After cataract surgery, patients must adhere to the following principles:

  • Do not rub or press on the eye
  • Take all prescribed medications as directed
  • Attend all follow-up examinations
  • Do not play sports or engage in other physical activities, especially during the first days after surgery
  • Avoid eye contact with water, shampoo or soap
  • Do not go to the sauna or swim

If the patient does not suffer from any other eye problems, it is likely that such an operation will lead to a full restoration of vision (cannot be guaranteed). In other words, patients will no longer need to wear glasses or contact lenses to see clearly. Sharp vision usually occurs as soon as the nurse removes the patient’s bandages. If the patient suffers from another eye disease or vision defect, it is necessary to correct them with a suitable visual aid after the operation.

How can cataracts be prevented?

Please note that not all causes of cataracts have been discovered yet. Depending on the cause, there are a number of ways to prevent cataracts. Age-related cataracts are a natural part of aging and cannot be prevented – the same goes for hereditary cataracts. Measles can cause cataracts in an unborn baby. Prevention in this case is vaccination against measles. The best course of action is to check your vaccinations before you become pregnant or as soon as you find out about your other condition. If necessary, arrange for additional vaccinations.

Cataracts cannot be effectively prevented in any other way than by avoiding specific factors that increase the formation of cataracts. These factors include:

  • Smoking and alcohol: A link between smoking and the development of cataracts has been shown, so it is best to quit smoking or not smoke at all. The same goes for excessive alcohol consumption.
  • Diabetes: Another risk factor is diabetes. Key measures to prevent diabetes include a balanced diet, adequate sleep and regular exercise. If the disease has already been diagnosed, it must be monitored or treated.
  • Eye injuries: Eye injuries can also increase the risk of developing cataracts. This risk can be prevented by wearing glasses whenever you perform hazardous tasks (eg drilling or polishing).
  • UV radiation: To prevent damage caused by UV rays, always wear UV protection glasses, especially when on vacation, in the solarium or in the mountains. Sunglasses or ski goggles are very important to ensure eye protection and also effectively reduce the risk of developing cataracts. UV light and UV rays can be harmful even when it’s cloudy. Therefore, protect your eyes and skin from UV rays, even if it is cloudy outside.

 

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