What is Cataract? How does it occur?
There is an invisible lens just behind the colored part of our eyes because it is transparent. Since this lens is transparent, we see the pupil in black.
The lens reduces the incoming rays to the nerve layer and provides a clear image. In order to the light to pass through the lens and reach the nerve layer, the lens must be clear (transparent). If this transparent lens becomes blurred for various reasons, it is called “cataract”. This blurring can occur anywhere particullary or throughout the whole lens.
Is cataract an age related disease? Is it also seen in young people?
It can be seen in people of any age, including infants. It is rare in middle age. Its frequency increases with age. Almost half of those between the ages of 50 and 59 and almost all of those over 80 have some incontinence. But this incontinence may not always significantly affect vision.
What are the causes of cataract?
The most important cause of cataracts in adults is the changes that occur with aging inside the lens. In children, metabolic diseases, consanguineous marriage, diseases in the womb, drug use during pregnancy, microbial conditions and injuries are effective. In addition, trauma, diabetes, intraocular inflammation (uveitis), kidney disease, glaucoma, radiation, high blood pressure (hypertension) and prolonged use of cortisone medication can cause cataracts.
Can cataracts be treated with medication?
Cataracts have no treatment other than surgery. Although there are some drugs that have been tried, no successful results have been reported yet. So, we can say that the treatment of cataracts can be done by surgery.
What are the signs of Cataract?
• Increasingly blurred vision without pain
- Glare or decreased sensitivity to light
• Frequent glasses number change
• The need to wipe the glasses frequently
• Strain while driving
• Night vision decrease and light scattering
• Need for strong light to read
• Double vision with one eye
• Fading or yellowing in colors
In what situations is cataract surgery inevitable?
Surgery is recommended if the patient is faced with any of the following conditions.
• When the vision does not meet the daily needs of the patient
• An inflammation in the eye, creates a cataract and impairs treatment and follow-up.
• Cataracts increase the eye pressure of the patient
• In congenital cataracts, which may lead to low vision and strabismus.
What are the cataract surgery methods?
For many years, cataract surgeries have been performed using the method called FAKO. It is a needle-free, seamless and painless surgery.
A small incision of 2.2-2.4 mm is made in the eye by numbing the eye of the patient to be operated. In the surgery, where all the procedures are performed through this small incision, a round piece is peeled off the front part of the membrane surrounding the lens with cataracts. Then, with the help of the device called FAKO and ultrasonic sound waves, the cataract lens is divided into small pieces. Later on these small pieces are suctioned and cleaned with the FAKO device. An artificial intraocular lens suitable for the patient's eye is placed inside the pocket consisting of membrane, which is completely cleaned. At the end of the surgery, antibiotics are injected into the eye. Finally, the incision site is closed seamlessly.
The latest method that has developed and spread rapidly in recent years is "Femtosecond Laser Cataract Surgery"
Thanks to the use of laser in cataract surgeries, cataract surgeries can now be performed much safer, more comfortable and the risk of complications is minimized compared to the classical FAKO method.
In the laser method, the eye of the patient is numbed with drops. First of all, the patient's eye is taken under the laser device, so that the patient cannot feel it, thanks to the computer-controlled laser, the process of creating an incision, opening the window in the front capsule and disassembling the cataract lens is performed (approximately 30-45 seconds). Then the patient is taken under an operating microscope. Here, by entering through the incision created by the laser (without a blade), the lens parts broken down by the laser are absorbed with the FAKO device and cleaned in a short time. Then an artificial intraocular lens is inserted, antibiotics are injected into the eye and the surgery is terminated.
What are the Advantages of Femtosecond Laser Cataract Surgery over Classical FAKO Method?
- Without knife (the incision is opened by laser)
- Computer control (error margin close to zero)
- In the surgery, the time in the eye is very short and therefore the tissues are protected.
- By opening the membrane in front of the cataract lens with a laser, the risk of tearing is eliminated.
- The cataract lens can be cut into pieces as small as desired thanks to the laser, and the damage to the surrounding tissues is prevented during this time.
- Opening the incision and breaking the cataract lens can be done within seconds and without damaging the eyes. However, all these stages are the stages with complication risk in classical FAKO method and success depends on the surgeon's ability and experience.
- One of the most important advantages is that the membrane from which the cataract lens is removed is cut very smoothly thanks to the laser, and thus the artificial lens to be placed inside it can be kept very smooth inside this membrane. In the classical FAKO method, since all the steps are done by the surgeon, this membrane may not always be opened with the same regularity and as a result, the artificial lens placed in it may not be able to stand in the center. This creates a situation that adversely affects the patient's vision, even if the highest quality lens is attached.
- Femtosecond lasers have been developed in order to increase the surgical success and provide maximum performance from the lenses, especially in patients who select multifocal, trifocal, thoric intraocular lenses and who want to stay without glasses. In patients who choose special intraocular lenses, "Femtosecond Laser" method should be preferred.
What should be the features of the intraocular lenses placed in the surgery?
The lenses to be used today are usually mono-focal, (i.e. far or near). After wearing this type of lens, the patient may need to wear glasses and contact lenses to see both far and near. Recently, “multifocal lenses”, lenses with special color coatings and preventing harmful light to the eyes have been used in order to make the patient see both far and near clearly after the surgery. Such lenses are used in situations where the patient and the physician will decide together.
What to do before cataract surgery?
Various examinations can be performed in the cases deemed necessary according to the age of the patient, other diseases, the drugs used, and the type of surgery to be performed. Especially, report all medicines you use to your physician and follow their recommendations according to the type of medication. Some medications can be taken by mouth or can be injected through the arm or hip after being taken to the operating theater.
You should not eat or drink anything at least 6 hours before coming to surgery. Having a companion with you may be good for some help after the surgery. You will need to remove your makeup and jewelry. Since some drops will be used in the eyes, your pupil may have enlargement and reddening in the eye.
Is it anesthetized during surgery?
General anesthesia is generally preferred in children in cataract surgery. Another preference is to apply (local) anesthesia by applying needles around the eyes. Surgery is also possible without needles, numbing only the eye with eye drops (topical anesthesia). This anesthesia is applied when the patient's compliance is good.
How is cataract surgery performed?
After the eye has been anesthetized for the operation, the eye is entered according to the chosen method and the front membrane of the lens is first opened, and the cataract part of the lair is removed either totally or by breaking in to pieces. Only the membrane of the lens is left inside. Again, according to the patient's age, the condition of the eye and the type of surgery, lens placement can be performed.
In some cases (such as children under 1 year old), the lens may not be placed. Sometimes, due to the operation and the condition of the eye, no lens can be placed or delayed until a second operation. In some cases, it may be necessary to use different types of lenses (requiring stitches to the eye wall, attached to the colored part) outside the planned type. When these situations occur, the physician performing the surgery will decide according to the most suitable option for you.
Is post-operative care required?
The eye after surgery is usually closed with a bandage. This bandage should remain in the eye as long as your doctor recommends. You should not press and rub the eye after surgery. You will be informed about your hospital stay. If you are going to be discharged from the hospital, do not drive yourself. You can start taking food and medication according to the recommendations of clinical nurses and doctors. Things like washing your face, bathing, carrying things, praying, doing sports, starting work, swimming in the sea and swimming pool should be consulted to the doctor. Drugs to be given after surgery (drops, pomade, tablets, syrup, etc.) should be used as and as recommended by your doctor. Do not change, reduce or cut your medicines without consulting your physician. The person who will apply them to the eyes before using the drops and pouches given must definitely wash their hands with soap. When applying the medication, the tip of the dropper or pouch box should not be touched on places such as eyelids, eyelashes, skin, hands, paper, or napkins. Controls are made on the 1st day, 1st week and 1st month after the operation. During this time the eyedrops both prevent germ infection and helps healing. Please carefully take your doctor's warnings about the follow-up time and the things to do.
Will reading after surgery harm the eyes?
Reading does not harm the eyes. You can use your old glasses when reading if they help you. But immediately after the operation, there may be discomfort and fatigue in the eye. Watching television is less tiring and not harmful to the eyes. The full far and near glasses are adjusted at the time that your doctor deems appropriate after the operation.
What are the changes in the lives of people who have had cataract surgery?
It is also wondered whether cataract surgery creates restrictions on some issues. After the surgery, people who achieve the vision specified in the law can get a driver's license and drive. They can do sports that do not require contact. According to the Turkish laws, they can’t work as cops or military members.
Does cataract recur?
Cataracts do not occur in those who have cataract surgery. With the operation, the membrane into which the lens is placed may become dense over time. Although this is called "secondary cataract" among the people, it is not actually a cataract. This formation can usually be easily treated with a laser. Surgery in children or in rare cases when the membrane becomes too thick may need to be cleaned.