Cataract is a condition in which the lens of the eyes become cloudy, causing less light to pass the lens to the retina. Sometimes, the cloudiness can cause abnormal light refraction and the wrong place focus, causing the retina cannot to receive light fully. Patients often have blurred vision without any inflammation or pain. The more the lens cloudy, the more the vision will decrease. The severity of the symptoms may vary, but they usually occur slowly. Therefore, it may take several month or years for a patient’s vision to become cloudy enough to be noticeable.
Symptoms of cataract
- Double vision
- Seeing circle around light
- Seeing white clouds in the center of the pupil
- Seeing blurry images. When reading a book, you have to use bright light.
Risk factor for cataract
Because age is the most important factors, it is often found in people over 60 years old. There are also others contributing factors such as diabetes, alcoholic beverages, excessive sun exposure, smoking, chronic eye infections and accidents.
Treatment guideline for cataracts
- At the early stage, the symptoms are not severe. The doctor will monitor the symptoms periodically.
- Treatment with cataract surgery is to remove the deteriorated lens. There are 2 methods, details as follows:
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- Non – incision surgery: Ultrasound cataract lithotripsy by breaking up the cataract into small pieces and sucking them out. This method will cause the small wound, approximately 2.5 mm. No stitches are required. It quickly healed and only takes 15-30 minutes. It is suitable for cataract lenses that are soft or moderate hard.
- Open- incision surgery is a large incision surgery to remove the entire deteriorated lens and stitch it up. It takes 30 minutes to 1 hour, which is suitable for very hard and mature cataract lenses.
Both methods do not cause pain to the patient. Anesthetic drops and injections will be used on the eyelids before surgery. In some cases, where the patient is uncooperative or afraid, anesthesia is recommended before surgery.
Additional advice
- In the case of elderly (≤ 60 years old) or those with underlying diseases, consult a geriatrician before surgery in every case.
- If taking blood thinning medications, consult a doctor to stop taking the medication at least 7 days before surgery.
Types of intraocular lens used for treatment
- Monofocal IOL is a standard or single-focal intraocular lens. This type of lens helps with clear distance vision, but require glasses to help to see in the distance.
- Multifocal IOL is a multifocal intraocular and lens developed to solve the vision of problem of people with presbyopia The lens surface is specially designed with Apodized diffractive or refractive technology, similar to a circular staircase in the middle, to help create a balance of near and far focus. It was found that 80% of users of this type of lens can do daily activities such as reading or driving without relying on glasses. (This lens should not be chosen in patients who have had retinal disease or diabetes.)
- Toric IOL, an artificial lens that correct astigmatism, which is mostly caused by an imbalanced curvature of the cornea. Toric artificial lens are designed to have an unequal curvature of the back of the lens in the vertical and horizontal directions to compensate for the unequal curvature of the cornea, allowing for clearer distance vision, but still requiring eyeglasses for near vision.
- Multifocal Toric, the latest innovation on artificial lenses that effectively corrects astigmatism and adjusts the clarity of images at multiple distance in the same lens, allowing patients to see both near and far more clearly, and reducing astigmatism. It also helps correct the development of cataracts for those prone to cataracts.
Self-care after cataracts surgery
- Have a cover over the operated eye to prevent rubbing and impact to the eye and should be worn to cover your eyes while sleeping.
- Do not bend down, cough, or sneeze hard during the first day after surgery because it may cause the lens move.
- Do not let water get into your eyes or get dust for 1-2 months (depending on the cataract removal method). If the cataract removal is done by ultrasound (should avoid getting water for 1 month, and should not swim for 2 months). If the surgery is done with a wide open wound and the wound is stitched (should avoid getting water for 2 months and should not swim for 3-4 months until you are sure that the wound is completely closed).
- Do not sleep with your face down to the bed after the surgery and should sleep on your back put your head on a pillow as usual during the first day after surgery.
- After surgery, the eyes must be closed for 1 day. They will be opened the next day and the doctor will teach how to clean the eyes.
- Take medicine and use eye-drops as prescribed by the doctor.
- Come to see the doctor for every appointment (if you have red eyes, eye pain, blurred vision, you should come before the appointment).
- Focus on eye care by avoiding bright sunlight, dust, smoke, pollution, etc. You can wear sunglasses to protect your eyes from pollution as well as take care of and control chronic diseases such as diabetes and follow the doctors’ advice regularly.
Advantage of cataract surgery
- To improved vision and improve quality of life.
- In some cases, with retinal diseases, eye surgery will make the treatment of the retina more effective.
Disadvantage that will occur
- Vision gradually blurred, causing the worsen quality of life.
- Unable to threat retinal diseases such as retinal detachment, retinal fibrosis, bleeding in the eye or diabetic retinopathy.
Possible complications during and after cataract surgery
- A chance of eye infection (<1%) which can cause blurred vision. Therefore, patients who undergo eye surgery must take very good care of their eyes and avoid dusty and dirty environments.
- Chance of the lens fall into the vitreous fluid (<1%) which may be caused by a weak lens holder, a cataract lens that is too hard or in some cases, the patient’s face moves during the surgery. If this happen, a second surgery is necessary and the patient must pay additional expenses.
- Chance of bleeding in the eye causing permanent vision loss. This cannot be corrected with a risk of approximately 1:1000.
