10 Frequently Asked Questions About Cataract Treatment

10 Frequently Asked Questions About Cataract Treatment

1. What is the difference between ECCE cataract surgery and phacoemulsification?
   ECCE cataract surgery is a method used before the introduction of phacoemulsification. It requires local anesthesia injection, a large incision because the entire cloudy lens is removed through an 8-10 mm wound, which must be sutured with very fine stitches causing astigmatism. It is suitable for countries without phacoemulsification machines or for cataracts left untreated for a long time that cannot be emulsified. It is less expensive. Phacoemulsification is currently the best treatment method. Mostly, only anesthetic eye drops are used, except in cases where the patient is very fearful or has complications requiring anesthesia injection to ensure cooperation during the procedure. The incision is very small, ranging from 1.8-3.0 mm depending on the instruments and the surgeon’s skill. Most wounds do not require sutures because they are very small. The procedure takes 5-25 minutes depending on the surgeon’s skill. Vision can recover well within 6 hours. The downside is that if the cataract is left too long until the lens hardens and turns black or overripe, the machine cannot emulsify it. It requires high surgical skill and costs slightly more than ECCE surgery.
2. Can leaving a cataract untreated for a long time cause blindness?
   Cataracts are the number one public health problem in Thailand causing severe vision loss. Patients will experience progressive vision blurring, which can lead to secondary glaucoma. Therefore, cataracts should not be left until they become hard or overripe.
3. Should cataracts be treated only when they are mature?
   This is a misconception because mature cataracts can cause severe inflammation in the eye, leading to secondary glaucoma, which causes eye pain and eventual blindness.
4. Can cataracts be cured with eye drops?
   Currently, the use of eye drops to slow down or cure cataracts is no longer accepted. Such medications do not slow down or cure cataracts. If diagnosed with cataracts, and if the cataract is not severe and the patient is not ready for surgery, waiting is possible. However, if the cataract is advanced and surgery is recommended, it is advised to proceed because leaving it untreated will harden the cataract, making it more difficult to emulsify.
5. Will cataracts come back after treatment?
   After treatment by surgery or phacoemulsification, cataracts will not recur.
6. Can cataract surgery correct nearsightedness, farsightedness, or astigmatism?
   Cataract surgery or phacoemulsification removes the cloudy natural lens and replaces it with an artificial intraocular lens (IOL), which can correct nearsightedness, farsightedness, and astigmatism.
7. How many types of intraocular lenses are there, and how do they differ?
   Types of intraocular lenses include: hard lenses 5.25-7 mm made of PMMA, suitable for ECCE surgery or implantation without the lens capsule; foldable soft lenses inserted through small incisions of 1.8 – 3.0 mm, suitable for phacoemulsification; toric IOLs for correcting significant astigmatism (2.0 D or more); multifocal IOLs for patients who need both distance and near vision without reading glasses. The choice of lens type should be based on consultation with the treating ophthalmologist to determine the most suitable lens for each patient.
8. Do cataracts only occur in the elderly?
   Cataracts can occur at any age, even from birth, due to various causes such as congenital rubella, accidents, or diabetes. However, the most common cause is age-related lens degeneration in elderly patients. If unsure whether blurred vision is caused by cataracts, it is recommended to see an ophthalmologist for a definitive diagnosis.
9. If a patient has both cataracts and glaucoma, can glaucoma surgery be performed?
   Cataract surgery can be performed and may improve angle-closure glaucoma. With advances in surgery, in some cases, both cataract and glaucoma surgeries can be done simultaneously, reducing costs and increasing safety. The ophthalmologist will provide clear recommendations before surgery.
10. Can cataract surgery cause infection and blindness after treatment?
    All surgeries carry a risk of postoperative infection. Ophthalmologists and hospitals prepare and provide antibiotic eye drops to prevent infection. Patients must take care to use eye drops properly and avoid water entering the eye when washing the face or hair. The general incidence of infection is about 1:35,000 but may vary by country and region. After surgery, if there are problems such as blurred vision, loss of vision, unusual eye pain, redness, or eyelid swelling within the first 4 days, patients are advised to see the ophthalmologist before the scheduled appointment to address any postoperative complications promptly.