What is Cataract?
Cataract is a condition where the lens of the eye becomes cloudy, causing less light to pass through the lens to the retina. Sometimes, the cloudiness can cause abnormal refraction and improper focusing, resulting in the retina not receiving light properly. Patients often experience blurred vision without any inflammation or pain. As the lens becomes more cloudy, vision gradually worsens. The severity of symptoms varies but usually develops slowly. Therefore, it may take several months or years before the patient notices significant vision impairment.
Symptoms of Cataract
- Double vision
- Seeing halos around lights
- Seeing a cloudy white haze in the center of the pupil
- Blurry vision, requiring bright light when reading
Risk Factors for Cataract
Age is the most important factor, commonly found in people over 60 years old. Other contributing factors include diabetes, alcohol consumption, excessive sun exposure, smoking, chronic eye infections, and eye injuries.
Cataract Treatment Approaches
In the early stages, when symptoms are not severe, doctors will monitor the condition periodically.
Cataract surgery involves removing the deteriorated lens, which can be done in two ways:
- Small incision surgery: This is ultrasound phacoemulsification, where the cataract is broken into small pieces and suctioned out. This method results in a small wound, about 2.5 – 3 mm, no stitches are needed, recovery is quick, and the procedure takes only 15-30 minutes. It is suitable for soft or moderately hard cataracts.
- Large incision surgery: This involves making a large incision to remove the entire lens and stitching the wound. It takes 30 minutes to 1 hour and is suitable for very hard and mature cataracts.
In both methods, patients do not feel pain. Local anesthetic eye drops and eyelid injections are used before surgery. In some cases, if the patient is uncooperative or fearful, general anesthesia is recommended before surgery.
Additional Recommendations
- For elderly patients (≥ 60 years) or those with underlying diseases, consult an internist before surgery.
- If taking blood-thinning medication, consult a doctor to stop the medication at least 7 days before surgery.
Types of Intraocular Lenses Used in Treatment
- Monofocal IOL: A standard single-focus intraocular lens. This lens helps with clear distance vision but requires glasses for near vision.
- Multifocal IOL: A multifocal intraocular lens designed to correct presbyopia. The lens surface is specially designed with Apodized diffractive or Refractive technology, resembling concentric steps in the center, to balance focus for near and far distances. About 80% of users can perform daily activities such as reading or driving without glasses. (This lens is not recommended for patients with retinal diseases, diabetes, or glaucoma.)
- Toric IOL: An intraocular lens that corrects astigmatism, which is usually caused by an uneven curvature of the cornea. The Toric lens is designed with different curvatures on the back of the lens vertically and horizontally to compensate for corneal irregularities, improving distance vision but still requiring glasses for near vision.
- Multifocal Toric: The latest innovation in intraocular lenses that can correct astigmatism and provide clear vision at multiple distances in one lens. It helps patients see clearly both near and far, reduces astigmatism, and also helps prevent cataract development in those prone to the condition.
Self-Care After Cataract Surgery
- Wear an eye shield on the operated eye to prevent rubbing or injury and wear it while sleeping.
- Avoid bending, looking up and down, or sneezing forcefully after surgery as it may displace the intraocular lens.
- Do not let water enter the eye and avoid dust for at least 1 month to prevent eye infections.
- Do not sleep face down or on the operated eye; sleep on your back with a pillow as usual for the first day after surgery.
- After surgery, the eye will be covered for 1 day, then uncovered the next day with instructions on eye cleaning.
- Take medications and use eye drops as prescribed by the doctor.
- Attend all follow-up appointments (come earlier if you experience redness, pain, or blurred vision).
- Protect your eyes by avoiding bright sunlight, dust, smoke, and pollution. Wearing sunglasses can help protect your eyes from pollutants. Also, manage underlying diseases such as diabetes and follow your doctor’s advice consistently.
Benefits of Cataract Surgery
- Improves vision and enhances quality of life.
- In some patients with retinal diseases, cataract surgery facilitates easier retinal treatment as the cataract no longer obstructs the doctor’s view of the retina.
Consequences of Not Undergoing Cataract Surgery
- Progressive vision loss leading to a poorer quality of life.
- Inability to treat retinal diseases such as retinal detachment, retinal scarring, eye bleeding, or diabetic retinopathy.
Possible Complications During and After Cataract Surgery
- Risk of eye infection (<1%) causing vision loss. Therefore, patients must keep the eye very clean and avoid dusty and dirty environments.
- Risk of the lens falling into the vitreous (<1%), which may be caused by weak lens support, very hard cataracts, or patient movement during surgery. If this occurs, a second surgery is necessary, and the patient will incur additional costs.
- Risk of eye bleeding leading to permanent vision loss (untreatable) with a risk of about 1 in 1000.
Frequently Asked Questions (FAQ)
- Can cataracts heal on their own? No, they cannot heal on their own and require surgical treatment.
- Is cataract surgery painful? No, it is painless because local anesthesia is used.
- How long does the surgery take? Generally, it takes about 15–60 minutes.
