CATARACT SURGERY

A CATARACT is a disease of the lens – the flexible structure placed inside the eye. Along with age the lens becomes opaque (entirely or in its different parts), harder, less flexible. Clouding leads to the loss of transparency, whose result may be a limitation of vision or a total loss of vision! A cataract can also have different stages of progression, which causes various symptoms in patients. The velocity of the disease and related loss of visual acuity may differ too.

In a healthy eye the lens is completely transparent and refracts light rays that come to the eye and then refract on the retina. Thanks to this process we can see a clear image of the object observed. Clouding of the lens makes the image unclear, blurred, distorted or it appears double with lower contrast. Often a patient feels as if he saw the world through a dirty pane.

Treatment: Although there are drops on the market which should slow down the progression of a cataract, they do not have satisfactory effect. There are also no effective tablets or injections. The only effective treatment method is surgery, consisting in removing the opaque lens and replacing it with an artificial implant. Untreated cataract can lead to the total loss of vision. If the patient does not suffer from any other diseases of the eye, the removal of the opaque lens gives very good results. The safest and painless method of treating cataracts is phacoemulsification.

Remember!
The only effective method of treating cataracts is a surgery and the replacement of the opaque lens with an artificial lens implant.

Eligibility for the procedure: Indication for the procedure is clouding of the lens hindering normal functioning and professional work, when a cataract disturbs patient’s lifestyle, hinders some activities or makes them impossible. The decision on the right time for the surgery is taken both by the patient and the doctor. Nowadays, waiting for a cataract to become “mature” is not practiced, quite the reverse, surgery of an advanced cataract is connected with an increased risk of surgical complications and inaccurate matching of an implant.

Contraindications: Making a decision on the surgery one needs to consider the overall health status of the patient. Generally there are no contradictions from the overall health status to conduct the procedure as it does not need a general anaesthesia and long recovery. However, the overall health status determines the type of anaesthesia and allows the anaesthesiologist to make a decision which medicines can be administered and which medicines can be dangerous. In order to assess the overall health status, there is a need of cooperation not only between the patient and the ophthalmologist, but also the general practitioner who normally takes care of the patient.

Expected results: A cataract surgery is a safe procedure which usually gives good results. However, it is connected, though only to small extent, with a risk of complications. Some stages of a cataract and comorbidities will influence the decision on when to conduct surgery. Additional diseases of the eye will also impact the result of a surgery. One should remember that at the elderly age there are other ocular problems beside a cataract. Often, they cannot be diagnosed before the surgery because the opaque lens covers the posterior segment of the eye. Only after the surgery, when the doctor can see the fundus of the eye, there is a possibility to diagnose other disorders.

Before the procedure: Every patient before the procedure is requested to go through a few additional tests and consultations and gets detailed ophthalmology examination. Such conduct enables appropriate preparation of the patient for the surgery. The more thoroughly you are examined, the more information we get while planning the procedure, which will increase the safety of the procedure and the chance to achieve better results.

Before the surgery, each patient gets detailed information on how to behave before, during and after the procedure. There is also a conversation explaining the most important issues connected with what can be expected and what the risk of the procedure is.

Remember!
Your cooperation on each stage of the preparation and the procedure as well as observing the instructions after the surgery increase the chance for satisfactory results!

Anaesthesia: The procedure may be performed using anaesthetic eye drops, local anaesthesia or general anaesthesia. Anaesthetic eye drops, which make the procedure painless and comfortable, are preferred. They do not cause additional risk for the patient connected witch administration of medicines, decrease the risk of surgical complications and reduces the period of recovery.

At the day of the procedure: Currently cataract surgery is done as an outpatient procedure. The patient stays in a clinic just for a few hours and after the surgery he can safely get back home. It is advisable that another person comes for you to the clinic and helps you during the first day. The eye will be covered with a dressing, and often the low acuity of the other eye and the drugs taken will impair unassisted functioning. The patient cannot drive a car and should avoid public transportation. The patient can walk and conduct basic activities.

SURGICAL TECHNIQUES

Intracapsular techniques: In the past the opaque lens was entirely removed using intracapsular technique, often with the use of a cryoextractor. The surgery required that the eye was cut “in half” in order to remove the whole opaque lens. After the procedure the patient needed correction with glasses of a power of 10 dioptres or more. It was then when people wore so called ‘coke-bottle glasses’. Nowadays, such thick glasses are used only in extraordinary cases of a serious ectopia lensis.

Extracapsular techniques: The revolution in treating cataracts took place when the extracapsular techniques were introduced. During the surgery a part of the patient’s own lens was left – the posterior capsule. A long 10 mm incision of the eye was made, and at the end of the procedure the wound had to be closed with a stich thinner than a hair. It caused a long process of healing and often postoperative astigmatism. Currently, a classic extracapsular technique is used only in sporadic cases.

Implantation of an artificial lens: Extracapsular techniques enabled surgical implantation of artificial lenses as a replacement for opaque natural lenses. The first artificial lenses were produced in the United States. At the beginning, they were so expensive that only few patients could afford them. Along with time they have become more and more available. In Głogów we have implanted lenses since 1994.

Phacoemulsification: Another revolution in treating cataracts took place after the introduction of a new method of an extracapsular surgery i.e. phacoemulsification (from Greek phaco, meaning ‘lens’). This technique consists in making three minimum incisions in the cornea and putting into the eye a special tool called phacoemulsificator. The tool by means of ultrasounds or a liquid stream breaks up the old opaque lens and then aspires the pieces of the lens material. Thanks to this, the lens with diameter of 12 mm can be removed through the tunnel in the cornea of merely 2-3 mm diameter, and the folded artificial lens can be put into this place. The implant then unfolds and gets the appropriate shape inside the eye. A specially constructed wound which is properly sealed at the end of the procedure does no required stitches. The small incision allows also for fast healing and rehabilitation. Astigmatism after the procedure is avoided. The whole procedure is performed in a surgical microscope. The surgery lasts 15-20 minutes and afterwards the patient gets back home on the same day. After a month it is considered that the eye is cured enough to select glasses.

Our experiences: Every year we perform in our centre around 500 cataract surgeries, while in the whole country it is 150 000 patients a year who get cataract surgery. It is the most frequent surgical procedure in the world. In our clinic, world-class experienced ophthalmologists specialized in cataract surgeries perform the procedures using the most technologically advanced and modern equipment. In the last years, the technique of cataract surgeries has been greatly modernized. Thanks to this, the time of the procedure, safety and comfort of life of the patient have also improved. As one of the first hospitals in Poland, we started operating the lens with the use of Constellation phacoemulsificator produced by the American company Alcon. Most of the cataract procedures are performed using OZIL tip. Thanks to this almost all surgeries are performed by micro incision without a need of postoperative stitches, which makes healing faster and better, and minimizes the risk of postoperative astigmatism, connected with stitching the wound. The period of rehabilitation is far shorter than in the case of other methods. For a few years we have also used Custom Pack by Alcon as a standard. This is a set of disposable tools and materials, which ensures safety of the surgery.

Lens implants: During cataract surgery an artificial lens in implanted into the eye. The result of the surgery depends to a great extent not only on the chosen technique and the course of the surgery, but also on the type of the lens implanted. Currently worldwide and in our clinic the implant is individually customized for the patient – dependently on his lifestyle, construction of the eye, other vision defects before the surgery and his needs. In our clinic also above-standard lenses are available: lenses PREMIUM. These lenses have a common name: AcrySof®.

PREMIUM LENSES: Aspheric lenses AcrySof®

AcrySof® are one-piece, acrylic, foldable lenses implanted during the cataract removal procedure. They replace the natural cloudy lens of the eye. They are flexible, and thanks to the special construction of the haptic components they adapt to the capsules of the lens of different sizes and shapes, which ensures that AcrySof® lenses will be properly centralized in the capsule of the lens (they are not subject to decentralization).

The material of which these lenses are made is biocompatible with the natural tissues of the eye. It ensures adherence to the anterior and posterior capsule of the lens, and therefore it prevents lens rotation after its implantation. According to clinical trials, these lenses ensure long-term centralization and stability, excellent refractive results and the reduction of the posterior capsule opacification. AcrySof® lenses still have one of the lowest rates of Nd: YAG laser capsulotomy out of all the lens materials available on the market today and lower proliferation of lens epithelial cells, which is an advantage of every lens designed for ensuring full range of vision.

AcrySof® lens blocks also harmful ultraviolet light. In addition, the material of AcrySof® is integrated with a yellow chromophore, which filters blue light in the 400-475 nm wavelength range. Blue light is considered as one of the factors causing retinal diseases. A yellow chromophore imitates colour and filtering features of the natural human lens. In vitro studies have shown that AcrySof® lenses with a yellow chromophore increase a few times human retinal pigment epithelium survival, exposed to blue light, in comparison with the lenses only with UV filter or with the lack of lens in the eye. These qualities of chromophore, filtering blue light, do not disturb the perception of colours or the quality of vision.

AcrySof® intraocular lenses are the most frequently implanted lenses all over the world: over 35 million of such lenses have already been implanted. The lenses are produced by Alcon company, a global leader in the field of care over the organ of vision.

AcrySof® IQ®

AcrySof® IQ® is a monofocal intraocular lens. It has been created to correct vision in the case of a cataract and simultaneously to improve the quality of the image seen. AcrySof® IQ® monofocal lens is recommended for clear distance vision. For certain activities such as reading, sewing, working on the computer there will be a need for correction eyeglasses for near vision.

Along with age the human lens changes its structure, which causes various bending of light in its central and peripheral part. This phenomenon is called spherical aberration. For the patient it means a lower contrast of vision. AcrySof® IQ® lens thanks to its aspheric optics significantly reduces spherical aberration. It allows the patient for increased sense of contrast, which results in better acuity and quality of the image, especially in weak light. AcrySof® IQ® lens has also been pronounced a new technology intraocular lens by the Centers for Medicare and Medicaid Services (CMS).

Aspheric lenses are recommended especially for those who drive a car in the evening and at night, work in weak light and need a very good quality of vision.

AcrySof® Toric®IQ

In many eyes cataract and astigmatism occur together. AcrySof® Toric® lenses were created for the patients with such a problem.

Sometimes the corneal surface is uneven so that the vision becomes distorted or unclear. This common irregularity is called a corneal astigmatism. Until recently astigmatism could be corrected only by the incision in the cornea (limbal relaxing incisions, radial keratotomy) or with the use of excimer laser (LASIK, LASEK, PRK). Presently used toric lens implants allow for simultaneous cataracts removal and astigmatism correction at the same time during a single surgery.

AcrySof® Toric® intraocular lens is implanted during the procedure of a cataract removal and it replaces the natural opaque lens of the eye. It has the ability to reduce or eliminate corneal astigmatism (causing distorted vision) and simultaneously correct cataract (causing cloudy vision). As a result, distance vision is improved and the use of glasses or contact lenses for distance vision is maximally limited.

A person with both cataract and corneal astigmatism, after surgical removal of the cataract only, will not restore high quality of vision unless the astigmatism is corrected as well. AcrySof® Toric® lens enables correction of cataract and astigmatism at the same time during a single procedure.

AcrySof® ReSTOR®IQ

Life without glasses – AcrySof® ReSTOR® lenses

Until recently, patients after cataract surgery have not been able to function without reading glasses or bifocals. AcrySof® ReSTOR® lenses are a unique technological innovation which can ensure perfect vision – both distance and near vision – with more independence from glasses!

The lens is a real chance for those suffering from cataracts, but also for those with only presbyopia (loss of ability of acute vision of near objects associated with age).

Clinical trials have shown an improvement of the quality of life of the patients with implanted AcrySof® ReSTOR® lenses, thanks to improved vision and more independence from reading glasses or bifocals. It has been proven that 80% of the patients with implanted AcrySof® ReSTOR® lenses never needed to use glasses after cataracts removal surgery in both eyes, while only 10% of the patients with monofocal lenses can enjoy such an improvement. This is the highest level of independence from glasses which has ever been shown in clinical trials of intraocular lenses. Besides, clinical trials of lenses have shown that over 93% of the patients participating in the trial were so satisfied with the new quality of vision that they would again decide to have the implantation of AcrySof® ReSTOR® lenses.

The construction of AcrySof® ReSTOR® lens is very complicated. These are lenses which create an image of the far away object (over 2 m) and for near vision (up to 40 cm), as well as for intermediate vision (between 40 cm and 2 m), using the techniques of apodization, diffraction and refraction. AcrySof® ReSTOR® lenses ensure better quality of vision in different light conditions.

Clinical trials have shown that 80% of the patients after the implantation of AcrySof® ReSTOR® did not used glasses while performing various activities such as reading, driving at day and at night, working on the computer.

AcrySof® ReSTOR® IQ Toric

Finally, the youngest child of a group of AcrySof IQ – ReSTOR Toric lens, which combines qualities of ReSTOR lens, such as ability of acute distant and near vision, and Toric lens, which allows for correcting astigmatism and removing cataract at the same time.

IMPLANT SELECTION

To select individual, most precise and „tailored” for the patient’s needs implant, every patient needs to have biometry test. On the basis of the test the computer program calculates the power of the implant needed. In our clinic we conduct biometry tests using two devices:

The measurements of the lens should be performed earlier, before a cataract develops and it is impossible to reach the inside of the eye with laser beams, and until the patient is able to see a point of light on which he should focus during the examination.

Remember!
Even a mistake of 1 mm in the measurement of the eye results in vision defect of 3 dioptres (so after the surgery the patient will need to use glasses with a power of 3 dioptres, and reading glasses with a power of 6 dioptres)!

Possible complications: During a cataract surgery, as in the case of any other surgical procedure, various kinds of postoperative complications are noticed. Fortunately, they are very rare and most of them are temporary.

The most dangerous complication is endophthalmitis (inflammation of the intraocular cavities). However, this problem occurs very rarely, on average once per thousand surgeries. It is caused by the bacteria getting inside the eye. Vitreous humour becomes opaque and pus is produced, which leads to the impairment of vision.

Another complication may be caused by an improperly selected lens; postoperative astigmatism or higher pressure may occur.

In patients with malfunction of corneal endothelium the cornea may be damaged, and then the patient needs another eye surgery – corneal transplantation.

Quite frequent complication is the opacity of the posterior capsule of the lens. The implant of the artificial lens is placed in the patient’s own retained capsule, which unfortunately can become opaque. It occurs in approximately 15-30% of all cases. The patient feels as if a cataract was getting back. This is a so called secondary cataract and it does not require another surgery. It is sufficient to cut the opaque lens with a laser and vision is restored immediately. The procedure is performed in an outpatient department; it is fast, painless and effective.

 

Registration – from Monday to Friday from 8:00 a.m. to 8:00 p.m.
Phone: +48 76 831 37 47, Fax. +48 76 831 37 48
CATARACT Expert: 570 50 70 50, LASIK Expert: 607 588 588
  • VITA-MED Ophthalmology Clinic
  • 67-200 Głogów PL, Legnicka St. 5
  • e-mail: klinika@vita-med.glogow.pl