The lens in the eye is a unique part of the body. It is formed of multiple layers of clear protein that are gradually laid down over the years, like layers on an onion or rings on a tree. As life progresses the lens gets harder just like wood matures over the years. For this reason the lens in a child is completely soft but the lens in an eighty year old is like a little stone. A cataract occurs when the protein in the lens in the eye goes cloudy. This usually happens slowly over time as the lens ages, although a cataract can form within a matter of hours with trauma! Cataract in children is usually congenital or associated with infection. Other causes include diabetes, chronic inflammation in the eye and drugs such as steroids.
Cataracts are the most common cause of curable blindness worldwide. They usually result in gradual loss of vision. For some people this happens so slowly that they fail to notice how bad things have become until one eye is done and there is still a cataract in the other eye to compare! One of the first signs of cataract is glare from on-coming headlights at night or reduced vision in bright sunlight. Patients with cataract often see better by shading the eye or wearing a peaked cap. The world gradually turns smoky brown to the extent that colours are no longer clear. People with cataracts have been known to buy a beige sofa, only to realise after the surgery that it was bright orange! As things get worse, distance vision can fall below the legal limit for driving and reading becomes difficult.
Almost everyone over the age of 65 will have some change in the lens of the eye and the very start of a cataract. Not all cataracts need to be removed. The day has also passed when we need to wait for the cataract to “ripen” before it can be treated. In the early days a minor adjustment to glasses often solves the problem. With time however vision never feels right even with updated spectacles and normal every day vision tasks become a chore. You avoid night driving. Faces on the TV are difficult to see. Reading always seems to require bright light. When vision starts to interfere with the pleasure of everyday tasks that is the time to consider cataract surgery.
Surgery to remove the opaque lens has been described as early as 600 BC! Vision loss associated with cataract is often completely reversible by modern cataract surgery, even for very dense cataracts. This involves removing the cloudy lens in the eye and replacing it with an artificial lens implant. Through a tiny 3 mm incision, the lens is removed by a probe that vibrates at ultrasonic speed and breaks the lens up into tiny pieces that are then washed out of the eye. The lens implant, which is made of acrylic is rolled up in an injector and then passed through the tiny incision to unfold within the eye like a contact lens with tiny legs on, to hold it in place. The surgery is generally completed without the need for any sutures. The procedure takes about 15-20 minutes and can be performed with just local anaesthetic drops or a small injection to freeze the eye and patients go home almost immediately afterwards. Drops are used for a few weeks after the procedure to reduce the risk of infection and settle down any minor inflammation.
With modern cataract surgery, the surgeon has the potential to make the patient as longsighted or as short-sighted as he/she wishes, depending on the choice of the lens that is put into the eye. Every patient’s eye is measured beforehand so that the best choice of lens can be used! Usually the surgeon chooses a lens that keeps the need for glasses for the distance to an absolute minimum such that the patient only needs reading glasses. More complex lenses are also inserted by some surgeons, which remove the need for glasses for both near and distance.
Cataract surgery has a very high success rate and the vast majority of people see an improvement in their vision after surgery. It is however, important to remember that this surgery will not resolve any vision problems caused by other conditions affecting the eye and that all surgical procedures carry risks as well as benefits. However, for problems caused by cataracts, the odds of success with this type of surgery are amongst the best associated with any surgical procedure.
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