Cataract Surgery | Rupaltest

Cataract Surgery

by Dr Rupal Morjaria

Cataract surgery is one of the most frequently performed operations in the country.

The eye’s lens helps to focus an image on the back of the eye (retina). When we are young, our lens is clear. As we age, the lens proteins begin to age, causing the lens to get cloudy and we call this a cataract. This can then lead to symptoms of glare and reduced vision. Most people develop cataracts with increasing age. Very occasionally, you can be born with cataracts. Studies have shown that people get an improvement in their vision, contrast sensitivity, depth perception, activity, anxiety, depression, visual disability, confidence, handicap and quality of life and reduce falls after cataract surgery.

Cataract surgery is one of the most frequently performed operations in the country. Approximately 330,000 cataract operations are performed each year in England alone. Most people undergo cataract surgery under local anaesthetic. Local anaesthetic can be administered as drops on the eye or as a small injection around the eye. In a small number of cases where patients are highly anxious or unable to keep their eyes still, they can be given sedation or general anaesthetic.

The surgical time can vary from 10 minutes to an hour depending on the type of cataract and complexity of your case. When Dr Rupal Morjaria sees your case, she will discuss your case in detail with you before surgery is repeated.

What happens before the operation?

When you come for your operation, the nurse will check your details and start putting drops in your eye. Dr Morjaria will come and speak to you and mark the eye that is being done with a mark on your head. When it is time for your operation, you will have drops put in the anaesthetic room and the anaesthetic that has been decided by you.

What test will be needed?

OCT Scan - Optical Coherence Tomography - This looks for damage to the photoreceptors at the back of the eye. Visual field testing - This looks for a reduction in visual fields which is common in retinitis pigmentosa. Electrodiagnostics - This is a test where wires are attached around the eye and the electrical response after your eyes are stimulated in different light conditions are measured. It is a valuable tool, to look at the function of the photoreceptors in the eye. Genotyping - A blood test can be performed to look at your genetic code for a definite diagnosis. This will help us understand the exact type or retinitis pigmentosa which will allow Dr Mojaria to advise you on the likelihood and severity of any visual loss that may occur.

Fluorescein Angiogram - You may need additional tests that involve having a yellow dye injected into your hand to take pictures of the blood circulation in your eye. This will allow Dr Morjaria to assess for areas of the eye that are not getting enough oxygen or areas that need laser treatment to prevent bleeding in your eye.

What happens during the operation?

You will be brought into the operating room, where the nurses and Dr Morjaria will check your name and information again. Your eye will then be cleaned. Dr Morjaria will place a thin clean gown over your eyes and face. You will feel some oxygen near your face.

It is very important that once surgery starts you do not make sudden movements. If you need to move or cough, please raise your hand so that the surgeon can stop the operation safely. During the operation you may hear the doctor and nurses talk. This is normal as they are passing the instruments.

You may feel Dr Morjaria’s hands rest on your forehead. Occasionally water can drip down your face that will be cleaned at the end of surgery. A small cut less than 2.5 mm is made and two smaller ones through which your natural lens is broken down in small pieces and then cleared away.

A new clear lens is then injected carefully in the previous space to help you focus clearly. If a stitch is needed during the surgery, this is normally removed after 6 weeks.

The surgical time can vary from 10 minutes to an hour depending on the type of cataract and complexity of your case. When you are seen by Dr Morjaria, she will discuss your case in detail with you prior to surgery.

Will I need glasses after surgery?

Intraocular Lenses (IOLs): EDOF, Multifocal, and Monofocal Lenses — Risks and Benefits

Intraocular lenses (IOLs) are artificial lenses implanted in the eye to replace the natural lens after cataract surgery or to correct vision problems such as presbyopia. With different types of IOLs available, each offers a unique set of advantages and considerations. Extended Depth of Focus (EDOF) lenses, Multifocal IOLs, and Monofocal IOLs are among the most commonly used, and each provides varying degrees of vision correction. This article outlines the benefits and risks associated with each type of IOL to help patients make an informed decision about their vision correction options.

1. Extended Depth of Focus (EDOF) Lenses

EDOF lenses are designed to provide a continuous range of focus, allowing for enhanced vision at intermediate and distance ranges, with some near vision correction.

Benefits of EDOF Lenses:

Smooth Transition Between Distances: EDOF lenses offer a continuous focus from near to far, particularly benefiting intermediate vision (like using a computer or tablet) while still providing acceptable distance and near vision.

Reduced Nighttime Disturbances: Compared to multifocal lenses, EDOF lenses produce fewer visual disturbances such as glare, halos, or starbursts, making them a good option for those who drive at night.

Improved Contrast Sensitivity: EDOF lenses typically provide better contrast sensitivity, allowing for clearer vision in low-light conditions compared to multifocal lenses.

Reduced Glasses Dependency: While not entirely eliminating the need for reading glasses, many EDOF patients experience a reduced dependence on glasses for most daily activities.

Risks and Downsides of EDOF Lenses:

Limited Near Vision: EDOF lenses provide strong intermediate and distance vision, but near vision may still require reading glasses for tasks like reading fine print or threading a needle.

Potential for Reduced Visual Sharpness: Some users may notice that certain distances may not be as sharply focused as with other IOL types.

Adaptation Period: Patients may need some time to adjust, particularly when shifting between near and intermediate vision ranges.

2. Multifocal Intraocular Lenses (IOLs)

Multifocal IOLs are designed with multiple focal points, enabling patients to see clearly at near, intermediate, and far distances without the need for glasses. This makes them particularly popular among patients seeking comprehensive vision correction.

Benefits of Multifocal Lenses:

Clear Vision at Multiple Distances: Multifocal lenses provide excellent vision at near, intermediate, and far distances, which means patients can perform activities like reading, using a computer, and driving without needing additional corrective lenses.

Convenience: Many patients find multifocal lenses to be highly convenient, as they reduce or eliminate the need for glasses, especially for tasks that require both near and distant vision.

Increased Independence: Multifocal IOLs often allow for greater independence in daily activities without relying on corrective eyewear.

Risks and Downsides of Multifocal Lenses:

Visual Disturbances: Some patients may experience glare, halos, and starbursts, especially at night or in low-light conditions, which can be bothersome for driving or reading in dim environments.

Reduced Contrast Sensitivity: Multifocal IOLs may slightly reduce contrast sensitivity, making it harder to see objects in low-contrast settings (such as fog or dim lighting).

Longer Adaptation Period: It can take a longer time for some patients to fully adjust to the varying focal points of multifocal lenses, especially if they have not worn multifocal lenses before.

Not Suitable for Everyone: Patients with high degrees of astigmatism or certain eye conditions may not be good candidates for multifocal lenses, and the results may not be as effective for them.

3. Monofocal Intraocular Lenses (IOLs)

Monofocal IOLs are the traditional type of intraocular lens and provide clear vision at one specific distance (either near or far). After cataract surgery, most patients opt for a monofocal IOL to restore distance vision, but reading glasses may still be needed for close-up tasks.

Benefits of Monofocal Lenses:

Clear Vision at One Distance: Monofocal lenses provide sharp, clear vision at a single focal point, often chosen for distance vision (for example, for driving or watching television). Near vision (such as reading) will still require glasses.

Lower Risk of Visual Disturbances: Since monofocal lenses focus on one distance, they generally cause fewer issues with glare, halos, or starbursts, making them an excellent option for night driving.

Reliable and Cost-Effective: Monofocal lenses are generally less expensive than EDOF or multifocal lenses and are a reliable option for patients who prioritize clear distance vision.

Simpler Adaptation: As they focus on one distance, the adaptation period is usually much shorter than for multifocal or EDOF lenses.

Risks and Downsides of Monofocal Lenses:

Need for Glasses for Other Distances: Since monofocal IOLs focus on just one distance (usually far), patients will still need glasses for reading, using a computer, or performing tasks that require near vision.

No Correction for Presbyopia: Monofocal lenses do not address presbyopia (the age-related loss of near vision). Patients who choose monofocal lenses for distance vision will still face the need for reading glasses after cataract surgery.

Not Ideal for Patients Seeking Multifocal Correction: For patients who want to reduce or eliminate their need for glasses, monofocal lenses may not be the best choice since they don’t offer multiple focal points.