What is a cataract?
A cataract is a clouding or opacity of the natural lens inside our eye. The lens sits in the eye, behind the coloured part of the eye (the iris). When cataract develops, the lens prevents light rays passing through or alters the pathway of these rays, resulting in objects not focusing sharply on the retina. This degrades the quality of vision.
Throughout life our lens gradually loses its natural elasticity, until the 5th decade of life when its ability to accommodate and focus for near objects becomes significantly compromised. This is known as dysfunctional lens syndrome or presbyopia. Over the next few decades the lens acquires a brownish hue; when the lens has lost its normal clarity and transparency, it is called a cataract.
What symptoms does cataract cause?
Cataracts are usually slow to develop over years, causing a gradual reduction and blurring of vision, a reduction in the sharpness or a degradation in the overall quality of vision. Glare may be noticed at night, even with early cataract; this may cause difficulty with night-time driving. Other symptoms may cause include double vision in one eye and the need for frequent change in spectacles.
A cataract does not cause pain or redness of the eye. However, if you are struggling to see clearly because of cataract and overusing your facial muscles in response, you may develop some headache over prolonged periods of detailed work.
How can a cataract be treated?
The only treatment for cataract is surgery. However, you do not need to have surgery if your eyesight is not affected.
During the operation, a small device is used to break up the lens and remove your cataract. A new clear lens, called intraocular lens (IOL), is then placed in the position of your old lens; it remains in the eye for the rest of your life. The IOL is made of plastic materials or derivatives, such as PMMA and silicone.
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What benefits can I expect after cataract surgery?
Around 99% of patients have a significant improvement in vision following cataract surgery helping with driving, reading, working, hobbies, safety and self-confidence.
Cataract surgery provides the opportunity to correct pre-existing and underlying refractive errors, such as astigmatism, short-sightedness and long-sightedness.
In addition, cataract surgery provides a great opportunity to reduce or eliminate the need for reading glasses.
Co-existing eye conditions, such as macular degeneration or glaucoma, can limit the extent of improvement after surgery. However, if a significant cataract is present, cataract extraction surgery can provide a substantial improvement in the quality of your vision and life.
Frequently asked questions
Why does cataract develop?
From the early years of our life there is natural decline in the elasticity of the normal lens inside your eye. This results in the lens losing its ability to accommodate and therefore focus at a range of distances. Once this causes difficulty or sluggishness in focusing for near objects, the condition is called dysfunctional lens syndrome or presbyopia.
Similar lens changes continue throughout life. Later on in life the lens assumes an increasingly brown hue and loses its transparency over many years and decades. The lens is described as a cataract when it has lost this transparency.
Other common causes for development of cataract, especially at a younger age, include metabolic disorders, such as diabetes, chronic corticosteroid use, trauma to the eye and previous eye surgery. Smoking and chronic exposure to sunlight have also been described as risk factors.
What are my lens options with cataract surgery?
- In broad terms, IOL types and options include monofocal, multifocal and toric lenses.
- All patients undergoing cataract surgery have a lens (IOL) that is matched to their eye. The calculation of the power of this IOL is based on the eye measurements that are taken during your clinic visit. The power of the IOL will determine whether your natural vision (without glasses) is focused for distance, near or intermediate.
- Most patients prefer to have good distance vision without spectacles and the IOL power is selected accordingly. Spectacles however may still be needed following surgery for your best distance vision; this reflects technology limitations in predicting the IOL power that your eye may need.
- Laser refractive surgery after cataract surgery may be considered as a top-up treatment to provide you with the best distance vision without spectacles.
- All patients with a standard monofocal IOL will need spectacles for near vision, e.g. for reading.
- Monovision can be used with monofocal lenses; this focuses your dominant eye for distance and your other eye for near, reducing your need for spectacles for near activities.
What about toric lenses with cataract surgery?
Very often the cornea is not a perfect sphere in shape, resulting in astigmatism; a toric IOL can be used with cataract surgery to compensate for this astigmatism. A toric lens greatly reduces or eliminates the need for spectacles after surgery, whether a monofocal or multifocal IOL has been used, and provides better quality vision. Detailed topography scans of the cornea are required to assess your suitability for a toric IOL.
What about multifocal lenses with cataract surgery?
A multifocal lens is a great option if you are interested in being less dependent on spectacles following surgery. It can provide clear vision for both distance and near without glasses. The majority of patients can read small print following surgery, however a weak pair of glasses may be needed for prolonged reading or computer use. This lens can also be combined with astigmatism reduction by using a toric multifocal lens; this would allow you to achieve the best possible vision.
What kind of anaesthetic is used with cataract surgery?
The vast majority of patients require local anaesthesia for cataract surgery. Local anaesthesia is applied either as eye drops or an injection around the eye. Once you have been given a local anaesthetic you will still be awake and aware of what is happening, but you will feel no pain during the operation. Rarely, a general anaesthetic may be needed.
What are the advantages of local anaesthesia?
Local anaesthesia works very well at stopping you feel pain during the surgery and also offers pain relief after the operation. Generally, it has fewer risks and side effects than a general anaesthetic. You will recover more quickly and can go home on the same day. With local anaesthesia you can continue to take your usual prescribed medication and can eat and drink as normal after the operation.
What will I see and feel during cataract surgery?
When the operation starts you will see a bright light from the operating microscope. It is not unusual to see shadows, movements, or kaleidoscope effect lights during the operation, but you will not be able to see details of the operation. It is important that you look straight into this light and not move your eye by looking around. You will be aware that the surgeon is working and may feel pressure at times.
How soon can I go home after cataract surgery?
Once you have recovered from surgery, you may go home. You will have instructions about post-operative care and will be told about the medication you need to take. You will be shown how to put your eye drops in, if you are unsure what to do. Drops are used following surgery to reduce inflammation and to prevent infection.
How can cataract be diagnosed?
WHAT PATIENTS SAY - REVIEWS
Cataract surgery with multifocal lenses
I had corrective lenses inserted in both eyes due to cataracts by Mr Aris Konstantopoulos. I am delighted with the results. After 10 years of wearing varifocal spectacles I no longer need them. Mr Konstantopoulos explained everything in detail before and during the procedure. I want hesitate to return to this consultant should I have any other problems with my vision in the future.
Consultant Ophthalmologist, University Hospital Southampton NHS Foundation Trust
Experienced cataract surgeon: standard lens, toric lens for astigmatism, multifocal lens for less dependence on glasses
Experienced refractive surgeon: LASIK, SMILE laser eye surgery, PRESBYOND laser blended vision
Fellowship trained in Cornea and Refractive Surgery
Fellow of Royal College of Ophthalmologists
GMC Specialist Register - UK qualifications and experience of 20 years