What is a cataract?

A cataract is a clouding of the lens inside the eye that affects the vision.  Most cataracts are a result of aging and everybody develops some degree of cataract if you live long enough.  Other less common causes of cataracts include drugs and trauma to the eyes.

What are the symptoms of cataracts?

Cataracts worsen over time and can cause a number of visual symptoms including:

• Cloudy or blurry vision
• Glare and sensitivity to bright lights
• Poor night vision
• Faded colours
• Double vision

In most people cataracts develop slowly so they are not aware of their loss of vision until after they have had cataract surgery and most patients notice a significant improvement in their vision and the vibrancy of colours.

What is the treatment for cataracts?

When cataracts are in their early stage, sometimes the visual symptoms can be improved by changing the prescription for glasses.  However, eventually the cataract gets to the point that it needs to be surgically removed.

When should a cataract be removed?

Cataract surgery in most cases is an elective surgical procedure.  In the past, cataracts were not removed until they were “ripe” or mature and by this time, most patients had very poor vision.  With modern cataract surgery, if patients are experiencing visual difficulties due to cataracts that are interfering with their everyday activities such as driving or reading, the decision to proceed with surgery can be made.  We no longer wait until cataracts are “ripe” to perform surgery as waiting too long can actually make the surgery more difficult and more likely for a complication to occur.  Ultimately, the decision when to perform cataract surgery is up to you, the patient, in conjunction with your surgeon.

What are the benefits of cataract surgery?

The main benefit of cataract surgery is sharper vision and improved contrast and vibrancy of colours. 

• For those people with pre-existing eye conditions such as astigmatism, myopia, or hyperopia, which required them to wear glasses or contact lenses to see clearly for distance, cataract surgery allows an opportunity to see without glasses or contacts.

• For people who only needed to wear reading glasses as they got older due to presbyopia, new intraocular lens implants have been developed such that after cataract surgery, many people enjoy spectacle independence the majority of time.

How is cataract surgery performed?

Modern cataract surgery is a day surgery which does not require you to be put to sleep or require any freezing of the eyes with needles.  

1. The eye is frozen with topical anesthetic drops or jelly which prevents you from feeling any pain or discomfort during the surgery. 

2. Tiny incisions are made in the periphery of the cornea to allow the cataract to be broken up and removed and to allow the implantation of the artificial lens.

3. The cataract is removed using a special instrument which uses water and ultrasound energy to fragment the cataract into tiny pieces which are sucked out.  Contrary to popular belief, cataract surgery is not performed with a laser

4. The intraocular lens is injected into the eye to take the place of the natural lens to focus light.  Because the incisions are so small, they usually heal on their on and stitches are usually not required.

The entire procedure takes 15-20 minutes or less and many people enjoy improved vision even the next day.  There is no bleeding involved and people cannot tell that you have had surgery by looking with the naked eye.

What are the risks with cataract surgery?

Cataract surgery is one of the safest surgical procedures in all of medicine with over 95% of patients having no problems.  However, it is still a surgery and thus there are potential complications that can affect your vision.

• Endophthalmitis: This is an Infection inside the eye and is the most devastating complication of cataract surgery.  This usually develops within the first 2 weeks after surgery and symptoms include redness, pain and worsening vision.  Fortunately, this is a rare complication occurring in approximately 1 in 1000 surgeries.  If it develops, early treatment is critical.

• Tear in the lens capsule: The cataract normally sits in a delicate capsule that is fractions of a millimeter thick.  During the surgery a break in this capsule could allow some of the jelly in the back of the eye (vitreous) to come forward causing the surgery to take longer.  This could affect what type of intraocular lens is implanted in the eye and also increase the risk of infection after surgery.

• Dropped lens material: If there is a tear in the lens capsule during surgery, sometimes a piece of the cataract can fall into the vitreous gel in the back of the eye.  Small pieces that fall do not need to be removed, but if a larger piece falls, a second surgery may be needed to remove it to prevent further problems

• Cystoid macular edema: This is swelling of the retina inside the eye which can cause blurring of vision.  This occurs about 2-3% of the time and is a less serious complication which normally improves with time or with treatment with eyedrops without causing permanent loss of vision.

• Retinal detachment: This is when the retina peels off the inside of the eye and can cause serious vision loss or even blindness if not treated.  This complication can occur weeks, months or years after cataract surgery, but fortunately most of the time it can be fixed with surgery.  The risk of this occurring is greater in patients who are very nearsighted.

• Corneal edema: Swelling of the cornea can cause blurred vision and is more likely in people with very advanced cataracts or people who have a predisposing corneal condition.  In most people who develop cornea edema, the swelling resolves on its own.

• Pressure in the eye: some patients may develop an elevation in the pressure in the eye which is usually temporary.