September 2021 - Armadale Eye Clinic

Cataract surgery is one of the most commonly performed procedures in Australia and throughout the developed world. As hundreds of cataract operations are conducted every day in our country, efforts are continually being made to advance the efficacy and safety of this procedure. So, how do cataracts affect you, what is cataract surgery and how does it work? Keep reading to find out.

What Are Cataracts?

In simple terms, a cataract is defined as any loss of transparency to the natural lens inside the eye. This lens starts out transparent at birth (barring any congenital cataract), which allows light to be transmitted through it to reach the retina at the back of the eyeball. This step is the beginning of the process we know as sight.

As we age, the natural lens of our eyes begins to lose its clarity. Although there are a few proposed underlying reasons for this, one cause is thought to be oxidative damage to the lens fibres, which results in them becoming cloudy. Ultraviolet exposure is also thought to contribute to the development of age-related cataracts. While increasing age is the most common cause of cataracts, which is why cataract surgery is so prevalent in our ageing population, it is not the only cause. Cataracts may also be:

Present at birth (congenital cataracts)
Caused by trauma, such as a high impact blunt blow or penetrating injury
Associated with systemic diseases, including diabetes or galactosaemia
As a result of another medical intervention, such as a retinal detachment repair or steroid use, known as an iatrogenic cataract

The result of a cataract is impaired sight. This is typically noticeable in the form of blurry, hazy, or foggy vision, but may also manifest as alterations to your colour vision, increasing glare sensitivity, or increased difficulty in low contrast lighting conditions.

In most cases, cataract surgery is able to safely and effectively restore your vision. So, what is cataract surgery?

What is Cataract Surgery?

At this time, cataract surgery is the only way to effectively treat a cataract. If you are in the early stages of cataract development, you may opt to safely defer cataract surgery. Managing the changes to your vision with updates to your glasses or contact lenses is a valid way of improving your functional sight while you wait for your cataracts to be ready for surgical removal.

During a modern cataract surgery procedure, your entire cloudy crystalline lens is removed from the eye and replaced with an artificial lens, known as an intraocular lens implant. This artificial implant is typically calculated to correct your eye’s prescription, resulting in the potential for clear, spectacle-free vision after your surgery!

There are two popular techniques of cataract surgery in Australia at the moment. The traditional, conventional method is known as phacoemulsification. This technique, although older, is still widely used by eye specialists and is considered safe and effective. With the advent of femtosecond laser technology, a highly precise laser tool, femtosecond laser-assisted cataract surgery is gaining popularity among some surgeons. Some ophthalmology clinics may even offer both surgery techniques, depending on your specific situation.

Both phacoemulsification and femtosecond laser-assisted cataract surgery techniques involve the same basic steps. The difference is typically whether the step is performed manually or with the femtosecond laser. In general, studies have concluded that both techniques are safe, effective, and result in very similar visual outcomes.

What is Cataract Surgery? The Steps

Before the operation, the eye must be prepared with an anaesthetic. This is administered either by topical eye drops or a local injection around the eye area. Once the eye is appropriately numbed, an incision must be made at the edge of the cornea, which is the clear dome of tissue at the front surface of the eyeball. This can be performed with a bladed instrument, as in conventional phacoemulsification, or with a femtosecond tool. Once this incision has been created, tools may be inserted into the eyeball to access the cataract.

The cataract sits inside a membrane, known as the capsular bag. To extract it, the capsule is cut open, either with a manual tool or with the laser. From here, an ultrasound probe is needed to break the cataract into smaller fragments. During phacoemulsification, ultrasound is utilised solely for this process. Alternatively, femtosecond technology may be used to first soften the cataract before the ultrasound probe is applied, which may reduce the amount of ultrasound energy required to fragment the cataract.

Once the cataract is broken into smaller pieces, it is then suctioned from the capsular bag. An intraocular lens is then inserted through the corneal incision and manipulated into position within the capsule. Some intraocular lenses may be placed in a different location within the eye, such as in front of the coloured iris rather than behind it inside the capsule. However, unless there is a reason the capsule is unsuitable to hold the implant, the majority of cataract surgery procedures will position the intraocular lens here.

You will be sent home with a protective eye shield and post-surgery instructions. Regardless of which surgery technique you had, the eye will take some weeks to settle and heal fully. The end result? Clear, crisp sight.

Call us on (03) 9070 5753 today for a consultation.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Considering cataracts are becoming increasingly prevalent in our population, it is fortunate that cataracts are one of the few eye conditions that can be fully treated and any vision loss restored. In this case, cataract surgery is the go-to, definitive treatment. Cataract surgery is considered a very safe, highly effective procedure in our society. However, as with any invasive medical procedure, cataract surgery carries benefits but also risks.

How do you decide whether the cataract surgery benefits outweigh the risks? Part of it will be discussing your concerns and potential risk factors with your optometrist, eye surgeon, or GP. These healthcare professionals will be able to guide you by taking into account the state of your cataract and vision as well as any pre-existing systemic or eye conditions that may predispose you to greater risk during cataract surgery.

To help you make a more informed decision, here are some cataract surgery benefits and risks you should be aware of.

Cataract Surgery Benefits

The most significant and obvious benefit of cataract surgery is, of course, restoring the clarity of your vision. This is typically the reason the vast majority of people will seek cataract surgery in the first place – because they’re no longer satisfied with the clarity of their vision.

Although cataracts are not typically associated with complete blindness in our developed society, the opacity of a cataract can significantly reduce the quality of your sight. The effects of a cataract can also often extend beyond simple blurriness. Having the opacity and haze removed from your eye’s lens through cataract surgery can also:

Make colours appear more vibrant and your colour discrimination more accurate.
Improve your contrast sensitivity.
Reduce your glare sensitivity.

Depending on the type and location of your cataract, and how it had been impacting your vision, you may experience one or all of the benefits listed above. This translates to improved comfort and function in scenarios such as reading the fine print in dim lighting or driving in low contrast environments, including dusk and dawn or heavy rain. The significance of these benefits may vary from individual to individual. For example, an artist or painter will place more value on the restoration of his or her colour discrimination, while an overnight truck or taxi driver will appreciate the improved contrast vision and reduced glare sensitivity.

Another big plus of cataract surgery is that it can help to stabilise your prescription. Because the shifting refractive index of the crystalline lens in the eye is largely responsible for changes to your spectacle or contact lens prescription, replacing this lens with an artificial implant can remove this driver behind prescription changes. However, it is important to note that other eye conditions, such as keratoconus, may still play a part in shifting your prescription post-cataract surgery.

In addition to stabilising your prescription, cataract surgery may potentially remove your dependency on a prescription altogether. Depending on what type of artificial lens implant you choose for your procedure, the outcome may be excellent long-distance and/or short distance vision without the needed-for glasses or contact lenses. There are different types of implants, known as intraocular lenses, available to suit various lifestyles and activities. The most premium intraocular lenses may provide you with clear unaided vision for both long-distance and reading in most situations. However, even the more basic lens implants can still correct one viewing distance, such as far sight, while you continue to wear glasses for reading or computer work.

Cataract Surgery Risks

In most cases, cataract surgery is an uncomplicated, straightforward procedure, taking only 15-20 minutes per eye. However, there is still a risk of complications or adverse side effects to be aware of.

The most common side effects are minor and temporary. These may include effects such as dry eye or an increase in glare sensitivity as the eye adjusts to the removal of the cataract and increased influx of light. Supportive therapies such as lubricating eye drops or sunglasses can be used to make you feel more comfortable as the eye settles. Another common observation after cataract surgery is the presence of floaters. These little drifting specks in your vision are a result of natural debris floating about the gel inside your eyeball.

Severe and sight-threatening complications during or after cataract surgery are uncommon but not unknown. These include:

A serious internal eye infection known as endophthalmitis.
A retinal detachment.
Swelling and fluid leakage around the macula (the central area of your vision).
Increase to the internal pressure of the eye and subsequent glaucoma.
Prolonged pain and inflammation of the eye.
Swelling of the cornea.
Haemorrhaging inside the eye.

Most of these complications may be effectively treated or managed but there is a small potential for permanent vision loss.

Although there is always room for the unexpected to occur during any medical procedure, your eye surgeon will take all precautions to reduce your risk of an adverse effect. This includes being aware of any other eye conditions, such as an existing retinal tear, that may increase your likelihood of experiencing a complication.

In the vast majority of cases, cataract surgery benefits will outweigh the risks. However, it is important to speak to your eye care professional for personalised advice.

Call us now on (03) 9070 5753 for a consultation.