Cataract and Cataract Surgery

Cataracts are one of the main reasons for the decline in vision acuity in the Western world and the main cause of blindness in the developing countries. Cataract surgery is essential to ensuring the patient’s independence and safety, and offers a complete and permanent solution to the disease.

Laser cataract surgery increases the speed and accuracy of the procedure.

Who suffers from cataracts?

About 40% of the population in Israel suffers from cataracts. Cataracts are primarily an adult illness, occurring mainly over the age of 55. However, it can also be caused by metabolic changes, eye disorders, medication treatments, and prolonged exposure to the sun. If you suspect a loss of visual acuity, it is advised to schedule an appointment for examination.

What is the impact of the cataract disease?

• Decrease in visual acuity.
• Change in visual acuity and color vision.
• Blurred vision, sensitivity to light or blinding from exposure to light.

• Blurred vision or decrease in visual acuity.
• Refraction change – hyperopia or myopia – which leads to a high frequency of change in the eyeglasses prescription and an increase in dioptre number.
• Sensitivity to light, blinding (especially at night and while driving).
• Difficulty in reading.
• Change in color and contrast.
• Double vision – monocular diplopia.
• Needing stronger lighting for reading.
• Weak night vision.

The diagnosis is performed by an expert ophthalmologist who examines the level of opacity in the eye lens. After the decision regarding the necessity of performing the surgery has been made, the patient will undergo the following tests:

• Vision examination by an optometrist.
• Biometrics test – measuring eye length and the corneal strength.

The type of implanted lens is chosen by the surgeon according to the needs of the patient and the condition of the second, untreated eye, or the institution’s policy regarding cost, quality of the lens and its optical features.

The common cataract is an “age-dependent cataract”. This cataract is divided into three types:

• Nucleus cataract – the most common cataract. It is simply the opacification of the eye lens, which develops with age. In most people, a slight yellowing of the eye lens occurs in advanced age. At a lower level, this condition does not impact vision quality, but at a higher level it may lead to blurring and severe vision impairment. Usually, this type of cataract progresses very slowly, and in addition it is not symmetrical, meaning that it can occur with greater severity in one eye, while remaining relatively weak in the other.
• Cortical cataract – damage to the peripheral areas of the lens. Here, the impairment mainly affects the night vision, since the pupils that expand in the dark encounter the opacity at the edges of the lens. Here, too, the opacity progresses relatively slowly, and it is also asymmetrical.
• Subcapsular posterior cataract – this is a cataract that results from cell migration to the posterior chamber of the eye. This cataract is relatively rare, but it is particularly troublesome and very impactful of the eyesight. The most common complaint among those suffering from this type of cataract is blinding, especially in daytime. This type of cataract appears in relatively young individuals, in comparison to the other two types of cataract. In addition, it is not only age-dependent, but can also occur as a result of various injuries.

Additional types of cataracts

Cataracts can also develop in children, even from birth.

In addition, cataracts can develop as a result of eye trauma, such as direct eye injury, exposure to ionizing radiation, chemical or electrical injury of the eye, as a result of eye inflammation, etc.

Diabetic patients also have a tendency to develop metabolic cataracts, especially when the blood sugar levels are not properly balanced.

How does the surgeon perform the cataract surgery?

The surgeon performs a small incision, a size of a few millimeters only, and through it the opaque natural lens is extracted out of the eye, and replaced by an artificial lens. Cataract surgery is usually performed under local anesthesia, and its’ average length is about 20 minutes.

Conditions leading to cataracts

Cataracts can develop due to a variety of reasons, with the cause common to all of them being the prolonged damage to metabolism of the lens:

• The most common cause of cataracts is advanced age.
• Eye diseases and metabolic disorders can cause cataracts to develop at a younger age due to the impact to nourishment of the lens.
• Metabolic changes like diabetes, dietary disorders and enzymatic deficiency.
• Congenital cataracts is a genetic condition that passes in some families from generation to generation.
• Various medicinal substances such as steroids and others.
• Injuries to the eye.
• Exposure to the sun without protective means, for prolonged periods (years).
• Rare diseases can accelerate cataract development.
• Infections, myopia, etc.

What is important to know about cataracts?

• Cataracts are not caused by overuse of the eyes, such as strenuous vision in poor lighting or prolonged reading.
• Cataracts cannot be treated through the means of exercising, medication or drops.
• Cataracts are treated through regular cataract surgery or laser cataract surgery.
• Early detection of cataracts allows the surgeons to give an early assessment of vision potential, select the urgency and type of the recommended cataract surgery, and expedite the entire process.
• In most cases, cataracts develop in both eyes and therefore cataract surgery is required in both. Each eye will be treated separately, and more frequently the eye that suffers most from the cataract will be treated first. The surgery of the second eye will only be performed after a complete recovery from the first procedure.

Preparations for the laser cataract procedure

Before entering cataract surgery general examinations should be performed, which the patient will be referred to by the surgeon. The results of these examinations should be brought along with the patient on the day of the surgery.

Possible types of examinations:

Blood tests, chemical test, PT, ECG, comprehensive eye testing and biometrics test for lens type selection.