Cataract Surgery - Expert Care, Latest Techniques
Cataract Surgery Tailored For You
Posterior Subcapsular Cataract
Did you know there are many different types of cataract? In posterior subcapsular cataract, the back layer of the lens become hazy like a frosted window pane.
Modern cataract surgery is extremely successful in restoring vision affected by cataract. Our Eye Surgeons are expert in the latest microsurgical techniques of phacoemulsification cataract surgery.
Prior to your surgery, a comprehensive evaluation allows your Surgeon to tailor your surgery to suit your individual needs. This will include an evaluation and discussion of which lens implant is best for you. For example, you might require a toric lens implant to correct your astigmatism. You might prefer single vision lens correction, multifocal implants, extended depth of focus (EDOF) or monovision lens systems. Your Surgeon will discuss these options with you, and also advise you on the most appropriate form of anaesthetic - most commonly topical eye drops combined with sedation. After a thorough review of your particular situation, our expert Eye Surgeons can advise you on the optimal approach.
The night driver's nightmare! When the outer layers (cortex) of the lens develops hazy spokes, there can be glare and night driving problems
What is a Cataract?
A cataract is a haziness in the natural lens within the eye. A healthy human lens is perfectly transparent, allowing the light to reach the macula at the back of the eye. If the lens becomes cloudy, a clear image cannot be formed on the macula. The result is similar to a smudge on your glasses - it prevents you from seeing clearly. The haziness in the lens scatters the light travelling into the eye, creating glare. As less light is able to reach the back of the eye, vision becomes poor in dim lighting conditions.
Many different types of cataract exist, resulting in differing amounts of glare, blur and dimming of vision. The type and density of your particular cataract may influence your Eye Surgeon's preferred approach to surgery.
While cataracts can occur at any age, the condition becomes more common as people grow older. Most people will eventually notice blur or glare from cataracts, although sometimes the cataracts develop so slowly that the person is unaware of the deterioration in their vision. In the early stages, cataracts change the way the lens focuses light on the macula, and a change in glasses may be all that is required to improve the vision. As further cataract develops however, surgery may be required in order to restore clear vision.
It is extremely rare for a cataract to be dangerous to the long-term health of the eye. Thus if your cataract is not causing you any symptoms, a glasses update or regular observation may be all that is necessary. After a thorough assessment, your Ophthalmologist will be able to discuss with you whether surgery is appropriate.
Modern-day cataract surgery is performed through a tiny (2.4mm) port, most commonly located at the side of the eye. This is so small that sutures are rarely required. It is almost certain that your surgery will be performed using phacoemulsification. This refers to a modern surgical technique in which the cataract is 'emulsified' by a specialised type of ultrasound, and then aspirated from the eye in microscopic fragments. The use of this clever technology results in the cataract being removed successfully through such a small incision, thus resulting in improved comfort, fewer risks and more rapid recovery.
Anterior Polar Cataract
This lens has become yellow with time (nuclear sclerosis - the commonest cataract), but also has a cloudy area right at the front 'pole' of the lens.
Blue Dot Cataract
A type of congenital cataract
Posterior Polar Cataract
Right in the middle
Once your cataract has been successfully removed, a lens implant will be inserted so that the eye can focus correctly. There are different types and strengths of lens implants, and the correct implant must be selected specifically for you.
Single Vision, EDOF, Multifocal Implants & Monovision
In order for you to see clearly, the lens in your eye must focus the light onto the macula at the back of the eye, in the same way that a lens in a camera focuses the light from an image onto the film,
In many people, the lens does not focus the light in quite the right location. This results in myopia ('short-sightedness') if the lens focuses too short, and hyperopia ('long-sightedness') if the focus is too long. People with myopia and hyperopia must wear glasses or contact lenses to correctly focus the light onto the macula.
During cataract surgery, the cloudy lens (cataract) is removed from your eye, and the focusing mechanism in your eye is then restored with an artificial lens implant. The type and power of this lens implant must be carefully selected for you, so that your new lens implant will correctly focus on your macula. Calculations performed in the Clinic allow your Surgeon to determine the correct lens for you.
Most commonly, a lens implant is chosen that will focus the light from a distance image onto the macula, resulting in a clear view of distant objects without glasses. If this system is chosen, reading glasses are usually still required. In some cases, focus for near vision is chosen instead. Short-sighted people who have always enjoyed reading without the need for glasses may prefer to continue with this choice of focus.
In specific individuals, a near-focusing lens implant can be chosen for one eye and a distance-focusing lens implant for the other eye. This is called 'monovision', and has the advantage of potentially avoiding the need for glasses altogether. However the brain must be able to cope with the difference in focus between the two eyes. After careful consideration, your Surgeon will advise you if this might be an option for you.
Multifocal lens implants are also selected in some circumstances. These lenses allow the eyes to focus objects at multiple different distances without the need for glasses. The advantage is increased freedom from glasses in many people, but there can also be some disadvantages, such as haloes and night driving problems. Your Surgeon will be able to advise you whether multifocal lens implants are an appropriate lens implant type for you.
Another modern type of lens implant is the EDOF (Extended Depth of Focus) lens implant. These implants are designed with the aim of good distance vision, but also some vision for intermediate tasks (reading your mobile phone, computer). While some people can read without glasses with these implants, most people with them still require reading glasses.
As Cataract Surgeons, we are fortunate to have so many excellent options to offer you. While you might find it confusing at first to have so many options, it is important to remember that there is usually no wrong answer - all of these systems result in excellent vision in the right person! After a thorough assessment, your Ophthalmologist will discuss these issues further, in order to recommend a focusing system tailored for your particular, individual needs.
This cataract has been present long enough to turn a milky white colour. This person would have very cloudy vision
Christmas Tree Cataract
This is perhaps the 'prettiest' type of cataract. The colours of a Christmas tree can be seen in the glistening crystals of this type of cataract.
Correcting Astigmatism - Toric Lens Implants
When you look at your eyes in the mirror, your eyeball looks round. However in most people, the clear cap (cornea) at the front of the eye is shaped more like an Aussie Rules Football. This is called 'astigmatism.' When your Optometrist makes up your glasses, she or he incorporates the appropriate correction for your astigmatism.
The new artificial lens implanted at the time of cataract surgery is also designed to correct your astigmatism. Modern-day 'toric' lens implants allow most or all of your astigmatism to be corrected at the time of cataract surgery. Using such a 'premium' lens implant will reduce your dependence on glasses after the surgery. Most lens implants being used in Australia today are toric lens implants. Your Surgeon will recommend a toric lens implant for your if this is the type of lens implant that will give you the best possible vision after your cataract surgery.
Anaesthetic Options - Drops & Sedation vs Other
Cataract surgery is most commonly performed with the use of topical eye drops for comfort, combined with intravenous sedation through a small drip inserted into the forearm or hand. This is similar to the sedation administered during a colonoscopy or arthroscopy, and results in a pleasant, comfortable procedure. .
In some situations, however, other anaesthetic modalities are preferable, including anaesthetic placed around the eye, or very occasionally, general anaesthesia.
Your Surgeon and Anaesthetist will discuss these options prior to your procedure.