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Prof. Dr. Safiye YılmazProf. Dr.Safiye YılmazGöz Hastalıkları Uzmanı

Cataract Surgery

For people with cataracts, the world they see is like looking through a slightly icy or foggy window. The only treatment for cataracts is surgery. There is no other treatment than surgical treatment.

Cataract Surgery

The people who have cataracts see blurred. This feeling is like look at the world from a frosted and misty window and surgery is the only option for cataracts.
Cataract has not any treatment method aside from the surgery. A cataract is known as the blurring of natural transparent lenses.
The lens inside our eye changes its shape, allowing the eye to see clearly over distances. In other words, it ensures that the image passing through it is sent clearly to the retina, where the visual cells are located, to create clear images of objects positioned at various distances. The retina works by converting the light from the lens into a signal.
It sends signals to the optic nerve, which carries them to the brain. As long as the image from the lens is blurred, the image carried from the retina will also be blurry. Even if the retina or optic nerve or other layers of the eye are completely healthy, only the cloudy lens prevents the person from seeing.
The world they see is a bit like looking through a frosted or misted window for people with cataracts. Blurred vision caused by cataracts can make it difficult to read, drive (especially at night),or see the expression on a friend's face.
Most cataracts develop slowly and do not impair your early vision. But over time, cataracts eventually affect your vision, changing your quality of life.


Why does Cataract Occur?


There are many building blocks inside our lens, the most important of which are proteins and water. When proteins in the eye form clumps or undergo structural changes that prevent the lens from sending clear images to the retina, a cataract is a start. As the water content of the lens decreases with age or due to the medical reasons that I will list below, the amount of water-insoluble lens proteins (albuminoids) increases. The lens hardens its flexibility (fitness decreases with age),and its transparency decrease. The decrease in the transparency of the lens with age is actually part of the normal aging process.
Age-related and other medical conditions cause the tissue within the lens to break down and clump, blurring small areas within the lens. As the cataract continues to develop, the clouding intensifies and includes a larger portion of the lens. A cataract scatters and blocks the image as it passes through the lens, preventing a sharply defined image from reaching your retina. As a result, your vision becomes blurred.
Cataracts usually develop in both eyes, but not equally. The cataract in one eye may be more advanced than the other and may cause a difference in vision between the eyes.


What are the Causes of Cataract?


Increased Age
Trauma
Diabetes
Smoking
Obesity
Hypertension
Radiotherapy
Excessive alcohol
Extremely exposure to sunlight
Previous eye surgeries
Previous eye injury or inflammation
Using of corticosteroid medications during long term
The pathogenesis of senile cataracts is complex and it’s still not clear completely. The thickness and weight of the lenses increase with age and their adaptability decreases.
Symptoms of Cataract
The development of cataracts and their symptoms is usually a slow process. Cataract symptoms include;
Blurred vision: At first, you may not be aware of any vision loss as the blurring of your vision caused by a cataract affects only a small part of the lens of the eye. As the cataract grows, it causes your lens to blur more and distorts the image passing through the lens. This can lead to more specific complaints. First of all, your far vision and then your near vision deteriorates. Here, there is a situation that generally misleads patients; With the development of cataracts, myopia increases and the patient may begin to see his relatives better than before. However, with the progression of the cataract, both distance and near vision deteriorate significantly.
Changes in color vision: The patients often see colors as duller and yellowish and after the surgery, the patients say firstly that they can be seeing colors vibrantly.
The person needs brighter light for reading and other activities. Since the light passes through the lens with cataracts is less, the person needs more light than before.

Problems with seeing in bright light (car lights at night): The areas with cataracts inside the lens are not the same throughout the lens and undergo different refraction as light passes through blurry and transparent areas, causing glare and scattering of lights. Also, the person complains of seeing "halos" around lights.
Pain does not occur: The lens inside our eye has a veinless and nerve-free structure, so there is no pain during cataract development.
Frequent changes in eyeglass or contact lens prescription.
Double vision in one eye.


When should go to the doctor?


If you notice any changes in your vision like double vision or scattering of lights, you should make an appointment with an eye disease clinic.
Types of Cataract
A cataract is examined under 3 headings depending on age. Cataract types are:
Childhood Cataracts: These are cataracts that can occur in children of any age from birth. It occurs with the deterioration of the balance of water and proteins in the above-mentioned lens from birth. These cataracts may be due to an infection or trauma in the womb or genetic.
Midlife Cataracts: These are early-stage cataracts that occur due to intraocular infections, trauma, drugs used, or some systemic diseases.
Old age cataract: It is the most common type of cataract. It occurs as a natural process of aging.


Diagnosis of Cataract


Your doctor will do a comprehensive and eye examination to check for cataracts and evaluate your vision.
The first stage is a vision test to check your vision at different distances. This test evaluates the acuity and clarity of your vision. Each eye is individually tested for the ability to see letters of different sizes.
Biomicroscopic examination: Your ophthalmologist will examine the cornea, iris, lens, and other areas in the front and back of the eye. A special microscope, the biomicroscope, makes it easy to detect abnormalities in all layers of the eye.
Your intraocular pressure will be measured, and apart from the cataract, it will also be tested for other anomalies such as glaucoma. Your doctor will also put drops in your eyes to dilate your pupils to examine your retina and optic nerve. This makes it easy to check for damage to the optic nerve and retina at the back of your eye.
Other tests your doctor may do include checking your sensitivity to glare and your perception of colors.
The Importance of Early Treatment in Cataract
A cataract is a very common reason that people lose their sight, but it can be treated. You and your eye doctor should discuss your cataract complaints. You can decide together whether you are ready for cataract surgery.
The timing of cataract surgery is decided together with the patient, based on each person's age, occupational needs, and how much the cataract affects their quality of life. However, as the cataract progresses, the risk of cataracts increases, the operation becomes more difficult, the duration of the operation is prolonged, and the recovery after the operation is delayed. Sometimes, increased eye pressure can also be seen in very advanced cataracts. Although the physician and the patient will decide together on the timing, delaying the cataract surgery by fearing the surgery increases the risks.
However, there is one exception to timing, which is congenital cataract surgery emergency. Because if congenital cataracts are not removed between the ages of 0-7 when the visual system develops, the visual system will get used to seeing as blurred, this will cause lazy eye and even if it is removed in the future, the child's vision will not improve. As soon as a cataract is noticed in infancy and childhood, surgery should be planned immediately.


The Ways to Prevent Cataracts


Nothing is guaranteed to stop cataract formation. Most often, they occur as we age. However, if you can limit some of the risk factors listed below, you can slow the rate of cataract development.
Wearing sunglasses during the day reduces your eyes' exposure to the sun's UV radiation.
Give up smoking.
Maintaining a healthy diet and doing some exercises regularly, even with light physical activity such as walking.
Managing the effects of coexisting conditions such as diabetes or hypertension and keeping these diseases under control.
To ensure that the developing cataract is diagnosed as early as possible, to have frequent eye examinations in order not to delay the timing of the surgery.


Cataract Treatment Izmir

According to the clinic and the patient's expectations, surgery is the only treatment for cataracts in all patients diagnosed with cataracts (social status, occupation, age). There is no drug treatment to prevent cataracts. The progression of the cataract, the time it takes to reach the surgical level, is everyone's personal structural.


Can cataracts be treated without surgery?


No! The only cataract treatment is surgery. There is no treatment other than surgical treatment.


Cataract Surgery Izmir


Cataract surgery in Izmir Hospital, your eye surgeon will remove the cloudy natural lens of your eye. As I explained at the beginning, since the natural lens of the person allows the objects to be seen clearly and the objects at different distances to be focused, an artificial lens will need to be replaced when the blurred lens that has lost its function is removed. This new lens is called an intraocular lens (or IOL).
When you decide to have cataract surgery, your doctor will talk to you about GILs and how they work.
People who have had cataract surgery may have blurred vision again years later. Patients may perceive this as a cataract has developed again, but because the intraocular lens is removed and cataract is a disease of the lens, cataracts will never develop again. The reason for this clouding is usually the clouding of the eye capsule, that is, the cataract membrane.
The capsule is especially left in place while the cataract is cleaned during cataract surgery, even leaving this thin membrane in place is an indication of surgical success and this membrane is the part of your eye that keeps the GIL in place. This membrane needs to stay in place and hold the lens in the first 6 months, but within 6 months, since the intraocular lens sticks to its location, this membrane is no longer needed as it was at the beginning.
Your eye doctor may use a yag-laser to open the cloudy capsule and provide clear vision. This is called a capsulotomy. After capsulotomy, the person can regain clear vision.


Types of Lenses Used During Cataract Surgery


The lenses to be placed during cataract surgery can be divided into main titles as monofocal, bifocal, trifocal, which we call smart lenses, or lenses that move the close distance a little further called the extended focus.
Single focus lenses only allow you to see far away, you will definitely need glasses to be able to read at close range. Bifocal lenses have far and near vision, but there is a feeling of emptiness at the distances we call the middle distance, the computer television distance, or when going down the stairs.
Trifocal smart lenses, on the other hand, are lenses where all distances can be seen easily without glasses. However, the closer a lens is moved to close vision, the greater the glare feeling in the evening.
The feeling of glare initially bothers most patients, and then patients get used to it over time, and because of the brain's ability to ignore bad images, the glare sensation does not remain. However, in some very sensitive patients, this feeling can be permanent, so they should prefer the new generation lenses of long-mid distance, where the close distance, which we call extended focus, can be seen from 60-80 cm, but there is no glare, especially in patients who drive at night.
Cataract surgery In our Izmir hospital, if the patient has a significant astigmatism defect before the operation, astigmatism is added to all these lenses and according to the patient's request, the doctor's examination result and the suitability of your eye, single-focal, bifocal, or trifocal special production astigmatic lenses are attached.
All these lens types I have mentioned are produced by many companies and are offered to you in many brands according to the experience and trust of the physician.


Cataract Surgery with Phaco Method


Many techniques can be used when removing the lens that has become cataract, but the technique applied by almost every physician today is cataract removal with phacoemulsification. During the operation, the eye is entered through 3 holes opened from the cornea.
The membrane surrounding the cataract is opened only in the middle of it. And with the help of the phaco device, the cataract inside is broken up and cleaned by using ultrasound energy, almost with the logic of a vacuum cleaner. The membrane surrounding the cataract is left in place. The folded lens is placed on the membrane left by entering into the eye through those small holes, the lens is opened in the eye and placed in the eye where your old lens was in the format it should be.


Cataract Surgery Prices


The most important factor that determines the price of cataract surgery is the type, brand, astigmatism of your lens to be fitted. Due to the wide variety of lenses, it is impossible to give an exact price. Because the choice of lens is a topic that can be discussed after a detailed examination of the patient's eye and deciding which lenses are suitable for the patient's eyes.


What Should Be Pay Attention After Cataract Surgery?


With modern techniques, the postoperative care period of the patient is reduced after uncomplicated surgery. It is not usually necessary to keep the eye closed. however, it is recommended to keep the eyes closed with transparent or cotton closures to prevent the person from touching them on the first night.
The most important period to follow the rules after cataract surgery is 1 month on average, no situation requires summer rest during this period, he can continue his normal life, he just wants to follow the drip treatment as described. It is also recommended to avoid back-lifting and creasing.

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