Cataract surgery (phacoemulsification)
What does the treatment involve?
Cataract surgery involves extracting the content of the opacified crystalline lens using ultrasounds and replacing it with a custom-made intraocular lens (IOL).
When is this treatment indicated?
With regard to incipient cataracts, palliative measures can be taken such as the use of sunglasses to avoid glare or prescription glasses if you've experienced a change in refraction. But the definitive treatment for cataracts is still surgery.
Cataracts may appear at any age. They may even be congenital, although in general, cataracts generally appear during old age. As soon as the patient starts to notice a loss of visual acuity and is no longer comfortable, cataract surgery can be proposed and performed.
How is it performed?
This surgical procedure is performed in a surgical theatre, with local anaesthesia. A small incision is made in the axis where the patient shows most astigmatism, and the surgeon works on the inside of the eye through this small incision.
First, the surgeon opens the anterior capsule of the crystalline lens and uses an instrument called a phacoemulsifier, a small metal probe, which in turn sends liquid to the eye, to break the crystalline lens into small fragments.
This phacoemulsifier uses ultrasound energy which also produces heat and breaks the crystalline lens into small fragments that are then aspirated.
Therefore, it is possible to perform the operation with a small incision and not have to make a large incision as was done in the past and required surgical sutures. This small incision will not require surgical sutures.
Once the whole crystalline sac has been cleaned and is transparent, the intraocular lens is implanted. With this intraocular lens, the power of which is calculated before hand, we can already correct the patient's vision.
We are currently using foldable intraocular lenses. There are different types:
- Monofocal IOLs: They provide excellent quality vision but they only have one point of focus, meaning they are used on patients who do not mind wearing glasses. We always try to provide the best quality of distance vision and patients have to wear glasses for the computer or nearsightedness.
- Multifocal IOLs: They have three focuses. In general, we use trifocal lenses, and they enable the patient to have far, intermediate and close-up vision. When the light divides into three focuses, they may lose a little quality of vision, although patients do not really notice it. They must be warned of the possibility of nocturnal phenomena, like the presence halos and glare. And there may be a slight loss of sensitivity to contrast. In general, patients who have a previous cataract do not usually notice these small optical changes and are usually very satisfied.
- Extended depth of focus IOLs: These have come about over recent years and they provide good far and intermediate vision. A minor addition of glasses will be needed to read small letters up close. These extended depth of focus IOLs have the advantage that they cause fewer nocturnal problems than trifocal IOLs.
Cataract surgery is generally performed on one eye first, and after a few days, the other eye is operated on.
It is a painless procedure, due to the anaesthetic. It is also a short operation, it lasts approximately 10-15 minutes.
The patient goes home immediately after the procedure and they can remove the bandage from their eye the following day and start antibiotic and anti-inflammatory treatment for a few weeks.
In general, the patient can go about their normal life after a few days, avoiding trauma to the eyes, contact with water and substances that may cause eye inflammation or irritation.
The prognosis of cataract surgery is good, recovery is fast and the ongoing developments in this procedure have made it one of the most successful operations.
Professionals who perform this treatment
Frequently asked questions
How do I know if I have cataracts?
Initially, when the cataract is not very dense, you will notice cloudy vision. In addition, lights may cause more glare than normal. As the cataract develops, vision becomes more blurred, making it gradually more difficult to perform daily activities.
When should I have my cataracts operated on? Should I wait until the crystalline lens is very mature?
In the past, the cataract would be left to mature as it would have been operated on in a different way. It had to be taken out as a whole and no intraocular lens would be implanted. Currently, due to the fact that the ultrasound fragments it, it is preferable that it is not very hard. Evidently we should not operate on all patients when their cataracts begin, but when the cataract is at a 3,4 or 5 out of 10, so that it does not harden and complications can be avoided. We tell patients that when they start to notice irritation and the cataract interferes with their daily tasks, they should get operated on.
Can cataracts be operated on using laser surgery?
Laser surgery is a type of technology that came out 5 to 7 years ago, and we have not seen any significant benefit. The only thing the laser does is cut, make corneal incisions and cut the crystalline lens, but we have not noticed any marked difference compared to the use of ultrasounds. Perhaps in the future, there will be other, quicker lasers that do not cut the crystalline lens, but rather dilate it so it can then be aspirated without the need for ultrasounds.