Well, the first thing will be actually to explain what is a cataract?
Inside the human eye, which works like a camera, there are two lenses.
One is the cornea. One is the crystalline lens.
The crystalline lens is the lens that allows us to focus when we are young and see for near without glasses.
And it’s completely transparent. It’s suspended inside the eyeball
—at the center of the eyeball through some very fine ligament.
With time, the lens hence loses transparency and that’s the main cause of cataract formation is age.
So I would say that in my practice and worldwide, the main cause of cataract formation is age
and normally, a cataract starts forming at the age of 50-60 when it becomes a little
bit less transparent and then later in life, starts affecting the quality and the vision itself and requires removal.
However, there are other causes. One of those is for instance,
retinal detachment surgery can increase the cataract formation rate or
most importantly, inflammatory eye disease conditions such as chronic uveitis which is
an inflammation of the inside of the eyes can cause cataract formation earlier.
Other reasons of cataract formation are trauma of the eye, be it minor or major.
They can cause early cataract formation. And our young patients are quite often
they have cataract forms because of minor or major traumas.
Finally, but less commonly, one cause of cataract
formation can be genetic that can be a family history of cataract and in those cases, usually
they happen either at birth or later in life but still in the young age before the age of 40.
It is actually very difficult to stop a cataract getting worse, in the sense that it’s a little bit like everything else
that we do in life; having a healthy lifestyle is what can prevent cataract formation.
Avoid excessive sunlight exposure by wearing sunglasses.
But ultimately, a cataract formation is not a big issue because removal of the cataract will give most patients
99% perfect vision with also the added benefit of improving of their need for glasses and
most patients nowadays view cataract surgery as a means not only to see better but also
to improve their lifestyle by increasing tremendously their independence from glasses.
Well, the obvious reason to remove cataracts is to make patients to see better.
As explained, the cataract will affect the vision to a certain degree and according to our lifestyle,
we will want the cataract removed to continue running an active life.
The timing of the removal of the cataract can differ from one to another but ultimately,
the cataract will need removal so we can see better.
One lesser side effect to remove the cataract for people who wear glasses is that also dependence
on the spectacles can be almost fully eliminated. We can use some special monofocal lenses to
give the patient good vision in distance or for near if they prefer so.
Or else, there are nowadays some very advanced, technologically advanced trifocal lens that allow the vast
majority of our patient to see well for any given distance after the cataract surgery.
So in basics, there are two reasons. The primary reason is so we can see better.
We carry on with our lives without being damaged by poor vision.
And the second one we can also improve on our lifestyle and reduce our dependence from glasses.
Imagine going skiing, if you’re very short-sighted, it’s quite difficult.
But after cataract surgery, short-sightedness can be completely eliminated then therefore
people can enjoy even a more active lifestyle than before.
Well, as explained before, the cataract is nothing else but our natural crystalline lens
that has become opaque mainly in the vast majority of cases with age.
So it is not the question just of removing it, but it’s a question of removing and
replacing it with an artificial plastic lens. Otherwise, our sight will not be good.
The operation is a surgical operation and is a very streamlined operation but
you still need an experienced surgeon to increase the success rate of the surgery.
What the operation entails is making a little incision on the cornea, which is the clear lens of the eye,
to then access the crystalline lens e.g. the cataract, which is situated right behind the pupil and the iris.
Then the crystalline lens, which has got a little container, is opened up and the inside is removed.
Once the inside is removed and cleaned, then
a new artificial lens is gently folded to be inserted inside the eye through a very
small incision of just 1.5mm and then the lens, once it is inside the eye, just unfolds,
opens up and fills up the natural container of the original crystalline lens.
The operation itself takes, in the hands of a very experienced surgeon, just a few minutes and
it’s almost always successful. However, like any surgeon, patients should
be aware that there is always a risk to the eyesight even though this is believed to be
well below one in a thousand which means that only one patient out of one thousand can have
an outcome that is far from ideal, whilst the vast majority 99.9% or more should have
a very good outcome, with super improved vision after the surgery.
Worthwhile to mention that the special laser called femtosecond laser can be used to assist
the cataract surgery and at Moorfields we’ve just completed a very large, randomized, clinical
trial comparing completely or fully manual surgery versus part-laser surgery and we are
expecting the result to see if this really is better or not.
At the moment the jury is still out.
Cataract surgery is a quick, usually painless procedure with almost always a good outcome.
As such, the recovery, in terms of sight, is really quick.
Most patients are able to go on a golf course to play golf within a couple of days and they will need to use some
anti-inflammatory antibiotic drops four times a day to start with, and then a little bit
less so for the next months or so, and they can do everything, really, using their common
sense provided they follow treatment and the advice.
What is not ideal is that they should avoid gym for one week, and swimming and contact
sports for one month. But all the rest is cinema, theatre, cooking is all permitted
and shouldn’t be a problem within common sense.
One thing that is very important, however, is counselling the patient prior to the surgery,
in terms of explaining the risks, benefits, and the outcomes and counselling the patient
about the type of implant that suits them most, because some of us will want to see very
clearly the distance and they’re very happy to wear reading glasses, especially in the older age.
This is accepted as physiological. Some others will take this chance to eliminate
the need for glasses almost fully and, therefore, counselling is important because like I explained before,
there are some very modern lenses that allow that in the vast majority of cases,
but occasionally, they can cause some side effects and also, they may need more visual-neural
adaptation which means that the patient needs to be warned of the possible side effects
because if they happen, they can easily be ignored and forgotten and the outcome can
be good provided the level of counselling pre-surgery has been good and adequate,
which is one of the most important things in doing cataract surgery.
But in short, after cataract surgery, life goes on exactly the same apart from
some common sense precautions and nothing else really.