Cataract Surgery

What Is a Cataract?

A cataract is the loss of transparency and clouding of the lens inside the eye. A cataract is a cloudy lens. Although it can occur at any age from birth, its most common cause is aging of the lens. Although its frequency increases after age 60, it can also be seen in the newborn period due to an infection the mother had during pregnancy, diabetes, other conditions, or for no apparent reason. It should be remembered that cataracts, known as a disease of old age, can also be present in newborn babies. For this reason, babies must have an eye examination right after birth.

As you age, the lenses in your eyes become less flexible, less clear and thicker. Aging and certain medical conditions can cause the proteins and fibers within the lenses to break down and clump together. This causes clouding of the lenses. As the cataract grows, the clouding gets worse. A cataract scatters and blocks light as it passes through the lens. This prevents a sharply defined image from reaching the retina. As a result, vision becomes blurred.

Cataracts usually develop in both eyes, but not always at the same rate. The cataract in one eye may be worse than in the other. This causes a difference in vision between the eyes. It should be remembered that cataracts can occur in any age group, particularly in conditions such as diabetes, cortisone (corticosteroid) use and trauma.

What Are the Types of Cataract?

Cataracts that affect the center of the lens are called nuclear cataracts. A nuclear cataract may at first cause distant objects to look blurry while near objects appear clear. A nuclear cataract may even improve your reading vision for a short time. Over time, however, the lens gradually turns more yellow or brown and further worsens your vision. It may become difficult to tell colors apart.

Cataracts that affect the edges of the lens are called cortical cataracts. A cortical cataract begins as white, wedge-shaped spots or streaks on the outer edge of the lens cortex. As the cataract slowly grows, the streaks extend toward the center and affect the light passing through the lens.

Cataracts that affect the back of the lens are called posterior subcapsular cataracts. A posterior subcapsular cataract usually starts as a small spot that forms near the back of the lens, right in the path of light. A posterior subcapsular cataract often affects your reading vision. It can also reduce your vision in bright light and cause glare or halos around lights at night. These types of cataracts tend to grow faster than the others.

Cataracts that are present from birth are called congenital cataracts. Some people are born with cataracts or develop them during childhood. These cataracts may be inherited from parents. They may also be associated with an infection or trauma in the womb.

These cataracts may also be linked to certain conditions. These include myotonic dystrophy, galactosemia, neurofibromatosis type 2 and rubella. Congenital cataracts do not always affect vision. If they do, they are usually removed shortly after they are detected.

What Are the Symptoms of Cataract?

• Decreased vision,
• Sensitivity to light,
• Glare in bright light,
• Double vision,
• Fading of colors,
• Blurred vision,
• Frequent changes in eyeglass prescription,
• Impaired night vision,
• Impaired vision on sunny days,
• Eye strain and headache,
• Reduced need for glasses, seeing near objects better without glasses,
• Loss of depth perception.

The most important symptom of a cataract is decreased vision, and the only treatment for cataract is surgery; it cannot be treated with medication. The main goal of surgery is to improve vision and quality of life. Therefore, the timing of cataract surgery is also directly related to the patient's vision and quality of life.

In addition, increasing age, diabetes, excessive sunlight exposure, smoking, obesity, genetic factors and excessive alcohol consumption are among the factors that increase your risk of cataract.

What Are the Methods of Cataract Surgery?

In the phaco (phacoemulsification) method, the damaged lens is removed using ultrasonic energy and an artificial lens is implanted. Thanks to the modern technology used in cataract surgery today, recovery is very fast and the risk of complications is almost negligible. The eye is numbed with drops only, and patients go through the operation, which takes about 10 minutes, comfortably and at ease. After surgery, they return home right away and resume their daily lives from the next day.

The eye is numbed with drops only, and patients go through the operation, which takes about 10 minutes, comfortably and at ease.

The artificial lenses used in cataract surgery are the most important factors determining the quality of vision after surgery. The patient's age, occupation and expectations (such as whether they want to wear glasses or not) are important factors in choosing the lens.

Advantages of femtosecond laser-assisted cataract surgery, which reduces the complication rate and is performed with micron-level precision under computer control:

• The corneal incisions used to enter the eye can be made precisely without a blade.
• A very regular, well-centered opening is created in the anterior capsule of the natural lens. As a result, the lens implanted in the eye is better centered in both the short and long term.
• Because the cataract is fragmented with the femtosecond laser, less energy is used inside the eye, and less inflammation and edema occur.
• Astigmatism can be reduced and corrected with laser treatment applied to the cornea.

Intraocular Lenses in Cataract Surgery

During cataract surgery, an artificial lens is implanted in the eye of all patients, with rare exceptions. The type of intraocular lens to be used in your surgery should be decided together with your doctor before the operation. Your doctor will recommend the most suitable lens for you.

What Are the Main Types of Lenses Used in Cataract Surgery?

• Monofocal Lenses: Depending on your eye and lifestyle, they can be focused for distance or for near. If the lens is focused for distance, you may need glasses for astigmatism and near vision.
• Toric (Astigmatic) Monofocal Lenses: This lens corrects your astigmatism. You may need glasses for near vision.
• Multifocal and Trifocal (Smart) Lenses: Multifocal lenses correct your distance and near vision. With trifocal lenses, popularly known as ‘smart’ lenses, distance, intermediate and near vision are corrected, providing continuous vision almost without glasses.
• Toric (Astigmatic) Multifocal and Trifocal Lenses: These lenses correct both astigmatism and distance, intermediate and near vision.

What Are the Side Effects of Cataract Surgery?

In the first hours after surgery, temporary:

• mild burning,
• a stinging or gritty sensation,
• and watering may occur.
• pain is not expected.
• good-quality vision begins within 1–2 days and reaches the desired level within 10–15 days.

What Should Be Considered After Cataract Surgery?

1. Use the prescribed eye drops as directed, and always after washing your hands.
2. During the first week, take care not to rub your eyes or lift heavy objects.
3. Soapy, dirty water running down while washing your hair should not get into your eyes.
4. If you have complaints such as pain or discharge, be sure to contact your doctor.

Can a Cataract Come Back?

A cataract does not recur. Because the problematic lens is removed and replaced with a new lens, a cataract will not develop in the newly implanted lens either. However, in some patients, months or years after surgery, the posterior capsule that holds the new lens can become cloudy (secondary cataract, or posterior capsule opacification), and vision may become blurred again. This can be treated with a short outpatient YAG laser procedure.

Is It Possible to Prevent Cataracts?

It is not possible to completely prevent cataract formation. However, there are some recommendations to reduce the risk of developing the condition.

1. Quitting smoking,
2. Keeping diabetes under control,
3. Protecting the eyes from sunlight and not looking directly at the sun,
4. Eating a healthy, balanced diet,
5. Having regular health checkups and keeping up with follow-up if you have a chronic illness.