Professor Yonca Aydın AkovaProfessor Yonca Aydın Akova Ophthalmologist and Eye Surgeon

Cataract and Cataract Surgery

Cataract and Cataract Surgery

What is cataract?

Cataract occurs when the lens looses its trasparency and becomes cloudy.

The symptoms of cataract include:

  • Blurred vision,
  • Double vision in one eye,
  • Faded or yellowish colors,
  • Halos around light,
  • Trouble seeing at night,
  • Discomfort when exposed to bright light,
  • Frequent changes in eye glasses.

Are there different types of cataract?

There are different types of cataract depending on the hardness of the lens and the location on the cloudiness in the lens. For instance, cataract located at the back of the lens (posterior subcapsular cataract) may lead more symptoms and progresses faster thus requiring early surgery. Other locations include nuclear cataract (central part of the lens) and cortical cataract (outer surface of the lens).

Is cataract an elderly disease?

In general, cataract is seen in middle-aged and older people. However, it can also be diagnosed in newborns and babies as an inborn disease. In addition, those people with diabetes, chronic kidney disease, long-term steroid usage may develop cataract earlier in their life. Eye trauma can also lead to cataract.

What are the risk factors for cataract development?

  • Middle or old age (55 years or older),
  • Diabetes,
  • Exposure to sunlight or uv lights,
  • Previous eye surgery,
  • Chronic kidney disease,
  • Uveitis (inflammation of the eye),
  • Long-term steroid usage,
  • Previous eye trauma,
  • Smoking,
  • Obesity,
  • Excessive amount of alcohol consumption,
  • Long-term, uncontrolled hypertension.

Is there any drug to treat cataract?

There is no medication to treat cataract. The only effective treatment is cataract surgery. The main purpose of the cataract surgey is to restore the vision in patients with decreased visual acuity and quality. During the surgery the patient’s clouded lens is changed with a new and clear intraocular lens. Roughly 19 million cataract surgery is performed every year, globally.

How is cataract diagnosed?

The development of cataract is diagnosed with ophthalmic examination. Therefore, every healthy individual should have an eye exam on a yearly basis. But, you should also make an appointment with an opthalmologist when you notice any change in your vision.

In general, the symptoms of the cataract develop gradually and slowly. Thus, the patient may not notice or ignore the earlier symptoms of cataract. Usually the patient sees an opthalmologist when his/her vision is imparied and causes difficulties in daily activities such reading and driving at night.

Steps of a complete eye exam to diagnose cataract

The following steps are applied to all patients for a complete eye exam to diagnose cataract:

  • Measurement of the visual acuity,
  • Identifying the type of cataract and its severity with slit-lamp examination,
  • Intraocular pressure measurement with applanation tonometry,
  • Retinal exam after dilating the pupil with special eye drops,
  • Checking optic nerve and macula with eye tomography (OCT),
  • Evaluating eye surface with corneal topography,
  • Performing a corneal endothelial cell count (specular microscopy),
  • Optic biometry for intraocular lens measurement,
  • If retina can not be visualized, an eye ultrasonography is performed.

Laser surgery for cataract

The surgical procedure is performed with topical anestesia in most patients and takes approximately 10-20 minutes. The patient will not need to stay in hospital and may be discharged 1 hour after surgery.

Currently “Phacoemulsification (Phaco)” surgery is the standart method for cataract surgery. This is widely known among lay public as “laser surgery”. With this method, first a small incision (2,2 mm) is made in cornea.

Then, using an ultrasonic hand-held device through this cut, the lens is emulsified (broken up into small pieces) and aspirated (sucked up) from the eye. A new, folded lens is inserted with a special syringe through the same incision into the eye. Since the cut in the cornea is so small, no stitches would be necessary.

The success of the cataract surgery depends on the ophthalmic surgeon’s experience, the advanced-technology surgical equipments and the quality of the lens and materials used during the surgery.

After the operation, the cloudiness of the vision disappears and visual acuity returns to normal in a few days. You notice the significant difference in vision before and after surgery. The healing generally takes a few days to few weeks and you may feel some discomfort in your eyes after surgery for the initial few days.

If you need cataract surgery for both eyes, your ophtalmologist will advice you when to have the operation for the second eye.

kataraktlı göz

Femtosecond Laser-Assisted Cataract Surgery (FLACS)

This is a U.S. Food and Drug Administration (FDA) approved methodology improving traditional Phaco surgery by using a computer-assisted laser device.

With FLACS, the type, lenght and location of the cut to be done in cornea are loaded to the computer. Then, the incision and breaking up the lens are perfomed by laser. Comparing with phaco method, this procedure is more precise and requires less phacoemulsification energy.

Is it possible to get rid of both reading and distant glasses after cataract surgery?

If trifocal lenses are applied during cataract surgery, one can maintain a normal vision without glasses for every distance. These special lenses have capability to provide a clear vision for near, intermediate and distant vision.

However, these lenses may not suit every individual. A detailed evaluation before surgery is necessary to identify the appropriateness of these lenses for a particular patient.

The opthalmologist questions the patient’s profession and daily activities and the importance of near, intermediate and/or distant vision for the patient. Additionally, age, social activities, reading habits and level of intellectuality are important factors for selecting the type of lenses for surgery.

For implanting trifocal lenses, the patient should not have diabetes, advanced glaucoma or retinal disease. The size of the pupil and regularity of the cornea are also important factors.

The cost of cataract surgery

The cost of the surgery is determined by the surgical technique (i.e. with or without laser) and, the type of lenses (trifocal, EDOF, trifocal toric, EDOF toric, monfocal toric lenses for astigmatism, etc.) to be used.

Thus, the exact pricing will only be available after a complete ophthalmic examination and discussion with the patient to identify the most suitable type of surgery and the intraocular lenses for the operation.

What happens if the cataract surgery is delayed?

The timely cataract surgery has utmost importance. Delayed, hard cataracts may increase the surgical risks and complications. The special lenses (e.g. trifocal, toric, “smart” lenses) may not be applicable in patients with delayed cataracts.

How to prevent development of cataract?

With advanced age, cataract develops in every person to a certain extend. The following precautions may prevent or delay cataract development:

  • Having regular eye exams,
  • Wearing quality sun glasses to filter UV light,
  • Healthy diet with lots of vegetables and fruits,
  • Maintaining a normal blood sugar level,
  • Quitting smoking,
  • Reducing alcohol consumption.
Update Date: 17.03.2022
Professor Yonca Aydın Akova, M.D. FEBO
Professor Yonca Aydın Akova
Ophthalmologist and Eye Surgeon
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Cataract, Cornea, Glaucoma Surgery
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