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Cataract

​​​​Cataract is a clouding in the lens of your eye which affects your vision. It is a common condition as you get older.​​

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​Th​e lens of the eye is naturally transparent and focuses incoming light rays to form a sharp, distinct image on the retina. This is similar to the way a camera lens focuses images onto film. A cataract is like a cloudy camera lens. It blocks light rays from entering the eye, resulting in blurred vision.

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The main symptom is blurred vision that is gradual and painless. Other symptoms include:
  • glare
  • poor vision under poor lighting
  • changes in the way you see colour
  • seeing multiple images
  • the need for frequent spectacle prescription changes

A cataract can be categorised according to its underlying cause:

1) Age-related
The most common cause of cataract is ageing, or senile cataracts. As you get older, the normal ageing process will lead to a hardening of the lens. This commonly affects adults above the age of 50.

2) Poorly controlled diabetes
Patients with poor diabetic control are also prone to cataracts. Diabetic cataracts can cause fluctuating vision due to poor control of sugar levels.

3) Eye injuries 
Injuries to the eye may also damage the lens resulting in traumatic cataracts. Sometimes, cataracts can occur years after the traumatic incident.

4) Genetic factors
Congenital cataracts are present at birth. These are usually hereditary or caused by an infection that had affected the pregnant mother and the unborn child.

5) Secondary cataracts
These are cataracts caused by medication or other diseases of the eye or body (eg. steroids, inflammatory disease and metabolic disease).

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Treatment for a cataract is warranted when it affects a person’s lifestyle. Surgery is the only effective way to remove a cataract. Fortunately, cataract surgery is usually highly successful with more than 90% of patients attaining good vision.

This high success rate is attributed to advances in surgical microscopes, machines and equipment, effective prevention of infections and early mobilization. Almost all cataract surgeries are performed as day surgical procedures without the need for hospital admission. Cataracts cannot be removed with medication.

​Cataract surgery is a surgical procedure used to treat cataract, which is a condition in which the lens inside your eye has become cloudy, usually as a result of ageing. This causes your vision to become hazy or cloudy. Surgery is needed to remove the cataract together with implantation of an intraocular le​ns. ​

Phacoemulsification, commonly referred to as “Phaco”, is the most common cataract surgery technique in developed countries. Using ultrasonic power, the cataract is broken down and removed through a small wound. Suturing is usually not required and vision restoration is fast.

With cataract removal, an artificial lens implant is needed to replace the original lens to focus light rays onto the retina. This can be achieved in the following ways:

  • ​​Foldable Intraocular Lens Implants
    This is the most frequently used implant. As the lens is foldable, it can be placed into the ​​​eye through a small wound usually without the need for sutures. The implant then unfolds itself into its appropriate position in the eye. The small wound heals quickly and visual quality is excellent. ​

  • ​Hard Intraocular Lens Implants​​
    These are non-foldable artificial lenses placed in the eye for cataract surgeries requiring large wounds, called extracapsular cataract extraction. These are usually done for patients with very advanced and dense cataracts. ​ ​ In the days before intraocular implants, patients were required to wear aphakic glasses. However, these spectacles were thick and heavy, providing poor quality of vision.​

    Today, with the advent of intraocular lens implants, spectacles are used only to correct any mild residual power, if any. As these prescriptions are generally very mild, the spectacles are much thinner and lighter, with no adverse impact on quality of vision.​​


​During Cataract Surgery:

Before the start of surgery, you will be given an anaesthetic, either as an injection or in the form of eye drops, to make the surgery more comfortable. Additional medications may be given through your bloodstream to help you relax and prevent discomfort.

Monitors will be attached to your chest, arm and fingertip. The skin around your eye will be cleaned and you will be covered with a sterile surgical drape.

During the surgery, the cataract is removed from the eye and replaced with an artificial intraocular lens. There are two surgical techniques. One method is called phacoemulsification as mentioned above, which uses ultrasonic energy to break up the cataract through a small wound. There is usually no requirement for sutures. The other method is called extracapsular cataract extraction, which requires a larger incision and several sutures. The surgeon will decide on the best technique suited for you. Both methods have equally good long-term outcomes.

During the procedure, it is normal for patients to see bright lights, colours, shapes and movement. Do not let these alarm you.

After Cataract Surgery: 

At the end of surgery, the nurses will place a shield over your eye to protect it. After which you will be transferred to the recovery area, and following a period of observation and detailed advice from the nurses on eye care, you will be ready to go home.​

Contribute​d by ​Department of Ophthalmology​