The term cataract refers to a clouding of the lens of the eye that leads to limited vision and vision problems.
The first thing we do is examine the refractive power and eye pressure with the autorefractometer.
This clouding is usually a normal age change of the lens, similar to wrinkles in the skin. Only rarely is it triggered by medications, especially cortisone, or is the result of injuries or inflammation in the eye, or general diseases such as rheumatism or metabolic disorders. Without treatment, cataract leads to a progressive deterioration of vision in the affected eye, which can lead to blindness. There is no prevention or drug treatment.
Cataract usually develops slowly and painlessly. Indications of a cataract include: decreased vision, blurred vision (as if through slightly dirty glasses), increased sensitivity to glare, and possibly double vision. Other than reduced vision, the cloudy lens rarely causes damage to the eye. This means that the timing of the treatment can be chosen by the patient, depending on the level of suffering and visual impairment.
The artificial lenses are selected after consultation with the patient.
The only treatment option for cataract, is surgical replacement of the cloudy lens with a clear artificial lens. It is a relatively short procedure, usually performed on an outpatient basis under local anesthesia. Based on the preliminary examinations, the artificial lens is chosen so that only weak glasses are needed after the operation. Of course, it is taken into account whether the patient without glasses, would like to see sharply afterwards, for the distance or rather in the proximity. For the respective other distance, a slight spectacle correction remains necessary. The correction must also be selected so that the two eyes function harmoniously.
Spherical and aspherical single vision lenses are used as standard lenses at the Bern Eye Clinic, and are fully covered by basic insurance. With a single vision lens, patients see best after surgery at a distance determined together in advance.
Compared to a standard lens, an aspheric single vision lens has an additional special surface. It improves contrast vision in low-light conditions such as fog, twilight and darkness (for example, when driving). For improved protection of the retina against harmful UV rays, the aspheric lens today, usually includes a blue light filter. The aspheric lens is especially recommended for patients with age-related macular degeneration (AMD). The blue light filter can help prevent retinal damage such as AMD. It is therefore also useful for younger patients. In addition, it makes colors perceived, somewhat “warmer” than with a colorless lens as is most often utilzed.
Experience shows that most people want their vision to be as they were used to after surgery. Afterwards, the so-called target refraction is discussed: for far-sighted and normal-sighted people, that distance vision is best. Glasses are needed for short distances, such as reading, writing, computer screen work, and with general use, at home. Normal-sighted patients are already familiar with reading glasses from presbyopia. Nearsighted people often want to be able to continue reading without glasses and wear glasses for distance vision as usual, while few want to correct their myopia right away. Irrespective of this, severe refractive errors are reduced. The glasses correction can be done with single vision or varifocal glasses.
Some patients want the greatest possible freedom from glasses. For this purpose, one eye can be focused in the distance and the other in the intermediate range (distance of computer screen or household work). The so-called monovision is first tested for compatibility with contact lenses. After a short period of habituation, many feel comfortable with it. However, if one finds it uncomfortable, both eyes should be planned the same way. For long reading of small letters, weak reading glasses are often still needed even with monovision.
Compared to the conventional single vision intraocular lens, the so-called EDOF intraocular lens allows an enhanced depth of focus (EDOF). In good lighting conditions, this means sharp vision not only in the distance, but also at medium distances without glasses. The optical properties of such lenses result in a barely noticeable residual blur. In difficult lighting conditions, slight glare may occur. As a rule, reading glasses are still required for the near range.
If EDOF lenses are combined with monovision (see above), a very large depth of field with good imaging quality is obtained with both eyes together using MonoEDOF.
By means of a toric artificial lens, a pre-existing corneal curvature can be compensated, which improves visual acuity and image quality without glasses, and reduces the necessary correction for glasses. Analogous to the single vision lens, the artificial lens corrects vision for that distance which is most important to a person. In most cases, good vision for distance is preferred, and reading glasses are used to help.
Development and production of such implants specially adapted to the patient’s needs, cause high costs. The additional costs of the special lenses are not covered by basic insurance. At the Bern Eye Clinic, we are happy to address the individual wishes and circumstances of our patients, and discuss the options together. We advise our patients on the most suitable intraocular lens for their life and eye situation, its costs, as well as the subsequent eyeglass solution.
COMMON PROBLEMS AND COMPLICATIONS
Cataract surgery is one of the safest eye surgeries. Nevertheless, there may be problems during the operation. For example, the holding apparatus of the lens may be too unstable to accommodate an artificial lens, or a small portion of the lens may slip into the vitreous cavity, requiring removal of the vitreous or attachment of the lens to the iris. The risk of retinal detachment is slightly increased even after uncomplicated cataract surgery. The measurement of the eyes is very reliable. Nevertheless, depending on the degree of opacification of the lens, spectacle power can be predicted with limited accuracy after surgery. After surgery, there is often an increased sensitivity to glare initially, and sometimes slight light or shadow phenomena are noticed.
Corneal swelling, or eye pressure elevation may occur in the first few days after surgery and later, swelling of the center of the retina (macular edema). This temporarily reduces visual acuity. In the initial period after surgery, the eyes are often dry, but this can be easily treated with artificial tears. After a certain time, clouding of the lens capsule often occurs. This, so-called after-cataract, can be treated easily and painlessly with a laser during a follow-up check-up.
Bleeding, infection or other complications that can lead to a loss of vision or possibly of the eye, are extremely rare (approx. 1:3000), but basically possible with any eye surgery.
Using the phoropter, we can accurately determine the patient's current visual acuity.
The clarification and treatment of a cataract takes place at our clinic upon medical referral, preferably by your ophthalmologist, who can also provide follow-up care. After we have received a referral letter, we offer the patient an outpatient examination during our consultation hours. For the highest possible measurement accuracy, soft contact lenses should not be worn for at least 2-3 days, and hard contact lenses, for at least 1-2 weeks or slightly longer.
ON THE DAY OF SURGERY
Upon arrival at the appointed time, you will be informed about next steps. . Before the operation, a discussion with the anesthesiologist will take place in order to identify possible risks. He/she will decide with you about the administration of a relaxant and sedative. The eye to be operated on is prepared for the operation with eye drops that dilate the pupil, and make the eye insensitive to pain. You will remain clothed for the operation and receive the protection necessary for sterility in the operating area.
The caregiver responsible for you will accompany you to the operating room, where you will take a seat. The surgical team will help you with the correct positioning. You will be covered with sterile drapes. This is followed by disinfection of the area around the eye, insertion of an eyelid blocker and disinfection of the eye. The procedure under the surgical microscope is performed as gently as possible. Through a small incision, the cloudy lens is liquefied and aspirated, then the new artificial lens is inserted and positioned. Due to the natural eye pressure, the incision usually closes by itself. Sometimes a bandage is applied for a short time.
After the procedure, you will recover in our clinic for about 2 hours. You will be given a small snack. If you feel well enough, any bandage will be removed. You will be given drops again and then; you may leave the clinic. For the way home, we strongly advise that you organize an escort or transport service.
BEHAVIOR AFTER THE OPERATION
Contact us if you experience pain or increasing redness. Likewise, if your vision deteriorates, if you notice a shadow or flashes occur.
Slight scratching, tearing or a foreign body sensation in the operated eye is normal for the first two days, double vision and increased glare as well. For some time, increased eye dryness is common.
A bandage is not necessary. You may protect the eye with glasses or sunglasses as desired.
The operated eye is treated with TobraDex eye drops for several weeks according to the dosage scheme:
TobraDex dosing schedule (unless otherwise prescribed)
Shake well before use, one drop into the operated eye at a time.8 am12 am4 pm8 pm
Your ophthalmologist will tell you at your follow-up visit when you can reduce the drops and start driving again.
- Showering and washing your hair, keeping the operated eye closed. No soap or shampoo should get into the operated eye.
- Light work, general activities of daily living, bending, light gymnastics, lifting of loads up to 10kg.
- Walks, and if in the sun, you can protect your eyes with sunglasses.
- Watching TV, reading and writing as far as you are comfortable.
- Eye rubbing, squeezing and tight pinching.
- Lifting loads over 10kg during the first week.
- Working in the garden or stable, during the first two weeks.
- Swimming or going to the sauna, during the first two weeks.
- Weight training, during the first two weeks, including swimming.
- Operating a car until permission is given by the attending ophthalmologist.
Follow-up examinations take place as agreed. The usual check-ups are 1-3 days after the surgery, after one week and one month. These and other necessary examinations can be done by the referring ophthalmologist.
Fitting of new glasses usually makes sense only after 2-4 weeks following surgery. The time until then can be bridged with temporary glasses if necessary.
In case of emergency (also on Saturday, Sunday and holidays), you can reach the on call doctor of the eye clinic at the following number: