Every normally developed human eye contains within it a crystalline lens. This lens is usually clear and is made up of proteins which are organised in such a way that it focuses images on the retina, much like the lens inside a camera that brings images to focus on film.
With time and under the influence of factors such as ultraviolet lights, smoking, poor nutrition, radiation and/or chemotherapy, but most commonly as part of the aging process, the lens becomes cloudy. This occurs due to denaturation of the proteins that make up the lens. This process of clouding of the lens is irreversible and is called cataract formation. As the cataract forms, the light is scattered by the increasingly dense and cloudy lens and results in poor vision.
Patients between the ages of 55 and 70 are at risk of developing cataracts in Australia, with up to 50 percent of them suffering from visually significant cataracts that interfere with activities of daily living. Individuals who are on chronic steroid administration, have undergone radiation or chemotherapy, and have had trauma are at risk of developing cataracts at an even earlier age.
Cataract symptoms include halos, glare, a decrease of visual acuity, loss of colour perception and contrast sensitivity. Frequently, symptoms are manifested as difficulty seeing road signs, seeing halos and glare from oncoming traffic, trouble reading and photosensitivity. Before the loss of transparency is noticed, reading vision changes – either for the better (in myopes) or more commonly for the worse as the lens becomes rigid and can not bend in to the shapes it used to be able to in order to focus light at different distances (presbyopia).
Most people with cataracts do not realize that they are suffering from a distortion on their lens, as initially any changes in vision may be undetected. The first sign of cataract formation may be when night vision begins to diminish. Fortunately, there are many advanced treatments for modern cataract surgery, without stitches or incisions. Near or far sightedness, as well as astigmatism may also be corrected at the time of surgery – we have excellent results in helping people rely less on their glasses. Depending on the degree of the cataracts, a procedure with an experienced cataract surgeon may be the only treatment option. The process involves breaking down the cataracts and removing them before replacing them with a permanent synthetic lens of your choice - a process called intraocular lens (IOL) implantation.
Modern cataract care involves the removal of a cloudy crystalline lens (the cataract) and its replacement with a clear intra-ocular lens implant or IOL. The use of intra-ocular lens implants (IOLs) is now considered to be the standard of care. Situations when it is not medically advisable or physically impossible to implant a lens are very rare. Before the advent of modern lens implants, patients were left aphakic (without lenses) and had to resort to use of very thick “Coke bottle” glasses or contact lenses. Other than the convenience of not having to wear “Coke bottle glasses,” there are a number of medical reasons why it is important to have a lens implant. Aphakic eyes (eyes without lenses), are at higher risk of developing glaucoma and retinal detachments. That is why every reasonable effort is always made to place a lens implant in the eye. There are a number of lens implant options available to the physician and the patient. These lenses all have a basic function of focusing images on the retina. Some lens implants have extended functions, such as correcting corneal astigmatism (Toric lenses) or allowing the eye to focus at both near and far distances, without having to resort to using glasses or contacts (Presbyopia Correcting Lenses). These IOL’s with extended functions are usually not covered by health insurance or Medicare. That is because these lenses, while providing patients with the convenience of spectacle freedom, are not considered to be “medically necessary” by most health insurers. The “spectacle freedom” afforded by such extended function lenses comes with an added cost that is absorbed by the patient. Cost issues aside, not all lenses are appropriate for all patients. There are various factors that are individual to each patient that must be considered. If the idea of being glasses-free is enticing, ask Dr De Wit about the premium Barossa cataract surgery options available at Barossa Eye Clinic.
Once you decide you’re ready to treat your cataracts and improve your vision, you will need to schedule a consultation with the team at Barossa Eye Clinic. During that appointment, you will undergo in-office preoperative testing and measurements. In addition to a full ophthalmic examination, Dr De Wit will review the risks and benefits of cataract surgery with you, along with all of the treatment options that are available to meet your visual needs. Once your surgery is scheduled at our local surgical facility, we will review all of the details and schedule your final examinations. For more information about how to prepare for your surgery and what to avoid post-surgery, visit our Cataract Instructions page. Typically, biometrics will be performed:
These biometrics will assist in choosing the proper intraocular lens calculations. Logistical aspects of the surgery as well as medications are also discussed at this time. Counselling will also take place during your appointments at our Barossa Eye Clinic office. This will include a discussion about the expectations concerning best corrected visual acuity (BCVA), including pre-operative conditions that may prevent perfect results, such as age-related macular degeneration. Counselling regarding uncorrected visual acuity (UCVA) may address goals of surgery, for example being left moderately nearsighted to allow near work to be performed without correction. Patients with high amounts of astigmatism may not be able to rid themselves entirely of glasses. In this case, Dr De Wit will talk to you about possible treatment modalities for astigmatism, including LRI (limbal relaxing incisions) and/or Toric IOL’s. Possible upgrade to a multifocal/accommodating lens implants may be considered if the patient desires.