Once a cataract has been diagnosed, you’ll need to determine your ideal treatment approach. In this section, you will learn about the various surgical and non-surgical technologies that are used in cataract care.
It is a fact that cataracts are irreversible. Once the vision starts to deteriorate it can only get worse or very rarely stay the same for a limited period of time. Most patients diagnosed with a cataract are faced with a choice of either coping with the symptoms, while trying to address them with glasses or contacts, or undergoing the definitive treatment of cataract extraction.
The definitive treatment for cataracts is cataract extraction. There are several widely accepted indications for requiring cataract surgery:
Modern cataract extraction includes several options, depending on the general status of your eye and your surgeon’s skillset. Your candidacy for the various procedures is best discussed at length during your visit to the Barossa Eye Clinic. Some of the options for your procedure include:
The progress of science and technology has led to the development of phacoemulsification and clear corneal micro-incisions (less than 2mm) that are self-sealing and require no stitches. This has helped cataract surgery become on of the most successful and safe operations available today. Even the lens technology has advanced to the point where a foldable lens is inserted through the microscopic opening. This means that in capable hands, cataract extraction takes 5 to 7 minutes, with the patient enjoying greatly improved vision almost instantaneously in the recovery room or once the anaesthetic has worn off.
Extraction of a visually significant cataract is widely considered a medically necessary procedure, covered by health insurance. The goal of standard cataract surgery is the best corrected visual acuity (best possible vision with glasses). This is achieved through extraction of the cloudy lens and its replacement with an artificial monofocal lens implant, without correcting coexisting astigmatism. This form of standard cataract surgery is safe, quick and painless. However, while this procedure improves vision, it leaves most patients with a need for both distance and reading glasses. This means that while the surgeon makes the best possible effort to eliminate the need for glasses, given the limitations of the technology utilized, glasses will most likely be necessary.
Premium or refractive cataract extraction has a much greater goal. This kind of surgery aims to completely eliminate the need for glasses or contacts. Through the use of specialized multifocal or toric lens implants and additional surgical manipulations to reduce astigmatism, the result is improved vision without the need for glasses or contacts in most situations.
The Barossa Eye Clinic offers laser cataract surgery in patients who qualify and who understand the risks and benefits of the actual procedure – not the hype. Laser may help in cases where absolute centration of the IOL is necessary (mostly a small percentage multifocal lens patients).The steps of cataract surgery that were previously performed with blades and ultrasonic probes, can now be performed with the laser. The beneficial effects of the laser to assist in these steps needs to be weighed up against the overall increased cost and some potential added risks of the procedure. Please see Dr De Wit to discuss this fully.
The non-surgical alternative to cataract extraction is to continue wearing spectacles or contact lenses. Although there are essentially no risks to wearing glasses, the quality of vision will not be optimal because the cataract will continue to cause degradation.
In addition, if the prescription is very high, it will result in a greatly enlarged or reduced image and a decrease in peripheral vision caused by the thickness of the lens. Although contact lenses may provide higher quality and more normal vision, they carry a slight risk of complications, especially if they are worn overnight. The risks of contact lenses include: infection, which if involving the central cornea can rarely cause loss of vision; allergies, which can make wearing the lenses difficult; mild irritation; and discomfort.
Sometimes, the surface of the cornea is curved more like a football, with both flatter and steeper curves, than like a spherical basketball. When the surface of the cornea has an uneven curvature, the resulting vision is distorted. It is very similar to bending the lenses of a cheap pair of sunglasses – the image becomes very distorted. This common irregularity, called “corneal astigmatism,” causes blurred vision because light rays are not focused at one spot to provide clear eyesight. A person who has both a cataract and a corneal astigmatism will not regain high-quality distance vision after cataract surgery unless the astigmatism is also corrected. Conventional cataract surgery is able to eliminate nearsightedness or farsightedness, but it cannot correct other refractive errors such as astigmatism. There are a few astigmatism correcting options available to be used in conjunction with cataract surgery. They include:
If you’re diagnosed with astigmatism, Dr. De Wit and his team will often recommend Limbal Relaxing Incisions, or LRIs. LRIs are grooved incisions placed on the far peripheral aspect of the cornea (the limbus) resulting in a cornea that is more perfectly shaped. The astigmatism is thus reduced and vision improved. The reduction or elimination of the astigmatism results in better quality vision without glasses. After an LRI procedure, you will not need glasses for better vision at a distance. However, reading glasses will still be required.