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As we get older our eyes go through a process of ageing. You may first start to notice your near vision getting a bit worse and that you need to hold things a little closer. Then you may need to start wearing reading glasses; this is called presbyopia. This is where the lens within the eye cannot flex as well as when we are young and unable to bend into focus and the lens starts to get cloudy. As our eyes age further the lens becomes stiff and rigid and very cloudy, this is called cataracts. If not detected early, cataracts can get so bad you may not be able to see through them and you lose the ability to see clearly, navigate, distinguish between colours and lose contrast. Ideally, before it gets that bad we would recommend performing cataract surgery to restore your vision. The main aim of cataract surgery is to remove the old lens and replace it with a new artificial intraocular lens (IOL) to improve your vision. A lot of people know about cataracts but are not clear on what the surgery actually involves. The initial stage of cataract surgery is for the eye surgeon to clean and numb the eye and to also dilate the pupil; this is to help the eye surgeon see the cataract clearly. The eye is held open throughout the procedure with a speculum. Most people are awake during surgery and anaesthetic is usually given via eye drops that take seconds to work. You should not be in any discomfort but may feel pressure and will see a bright light. The surgeon will then make a minute incision, which can be less than 2.2 mm. A substance called viscoelastic is introduced to stabilize the eye and maintain pressure. The lens capsule is where your natural lens sits, the surgeon will open up a small portion of this to be able to remove the old lens and insert a new lens. Depending on how bad the cataract is, the surgeon may first need to segment the cataract prior to removal. The removal of the lens is called phacoemulsification (phaco), this is where the eye surgeon will use a machine with an ultrasonic hand piece. The tip of the hand piece vibrates at an ultrasonic frequency which makes the lens substance emulsify which is then irrigated and aspirated out. If needed, the surgeon may then polish the capsule prior to inserting the new intraocular lens. The new lens is usually folded within an injector. The injector places the lens within the capsule and as it unfolds the surgeon guides it into place. The viscoelastic is then removed via aspiration. Once this is done the eye surgeon will check over the eye to ensure everything is perfect and that the incision is water tight, and then apply an antibiotic and steroid eye drop. The use of stitches is not normally needed as the incision is so small and self-sealing. The surgeon will then place an eye shield/patch over the eye to protect it and the surgery is complete. If both eyes need surgery, they will normally be treated on separate days to prevent risk of infecting both eyes and to also see how the first eye heals. The surgery takes an average of 20 minutes per eye and you can expect to leave within an hour or so after the surgery. Your vision should improve gradually over the next 24-48 hours. Full visual recovery and achieving final outcomes might take up to 4 weeks. Author: Samer Hamada is a distinguished consultant ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries. Please visit http://eyecliniclondon.com/ Please call 0800 197 8808 for friendly advice and information.
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