Cataracts: When is it time for surgery?

What is a cataract?
A cataract is a clouding of the lens, a clear organ within the eye that focuses images on the retina.  As a person ages, the water content of the lens diminishes. Proteins and sugars clump together, causing the lens to become clouded. Vision becomes blurry, sometimes leading to blindness. This disorder is primarily age-related, but other causes exist such as eye trauma, corticoid intake and other, less common factors. Diabetes can also cause cataracts. Some babies are born with a congenital cataract, which may be hereditary or caused by intrauterine infections like rubella or mumps.

What are the symptoms?
Cataracts develop differently depending on the patient, and the symptoms may vary from one person to the next. Depending on exactly where the lens has begun to cloud, some patients may have trouble seeing up close, while in others, distance vision will be impaired. Others still will experience a “foggy” sensation, increased sensitivity to bright light or difficulty distinguishing colors.

When is it time for surgery?
It is the patient who decides when it is time for surgery, after being informed by his or her ophthalmologist and depending on symptoms. Surgery mustn’t be delayed for too long, as the cataract will increase in size and become hard, making removal more complex. 

Can both eyes be operated at once?
For comfort-related reasons, it is best to operate one eye at a time, to avoid having to wear a patch over both eyes at once! Operating one eye after the other also allows the surgeon to adjust the second implant based on the patient’s vision following the initial procedure.

What are the risks of surgery?
Cataracts affect more than one in five people starting from age 65, more than one in three after age 75 and close to two in three after age 85! As a result, surgery has become very common, but can still be a source of anxiety for patients. Cataract surgery is completely painless and heals quickly.  Patients regain their vision very rapidly, as early as the day after surgery, with no particular difficulties or pain. Complications are rare.

How is surgery performed?
The intervention consists in replacing the natural lens by an artificial one. The procedure has been revolutionized through micro-surgery. Previously, ophthalmologists removed cataracts without using a microscope.  They simply made a large incision in the eye, and didn’t replace the lens. After surgery, patients had to wear very thick-lensed, unattractive glasses. Now, the surgeon makes a very small incision, barely 2 millimeters long, in the cornea. A probe emitting ultrasound waves is inserted into the eye.  Within a few short minutes, the waves partially break down the lens, which is then removed through suction. Through the same incision, the surgeon then inserts the artificial lens, which unfolds like a tiny umbrella inside the eye. The procedure is usually performed under topical anesthesia in the form of anesthetic eye drops. The surgical procedure lasts under 30 minutes per eye. Cataract surgery is generally performed as an ambulatory procedure, enabling the patient to leave the hospital a few hours after the intervention.

And in the future?
Although technology is already very advanced with regard to implants, with the availability of all-distance and multifocal intraocular lenses enabling clear vision from all distances simultaneously, laser technology is only in its infancy. Some day it could be used to fully or partially replace the manual procedure.