Cataracts - a guide (My Experience of Cataracts)

Member Name: jo1l

Product:	My Experience of Cataracts
Date:	01/03/01 (665 review reads)
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Advantages: a simple operation can restore sight

Disadvantages: they are a nuisance

My personal experience of cataracts is on a professional basis having spend over 10 years as an ophthalmic nurse I have looked after numerous patients under going a cataract extraction.

What is a cataract?

A cataract is basically a clouding of a persons natural lens. this in the majority of cases seen here in the UK is due to age related changes.Other forms of cataract can becaused by a congenital ( birth) defect and also as a result of trauma to the eye, which then goes onto form a cataract and steroid induced cataracts.

What can be done to treat them?

Basically the only way to treat a cataract is by surgically removing it when it becomes a nuisance. Depending on which part of the lens is involved and how dense it is you can live with a cataract for quite some time without it becoming a nuisance to you. Unfortunately alot of people are under the belief that cataracts can be treated by laser, if only this was true!

So what does the operation involve?

Gone are the days when a patient was in hospital for other 10 days, nursed flat and given liquidised food in the hopes of not disturbing the eye and the intra occular lens too much. With the advant of new intra occular lenses and key hole surgery this is now a relatively safe operation to have, thus it can be done before all vision is lost. 20 years ago it was common practise to wait till the cataract had ripened before risking such an operation due to the nature of the surgery and the risk of infection was greater. Due to modern technology it is now becoming increasingly common to do cataract extraction when some one has only minor visual disturbance eg glare from night driving.

The modern day cataract extraction is usually done by a process called phacoemulsivication, or phaco for short. This basically involves a small incision being made about 3 mm in total on the edge of where your cornea ( the window of the eye) joins the sclera ( the white part of you
r eye), the surgeon then passes a probe throw your dilated pupil ( the black part of your eye) and breaks up the cataractous lens then aspirates it. Then an intra occular lens is then put into the little bag that your natural lens sat in. In most cases your wound will not be suctured as it is small enough to seal itself

Are there other methods?

If it is a very dense cataract and would not break up using the ultra sound probe used in the phaco method then you might have to have what is called an extra capsular cataract extraction or ECCE for short. This involves a larger incision being made normaly from about 10 o'clock to 2 o'clock if you imagine the cornea to be a clock face.The cataract is then removed in one peice and an intra occular lens is then inserted. The wound is then stiched up. These suctures are then removed at a later date at a routine out patients appointment. with this method it does take the eye longer to heal as there has been more surgical trauma to the eye.

Whats an intra occular lens?

Intra occular lenses or IOL's for short are a small plastic lens that is inserted during your operation. They are not like a contact lens so you will not be able to feel them. IOL's were first thought of just after the 2nd world war when an ophthalmic surgeon by the name of Arthur Ridley noticed that pilots who had major facial trauma did not suffer any ill effects when small fragments of perspex from their windscreens was found to have lodged into their eyes. Ridley went onto insert the first IOL's in the 1950's but it was not really till some what later that his great idea was to catch on. Ridley is prehaps the unsung hero of ophthalmolgy it was not till he was in his 90's that his discovery was finally recognised in the form of an honour.

Why do you need an IOL?

The eye has two refractive parts the cornea and the lens. If you take away one of these part you will not be able to
see. Prior to cataract surgery your eye will be measured and the appropriate lens for you will be inserted at the time of surgery.

My gran is 90 surely she's too old for surgery?

A spring chicken in terms of cataract surgery! The vast majority of cataract operations are actually done under a local aneasthetic ie the patient is awake. If you are able to lie flat for the half hour or so the operation takes and met the aneasthetic criteria then anyone can have it done without detramental health risks.

Awake are you sadists?

Erm no! The local aneasthetic injection is given into the muscles around the eye, this makes the eye go completely numb you are unable to move it and will not realise if your eye lids are open or closed. You will not be able to see the operation as your other eye is covered by the sterile surgical drapes, so there is not risk of seeing the operation what so ever.

So what happens afterwards?

The vast majority of cataract extractions are now done on a day case basis so within a few hours of your surgery you could well be sat at home wondering what all the fuss was about. On the day of your operation you will have a sheild over your eye to protect it. This should be worn until you are examined again at the hospital this is normally the following morning, some hospitals examine you a few hours after your operation this really depends on the surgeons preferance.

You should notice a change in your vision within a few hours of the surgery, but some times it takes a little bit longer. The best vision will not be obtained for about 6 weeks after your operation and longer if you had to have an ECCE

You will be given a course of steroid/ antibiotic drops to use and other drops if needed. Should you have difficulty instilling your drops most chemists have a vey handy little gadjet called an auto dropper.

In the initial post operative period you may well notice that your ey
e feels gritty and sore. It can also water perfusely.

Hopefully this might be of some use to you or a relative who has a cataract, I would say that if you do have any further questions then ask the medical staff or nursing staff thats what they are their for.

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