Cataract surgery is a procedure surgery which is conducted to remove the cloudy lens of the eye and replace it with an artificial lens. In general, cataract surgery is a safe procedure and rarely causes complications.
Under normal conditions, the eye lens will be clear because it is in accordance with its function, namely to transmit light into the retina. If a person suffers from cataracts, the lens of his eye becomes cloudy and the cloudiness will increase slowly.
Cataracts can make it difficult for sufferers to carry out daily activities because of impaired vision.
There are no medications that can treat cataracts or prevent this condition from getting worse. Cataract surgery is the only way that can be done to improve the vision of cataract sufferers.
Cataract Surgery Indications
If the cataract is still relatively mild and has not caused significant visual impairment, cataract surgery is usually not recommended. Doctors will recommend this procedure when the following cataract symptoms appear:
- Impaired vision at night
- Blurred vision
- Difficult to distinguish colors
- Sensitive to light
- There is a halo when looking at a light source, such as a lamp
- Nearsighted
- Double vision
Although generally used to treat cataracts, this procedure can also be performed to treat other eye disorders, such as:
- Macular degeneration, which is characterized by blurry vision in the center of vision
- Diabetic retinopathy, which is a complication of the eye due to diabetes
Cataract Surgery Warning
Tell your doctor if you have any other eye problems, especially glaucoma or macular degeneration, as these conditions may need to be treated before cataract surgery. The reason is, if there are diseases or other disorders in the eye, the results of cataract surgery in improving the quality of vision may not be optimal.
You should also tell your eye doctor about any medications, supplements, and herbal products you are taking, as they may need to be discontinued for a few days or weeks before cataract surgery.
Before Cataract Surgery
Prior to cataract surgery, the patient will undergo an eye ultrasound examination to measure the shape and size of the eyeball. The aim is to estimate the size of the artificial lens or intraocular lens (IOL) to be placed in the patient's eye during cataract surgery.
Based on the measurement of the eyeball, the doctor will tell you the types of lenses that can later be used for cataract surgery. The doctor will also tell you the risks and benefits of cataract surgery, as well as the possibility of wearing glasses after surgery.
The following are the types of artificial eye lenses that can be installed to replace the lens of the eye that has cataracts:
Monofocal lens
Monofocal lenses are the most common type of artificial lens used in cataract surgery. Monofocal lenses only have a focal point at a certain distance and cannot treat astigmatism (cylindrical eye) due to the uneven shape of the cornea.
Patients who wear monofocal lenses are usually required to wear glasses to aid vision or correct astigmatism.
Multifocal lens
This lens can help patients see objects at different distances, either near, medium or far. However, multifocal lenses cannot treat astigmatism, so patients still need glasses after surgery.
Multifocal lenses can also cause users to easily glare and the visible color contrast is reduced.
toric lens
Toric lenses are artificial lenses that can treat astigmatism. Toric lenses can also help patients see distant objects, but still need to wear glasses to perform certain activities, such as reading and writing.
In order to function optimally, toric lenses must be installed with certain specifications in the patient's eye.
After the examination is done and the lens has been selected, the patient will usually be asked to fast for 1 day before undergoing cataract surgery. The patient will also be asked to be accompanied by a family member, so that the postoperative recovery process that the patient undergoes later can be assisted by the family.
Cataract Surgery Procedure
Generally, the entire cataract surgery process takes 30–45 minutes. During cataract surgery, the patient will remain conscious and keep his eyes open until the operation is complete. If the patient is tense or anxious prior to surgery, the doctor may prescribe a sedative.
To facilitate the operation, the doctor will drip a special drug that functions to dilate the pupil. After the pupil is dilated, the doctor will give a local anesthetic to the eye, so that the eyeball will be numb and the patient will not feel pain during the operation.
The doctor will also clean the skin around the eyes and eyelids, and place a sterile cloth over the patient's head and around the eyes. A speculum (support device) will be placed on the eyelid to ensure the patient's eye remains open during the operation.
In cataract surgery, the cloudy lens will be destroyed with a special tool. Once destroyed, the lens is removed from the eyeball and replaced with an artificial lens (IOL). However, in some cases, it is not necessary to replace it with an artificial lens.
There are several techniques in cataract surgery that can be used to destroy the damaged lens, namely:
1. Phacoemulsification
This technique is done by destroying the cataractous lens with high-frequency sound waves (ultrasound).
The trick, in the eyeball that has dilated the pupil, the doctor will make a small incision at the edge of the cornea. Through this incision, a special tool that can emit waves ultrasound inserted into the eyeball until it reaches the lens.
Sound waves from these devices can destroy the cataractous lens, then the destroyed lens will be removed from the eyeball using another tool. Next, an artificial lens is attached to the location of the old lens.
After surgery, the incision made by the doctor at the edge of the cornea will close by itself (self-healing).
2. Laser technique
The principle of cataract surgery with laser techniques is almost similar to that of phacoemulsification. The difference is in the process of making the incision and the destruction of the lens.
In the laser technique, the doctor uses a laser beam to make an incision on the edge of the cornea and destroy the cloudy lens of the eye.
The destroyed lens is then removed by suction and a new lens will be installed in the place of the old lens. When finished, the incision will close by itself.
3. Oextracapsular cataract surgery
This technique is done by removing one eye lens completely and leaving the back capsule of the lens to be where the artificial lens is attached. The extracapsular technique is usually used if the cataract is dense enough that it cannot be destroyed.
Compared to technique phacoemulsification, The incisions made in this technique are usually more numerous and recovery after surgery also takes longer.
4. Intracapsular cataract surgery
This surgical technique is performed by making a large incision, then removing the entire lens along with the capsule from the eye. After that, the new lens is attached in the same location as the old lens or in a new location, usually in front of the iris.
In general, cataract surgery has a fairly high success rate. In most patients who undergo cataract surgery, vision can return to normal and not blurry.
If the patient has cataracts in both eyes, the doctor will perform cataract surgery on one eye first. After the eye healed, surgery was performed on the other eye.
After Cataract Surgery
After cataract surgery, patients are usually allowed to go home on the same day, but they are not allowed to drive themselves. The patient's vision still feels blurry after surgery and will improve in a few days, marked by a more vivid color.
After surgery, the patient may feel discomfort and itching in the operated eye. This is natural. Avoid scratching or rubbing your eyes as this can cause complications.
To protect the patient's eyes, the doctor will put a bandage or eye protection. The doctor will also schedule the patient for follow-up after surgery, so that his recovery can be monitored.
During the recovery period, the patient will need to instill eye drops prescribed by the doctor to avoid infection and inflammation, as well as control the pressure in the eye.
Discomfort or itching in the eye will usually go away within a few days, and the eye will recover about 8 weeks after surgery. If the patient needs glasses after cataract surgery, the doctor will prescribe eyeglass lenses.
The patient should immediately notify the doctor if during the recovery period any of the following occur:
- Red eye
- Swollen eyelids
- The pain doesn't go away even though you've been given painkillers
- Dizzy vision
- There are shadows like smudges that seem to float and block vision
- Loss of sight
Cataract Surgery Complications
Cataract surgery is a relatively safe procedure and rarely causes complications. However, like any other surgical procedure, cataract surgery can cause complications, such as:
- Inflammation and infection of the eye
- Increased eye pressure
- The drooping of the eyelids makes the eyes look sleepy
- Bleeding
- The rear capsule of the lens is torn
- The back capsule of the lens is cloudy
- Lost artificial lens
- Retinal detachment
- Glaucoma
- Blindness
The risk of complications due to cataract surgery will increase if the patient suffers from other eye diseases.
In addition, patients who have undergone cataract surgery may also experience cataracts again. This condition is called secondary cataract and occurs when the lens capsule that was not removed during surgery becomes cloudy. Secondary cataracts can be treated by repeat cataract surgery.