Cataract Surgery and Clear Lens Extraction (to Treat Ametropia)

The natural lens inside the human eye is located behind the iris & the pupil. It is supported by multiple suspensory ligaments. The lens consists of crystalline, a special kind of protein. This protein is clear at the early age of life, but metabolic processes change it over time and lead to opacification. The lens is surrounded by a capsule, which gives it the typical form. The lens does not consist of any blood vessels or nerve fibers, which means that the lens is naturally transparent.

The lens is responsible for the process of focusing and refraction. On this occasion it has the capacity to change its form for better focusing at near distances (like the lens of a camera).

This ability is called accommodation. By aging, the hardening of the crystalline lens increases, so the result is a decrease in accommodation power, which is called presbyopia.

Cataract is the opacification of the natural human lens. Additionally, this opacification will lead to a thickening of the lens and therefore the anterior chamber of the eye will be reduced.

Your eye doctor can check the lens during a regular/ routine appointment by using a special microscope (slit lamp). Usually the pupil will be dilated for this examination, so the whole structure of the lens can be evaluated. Giving the patient a postoperative prognosis of his visual ability, some further examinations are necessary before undergoing surgery. Additionally, we will explain to you all different intraocular lenses.

Less light will pass the lens, caused by opacification of the proteins in the lens. The more light is blocked, the less light is getting through to the retina, which results to insufficient projection of an image. Patients will become easily dazzled by bright lights, colors seem faded, poor night vision, cloudy or blurry vision, double vision, etc.

The progression of cataract is in every patient individual. The first opacification starts very slightly at the age of 30 and progresses very slowly. Cataract is seen in very few exceptional cases in younger ages and newborns (juvenile cataract). In such cases, the cataract surgery should be performed earlier.

Some forms of cataract result in progressive myopia. The patient observes a better reading in near distance without glasses. This situation is only for a short period of time and results in very poor vision.

Nowadays a microinvasive surgery is performed as soon as your doctor diagnoses a moderate stage of cataract. The most important indication for the surgery is the visual impairment of the patient and the anatomical structure of the eye. Therefore, the ideal point in time for undergoing a cataract surgery depends on the individual.

No, the only effective therapy against cataract is to undergo a microinvasive surgery. The cloudy lens is removed and replaced by a high-quality artificial lens afterwards. Other therapies, as for example, using eye drops etc. does not exist. Suffering from a progressed stage of cataract increases the risks during surgery. Therefore, patients should not wait for too long after the diagnosis.

The power of the implanted artificial lens is calculated for the individual, similar as when getting glasses, and measured by an optometrist.  Therefore, refraction errors are considered while calculating for an artificial lens. Thus, even patients who had been myopic or hyperopic their whole life, are able to have a good vision for far distances even without glasses after surgery. A correction of astigmatism is possible as well. A standard monofocal intraocular lens, however, does not cover vision for near distance. Therefore, many patients still need glasses for reading. If a good vision in every distance (without glasses) is required, a multifocal intraocular lens is highly recommended. Before surgery, the patient decides which distance for vision is the most important during everyday life. Afterwards your doctor performs a painless ultrasound test (without touching the eye) to measure the size and shape of your eye. This helps to determine the right type of lens. You and your doctor will discuss which type of intraocular lens (IOL) might work best for you and your lifestyle. The aim is to see without glasses for the chosen distance.

Important: This decision is always based on your wish – seeing without glasses for a certain distance.  Obviously, additional glasses will provide a slightly better vision for all distances, if the other structures of your eye/ brain are healthy.

We will inform you about all the IOL before undergoing the procedure. Cost may be a factor, as insurance companies may not pay for all types of lenses.

You can choose between:

• Standard IOL
• Aspherical IOL
• Toric IOL
• UV- protection IOL
• Multifocal IOL

The exact refraction power after surgery is easy to determine but ensuring this is still not possible. Anatomical structures, as physics play an important role – those can´t be measured before surgery.

A life without any glasses can´t be guaranteed but it is very likely to get the refraction power you discussed with your doctor, by using the best possible techniques!

As mentioned before, your doctor performs a painless ultrasound test (without touching the eye) to measure the size and shape of your eye for calculation of the IOL, which will be implanted during surgery. Therefore, the length, thickness etc. of your eye and your natural lens is needed. Additionally, the astigmatism of your cornea will be measured.

It is also very important to exclude further eye diseases before the procedure, so the best possible result can be gained after the procedure. The surgery is a mild physical burden for your body, usually it is done in local anesthesia. You can decide yourself, if sleeping is required or not.

Every patient gets specific clothes to enter the operation room. These clothes are worn over your own clothes, so you don’t have to get undressed. You will undergo a short measurement of your intraocular pressure and visual acuity. Then anesthesia can be done. The preparation lasts only a few minutes.

The procedure typically is performed on an outpatient basis and does not require an overnight stay. It takes ten minutes or less to perform. A special microscope from ZEISS is used for the surgery. While the patient is under sedatives and sleeping, a small clip is attached to top of the eye to keep the eye open during the procedure. A tiny incision is made in the front of your eye (cornea). Afterwards the very front of the lens (the lens capsule) is opened. The surgeon then uses a special probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The very back of your lens (the lens capsule) is left intact to serve as a place for the artificial lens to rest. Once the cataract has been removed by phacoemulsification, the artificial lens is implanted into the empty lens capsule.

Cataract surgery is the most common surgery in the world, as cataract is a normal part of aging. It is a minimal invasive procedure, so complications are uncommon, and most are treated successfully. Examples include fluctuations of the intraocular pressure and inflammation of the cornea or retina, which usually can be treated with eye drops. Also, a posterior capsular tear could be a possible complication, but an experienced surgeon is able to replace the intraocular lens in the same procedure. Very few patients develop a retinal detachment, which can be re-attached by surgery. The chances of suffering from any form of complication is under 2%.

It is very important to wear an eye patch the first day and night post-surgery. Your doctor then removes the eye patch and examines the eye a day after the surgery. Your vision may be blurry at first, as your eye heals and adjusts but clears up in the next 2-3 days. You’ll usually see your eye doctor a day after your surgery, the following week, and then again after about a month to monitor healing. It is mandatory to take medications (mostly eye drops) as prescribed. Your doctor will let you know when your eyes have healed enough to stop medicating. Usually eye drops are taken for 6 weeks after surgery. Avoid rubbing or pushing on your eye during this time. Operating vehicles should be avoided the first day after surgery, ask your doctor when you can drive again. Most of your daily work can be done after cataract surgery. There are few activities which should be paused: swimming, diving, sauna, gym and flying. Approximately one week after surgery you can go back to your everyday life. If necessary, you get a final prescription for eyeglasses after 6-8 weeks.

Contact your doctor immediately if you experience any emergency such as vision loss, heavy pain and increased eye redness. After the procedure you get a portfolio with all the important documents, including a phone number you can call 24/7.

People who’ve had cataract surgery may develop a secondary cataract. The medical term for this common complication is known as posterior capsule opacification. This happens when the back of the lens capsule becomes cloudy and impairs your vision. It´s treated with a painless, one-minute outpatient procedure called YAG laser capsulotomy. A painless laser beam is used to make a small opening in the clouded capsule to provide a clear path through which the light can pass and you´ll be able to enjoy unrestricted vision again.

Regular check-ups are commonly done once a year. Some patients need to visit the eye doctor more often because of other diseases like glaucoma or macular degeneration.