Mangaement of Cataracts

Initial Mx:
• Glasses, strong bifocals, magnification, stronger lighting and other visual aids

Surgery:
• When cataracts begin to affect everyday life, most effective Rx is surgery, no medical Rx (usually when acuity is b/w 6/6 and 6/18)
• Cataract surgery proves effective in 95% of cases, with improvement in vision and no complications
• Day surgery/outpatient procedure: takes less than an hour
• If both eyes affected, surgery performed on one eye at a time, with 1-2 month gap b/w to let initial eye heal
• Can choose to postpone surgery if vision/lifestyle not affected significantly, but younger or diabetic patients have greater need for surgery-progress faster

Preparation:
o Ophthalmologist measure eye with ultrasound to determine power of lens to insert
o Local anaesthetic used, general used only if patient very distressed/anxious

Technique:
Basically crystalline lens with cataract removed during surgery, capsule remains, new artificial intraocular lens inserted
o 2 types:
 Extra-Capsular Cataract Extraction (ECCE)-lens removed but majority of lens capsule remains to support the artificial lens.
-Can be via phacoemulsification, where a small incision is made-3mm long- where cornea meets conjunctiva, horizontal incision. Small needle like probe inserted via incision, and ultrasound waves emitted into eye via probe break up lens+cataract, and bits are suctioned out via probe
-If cataract is advanced stage, ultrasound waves may not be able to break it up, so larger incision required-10mm-where cornea meets sclera. Ophthalmologist opens lens capsule through incision, removes nucleus of lens in 1 piece followed by softer lens cortex, capsule remains in place
 Intra-Capsular Cataract Extraction (ICCE)¬-lens and capsule removed b/c cataract has progressed into capsule (rarely performed)
o After cataract removed, a plastic intraocular lens-silicone/acrylic-folded when outside the eye is inserted through the incision
o Once in the eye, IOL unfolds and is position inside lens capsule, it’s 6mm in diameter
o Most IOLs are monofocal, multifocal lenses are being developed but problems exist with intermediate focus and glare with multifocals.

Recovery:
o Incision heals fast, b/c very small and made horizontally. No stitches.
o Swelling and redness should go down within few days- week and vision should improve almost immediately
o If larger incision may take up to 8 weeks to heal completely
o Can’t drive home, and ophthalmologist may restrict movement e.g. bending/lifting for a few days
o Need follow up next day, one week and one month after surgery
o Doctor may prescribe medication to prevent infection and to control eye pressure
o Contact Doctor if experience: Vision loss, pain despite use of over-the-counter drugs, increase in inflammation/redness, nausea/vomiting/excessive coughing, light flashes or spots in front of eyes
o Most people require glasses after surgery b/c artificial lens usually monofocal and astigmatism may arise from surgery (Px has difficulty focussing b/c cornea is not curved evenly in all directions, less common with smaller incisions)
o 2nd Cataract: about 25% of patients develop a second cataract where back of lens capsule-left in during surgery-becomes opaque b/c of build-up of cells. Also called Posterior Capsule Opacification (PCO)
-PCO can develop months/years after procedure
-Rx is YAG (yttrium-aluminium-garnet) laser capsulotomy where laser is used to make a small opening in capsule to let light shine through
-short procedure, less than 5 mins, but Px has to remain for about 1 hr to monitor eye pressure. Can cause glaucoma, or increase welling of macula and retinal detachment

PS. I've sent two pics of anatomy of eye+catract surgery to emails