Cataract

What is cataract ? How does it emerge ?

CataractThere is an unseen lens due to its natural location right behind the colorful side of the eye and it is transperant. Because this lens is transperant we see the pupils black.
The lens provides a clear image by leaching the beams received by the eye to the nerve layers. In order for the light to reach the nerve layer by penetrating the lens, the lens should be transperant. When this transperant lens, in any way, becomes blurred, there emerges cataract.  This blur can emerge on any spot of the lens or on the whole lens.

Is cataract a disease emerging at older ages ? Can it emerge at youth ?

It can emerge in any age including the infancy. It is rare in middles. It’s frequency increases when the age gets older. There is some denseness (at least a little amount) on half of the people aged between 50 – 59 and on almost all the people aged above 80.  However this denseness may not effect the capacity to see in a significant amount.

What are the reasons of the emergence of cataract ?

The most important reason of the emergence of cataract on adults is the changes occuring as a result of the aging of the lens. On kids, however, the factors effecting this emergence are metabolic diseases, consanguineous marriage, the diseases undergone in mother’s womb, use of drugs during pregnance, microbic situations and injuries. Besides these, eye’s harsh concussion with any object (trauma), diabetes, uveit, nephropathy, glaucomia, radiation, high blood pressure (hypertension) and the long term use of the durgs containing cortisone may cause cataract.

Can cataract be treated with drugs ?

Cataract has no other way of treatment than surgery. Various drugs are in the test stage however no successful result has been announced yet.  Therefore we can say that the treatment of cataract can only be implemented by surgery.

  •  Gradually blurring, indolent vision
  •  Dazzling, or the decrease of light sensibility
  •  Frequent need to change the diopter value
  •  The frequent need of clearing the eyeglasses
  •  Having a hard time while driving
  •  Decrease of vision at night and the disintegration of lights
  •  The need of intense light while reading
  •  Having double vision with a single eye
  •  Dim vision, or an unusal yellowness of colors

In what conditions the cataract surgery is unavoidable ?

Surgery is recommended for the patients exposed to the situations defined below:
If;

  •  The visual capacity of the patient can not fulfill his/her needs
  •  An ailment like an infection in the eye led to cataract and disrupts the treatment and its tracking
  •  Cataract causes high eye pressure

What are the methods of surgery in the conditions which low vision and strabismus might be present for the people having congenital cataract ?

It is split into two in accordance with the extaction of medical lens.
1.Intracapsular Cataract Extraction (ICE): It is extracted as a whole, with the lens membranes. It is an old method.
2.Extracapsular Cataract Extraction: A section of the frontal capsul of the lens is extracted, the other sections are cleared with absorption, fractionation by ultrasonic waves (FAKO) methods.
The type of surgery can change depending on the age of the patient, the condition of his/her eye, the preference of the surgeon.

Can cataract be treated by using laser ?

This operation is colloquially considered as the cataract treatment with laser but it is a method of FAKO. Caract surgery can be performed with laser. However it is not commonly preferred because of the fact that it is no different than FAKO as a surgery method. Today cataract surgery with laser is in its experimental stage. It is not possible to curing cataract without operating and only using laser.

Today in the cataract surgeries, after the cleanup of cataract, the implantation of artificial lens inside the eye is implemented to almost all the patients. Unless there are special conditions for the patient (kids under the age of one, people with ophthalmia etc.) the intraocular lens should absolutely be planted. Whether it is suitable to plant the lens inside the eye or not will be decided by the operating ophthalmologist who analyses the condition of the patient. Unless the lens is used the patient should wear thick glasses.
What is the best method to use in the treatment of Cataract?
The method can vary depending on the age of the patient, condition of the eye, preference of surgeon and the type of lens that will be used. Today, the extracapsular methods, meaning the methods in which the lenses protect their own membranes.  The other method may also be needed depending on the condition of the patient or the pace of the surgery.
What should be the characteristics of the intraocular lenses planted during the surgery?
Today the lenses are generally produced in a single focal type, meaning that they can provide a clear vision of close and distant objects. The patient may need to wear contact lenses or glasses to clearly see the objects located far from or near him/her.
Recently, “multifocal lenses” providing clear vision of the close and distant objects, and also the lenses having special color coatings and having the feature to prevent the eyes from harmful lights coming to the eye are started to be used. These type of lenses are used in the conditions where the patient and the doctor collectively decide.

What is implemented before the Cataract surgery ?

Depending on the type of surgery, various examinations can be made about the age of the patient, his/her other diseases, drugs used by the patient if deemed necessary. Especially, it is of utmost importance that you should inform your doctor about all the drugs you use and follow his/her advices about the types of drugs. Before or after being taken into the operating room some drugs may be implemented to the mouth, arm or hip. You should not drink or eat anything at least 6 hours before the surgery. It would be good if you come with an attendant to support you. You will need to remove your make-up and wear off your jewelry. Enlargement of the pupil and reddening of the eye may emerge because a series of eye drops will be dripped to your eye.

Is the patient anaesthetized during the surgery ? 

In Cataract surgery general anesthasia (in a completely narcotized state) is commonly preferred for children. Another option is the local anesthesia implementation in which the eye contour is given injection. Without using injection, narcotizing the eye by only using drops (topical anesthesia) is possible. This anesthesia is implemented in the conditions where the patient has a good adaptation.

How is Cataract surgery implemented ?

katarakt-tedavisiAfter the eye is narcotized for the surgery, depending on the chosen method, firstly the front membrane of the lens is opened by penetrating the intraocular layer and the section containing cataract in its lair is extracted by either as a hole or by splitting it into pieces. Only the membrane of the lens is left inside. Again, it should be stated that depending on the age of the patient, condition of the eye and the type of surgery, lens implantation operation can be performed. In some cases (ex. Children under the age 1) the lens may not be implanted. Sometimes due to the sequence of the surgery and  the condition of the eye, the lens may not be implanted or this operation may be suspended until the second surgery. In some cases there may be a need to use lenses in different types (the ones requiring suture to the eye wall, attachment to the colorful side) other than the planned ones. When such cases happen the surgeon will decide the best option for you.

Is there a need for post operative care ?

The eye is generally bandaged after the surgery. This bandage should be kept during the time period recommended by the doctor. No pressure should be applied to the eyes and they shouldn’t be rubbed after the surgery. You can start taking your nutrition and drugs by considering the advices of the clinic nurses and doctors. Ask your doctor before washing your face, having a shower, moving an object, performing prayer (salaat), doing sports, beginning to the work, getting in the sea or a pool.
The drugs given after the surgery (drop, pomade, tablet, syrup etc.) should be used in the time period and the method quoted by your doctor. Do not change, stop or reduce your drugs frequency without consulting your doctor. Before using the given drops and pomades the person applying them to the eye should absolutely wash his/her hands using soap. While applying the drugs the edge of the dropper or of the pomade box should not get in contact with the eyelids, eyelashes, skin, hand, paper, and napkin. The first day, the first week and the first month after the surgery are the times when examinations are made. In this time period both the eye is recovered and it is protected from an infection. Please pay attention to the warnings by the doctor about the tracking time and the checklist. Does reading after the surgery harm the eye? Reading will not harm. To read, you can use your previous glasses if they help. However there might be a feeling of uneaseness and tiredness on your eye right after the surgery. Watching T.V is less tiring and it is not harmful to the eyes. Glasses after the surgery, for seeing the distant and the closer objects are arranged for a convenient time considered by your doctor.

What kind of changes happen to the people who had a cataract surgery?

It is also another subject that people wonder whether the cataract surgery limits them somehow. After the operation, people who could obtain the vision stated by the law can get a license and drive. They can do sports which does not require contact. They only can not become police or soldier.

Can cataract emerge again ?

 Those who had cataract surgery will never have cataract again. The membrane planted inside the lens during the operation may become opaque with time. Although this is named as “secondary cataract” by the public, it is not actually cataract. This formation can be treated by laser easily. In rare conditions which the membrane gets too thick, or for children it might be necessary to clear by surgery.