Cataract (phacoemulsification) surgery

Definition

A cataract is the clouding of the natural lens in the eye. This scatters light rays resulting in a general dimming of vision. It can be likened to looking through a dirty camera lens. The condition is progressive, becoming worse over time as the cloudiness increases.
Cataracts are a natural part of the ageing process. About 50% of people aged 65 and over will suffer a cataract at some stage in their lifetime

Symptoms

Cloudy or blurry vision

Colours appearing faded
Frequent changes in your glasses prescription
Problems with light, such as:
headlights that appear too bright at night
glare from lamps or the sun
a halo or haze around lights, or
decreased vision in bright light

The symptoms described above may not necessarily mean that you have cataracts. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam.

Treatment

Surgery is the only way your ophthalmologist can remove the cataract.
Cataract surgery is indicated when there is visual disability preventing you from carrying out your daily activities. You and your ophthalmologist should decide together if surgery is required.
Continuity of care is crucial for patient satisfaction and to achieve optimal results. Therefore, we ensure that you are seen by Mr Ansari throughout the process of your consultation, surgery and aftercare.

You will go through a 5 step process:

Step 1. GP

You need to inform your GP that you are interested in having cataract surgery. Your GP will then send us a letter of referral.

Step 2. Consultation

To ensure your suitability for surgery, Mr Ansari will assess your general health and undertake a comprehensive eye examination. Assuming a satisfactory outcome you will be offered surgery, which can take place soon afterwards.

Step 3. The Day of Surgery

Cataract surgery with intraocular lens implant is performed on an outpatient basis (i.e. you do not stay in hospital).
As standard medical practice, the surgeon will ask you to sign an Agreement & Consent Form.
This summarizes and confirms the surgical procedure, highlights potential risks and complications and informs you of the options and alternatives available to you.

Preparation

You will be given a local anaesthetic so that you will not feel anything. This may be in the form of drops to the eye or an injection around the eye. The area around the eye is cleansed and your face covered with a sterile drape. You can usually remain in your own clothes throughout the procedure and walk into and out of the theatre (ambulatory care).
Following treatment

After the operation you will need to rest at the clinic for about an hour. Medical staff will give you some eye drops and explain how to use them and clean your eye. You will also be given written instructions to take home and a clear shield to cover the treated eye for 24 hours after the operation. You can then leave the clinic.
You will need to be accompanied home. You will also need someone to bring you to your aftercare check-ups.

Step 4. Aftercare

You will have a check-up with Mr Ansari one week after surgery. Sometimes he may want to examine you the day after the operation especially if you have other conditions such as diabetes, glaucoma or uveitis.
After cataract surgery, you may return almost immediately to all but the most strenuous activities. Mr Ansari will assess your individual needs.
Most patients need to use eye drops 4 times a day for the first week and then tail off the frequency of drops over the next 2 to 4 weeks.

Step 5.

Arrangements can be made to have your second eye treated if necessary.

CATARACT SURGERY- PHACOEMULSIFIACTION AND INTRAOCULAR LENS IMPLANT

The operation takes approximately 10-15 minutes. The eyelid is held open with a lid guard and surgery is carried out under the microscope while you are fully awake. Stitches are not normally necessary.

The most common and advanced cataract surgery technique is phacoemulsification or "phaco."

• The surgeon first makes a small incision at the edge of the cornea (figure 1) and then creates an opening in the membrane that surrounds the cataractous lens (figure 2). This thin membrane is called the capsule.
• Next, a small ultrasonic probe is inserted through the opening in the cornea and capsule (figure 3). The probe's vibrating tip breaks up or "emulsifies" the cloudy lens into tiny fragments that are suctioned out of the capsule by an attachment on the probe tip.
• After the lens is completely removed, the probe is withdrawn leaving only the clear (now empty) bag-like capsule, which will act as support for the intraocular lens (IOL).

	Figure 1: small incision at edge of cornea
	Figure 2: Opening made in lens capsule
	Figure 3: Cataractous lens being removed
	Figure 4: Clear IOL in place

It is possible to implant a multifocal lens which helps to focus for both near and distance.
Your ophthalmologist performs this delicate surgery using a microscope, miniature instruments and other modern technology.

LATEST ADVANCES IN CATARACT SURGERY

Local anaesthesia using drops only
Small incision of 3mm- no stitch required and faster healing and visual recovery
No patch required after surgery
Phaco-refractive surgery- corrects astigmatism to sharpen the image further

ALL THESE REFINEMENTS ARE AVAILABLE ROUTINELY