Cataract: Symptoms, Causes, Operation, Convalescence and Cost

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What is Cataract

A cataract is the clouding of a lens (the crystalline lens) inside the eye. Cataract surgery consists of replacing the cloudy crystalline lens with a new transparent lens. The crystalline lens is a lens that allows images to be focused on the retina, over time the crystalline lens becomes opaque and cataracts occur. Depending on the type of opacity, different types are distinguished:

The Different Types of Cataracts

Nuclear: it is characteristic of adulthood in which the central part of the lens is opaque, precisely it is the nucleus of the lens that loses transparency. Cortical: involves the external part of the lens, it can also develop following trauma. Posterior Subcapsular: affects only the posterior part of the lens and is typical of those who have used Cortisone for a long time in eye drops or generally. Pseudoexfoliative or PEX: this cataract exfoliates, that is, it loses part of the external layer (the capsule) over time. This is associated with the risk of developing another eye disease called Glaucoma and increased risks of complications during cataract surgery. Secondary: it is the opacity of the posterior capsule where the artificial lens inserted into the eye during the first cataract surgery is housed. It therefore occurs only after cataract surgery (from 1 to 5 years later) and does not require intervention in the operating room but is treated with a simple laser treatment called Yag Laser Capsulotomy.

Cataract Symptoms

The most important symptom is a progressive loss of vision. Initially the visual discomfort is modest because the clouding of the lens can be limited to small areas but as time passes the following symptoms appear:

  • Blurred vision
  • High sensitivity to light with sensations of glare (illuminated objects seem surrounded by halos, discomfort in sunlight)
  • Reduced visibility at night
  • Decreased image contrast ( colors appear faded )
  • Change in myopia, astigmatism or hyperopia.

Cataracts do not cause pain. The appearance of these symptoms can also be a warning sign of other eye-related diseases, we recommend that you consult your ophthalmologist for a more in-depth diagnosis.

Causes and Prevention of Cataracts

The causes

The causes of cataracts include familiarity and then a series of specific factors such as:

  • The age
  • Unprotected exposure to ultraviolet rays
  • Eye trauma
  • The use of drugs such as cortisone (posterior subcapsular cataract)
  • Systemic diseases such as diabetes
  • Ocular diseases such as glaucoma and high myopia can predispose to the formation of cataracts.

In the case of cataracts and glaucoma, as in the case of cataracts and myopia, we find ourselves faced with very particular combinations where cataract surgery often allows the other pathology to be improved as well.

Prevention

There are some simple rules that allow you to slow down the onset of cataracts. This is particularly important for those most at risk such as those who have family members affected by cataracts at a young age, those who have glaucoma, uveitis or other eye diseases that require chronic therapies, those who suffer from diabetes or need to use cortisone-based therapies. All these people at risk of developing cataracts early should follow these tips:

  • Use sunglasses outdoors
  • Not smoking
  • Have a diet rich in antioxidants (so colorful fruit and vegetables, fish, olive oil)
  • Use adequate protection from the blue light emanating from PC, tablet and mobile screens.

In the past, eye drops were prescribed to slow the progression of cataracts. Today this practice has been abandoned because it has proven to be ineffective. In any case, after the age of 60 it is advisable to undergo an ocular examination with pupil dilation at least every couple of years. This test will allow you to discover the first signs of eye diseases (Glaucoma, Maculopathy, etc) in order to allow early diagnosis and adequate and timely treatment.

Cataract Surgery

The only proven effective treatment for cataracts is surgery. Today the operation is not painful or invasive and has an extremely rapid recovery thanks to the help of the most innovative technologies.

During the operation the cataract is fragmented using a laser device (FemtoLaser) or a sophisticated ultrasound instrument (phacoemulsifier) and aspirated. In its place, an intraocular lens, also called artificial lens or IOL (Intra-Ocular-Lens), is inserted inside the eye. Choosing the most suitable intraocular lens for each eye is essential for the good outcome of the surgery. The operation is performed in an operating room equipped for eye surgery. The patient usually arrives about an hour before the operation and is prepared with drops to dilate the pupil. He then enters the operating room where he is made to lie down on a bed and after careful disinfection of the eye to be operated on, it is covered with a cloth to maintain the sterility of the operating field. The operation, which lasts about ten minutes, begins with a micro-incision on the cornea of 1.8-2.2 millimetres. Subsequently, the capsulorhexis is performed, i.e. the removal of the anterior capsule, the capsule would be the bag that contains the cataract. The Phacoemulsifier is introduced through the capsulorhexis which allows the fragmentation and aspiration of the cataract. The next step is the introduction of an intraocular lens (IOL) inside the capsule. The new minimally invasive surgery allows you to completely free yourself from glasses through the use of cutting-edge intraocular lenses that allow you to simultaneously eliminate cataracts and other possible vision defects: myopia, astigmatism, presbyopia or hyperopia. The choice of the correct intraocular lens is of fundamental importance for the complete success of the operation. The intraocular lens best suited to the characteristics of each eye can only be identified through accurate diagnostic tests and the great experience of the ophthalmologist. For over ten years in our Advanced Ophthalmology Clinic in Milan and Catania the most innovative intraocular lenses have been implanted for the treatment of myopia, astigmatism, hyperopia, presbyopia and maculopathy as testified by many patients in the testimonials section.

Cataract surgery with FemtoLaser

Cataract surgery has also made use of laser technology for about ten years. This is the Femto-Laser which was previously used for refractive surgery, i.e. surgery for Myopia, Astigmatism etc. The introduction of the laser for the operation is aimed at increasing precision, making this surgery even more precise. Intervento Cataratta Cataract surgery with the FemtoLaser has as its main advantage the possibility of performing a phase of the surgery very precisely: the capsulorhexis. The capsulorhexis consists in the opening of the capsule that contains the lens. The capsulorhexis done properly, obtained by an expert surgeon or through the use of the FemtoLaser, allows the use of innovative intraocular lenses. The Femto Cataract operation (this is what the operation using the FemtoLaser is called) is particularly useful in complicated cases such as complete white cataracts or pseudoexfoliative or PEX cataracts or cataracts associated with a fragile capsule. In the most common cases, the added value of the Laser clashes with an increase in the operating time and often requires moving the patient from one operating room to another. Therefore the use of laser for cataracts remains limited and by far the most performed operation remains phacoemulsification. A clinical study has recently been published in the prestigious Lancet journal which demonstrates the equivalence of the two techniques Laser and Phacoemulsification for cataract surgery.

Innovative Intraocular Lenses

The most important innovations in cataract surgery are the new intraocular lenses.

The most common intraocular lenses are made of acrylic plastic material, but there are also some made of silicone, and a material called PMMA (PolyMethylMetaAcrylate). It is not so much the material that composes them but rather their shape that gives intraocular lenses different characteristics. Today there are various types, including customizable ones, which are modeled on the characteristics of each eye, thus also allowing the correction of small individual defects ( Hi Tech intraocular lens). Let’s discover the different Intraocular Lenses together:

In the Testimonials section you will find the stories of patients operated on with the most innovative intraocular lenses.

When to operate on cataracts?

The operation today is performed when the quality of vision is not satisfactory for the patient’s needs. It is no longer necessary to wait until the cataract is “mature” to operate, it is better to have the operation when you realize that you can no longer see well to carry out the tasks and activities that interest you. Today the operation is minimally invasive if it is performed with the most modern techniques in a cutting-edge center. Visual recovery is almost complete in 24 hours. If you are over 50 it may be advisable to have cataract surgery also to remove glasses from near and far. Today, thanks to the most innovative intraocular lenses, after surgery you can get rid of myopia, astigmatism and presbyopia.

When not to operate on cataracts?

In young patients up to 40 years of age it is advisable to postpone cataract surgery if there is no significant reduction in vision because the ability to accommodate is lost with the operation. That is, focusing far and near, typical of people under 40. In the presence of other ocular diseases such as glaucoma and maculopathy, the possibility of cataract surgery must be evaluated with caution. The expert ophthalmologist will be able to advise you.

Convalescence and Complications

Convalescence after cataract surgery

Today after minimally invasive cataract surgery under topical anesthesia the convalescence is as follows:

  • the patient is discharged without a bandage approximately one hour after the operation
  • you feel a slight discomfort as if shampoo had entered your eye for 4-5 hours
  • you start to see better after 4-5 hours
  • the first following day you can see well and have no discomfort
  • watching television, using the computer and driving is possible from the day after cataract surgery. It is always a good idea to ask your ophthalmologist for the check-up performed the day after surgery

  • not lifting weights for a week is appropriate
  • Abstaining from sports for a month is advisable
  • not touching the operated eye for a week is essential
  • it is good practice not to sleep on the side of the operated eye for a few days
  • taking a shower, washing your hair, taking care not to get soap or shampoo into your eyes is possible after the first two days.

Complications Cataract Surgery

The most feared complication, although very rare, is infection. In the first days after the operation the risk of infection is still high. Therefore the patient will have to respect exactly the deadlines set by the ophthalmologist for check-ups and carry out therapy with antibiotic eye drops. In the event of the onset of any visual disturbance, extraordinary check-ups are necessary. Even an infection – if discovered immediately – can be treated in the best way. It is good practice not to touch the operated eye for the first few days and to use good hygiene rules to avoid the risk of an infection which can be particularly serious after surgery. Another fearful complication can be retinal detachment, especially in highly myopic subjects. If not treated promptly, retinal detachment can lead to vision loss. To avoid this complication, it is good practice to carry out a thorough examination of the retina before surgery and, where risk factors are present, intervene before surgery to strengthen the retina with a Laser Photocoagulation treatment of the retina. In any case, the appearance of flashes of light, cobwebs or black midges moving after cataract surgery must immediately lead to a thorough check of the retina by the treating ophthalmologist. Another serious complication can be an eye hemorrhage during or shortly after surgery. This is a hemorrhage inside the eye that is not visible to the naked eye from the outside. This type of hemorrhage should not be confused with the more common subconjunctival hemorrhage – a red, bloodshot eye – which is not a sign of danger. To reduce the risk of hemorrhage during surgery, it is good practice to suspend antiplatelet and anticoagulant drugs in therapy after consulting with a specialist and to keep blood pressure under control with appropriate antihypertensive therapies. On the day of surgery it is essential to take the blood pressure pill if you use it routinely. Another complication is Secondary Cataract which occurs in all people who have undergone cataract surgery.

Secondary Cataract

Why does secondary cataract occur?

With cataract surgery, the opaque lens is removed and an artificial lens is inserted in its place in the bag that contained it. Over time, this bag containing the artificial lens can become opaque, resulting in the so-called secondary cataract. It takes a variable time between 1 and 5 years after surgery before secondary cataracts are observed. It usually occurs earlier in young subjects than in elderly subjects.

How is secondary cataract treated?

Secondary cataracts are treated with an outpatient laser treatment called Yag Laser treatment. There is no need to enter the operating room. The treatment lasts a few minutes and the patient starts seeing well again a few hours after the Yag-laser treatment of secondary cataracts. It is normal to see midges moving for a few days after laser treatment of secondary cataracts.

How Much Does the Surgery Cost

Cataract surgery usually costs between 2,500 and 4,000 euros all inclusive. Price changes are linked to several factors:

  1. Instruments and materials used to remove cataracts (Operating Microscope, Phacoemulsifier, FemtoLaser, etc.)
  2. The Intraocular Lens that is implanted inside the eye during surgery. The cost of intraocular lenses varies greatly, ranging from 50 euros for a basic lens made in developing countries (India, China etc.) to 3000 euros in the case of sophisticated intraocular lenses
  3. The co-presence of other eye diseases such as glaucoma, maculopathy, guttate cornea, myopia or high astigmatism usually requires the use of additional instruments and this can increase the cost of cataract surgery
  4. The eye clinic accounts for approximately 30-50% of the overall cost based on the hotel comfort offered, the location and the type of hospitality offered
  5. The operator’s experience.

The cost of the surgery can be paid in the following ways:

  1. The National Health Service (NHS) pays the cost of the operation in public hospitals or affiliated private nursing homes. The NHS takes full responsibility for the operation except requiring the payment of a Ticket to the patient who is not entitled to exemption due to pathology, income or age. The NHS usually does not allow the use of more sophisticated intraocular lenses and does not allow you to choose the operator who will perform the operation.
  2. Private insurance, health funds and supplementary funds can reimburse the cost of the intervention both directly and indirectly. The Direct Formula provides for the full payment of the benefit by the Insurance without the insured having to pay anything in advance except for the payment of a ticket. With the Indirect Formula the insured pays the service and then sends the invoice to the insurance company which will provide reimbursement.
  3. Direct Patient Payment. It obviously allows maximum freedom of choice for both the operator and the instruments and intraocular lenses used. The patient will then be able to request a tax deduction for the medical expenses incurred.

We are a private eye clinic affiliated with the major private insurance companies for cataract surgery.

For further information, please contact us. The main advantage of paid cataract surgery is the patient’s freedom to choose: the doctor, the intraocular lens, the most advanced technology. The quality of vision essentially depends on the technology used, especially in the presence of maculopathy, glaucoma, corneal problems or if you want to correct myopia, hyperopia, astigmatism and presbyopia associated with cataracts.