Cataract surgery

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Cataract surgery

You are welcome to call into our clinic for a comprehensive leaflet on cataract. It goes without saying that we will be more than happy to post one out to you as well.

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What is cataract?

When your ophthalmologist tells you that your eye is showing signs of cataract, it basically means that he has noticed a clouding in your eye’s lens. The vision of patients suffering from cataract can be compared to what you would see if you were looking through frosted glass or through a waterfall. The word “cataract” has been derived from the Greek for “waterfall”. At the onset of cataract, reading can become easier though long-distance vision deteriorates. You can see things less clearly and colours seem to fade. Contrasts become less pronounced and at times you will suffer from double vision in the affected eye. Sometimes you may find it harder to see properly in strong sunlight or at dusk.

Who suffers from it?

WHO SUFFERS FROM IT? This brown cataract, as it is known colloquially, usually manifests itself in people from the age of 65 upwards but youngsters and children can also develop cataract. If you have been diagnosed with cataract you will have to undergo a number of tests to establish the underlying cause of the problem. Cataract can be caused by:
• Diabetes, endocrinological complaints
• Extended Cortisone treatments
• Hereditariness
• Trauma, for instance following a fall or a blow to the eye
• Eye diseases such as glaucoma or inflammation of the iris
• Previous eye surgery

Preliminary examination

First of all, you will be given a comprehensive eye examination in which not only your eye pressure and retina are checked but also the strength of the implant (cf. IOL master) and the quality of your cornea (cf. specular microscopy) are determined. You will also be given a retinal examination (cf. OCT) which allows us to study your macula.
Our secretariat will hand you our report which you must then take to the Ophthalmological Centre (1st floor), located on the campus of the Volkskliniek AZ-St Lucas [St. Lucas General Hospital]. You are permitted to have a light breakfast and to take your normal medication. Just make sure not to wear any make-up on the day of your surgery. As the procedure is performed under topical drop anaesthesia and as there is no blood whatsoever involved there is no need to discontinue your anticoagulant or aspirin treatment.

The procedure itself

The cloudy lens is replaced with an artificial lens, also called an implant. This is done on an outpatient basis, so you will only have to spend about two hours in the hospital. We would advise you not to travel on your own. The procedure itself is performed under local anaesthetic, administered in the form of drops, dispensing with the need for injections around the eye or a general anaesthetic.
You will be put on a drip and a heart monitor and will be given a little oxygen via the nose to ensure that you will be able to breathe comfortably during the procedure.
This procedure, which takes about 10 to 15 minutes, is completely painless. As the ophthalmologist will explain to you, the noise you will be hearing during the procedure is merely the sound of the lens being aspirated. As the incision in the cornea only measures 2.2 mm, no suturing is required.

Equipment

The technique used is called phacoemulsification (phakos = lens and emulsification = destruction by means of ultrasound waves). The lens itself is removed by means of Alcon’s latest Infiniti-Ozil technology (which has only been available since January 2007). In this technology, a torsional movement of the phaco tip is used to shatter the lens by means of ultrasound.

Choice of implants

1. A lens designed to give you excellent long-distance vision through reading glasses will still be required. Once your original lens has been removed, it is replaced by an acrylic implant lens. This flexible lens is injected into the capsular bag through a 2.2 millimetre aperture, by means of an injector. The incision does not require any suturing as it is minuscule and waterproof. Once the procedure is completed, antibiotics are applied to the eye to prevent any infections.
2. If you would like to correct both your long and your short-distance vision, we can offer you an accommodative lens, i.e. a multifocal lens, implant. (Proceed to prelex for further information)

Following the procedure

As soon as the procedure is finished, disinfectant drops will be put into your eye and you will be given a protective eye shield. Then, you are free to return home again. That evening, you will have to apply drops to the eye in question as specified on the chart your doctor will give you. You will need to keep the eye shield in place until the next morning.

Follow-up visits?

The day after the procedure you will have to go to our surgery in Latem for a follow-up visit. One day after the operation, you may resume all your daily activities, including bending and watching TV. However, you will have to apply antibiotic and anti-infective drops for 4 weeks. We would recommend that you continue to wear the protective eye shield in front of the eye you have just been operated on at night for the first week. One week after the procedure you will have to come for a second follow-up visit to make sure that you haven’t contracted any infection. Four weeks after the procedure, we will need to see you for a final check-up during which we can prescribe you reading glasses, if required.

When can I have my second eye operated on?

If your second eye has also been affected by cataract we will generally give you a second appointment when you come for your first follow-up visit. Normally speaking, your second eye can be operated on one week after the first eye.

Results and complications

Cataract surgery is not only the most common of all medical procedures in humans but it also has the highest success rate. More than 99% of patients notice a marked improvement following the procedure. The main possible risk of the procedure is an infection (occurs in less than 1 in 2000 operations) which can generally be sorted out with a course of antibiotics or by surgically removing the vitreous humour from the eye (vitrectomy). On occasion, a slight tear may arise in the posterior lens capsule, causing the procedure to take a little longer as the corpus vitreum will need to be rinsed. In that case, sight recovery may take a little longer. The most frequent complication is the occurrence of secondary cataract which means that vision becomes blurred again after a number of months or years. This is caused by the opacification of the posterior lens capsule (< 5% in the case of acrylic implants). Treatment is straightforward and is performed by means of a Yag laser. This is a one-off, painless procedure which is performed at the clinic and only takes a few minutes, after which sight fully recovers again.

Cost

The bulk of the fees for the preoperative examinations and the follow-up visits and tests are refunded by the National Institute for Health and Disability Insurance (RIZIV – Rijksinstituut voor Ziekte- en Invaliditeitsverzekering). Some two months after the procedure you will receive an invoice from the hospital at home. You will have to pay an additional fee of about € 400 for the normal procedure involving a standard lens. Fees for progressive and accommodative lenses are slightly higher. Please do not hesitate to contact our secretariat to enquire about our current fees.

Summary

Cataract surgery by means of phacoemulsification under local anaesthetic is an effective and safe technique. The results are predictable thanks to a meticulous preoperative examination performed with the latest diagnostic equipment. Because there is only a tiny incision involved no suturing is required.
Patients cannot only see clearly the very next day but can even resume their daily activities. This means that attending the follow-up visits unaccompanied is not an issue. Currently, both long-distance and short-distance vision can be corrected although these implant lenses are more expensive.