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Cataract Surgery: What You Need To Know

Contents
1. Cataract Surgery in a nutshell
2. How safe is cataract surgery, and how good is it?
3. Here is more information on the 3 types of Cataract Surgery
4. Which procedure is best?
5. Phacoemulsification (Phaco): The Gold Standard
6. Intraocular Lenses (IOLs) are essential in every cataract surgery

Cataract Surgery in a nutshell

Once you have a cataract that is causing vision problems, the only way to improve vision is to have the cataract surgically removed.
The surgery is an outpatient surgical procedure performed in an operating theatre under sterile conditions. The cataract is removed either through a small incision with ultrasound (phacoemulsification), a larger traditional incision (extracapsular cataract extraction) or with the help of a laser (femtosecond laser-assisted cataract surgery). Following removal of the cataract, an intraocular lens (IOL) is inserted into the eye. Antibiotics are instilled at the end of the surgery.

How safe is cataract surgery, and how good is it?

Cataract surgery is a very safe, successful and life-changing operation. Millions of people around the world have benefited from it. The success rate is at least 95%. As with any surgical procedure, complications can occur during or after the surgery. Fortunately, serious side effects that result in loss of vision are rare. Most patients have their vision restored after the surgery and their quality of life enhanced.

Here is more information on the 3 types of Cataract Surgery

Phacoemulsification (Phaco). This modern method is commonly but mistakenly known as the “laser” method. A small incision is made in the eye. A special device utilizing high-frequency ultrasound energy is used to soften and break down the cataract so that it can be removed.
Femtosecond Laser-assisted cataract surgery (FLACS). In conventional “phaco” surgery, the surgeon uses a blade to enter the eye through a small wound and ultrasound to break down the cataractous lens. In the femtosecond laser method, no blade is used. Instead, the surgeon uses a femtosecond laser to create the wound and facilitates the removal of the cataract. The surgery is subsequently completed with the ultrasonic removal of the lens material in the usual manner.
Extracapsular cataract surgery (ECCE). This is an older method whereby a larger incision (wound) is made in the eye. The central part of the cataract (the nucleus) is then removed in one piece through the wound. In view of the larger wound, suturing is required (usually 6-7 stitches are used) and therefore the recovery time is longer. This form of cataract surgery is not routinely offered, but some very dense and complicated cataracts may have to be removed by this technique.

Which procedure is best?

Your eye doctor will discuss your options and make the important decision for you.

Phacoemulsification (Phaco): The Gold Standard

Phacoemulsification is the surgical method that uses ultrasonic waves to remove a cataract. It remains the gold-standard of modern cataract surgery and is the most commonly used surgical technique worldwide.
In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye through a small incision between 1.8 to 2.75mm. The probe ‘emulsifies” or breaks up the lens nucleus, which is the center of the lens. The emulsified pieces are simultaneously removed from the eye by an aspiration system which absorbs or sucks in the pieces. Most of the outer covering of the lens (the capsule or bag) is left behind. In this capsule, an intraocular lens implant, or IOL, is placed. An experienced surgeon using state of the art phacoemulsification technology can successfully perform the surgery within 10-15 minutes. The procedure is painless, without injections and does not require stitches or sutures most of the time. Vision returns quickly and one can resume normal activities within one to two weeks. New technologies in phacoemulsification have significantly reduced the risks of cataract surgery, making cataract surgery one of the safest surgical procedures available.

A video show-casing modern day cataract surgery. Phacoemulsification with intraocular lens implantation is the procedure shown here. In this case, a monofocal lens is injected into the eye after removal of the cataract.

Intraocular Lenses (IOLs) are essential for every cataract surgery

An intraocular lens (IOL) is a tiny, lightweight, clear disc placed in the eye during cataract surgery. An IOL mimics the focusing power of the eye’s natural lens. Following removal of the cataract, if no IOL is placed in the eye, you will not be able to see, as the focusing power of the eye is lost. IOLs are routinely inserted following cataract extraction. Cataract surgery is therefore very much a procedure that replaces the aging, diseased lens in your eye with a new, well functioning artificial lens.
Unlike contact lenses, which must be removed, cleaned, and reinserted, the IOL, once inserted, remains permanently in the eye after surgery. It is designed to last throughout a patient’s lifetime.
An IOL may be placed either in front of or behind the iris, which is the colored part of the eye. Behind the iris is the most frequent placement site (posterior chamber). The IOL material can be hard plastic, soft plastic or soft silicone. The soft IOLs are foldable, and thus can be inserted through a small incision (wound). A small wound means shorter recovery time and faster visual rehabilitation.
The rapid evolution of IOL design, materials, and implant techniques have made them a safe and practical way to restore normal vision after cataract surgery. There are two main types of IOLs

  1. Monofocal IOLs are lenses that correct distance vision. They provide excellent vision for far, but glasses will be required for reading and close near work.
  2. Multifocal IOLs are lenses which correct a range of vision. They include bifocal, trifocal and extended range IOLs. Depending on the type of multifocal IOL, these can correct distance, intermediate and near vision, and reduce one’s dependence on glasses.

A video showing the implantation of a multifocal lens in the eye after removal of the cataract. The lens shown here is a trifocal lens, which gives the patient spectacle independence for far, intermediate and near distances.

Which IOL is best?

The best IOL that suits your lifestyle and visual needs will be chosen by your eye doctor.

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Eye Surgeons @ Novena, Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #09-28 Singapore 329563
Contact: +65 66940400,  eyesurgeonsnovena@gmail.com