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What is Cataract
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Cataract refers to the clouding of the native lens of the human eye. This occurs with aging, and may present earlier in some individuals such as diabetics and patients on long-term steroid use.
Symptoms and Causes
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What Are The Symptoms?
Patients most commonly experience slowly progressive, painless blurring of vision. One eye may also be more affected than the other.
Some signs of cataract include:
Cloudy, blurry or foggy vision
Dimming of vision
Loss of colour vibrancy
What Causes Cataract?
Ageing is the most common cause of cataract. Most forms of cataract develop in the adult life. As we age, the protein in our lens may gradually change shape and clump together to cloud the lens. The lens becomes thicker, less transparent and yellowish.
Other Risk Factors include:
Excessive exposure to ultraviolet (UV) radiation
Prolonged use of drugs
Previous eye injury or trauma
What Can I Do To Prevent Cataract?
There is no known prevention for cataract. However, standard precautions such as reducing sunlight exposure (ultraviolet rays) may slow down its progression.
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What Treatment Is Available For Cataract?
Early cataract is managed conservatively, and patients are usually prescribed glasses to aid their vision. When cataract affects one’s vision significantly, or in some individuals who may have other eye problems, cataract is managed by the surgical removal of the lens (cataract extraction surgery).
When Do I Have To Remove My Cataract(s)?
Cataract surgery is recommended when visual impairment affects activities of daily living (dressing, navigating, cooking, showering, etc., or when patients have challenges with their vision as the cataract becomes more severe. There is no absolute cut-off age for cataract surgery.
What Happens If I Leave My Cataract(s) Untreated?
Cataract(s) cause progressive loss of vision and eventually reversible blindness if left untreated. In uncommon circumstances, it may lead to acute angle closure.
What Are The Different Types Of Cataract Surgery?
The most common form of cataract surgery is phacoemulsification. The procedure takes about 20-minutes and can be performed under local anesthesia as a day surgery.
Patients with more advanced cataract may undergo a more traditional surgery known as extracapsular cataract extraction (ECCE). This surgery is about half an hour long and requires a larger incision. Visual rehabilitation will take longer and sutures may need to be removed about one to two months after surgery.
Cataract surgery involves removing your existing lens and replacing it with an intraocular lens with
refractive power correction. Typically, a monofocal lens which corrects vision for distance only is used.
What Are Some Important Pre-operative Information Required?
You MUST inform your surgeon if you had laser refractive surgery performed (e.g. LASIK, PRK, epi-LASIK, SMILE) previously. Please bring along records of your previous treatment. This information is very important in ensuring accurate IOL calculation.
You will need to stop wearing contact lens (at least one week for soft lens and at least two weeks for hard lens) prior to undergoing IOL calculation for surgical planning.
What Happens After Cataract Surgery?
Cataract surgery is done as a day surgery procedure. Patients are usually discharged home on the same day, a few hours after surgery. They would be started on an eye drop and reviewed in the clinic one day, one week, and one month after the operation. Patients who undergo ECCE may require suture removal one to two months after the surgery.
After the operation, patients are given an eye shield to be used when sleeping. Patients are advised not to rub their eyes and to keep their operated eye clean and dry.
Will I Benefit From Femtosecond Laser Surgery
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What Is Laser-Assisted Cataract Surgery?
Femtosecond laser-assisted cataract surgery (FLACS) is the latest form of cataract extraction surgery where a precise laser replaces some, but not all, steps of standard phacoemulsification. The laser creates an opening in the anterior lens capsule, and softens the lens nucleus. It aims to reduce damage to the inner surface of the cornea and increase precision of intraocular lens placement.
The laser would firstly be performed at a separate machine, before the patient is transferred to the surgical bed for completion of the cataract surgery. Your surgeon will need to evaluate your suitability for this procedure.
Would I See Better After FLACS Compared To Phacoemulsification?
There are many factors affecting visual outcome after cataract surgery. They include the amount of spectacle power correction after surgery, the amount of inflammation and the wound healing process. It would be best to discuss this with your eye doctor.
What Are The Additional Risks Of FLACS?
The complications of FLACS is similar to that of standard phacoemulsification in major clinical trials (Abell et al, 2014; Daya et al, 2014). Risks include anterior capsule tear and tags, which increase the risk of posterior capsule rupture. After the surgery, there may be swelling of the back of the eye (macula edema) or raised intraoperative pressure.
Who Should Consider FLACS?
FLACS may be beneficial for patients with less healthy corneas; it is not currently recommended as a standard procedure for all cataract surgeries (Day AC et al, 2016). The decision for FLACS should be discussed with your eye doctor.
Chen X, Xiao W, Ye S, et al. Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis of randomized controlled trials. Sci Rep. 2015 Aug;13;5:13123.
Conrad-Hengerer I, Al Juburi M, Schultz T, et al. Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up. J Cataract Refract Surg. 2013 Sep;39(9):1307-13.
What Intraocular Lenses Are Suitable For Me
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What Are Intraocular Lenses?
Intraocular lens (IOL) focuses light beams onto the retina so that distant objects appear sharp without glasses. It is placed into the capsular bag at the end of cataract surgery.
What Are The Different Types Of Intraocular Lenses?
Standard monofocal lens corrects for distance vision. However, reading glasses will still be required for near vision.
Monovision is a form of presbyopic correction whereby one eye is corrected for distance and the fellow eye corrected for near vision. This allows for spectacle independence in selected patients. However, fine depth perception may be compromised.
Multifocal IOL reduces spectacle dependence by correcting for both distance and near vision in both eyes.
However, these IOLs may be associated with increased glare and haloes and reduction in contrast. There are rare instances that a second procedure may be necessary to refine the refractive correction. Multifocal IOLs are generally not recommended if you have had previous refractive surgery.
Some patients may have high corneal astigmatism that requires correction. Standard IOLs do not correct for astigmatism. Residual astigmatism can be corrected with the use of glasses post-operatively, corneal incisions or with toric IOL. Toric IOL aims to reduce the residual astigmatism. There are rare instances that a repeat surgery may be required to adjust the IOL rotation.
What Are Some Questions To Consider In Deciding My Preferred Choice Of IOL?
Do you mind wearing glasses (for distance and/or near)?
Do you hope to be spectacle-free?
Are you very sensitive to glare and haloes?
Do you do a lot of reading or computer work?
Would I be suitable for monovision?
What are my hobbies?
To Find Out More Information:
Book an appointment with NUH Eye Surgery Centre for a comprehensive eye check-up and recommendations for your individualised treatment plan.
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Associate Professor Clement Tan
Associate Professor Paul Chew
Clinical Associate Professor Caroline Chee
Associate Professor Lingam Gopal
Dr Anna Tan
Dr Chan Hwei Wuen
Dr Charmaine Chai
Associate Professor Chelvin Sng
Dr Dawn Lim
Dr Gangadhara Sundar
Dr Hazel Lin
Dr Loon Seng Chee
Dr Paul Zhao
Associate Professor Ray Manotosh
Dr Su Xinyi
Associate Professor Victor Koh
Dr Vivien Lim
Dr Yuen Yew Sen
Dr Janice Lam
Dr George Thomas
Dr Katherine Lun
Dr Marcus Tan Chun Jin
Dr Lai Yien
Dr Sun Chen-Hsin
Dr Blanche Lim
Dr Lennard Thean (Visiting Senior Consultant)
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