Cataract • lens extraction • lensectomy • customised lens implants • laser vision correction and enhancement • cataract surgery after laser vision correction • glaucoma and cataract • Parramatta
Thomson, Sumich, Lim and Associates
Hunter Street Eye Specialists
Parramatta, Sydney

FAQs

What is a cataract?
A cataract is the clouding of the natural crystalline lens of an eye. A young lens is clear and free of opacities. With age, the lens begins to opaque and impairs vision by scattering or obstructing the normal passage of light. This lens is then called a “cataract”.

What are the symptoms of cataract?
Cataract can reduce the vision and cause clouding of your vision. Cataract may cause other symptoms such as reduced night vision, glare in sunlight and a change in colour perception; cataract can also cause halos around lights. Sometimes cataract can change your refraction, that is, it may make your current glasses not to be any good. When cataract is severe, reading becomes difficult. Cataract does not cause pain.

What is the treatment for cataract?
Early cataracts may simply require a change in your glasses. As the cataract advances, this will not be sufficient and cataract surgery will be required. Cataract surgery is one of the most frequently performed surgeries in Australia. Cataract surgery is a day only procedure, performed under local anaesthesia. The vast majority of cataract surgeries are successful and lead to restoration of normal vision.

What does cataract surgery involve?
Cataract surgery begins with a small incision of less than 3 mm into the cornea. The pupil is dilated with eye drops prior to the surgery. The cataract has a natural covering called a lens capsule and this is then incised to access the cataract. The cataract is cut up into small pieces and then removed by using ultrasound; this is called “phacoemulsification”. Because the cataract is your lens, it must be replaced and this is the lens implant. The lens implants are made of various materials such as acrylic, silicone and PMMA (plastic). These days we favour the lenses with an ultraviolet filter which protects your retina from harmful UV light and makes you about 25 years old, again! The lens is injected into the eye through the small incision and no stitch is required, most of the time.

What anaesthesia is required for cataract surgery?
In the past, cataract surgery was performed under general anaesthesia but this is almost never required now. Anaesthesia to numb the eye in a number of ways including peribulbar (sharp injection around the eye), sub-Tenon’s (blunt injection around the eye) and topical (just drops); intravenous sedation is also given to relax you. We favour sub-Tenon’s injection for cataract surgery for its level of patient comfort and safety.

Can I be free of my glasses after cataract surgery?
When cataract surgery is performed, an individualised measurement is performed prior to the cataract surgery, called biometry. This is a measurement to work out what power lens to insert into your eye. Every eye receives a tailored intraocular lens. The lens chosen for you should give you very good distance vision and some intermediate vision. Glasses may still be required for some tasks.

The cataract surgery can be a vision correction procedure. It can both equalise long-sightedness and short-sightedness. That is that with cataract surgery we can get the light to focus much closer to the retina than when you had your natural crystalline lens. We now have the lens technology to reduce astigmatism, as well. We insert “toric” lenses to reduce astigmatism in many of our suitable patients. Astigmatism arises when your cornea, the front window of your eye, is shaped more like a rugby ball than a basketball. Because of the differing curvature in the two axes, light entering the eye focuses in two places and not one. A toric lens can abolish or reduce this and bring the two foci back together again. You will notice this a better vision without glasses after cataract surgery.

We use state of the art technology to work out if you are suitable for a toric lens. This involves taking a scan called an “Orbscan” to study your astigmatism and to ensure that the cornea is the cause of the astigmatism.

Complete independence from glasses is sometimes seen after cataract surgery; more often people can get around mostly without glasses but use glasses for some activities such as reading.

How successful is it?
It is an excellent operation but a real one. It has a very high rate of success but we must all keep in mind that it is a real operation with inherent risks such as bleeding, infection and other risks involving the structures within the eye: the cornea, lens and retina.

Recovery from surgery is rapid with some patients seeing well enough to drive the next day. Complications that can affect the vision occur rarely and this can be discussed in greater detail with your ophthalmologist.

What do I have to do on the day and after?
The cataract surgery in a day procedure, in fact, it is usually just half a day. Someone should accompany you to the day surgery as you will have some sedation. The eye is usually patched and so you will not be able to drive yourself home. Paracetamol can be used if there is eye discomfort but this is often not necessary. Most people are quite comfortable after cataract surgery.

You are examined the following day after cataract surgery and then a couple of times in the following month. Drops are given to reduce infection risk and to reduce post-cataract surgery inflammation. Glasses are changed about a month after cataract surgery to give you the best result.

The intraocular lens, once inserted, is very stable. Apart from vigorous rubbing, it will not dislodge the intraocular lens from its position. We still advise people to take it easy for the first couple of weeks. The second eye is done separately, usually with a few weeks between the two procedures.

What about refractive lens removal (clear lens extraction, refractive lensectomy)?
Refractive lensectomy is a vision correction procedure that can be performed if you are not suitable for other laser vision correction procedures. It is the same procedure as cataract surgery, except for the fact that the lens that is taken out is clear and not cloudy. For this reason the other name for this procedure is “clear lens extraction”. An intraocular lens is inserted just like with cataract surgery and as for cataract surgery, toric lenses can be inserted if there is significant astigmatism.

What do I do if I am interested?
Please ring us and see one of our cataract surgeons for an assessment.