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A cataract is a clouding of the eye's
lens that can cause vision problems. The most common type is related to
aging. More than half of all Americans age 65 and older have a cataract.
In the early stages, stronger lighting and eyeglasses may lessen vision
problems caused by cataracts. At a certain point, however, surgery may
be needed to improve vision. Today, cataract surgery is safe and very
effective. |
The lens is the part of the eye
that helps focus light on the retina. The retina is the eye's
light-sensitive layer that sends visual signals to the brain. In a normal
eye, light passes through the lens and gets focused on the retina. To help
produce a sharp image, the lens must remain clear.
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A cataract is a progressive clouding of
the eye's natural lens that hampers with light passing through to the
retina. People who suffer from cataracts usually describe the condition as
being similar to looking through mist, smoke, a cloud, a waterfall, or a
piece of wax paper, with a gradual blurring or dimming of vision.
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More than half of people over the age of
60, and quite a few younger than that, suffer from cataracts. It is said
that everyone will develop a cataract if they live long enough.
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Reading may become more difficult and
driving a car can actually become dangerous. Cataract sufferers may also be
troubled by a bothersome glare, halos around lights, or even double vision.
And as the cataract becomes worse, frequent changes in eyeglass
prescriptions may become necessary.
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Age-related cataract:
Most cataracts are related to aging.
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Congenital cataract:
Some babies are born with cataracts or
develop them in childhood, often in both eyes. These cataracts may not
affect vision. If they do, they may need to be removed.
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Secondary cataract:
Cataracts are more likely to develop in
people who have certain other health problems, such as diabetes. Also,
cataracts are sometimes linked to steroid use.
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Traumatic cataract:
Cataracts can develop soon after an eye
injury, or years later.
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Currently there is no medical treatment
to reverse or prevent the development of cataracts. Once they form, there is
only one way to achieve clear vision again, and that is to physically remove
the cataract from the eye.
Although we don't know how to protect
against cataracts, people over the age of 60 are at risk for many vision
problems. If you are age 60 or older, you should have an eye examination
through dilated pupils at least every 2 years. This kind of exam allows your
eye care professional to check for signs of age-related macular
degeneration, glaucoma, cataracts, and other vision disorders.
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For an early cataract, vision may improve
by using different eyeglasses, magnifying lenses, or stronger lighting. If
these measures don't help, surgery is the only effective treatment. This
treatment involves removing the cloudy lens and replacing it with a
substitute lens.
A cataract needs to be removed only when
vision loss interferes with your everyday activities, such as driving,
reading, or watching TV. You
and your eye care professional can make that decision together. In most
cases, waiting until you are ready to have cataract surgery will not harm
your eye. If you decide on surgery, your eye care professional may refer you
to a specialist to remove the cataract. If you have cataracts in both eyes,
the doctor will not remove them both at the same time. You will need to have
each done separately.
Sometimes, a cataract should be removed
even if it doesn't cause problems with your vision. For example, a cataract
should be removed if it prevents examination or treatment of another eye
problem, such as age-related macular degeneration or diabetic retinopathy.
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Cataract removal is one of the most
common operations performed in the U.S. today. It is also one of the safest
and most effective. In about 90 percent of cases, people who have cataract
surgery have better vision afterward.
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There are two primary ways to remove a
cataract. Your doctor can explain the differences and help determine which
is best for you:
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Phacoemulsification, or phaco.
Phacoemulsification is an advanced technique of cataract extraction. It
is also known as small-incision cataract surgery. Others call it the
"no-needle, no-stitch" technique. After application of a local
anesthetic, your doctor makes a small incision on the side of the
cornea, the clear, dome-shaped surface that covers the front of the
eye. The doctor then inserts a tiny probe into the eye. This device
emits ultrasound waves that soften and break up the cloudy center of the
lens so it can be removed by suction. Most cataract surgery today is
done by phaco. |
Extracapsular surgery.
Your doctor makes a slightly
longer incision on the side of the cornea and removes the hard center of
the lens. The remainder of the lens is then removed by suction.
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Illustrated guide to
Phacoemulsification
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After placing topical
anesthesia, clear corneal incision is made with a crystal/diamond
keratome. This is usually only 3.0 mm in size. This is a self-sealing
incision which allows a sutureless procedure.
Image by Mark Erickson
Property of JirehDesign.com
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Arguably one of the
more delicate steps in the procedure of cataract removal, continuous
curvilinear capsulorhexis (CCC) is the careful creation of a
well-controlled tear in the anterior capsule of the cataract.
Image by Mark Erickson
Property of JirehDesign.com
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Ultrasonic vibrations (phacoemulsification)
are now created to crush the cataract into manageable particles which
are then aspirated into a port using the same tip (handpiece).
Image by Mark Erickson
Property of JirehDesign.com
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The conventional way of
approaching the removal of a cataract is by the "divide and conquer"
method. The cataract is rotated and grooving is continued to create
manageable pie shaped segments.
Image by Mark Erickson
Property of JirehDesign.com
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This provides a side
view of the actual inclination of the phaco tip (handpiece) as it
proceeds with phacoemulsification of the cataract.
Image by Mark Erickson
Property of JirehDesign.com
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After removal of the
tough nuclear component, the softer cortical material are then aspirated
with an irrigation/aspiration (I/A) handpiece. Complete removal of the
cataract lessens the likelihood of developing an "after cataract" or
posterior capsular opacification necessitating a YAG laser capsulotomy
post operatively.
Image by Mark Erickson
Property of JirehDesign.com
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After injection of
viscoelastic material into the capsular bag and the anterior chamber a
foldable intraocular lens is then inserted and unfolded into the eye.
Image by Mark Erickson
Property of JirehDesign.com
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The intraocular lens
is then dialed into place. The remaining viscoelastic material is
removed. The eye is then checked for leaks.
Image by Mark Erickson
Property of JirehDesign.com
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This is the lateral
view of the posterior chamber intraocular lens after cataract surgery.
Image by Mark Erickson
Property of JirehDesign.com
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In most cataract surgeries, the removed
lens is replaced by an intraocular lens (IOL). An IOL is a clear,
artificial lens that requires no care and becomes a permanent part of your
eye. With an IOL, you'll have improved vision because light will be able to
pass through it to the retina. Also, you won't feel or see the new lens. The
self-sealing corneal incision precludes the need for stitches, however, one
may receive one or several stitches in some instances.
Some people cannot have an IOL. They may
have problems during surgery, or maybe they have another eye disease. For
these people, a soft contact lens may be suggested. For others, glasses that
provide powerful magnification may be better.
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A week or two before surgery, your eye
care professional will do some tests. These may include tests to measure the
curve of the cornea and the size and shape of the eye. For patients who will
receive an IOL, this information helps your doctor choose the right type of
IOL. Also, doctors may ask you not to eat or drink anything after midnight
the morning of your surgery.
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When you enter the hospital or clinic,
you will be given eye drops to dilate the pupil. The area around your eye
will be washed and cleansed.
The operation usually lasts less than 1
hour and is almost painless. Many people choose to stay awake during
surgery, while others may need to be put to sleep for a short time. If you
are awake, you will have an anesthetic to numb the nerves in and around your
eye.
After the operation, a patch will be
placed over your eye and you will rest for a while. You will be watched by
your medical team to see if there are any problems, such as bleeding. Most
people who have cataract surgery can go home the same day. Since you will
not be able to drive, make sure you make arrangements for a ride.
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It's normal to feel itching and mild
discomfort for a while after cataract surgery. Some fluid discharge is also
common, and your eye may be sensitive to light and touch. If you have
discomfort, your eye care professional may suggest a pain reliever every 4-6
hours. After 1-2 days, even moderate discomfort should disappear. In most
cases, healing will take about 6 weeks.
After surgery, your doctor will schedule
exams to check on your progress. For a few days after surgery, you may take
eyedrops or pills to help healing and control the pressure inside your eye.
Ask your doctor how to use your medications, when to take them, and what
effects they can have. You will also need to wear an eye shield or
eyeglasses to help protect the eye. Avoid rubbing or pressing on your eye.
Problems after surgery are rare, but they
can occur. These can include infection, bleeding, inflammation (pain,
redness, swelling), loss of vision, or light flashes. With prompt medical
attention, these problems usually can be treated successfully.
When you are home, try not to bend or
lift heavy objects. Bending increases pressure in the eye. You can walk,
climb stairs, and do light household chores.
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You can quickly return to many everyday
activities, but your vision may be blurry. The healing eye needs time to
adjust so that it can focus properly with the other eye, especially if the
other eye has a cataract. Ask your doctor when you can resume driving.
If you just received an IOL, you may
notice that colors are very bright or have a blue tinge. Also, if you've
been in bright sunlight, everything may be reddish for a few hours. If you
see these color tinges, it is because your lens is clear and no longer
cloudy. Within a few months after receiving an IOL, these colors should go
away. And when you have healed, you will probably need new glasses.
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Sometimes a part of the natural lens that
is not removed during cataract surgery becomes cloudy and may blur your
vision. This is called an after-cataract. An after-cataract can
develop months or years later.
Unlike a cataract, an after-cataract is
treated with a laser. In a technique called YAG laser capsulotomy,
your doctor uses a laser beam to make a tiny hole in the lens to let light
pass through. This is a painless outpatient procedure.
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Please call your local eye care
professional for more information about cataract. To arrange for an
appointment with the cataract surgeons of the Ophthalmic Consultants
Philippines Co., kindly call:
Eye Republic Manila
Eye Republic 3/F Don Santiago Building Unit 310
1344 Taft Avenue, Ermita, Manila, Philippines 1000
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(+632) 536-2398 Telefax
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(+632) 523-8271 to 79 local 30 Trunk
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(+63918) 908-2010 Smart Mobile
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(+63917) 899-2020 Globe Handyphone
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help@EyeRepublic.com.ph
Asian Hospital and Medical Center
Eye Republic 5/F Medical Office Building Suite 509
2205 Civic Drive, Filinvest, Alabang, Muntinlupa City,
Philippines 1780
Note: Some of the materials here are
abridged from the National Eye Institute, National Institutes of Health
website.
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