Primary prevention and early detection are the most effective and instrumental in reducing the incidence and morbidity of vision disorders. To mark World Sight Day, which is celebrated today, Professor Eugenio Leite speaks of cataract, a disease that mainly affects older limiting their quality of life.
Cataract is a disease which appears with age or as a consequence of a systemic disease. Gradually, your vision begins to become blurred and objects no longer seem bright and alive as before. The onset of these symptoms may indicate the development of a cataract. Should consult an ophthalmologist to whether it is advisable to undergo cataract surgery to improve the quality of your vision.
The type of surgical technique is a decision that falls to the ophthalmologist, after clarifying conversation with the patient, which should include the entire procedure that involves undergoing surgery. To make the decision to undergo surgery is important to clarify all your doubts.
Next, we will present some questions that will help you understand the various types and causes of cataracts, so you can take your decision.
What is a cataract and what causes it?
The human eye functions like a camera. The visual rays are focused by the lens onto the retina, the fotorecetores layer that acts as the film of the camera, the back of the eye.
In the normal eye, light rays pass through the transparent lens and are focused on the retina, which will lead to a clear and bright image.
With advancing age, the lens continues to grow, adding to the existing layers on the surface. With the progress of time, the lens hardens and loses transparency, which results in a blurred and imperfect vision.
In this clinical situation, the cataract is age related. It is a normal process and, later or earlier, occurs in all individuals.
If the cataract formation process affects only a small area of the lens and it is not central, your vision can not be achieved or greatly disturbed. If, however, the process is severe, it reaches the central zone or whole lens and vision is greatly affected.
Although cataract usually occurs in both eyes rarely develops simultaneously in both eyes.
What are the other causes of cataracts?
There are other less common types of cataracts that are not related to aging. Let’s highlight some of these types:
Cataracts Congenital – occurs in children and can be hereditary or due to birth trauma. Some occur without any obvious cause.
secondary cataract – is caused by diseases or previous surgery to the eye. The formation of secondary cataracts may be accelerated by chronic diseases such as diabetes or excessive use of steroids.
traumatic cataract – The cause is an eye injury. Its appearance may arise immediately after trauma or slowly develop months or years after the accident.
What are the symptoms of cataracts?
Patients with cataracts may have one or some of the following symptoms:
- Sensitivity to light or dazzle, especially in bright sunlight or the headlights of other cars while driving.
- Depth perception Reduction.
- Increased reading difficulties, which require multiple changes of glasses.
- Loss of vivid.
- Distortion or ghost images.
- Turbidity or darkening images.
- Decreased visual acuity.
There are some concepts well publicized and that are incorrect and should be fixed.
- A membrane to grow over the eye.
- A tumor, cancer, or infection.
- An irreversible cause of blindness.
- A contagious disease that is transmitted from eye to eye and from person to person.
How is the diagnosis of a cataract?
The use of a slit lamp or biomicroscope allows the ophthalmologist three-dimensional and magnified examination of the lens. Through Slit lamp examination can detect the presence of cataracts, as well as any other disease that causes a blurred visual acuity or ocular discomfort.
After the diagnosis of a cataract and to analyze and prepare the surgery, you must perform some additional tests, including:
- Corneal Topography
- Microscopy speculate
- Biometrics in calculating the power of intraocular lens
- Ocular ultrasound.
When to perform cataract surgery?
Previously, there was the concept that one should not operate cataract when the patient no longer see anything. Today, if the vision is a bit blurred and disrupt daily activities, should be considered the possibility of surgery. Surgery is the only way to remove the cataract. No other treatment can remove the cataract, whether drops, exercises or glasses. It should be noted also that no treatment, drops or glasses will influence the development of cataracts. This will increase according to their own evolution varies from person to person. The cataract surgery should be performed by an ophthalmologist with surgical experience.
The technique that is used in cataract?
Currently, there are two techniques for performing cataract surgery, the conventional technique called phacoemulsification, and the laser, an innovative and cutting-edge surgery. The consultation and preoperative examinations will be decisive for choosing the most appropriate technique.
The phacoemulsification technique involves performing two incisions, greater than 3mm and another 1mm in the cornea through which the surgeon introduces the tip of the phacoemulsifier (the largest), a high-frequency ultrasound device, with which dissolves and aspirates the core (center) of cataracts. The remainder of cataract is sucked with the tip irrigation-aspiration. A smaller incision is to use the handler or aid instrument.
The laser technique is innovative and qualitative step for patients and consists in using a cutting edge equipment, Femtofaco LenSX with high security and accuracy indices.
After removal of cataract, regardless of the technique, an intraocular lens within the cataract is implanted or placed. This new intraocular lens will allow the focusing of the light beam on the retina. The intraocular lens will become a permanent part of the eye, unlike contact lenses are removed and replenished daily.
In most cases, the intraocular lens is placed (IOL) into the capsular bag, so in the case of a subsequent IOL. If the technique used is the focoemulsificação, it uses a folding lens, which comes wrapped and only opens into the eye. If, however, the IOL is placed in front of the iris and the anterior chamber IOL is called the anterior chamber.
Finally, only in some cases it is necessary to suture the incision, because the technique is phacoemulsification and IOL using a roll, no need suturing (give points).
What are the pre-operative care?
As already mentioned, it is necessary to perform tests before the operation to which the setting technique or care type of IOL to have. Some recommendations will be made to the patient by the surgeon to go to the clinic fasting or eating until a certain time. At the clinic will be you put drops before surgery. In the operating room, the eye to operate will be disinfected and sterile surgical field to protect the surgical area will be applied.
What type of anesthesia to use?
The cataract surgery does not require a general anesthetic. Today, surgery is performed with a topical anesthesia (drops) and sedation given systemically. This type of anesthesia allows the patient does not feel any pain and not remember anything.
How long is the clinic?
Today, cataract surgery do not need several days of hospitalization.
Cataract surgery is a surgical procedure that can be performed on an outpatient basis or with short hospitalization (24 hours) depending on the type of patient or technique that is used. With current techniques, the patient can resume immediately afterwards your daily activity.
What is the recovery process?
The current procedure allows there is no need to cover the operated eye and should only rest in peace and then return home. This quiet is essential to avoid complications, including bleeding, infection or other problems.
Some other precautions are as follows:
- Apply the drops prescribed correctly.
- Wait 3 to 5 minutes between each type of droplets.
- Do not rub or press the eye.
- Do not perform hazardous tasks while recovering the vision.
- Do not start intense activities without authorization from the ophthalmologist.
What postoperative controls?
The patient should perform some post-operative checks, usually 2 to 3 exams in the first 6 to 8 weeks. In these queries will be controlling the process of wound healing and functional recovery of the operated eye view.
Sometimes, when using IOLs later, after some months or years, the posterior capsule in which the lens is supported can “get dirty” or opacify, which cause something blurred vision. The ophthalmologist, using a YAG laser, will open the center of this capsule, a painless and effective procedure without hospitalization and with immediate recovery.
You need to wear glasses after surgery?
Patients who used bifocal / progressive lenses for near or just lenses will still need at least glasses for close, even today there are already progressive intraocular lenses / multifocal and in some cases can be implemented. In addition to the issues that have been exposed, some consider some other parameters, such as compare the potential beneficial and possible risks.
What are the risks of complications?
As with any surgery, a good result can not be guaranteed by anyone. But it is important to note that 95 to 97% of cataract surgeries result without any complications. Although rare, complications can occur during or after surgery, imposing some visual limitations.
What happens if it is not operated?
With some exceptions, the presence of cataracts will evolve without being able to modify their progression with their vision loss. However, the wait, although not jeopardize the recovery of vision, will put some technical problems motivated by hardening of cataracts. Remember that 90-95% of patients are satisfied with the outcome of surgery. But remember that cataract surgery will not improve poor vision caused by other diseases, such as diabetes or stroke.
Finally, the decision is yours, but remember that cataract is a common cause of vision loss in the aging process. The older, the greater the possibility of having a cataract that interferes with their quality of life. Therefore, it is strongly considering the possibility of a surgery that is safe, with good results and almost no complications.
New techniques, such as laser, offer you a new quality of life, safety and accuracy.