Grey cataract

Dear Patient!

This page is intended to provide information on grey cataract and the treatment possibilities available to us today

 

What is grey cataract?

Grey cataract is clouding of the lens of the eye. The eye lens has the same function as the lens of a camera - i.e. to produce a sharply focussed image in the eye. Cataract, therefore, is not an infectious disease, and it is also not possible to contract it through straining the eyes.

What does the word "cataract" mean?

The word "cataract" dates from the middle ages and comes from the Greek "katarraktês". In Greek the word describes something which falls, such as a waterfall, a flap or a trap-door. This concept has been taken over in medicine to describe the "grey visor" which "falls in front of the eyes" when the lens clouds over.

But why should I be affected with this disease?

Apart from diseases of the metabolism and rare congenital defects, this condition is basically age-related, usually occurring over the age of 60.

What visual defects point to cataract?

Blurred vision and increased sensitivity to light, deterioration of contrastive vision, worsening or development of short-sightedness. "I used to be longsighted, but now I'm short-sighted and read without glasses" - changes in spectacle strength in a short space of time can be caused by an increase in clouding of the eye lens.

How is cataract treated?

 

Preferably by an operation to implant an artificial lens matching the dioptre of the original eye lens.

Are there any possibilities of treating cataract conservatively, i.e. without an operation?

For many conditions which are age related and occur after middle age, the only possibility is to change your diet and other personal habits before the onset of the ageing process, i.e. normally between the ages of 25 and 30. Later, taking eye drops or medicines or homeopathic remedies are ineffective and merely delay the restoration of the quality of life we could be enjoying with good eyesight.

Are there any possibilities of treating cataract conservatively, i.e. without an operation?

For many conditions which are age related and occur after middle age, the only possibility is to change your diet and other personal habits before the onset of the ageing process, i.e. normally between the ages of 25 and 30. Later, taking eye drops or medicines or homeopathic remedies are ineffective and merely delay the restoration of the quality of life we could be enjoying with good eyesight.

When should a cataract be operated?


The subjective feeling that "I can see still quite well" is not decisive; the demands placed upon your eyesight - for example driving, work and your favourite hobby - are often quite considerable, and as a result your ophthalmologist will advise you to undergo an operation before there is any noticeable deterioration in your eyesight. Improving your quality of life through good eyesight is your eye specialist's responsibility - but you can play an important role by helping determine the optimum time for the operation.

How great are the risks associated with the operation?


Given all the modern techniques the risks are very low. In fact, these days they are below the risk of being involved in an accident (0.01 %).

What risks are there in the period just after the operation?


There is an increased risk of infection in the first two weeks after the operation. This is why you should strictly keep all the follow-up appointments. Arrange for extra appointments if you have any problems with your eyesight. Infections, if diagnosed immediately, can be treated effectively these days.

Are there any longer-term risks - say after 10 or 20 years?

At present there are no signs of any longer-term risks. The first artificial lenses were implanted roughly 40 years ago and some are still in place without causing any problems.

How is the artificial lens attached in the eye?

The artificial lens is inserted into the polished, wafer-thin natural lens sleeve. It is only slightly heavier than water and holds itself in position by means of small filament arms.

Can you feel the artificial lens?

No. Unlike contact lenses there is no feeling that you have something in your eye or any kind of irritation.

Is it possible to replace an artificial lens?

Yes. We have developed special operation techniques. These are so patient-friendly that a lens can be replaced by another one through the tiniest possible incision.

What do you mean by "tiniest possible incision"?


A tiny cut of just 2.5 mm is sufficient to carry out the entire operation. Extending the cut to 3.0 to 3.5 mm is enough for inserting a modern folding lens.

How is it technically possible to remove a lens which is 10 - 11 mm in diameter and 5 - 6 mm thick through such a small opening?


By using short bursts of targeted ultrasound waves the diseased cloudy lens tissue can be disintegrated in the eye itself and sucked out. If the tissue is harder, which is the case with advanced cataract, you need to use higher doses of ultrasound energy. It is also possible to disintegrate the hard core of the lens a few days before the actual operation using a special laser, meaning that less ultrasound energy is needed.

Do the national health insurance schemes in Germany pay for this?

At present they cover only 35% of the total costs - it varies from state to state. In the future the operation will only therefore be invoiced according to the cost reimbursement principle. Patients receive a bill which, after paying, they hand to the insurance scheme for reimbursement. Don't worry, the insurance schemes are committed to refunding the statutory fee. So there will be no additional costs for you. The laser pre-treatment, which is sometimes beneficial but not absolutely necessary, is not covered.

Can I have a peek into the operating theatre? How big is an eye operation team?

A standard team consists of the surgeon, three surgical nurses, an anaesthetist, an anaesthetist nurse, and one or two ordinary nurses for preparation and post-operative care.

What type of anaesthetic will I receive?

The least harmful type of anaesthetic for the body is a local one. The eye is anaesthetised with eye drops and a small injection next to the outer eye. Only in rare cases is a general anaesthetic preferred. You doctor will help you with the decision. An effective supplement is acupuncture and mild sedation.

Will I need to go into hospital?

No.
An expensive hospital stay goes against the cost reduction guidelines. As a result of the perfect operation techniques and the low risk there is no longer any medical reason for the operation to involve a stay in hospital. In this way 70 % of the costs can be saved. Almost all eye operations can be carried out on an out-patient basis today, either in the output clinics or in the hospital ophthalmology departments.

What do I need to be careful of after a cataract operation?

  • Do not rub or press the recently operated eye.
  • Do not lie on the side of the recently operated eye.
  • Follow the instructions of the prescribed eye medicine.
  • You can drive after successfully passing an eyesight test carried out by your ophthalmologist.
  • In the first few days avoid extremely strenuous activities.
  • Swimming and taking a sauna is normally possible after 10 days.
  • Wear a pair of sunglasses to protect against light-sensitivity and draughts.

Special Instructions  for the period after your eye operation

What am I allowed to do just after the operation?

You may
watch TV
go for walks
depending on the quality of your eyesight (ask your doctor) you may read, drive and move normally
there are no other special restrictions as used to be the case.

I am very short-sighted/ I am very longsighted. Does all the above also apply to me?

Yes
In fact somebody like you can benefit doubly because you may be able to do without your glasses due to the lens strength calculation. The strength of the lens to be inserted during the operation can be calculated so that that you will either need no glasses at all or only very weak ones. In many cases, you will not then need glasses for most day-to-day activities, only for driving etc.

I suffer from curvature of the cornea. How does this affect things?

Curvature of the cornea or astigmatism (distorted vision) can sometimes also be corrected during the cataract operation. Ask your surgeon if this is possible in your case! If not, then roughly 2 to 3 months after the cataract operation you can have your eyesight improved by a further small outpatient procedure involving RK (radial keratomy) or PRK (excimer laser treatment) after TMS (topographical analysis of the cornea).

What is secondary cataract?

Secondary cataract is clouding of the lens sleeve - "capsule" - behind the artificial lens.

How, when and why does it arise?

This occurs if the rear surface of the lens sleeve into which the artificial lens is inserted clouds up. The probability of occurrence is roughly 25 to 30% within the first two years after the operation.

What is the treatment?

The clouding can be removed through short, painless laser treatment carried out on an out-patient basis.

What are the risks?


None, however, for safety's sake you should have your retina checked regularly, because there have been isolated incidences of detached retinas after secondary cataract treatment.

What new developments are there?

The first long-term studies (3 years) have shown that new folding lenses made from acrylic have significantly reduced the incidence of secondary cataract. (D. Klaas - AAO talk 1996). A new multifocal folding lens made form silicon can in many cases permit both long-distance and close-up vision. Improved instruments are making operating techniques even more minimally invasive (D. Klaas new "Shark™" new folding system for gentle folding of lenses).

One last question. I'm overweight. Can you recommend a diet which is also appropriate for my eyes?

Yes. It's called the Toronto General Hospital Diet. Toronto General Hospital Diät.