Cataracts are an age-related clouding of the lens of the eye and the most common eye disease of all. The lens grows throughout life, but can only become larger and thicker to a limited extent. As a result, the inside of the lens becomes increasingly dense, which leads to clouding. Metabolic changes with age or even injuries also contribute to this.

This process occurs in everyone at some point in their lives. Cataracts usually begin to impair vision around the age of 60. The cataract becomes noticeable through a cloudy visual impression such as a gray haze, increased sensitivity to glare and rapidly changing spectacle strength.

Cataract surgery is the most common and most successful operation in eye surgery – 15 million operations are performed every year.

During cataract surgery, the cloudy lens is removed and replaced with an artificial lens (lens replacement). By using a wide variety of lenses, existing visual defects such as short-sightedness or long-sightedness, astigmatism or presbyopia can also be corrected!

During a consultation, including a preliminary ophthalmological examination, we will examine your cataracts and inform you about the various treatment options and implants. The treatment of cataracts is generally covered by health insurance. At EyeLaser, we offer you not only many years of surgical experience, but also the latest lens implants and comprehensive advice – all without having to wait months. We can even make you completely independent of glasses if you are suitable.

All about the OR

The only treatment option for cataracts is surgery. To date, there is no effective alternative and no medication that could alleviate the impairment caused by cataracts or halt their progression.

This procedure, which usually takes less than 15 minutes, is usually performed under drip anesthesia – only eye drops are required to anesthetize the eye.

Step 1: First, the surgeon removes the cloudy lens through a tiny incision

Step 2: The surgeon then implants a precisely calculated artificial lens in the same place.

Nowadays, thanks to the latest lens technology, there are numerous options for adjusting the spectacle prescription to individual requirements after surgery.

For example, the visual acuity can be perfectly adjusted during the operation for optimal distance or near vision.
So-called toric intraocular lenses (IOLs) can also be used here. Toric intraocular lenses (IOLs) also make it possible to correct astigmatism.
If desired by the patient, multifocal IOLs or EDOF (enhanced depth of focus) IOLs can also be implanted. With the help of these ultra-modern implants, it is often possible to dispense with glasses altogether after the operation.

In order to achieve the best possible result, a comprehensive and precise examination and measurement of the eye, as well as an in-depth consultation, are of great importance. We are happy to take the time to explain all possible variants and options to you and compare them with your wishes and ideas.

You can enjoy your “new eyes” just a few days after the operation, even if a certain adjustment phase and slight fluctuations in visual acuity are quite normal during the first few weeks. During this time, eye drops help with care and controlled wound healing.

Despite precise measurement and calculation, in rare cases wound healing can lead to a deviation from the desired result. But don’t worry, even then the result can be perfected with a short corrective procedure.

Cataracts – how to notice them

At first, often in the dark, something like a clouding is noticeable, and one is sometimes more sensitive to light than is usually the case. Patients often say that they think they are looking through dirty glasses or a dirty window pane. However, it is also clear that everyone feels differently – and every manifestation is different. The clouding of the lens progresses rapidly for some, but very slowly for others.

The lens often becomes so cloudy that myopia increases significantly or you can hardly see anything with glasses. However, the opposite can also be the case: without glasses, vision is suddenly better than with.

Either way, you should see an ophthalmologist as soon as possible. There, the eye will be examined in detail and an eye test carried out. Using a so-called slit lamp, it is possible to determine whether a cataract is present or whether other causes are responsible for the symptoms. This usually involves dilating the pupil.

Cataract surgery is one of the safest and most successful procedures in medicine. The doctor and patient decide together when the time is right for the operation, depending on the intensity of the symptoms.

The preliminary investigation

In order to ensure maximum safety and precision during the operation, a comprehensive and precise preliminary examination is of great importance. As part of this preliminary examination, numerous measurements and examinations are carried out that are necessary for the precise fitting of the artificial lens.

The pupil will also be dilated with medication. Therefore, please note that you must not drive for 3 hours after this examination. Ideally, you should be collected by someone you trust. A medical report from your GP is very helpful if you have to take medication regularly or if other important treatments are required on a regular basis.

The day of the operation

On the day of the procedure, please have breakfast as normal and take your medication as usual. However, please refrain from wearing make-up, face creams, perfume or eau de toilette.

The local anesthetic

The eye is usually anesthetized with eye drops during the operation. This minimizes the stress of the operation and the effect wears off quickly after the procedure. A low-dose sedative can also be used in addition. In rare cases, an injection next to the eye or a general anaesthetic can also be administered if absolute immobilization of the eye is required.

Preparation

After dilating the pupil with drops or inserting a tablet into the palpebral fissure, the patient is led into the operating theater wearing special surgical clothing (gown, cap, etc.).

The patient is placed on the operating table, then the operating area is neatly covered with sterile drapes and foil. A sufficient oxygen supply is of course guaranteed, but this is monitored by means of a pulse oximeter during the entire stay in the operating theater.

An eyelid holder is then inserted to keep the eye open during the procedure. To prevent the surface of the eye from drying out, the eye is permanently moistened with a special liquid.

The OP

The operation is performed under a high-resolution microscope. A tiny incision is made in the eye with a steady hand. The lens capsule, which encloses the cortex and the nucleus like a shell, is opened through this incision. The cloudy lens can now be broken up and suctioned out using ultrasound waves. What remains is the empty lens capsule – the so-called capsular bag.

The tightly rolled-up lens is now inserted into the eye through the small incision, where it can slowly unfold in the capsular bag.

Finally, the wounds are sealed and an antibiotic is injected into the anterior chamber to prevent infection.

The eye is then treated with an eye cup.

Can there be complications?

Cataract surgery is one of the safest and most successful procedures in medicine. However, surgery always involves risks. Up to 95 percent of all operations of this type go without incident, with complications occurring in the remaining cases. Most complications can be treated directly by the doctor – long-term problems are therefore rare.

Below are some of these possible complications and what is being done about them:

• In rare cases, the intraocular pressure may rise or fall after the operation. Treatment is usually carried out with eye drops or tablets
  Swelling of the cornea can delay the recovery of visual acuity after surgery. In most cases, no special treatment is required. In extremely rare cases – especially in the case of congenital weakness of the innermost corneal layer – a corneal transfer may be necessary.
• If the suspension apparatus is too weak or the capsular bag is defective, the artificial lens cannot be fixed in the capsular bag. The lens is then either implanted in front of the capsular bag, fixed to the iris or sutured into place. Sometimes a further operation is required for this. Special eye drops are usually effective for retinal swelling. In rare cases, a so-called IVOM (injection of medication into the inside of the eye) may be necessary.
• Retinal detachment as a result of cataract surgery is extremely rare. In this case, treatment is carried out using a laser or a further operation, the so-called pars plana vitrectomy (PPV).
• Even the loss of vision or the eye cannot be ruled out with absolute certainty – for example in the case of mass bleeding or severe infection. However, the risk of this is not even in the per mille range.

After the procedure: what happens next

During the first night after the operation, the eye is protected from involuntary contact by a bandage and an eye shield.

In the first few days, the eye can often water and scratch a little, and sensitivity to light and glare is not uncommon. Vision is still somewhat blurred in the first few days and visual acuity fluctuates. After a week, the symptoms have usually largely subsided and the final result is achieved after around 8 to 12 weeks.

During this time, there are a few things to consider that we would like to mention here. Some only concern the initial period after the operation, others need to be taken into account in the longer term:

• The prescribed eye drops must be taken exactly as prescribed by the doctor. It is not possible to overdose; if the eye is moist enough, the excess fluid will simply leak out. If in doubt, it is better to use one drop too many than too few.
• A check-up is usually arranged the day after the procedure, with further check-ups to follow. These are arranged individually with the doctor.
• Avoid touching the eye in the first few weeks, especially strong pressure on the eyeball.
• It is okay to wash your hair and face a few days after the operation, but with due caution. Contact with soap and shampoo should be avoided. Sauna visits and swimming are only recommended after 6 – 8 weeks at the earliest.
• Avoid eye make-up and eye creams for the first four weeks.
• Driving a car is usually possible again after approx. 1 week. However, clearance from the ophthalmologist is absolutely necessary.
• Sport and physical activity: avoid strenuous physical activity in the first week after the operation and avoid dirty or dusty environments. Normal physical activity – e.g. in the household – is not a problem. The general guideline is: feel and common sense. Avoid anything that seems unwise or risky and stop your activity if it causes discomfort.
• If there is any wobbling or flickering of the perceived image in the first few weeks after the operation, this is no cause for concern. The artificial lens only grows slowly into the new environment, so that it is still a little loose at the beginning. During this time, it is also possible that incident light is refracted at the edge of the lens in such a way that reflections are created which are perceived as crescent-shaped objects. It is also normal if the eye feels scratchy or if the new lens still feels like a foreign body. This is due to the fact that the incisions in the eye are healing or that the surface of the eye dries out faster than normal because the eye drops contain cortisone. This can be counteracted with so-called artificial tears (jelly or drops). After a while, however, these symptoms disappear completely.

As a rule, vision recovers relatively quickly within a few days after the operation. However, fluctuations in visual acuity and moderate discomfort such as occasional foreign body sensation or watering of the eyes may persist for some time. If the result still deviates from the desired goal due to wound healing, correction with temporary glasses may be advisable in rare cases in the meantime.

In the event of an emergency

If – especially in the first 14 days after the operation – you suddenly experience severe pain or an abrupt deterioration in your vision, please contact an ophthalmologist immediately or visit the emergency outpatient clinic. Even if you suddenly see flashes of light and “black clouds” in one eye – immediate clarification is required. If in doubt, it’s better to check once too often than too little – so don’t hesitate if necessary.

The so-called secondary cataract

The artificial lens is usually implanted in the so-called capsular bag, which surrounds the lens like a natural sheath. As the wound heals, the tissue first shrinks and then sometimes becomes cloudy. This manifests itself in a slow deterioration in vision and blurred vision. This so-called “secondary cataract” can occur in some patients after just a few weeks, in others only after many years. But – no need to worry! With a short and painless laser treatment, the secondary cataract can be successfully removed within a few minutes. Recurrence after laser treatment is virtually impossible.

The patient is given a local anesthetic in the form of eye drops or an injection next to the eye.

The first step is to make a small incision at the edge of the cornea, which allows the natural lens to liquefy and be aspirated.

Instead of the removed lens, the multifocal lens is now inserted in this place. As the name suggests, the inserted multifocal lenses enable simultaneous and sharp imaging of different distances. This means that patients can see clearly at near and far distances again after the procedure.

After the procedure, the eye is protected from environmental influences such as dirt and dust with an eye patch so that the incision can heal well over the next few days.