Cataract
A cataract is the clouding of the eye’s natural lens, causing vision to become blurred, as if looking through a waterfall.
How does a cataract develop?
The lens of the eye focuses incoming light onto the retina, producing clear, sharp images. With age, the lens gradually becomes less flexible, less transparent, and thicker. Age-related changes, along with certain medical conditions, lead to the formation of cloudy areas within the lens. Early changes may appear as early as the age of 40–50. As the cataract progresses, it blocks light from properly reaching the retina, resulting in blurred and reduced vision. Cataracts usually develop in both eyes, but not equally. One eye may be more affected than the other, leading to a noticeable difference in vision.
Types of cataract
Nuclear cataract: The most common type, usually related to aging. In its early stages, it can cause myopia, sometimes improving near vision (e.g., easier reading). Over time, however, it becomes denser and gradually reduces vision.
Cortical cataract: Begins at the outer part of the lens cortex, where wedge-shaped white streaks appear. As it progresses, these streaks extend toward the center of the lens, interfering with light passing through.
Posterior subcapsular cataract: Develops as a small opaque area at the back of the lens (the capsule). It often causes difficulty with near vision (e.g., reading), increased sensitivity to bright light, and “halos” around lights at night. This type tends to progress more rapidly than others.
Congenital cataract: Present at birth or developing in childhood. It may be hereditary or linked to intrauterine infections, trauma, or systemic conditions such as myotonic dystrophy and galactosemia. Not all congenital cataracts affect vision, but when they do, surgery is usually required.
A secondary cataract (posterior capsule opacification) can also occur after cataract surgery, caused by clouding of the capsule behind the artificial lens. This is not a true cataract and does not require surgery – it is treated quickly and effectively with a YAG laser procedure.
An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.
Causes of cataract
The leading cause is aging. Changes usually begin after the age of 40, and by age 65, about half of people have some degree of cataract. By age 70, almost everyone shows signs of lens clouding. Other causes include eye trauma, chronic diseases (such as diabetes), prolonged corticosteroid use, autoimmune conditions, and excessive sun exposure without UV protection. Cataracts may also be hereditary or appear in younger patients.
Risk factors
Certain risk factors may increase the likelihood of developing cataracts, such as:
Age
Diabetes
Excessive UV exposure
Smoking
Obesity
High blood pressure
Previous eye injury, inflammation, or surgery
Long-term corticosteroid use
Excessive alcohol consumption
What are the symptoms of cataract?
Blurred or cloudy vision
Sensitivity to light and glare
Halos around lights (especially at night)
Faded or yellowed colors
Difficulty driving at night
Frequent changes in glasses or contact lens prescriptions
Double vision in one eye
Why choose Dr. Trakos?
Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life.
How is cataract diagnosed?
For the diagnosis of cataract, the ophthalmologist will examine the patient’s medical and family history and perform a full ophthalmological examination. Measurements and tests for the diagnosis of cataract include:
- Slit lamp examination: This examination allows the ophthalmologist to see, under magnification, the lens of the eye to see if it has cataracts, and of course examines the cornea, the iris, and the anterior chamber to see if there are abnormalities that affect vision. In this examination the eyelids and the lacrimal apparatus are examined, since any blepharitis or lacrimal duct obstruction should be treated first, and then the cataract surgery.
- Refractive examination: During which the ophthalmologist accurately checks the patient’s vision with a phoropter, which is the most effective and fast way to assess vision. In this examination, glasses that correct the patient’s vision with cataracts are quickly alternated so that the responses are not affected by a possible dry eye syndrome. It is also found with accuracy whether the cataract coexists with myopia or other refractive abnormality and astigmatism axis. Thus, if there is a cataract, the visual acuity will be measured correctly, which is one of the criteria for whether the patient needs cataract surgery or may be happy with changing glasses.
- Fundoscopy: after dilation of the pupil (mydriasis), Dr. Trakos can examine the retina with its vessels and the optical disk to see if there are concomitant causes of vision decrease. If pallor or optic neuropathy coexists with cataract, further investigation may be required.
- The OCT of the macula and optic nerve: it is the most modern examination to determine whether the cataract surgery is performing, and to prepare the patient, since if there is for example wet pale, it should be treated with an anti-angiogenic agent and in a second stage the cataract surgery.
Cataract surgery
Cataract surgery is a quick, safe, and painless procedure performed with anesthetic eye drops. It lasts 10–15 minutes and does not require hospitalization. Using ultrasound (phacoemulsification), the cloudy lens is broken up and removed, then replaced with an artificial intraocular lens (IOL), restoring clear vision.
The surgery requires no stitches, and patients can usually return to normal activities the same day, with only a few restrictions (avoid water and rubbing the operated eye for five days). Eye drops (antibiotic, anti-inflammatory, and lubricating) are prescribed for several weeks.
Cataract surgery is one of the most common and successful surgeries worldwide, dramatically improving vision and quality of life.
The patient should avoid two things only:
Do not drop water and do not rub strongly the eye that has been the cataract surgery for the next 5 days after surgery. You will need to drop drops of an antibiotic eye drops for 10 days after cataract surgery and an anti-inflammatory eye drops, but also artificial tears for 1 month. Cataract surgery is routine surgery. The artificial intraocular lens that enters the eye enables the patient to see very well away, resees the colors alive and regains the quality and quantity of vision. You may need a small utility glass to keep close. We always explain before cataract surgery that laser may be needed after 2-3 years, because cells from the body itself behind the intraocular lens, the so-called clouding of the posterior lens capsule, may develop. If this happens, a laser will be needed to clean the capsule from these cells, which takes five minutes, and the patient does not need to lie down or get into a clinic, but it is something that is done at the clinic level.
Your ophthalmologist will evaluate your vision together with other tests and will suggest the appropriate solution based on your needs, your daily routine and your overall health.
When should I visit the ophthalmologist?
According to the principles of the American Society of Ophthalmology Dr Nikolaos Trakos suggests once a year an ophthalmological examination and in some cases earlier if necessary. In case you notice a change in your vision for the worse, such as blurred vision, “hoops” around the lights, difficulty driving at night visit Dr. Trakos and he will advise you in the most responsible way about your cataract.
When should cataract surgery be performed?
Cataract surgery can be decided based on the degree of discomfort caused by cataract in the patient’s daily life. When the cataract begins to cause significant discomfort in the quality of vision, resulting in problems in the daily activities of the person (reading, TV, safe driving a car), then we may proceed to cataract surgery. Of course, there are objective criteria, such as seeing only 5/10, losing 50% of the excellent visual acuity, or not meeting the criteria for renewing the driving license, and in this case, cataract surgery should be performed regardless of the degree of the subjective discomfort.
Based on your symptoms, you and Dr. Nikolaos Trakos will decide together when the surgery will be performed. It is no longer true that the cataract must be “mature” to be removed. With the new techniques (phacoemulsification, laser) this perception is now past.
On the contrary, the removal of an overmature hard cataract makes the surgery more difficult, since the energy to be used will be greater. Also an overmature cataract may be the cause of an increase in intraocular pressure leading to glaucoma.
In any case, Dr. Nikolaos Trakos is by your side to advise you properly and responsibly.
What should I know before cataract surgery?
When you visit us you will be asked about your health history and any medications you are taking. The medical staff or the ophthalmic surgeon will advise you on whether you will normally take your medicines. You may be asked not to take some of your medicines before cataract surgery, such as prostate. For anticoagulants, discontinuing them for 1 week before surgery is preferable, without being necessary and mandatory, since cataract surgery is performed in a minimally invasive manner. The trained medical staff will measure the parameters of your eye by doing the pre-operative check-up with special machines that help determine it:
- correct focus force of the artificial intraocular lens (latest generation – ZEISS IOL Master)
- quality of the cornea (latest generation Corneal Topography)
- quality of the optic nerve and macula (with the state-of-the-art OCT)
You may be prescribed eye drops which you will use for a short time before starting cataract surgery. If you have Dry Eye Syndrome you will need to shed drops of artificial tears at least one week before surgery. These drugs help prevent infection or inflammation during and after surgery. The ophthalmologist will guide you on how to use them.
On the day of surgery it is advisable not to eat at least 3 hours before cataract surgery. If you are taking medications for arterial hypertension, it is advisable to take them on the morning of the operation. On the day of surgery you can normally take your medicines such as antihypertensives, thyroid or other medicines. For male patients taking medications for prostatic hypertrophy, it is advisable to discontinue them 15 days before surgery. You do not need to stop any anticoagulant medication before cataract surgery.
What should I watch out for after surgery?
The patient can go home after the surgery. On the same day he can bend and lift weight, while he should not pour water into his eye, and rub it vigorously for 5 days. If he wants to bathe in the next 5 days he can do it with the head tilted backwards as in hairdressers. Otherwise he can watch TV and drive. When outdoors in the day, it is advisable to wear sunglasses.
You should also avoid dust and smoke in the eyes, just as it is done after laser eye operations.
When pouring the drops of antibiotic and anti-inflammatory eye drops, it is advisable to press with the finger on the inner corner of the eyelids, so that the drop remains on the ocular surface and is not lost from the nasolacrimal duct. It is also good to throw drops of artificial tears without preservatives.
What should you expect after cataract surgery?
Cataract surgery cannot restore vision loss from conditions such as Glaucoma, Maculopathy, Diabetic Retinopathy, Vein or artery occlusion, Posterior or anterior ischemic optic neuropathy. It is, however, a surgery that can significantly upgrade the quality of vision even of a problematic eye with another pathology.
What type of intraocular lens is recommended?
Cataract surgery cannot restore vision loss from conditions such as Glaucoma, Maculopathy, Diabetic Retinopathy, Vein or artery occlusion, Posterior or anterior ischemic optic neuropathy. It is, however, a surgery that can significantly upgrade the quality of vision even of a problematic eye with another pathology.
What type of intraocular lens is recommended?
The intraocular lens used in the phacoemulsification surgery is an artificial lens that replaces the existing cloudy lens. The technology of intraocular lenses has made tremendous progress in recent years. The lenses we use for cataract surgery are high quality aspherical modern single-focal intraocular lenses. This type of lens could provide good, functional distant or close vision, but people still had to keep wearing glasses for their activities. Another option is modern intraocular lenses, which can help in more distances such as multifocal.
Types Of Intraocular Lenses
– Monofocal: Intraocular lenses that focus far or near depending on their refractive power. They are the lenses most commonly used in cataract microsurgery
– Toric – Astigmatics: It is the intraocular lenses that with their special construction manage to correct together with the cataract and astigmatism of the patient resulting in the less need for corrective glasses and of course increased quality of vision
– Multifocal: They are the most modern intraocular lenses that now have the ability to focus close (30-35 cm), at an average distance (40-45 cm) and far in order to achieve maximum independence from glasses in all our daily activities. These intraocular lenses are configured for each patient individually to achieve maximum vision performance. At the EYD Ophthalmology Center we work with the leading companies in the field to always incorporate the most modern technology.
– Special Intraocular Lenses: They are intraocular lenses that are used by the LID Ophthalmology Center in case the reference center is called to use them in special cases with complications such as eye trauma, intraocular displacement, etc.
The choice of the appropriate type of intraocular lens depends on the needs of each patient, and Dr. Trakos suggests and applies the best, having prepared his PhD thesis on types of intraocular lenses for cataract, as shown by the following article published in the reputable ophthalmology journal.
Trakos N, et al Clin Ophthalmol. 2008 Dec;2(4):997-1005.PMID: 19668459 Free PMC article.
His doctoral thesis was elaborated on the Blurring of the Posterior Capsule (Secondary Cataract). In particular, after having operated large series of rabbits with the method of phacoemulsification – the most modern method of cataract removal – he followed them and then carried out eye mining by applying modern Techniques of Orbital Surgery. He then studied the development of secondary cataract in relation to different types of intraocular lenses of the largest companies worldwide, such as Alcon and Bausch & Lomb, in an experimental rabbit model at a pathological and microscopic level. This large clinical-laboratory and surgical research program was organized and completed entirely by him, and helped to improve the construction of intraocular lenses. On the basis of this program he was awarded a PhD from the Medical School of the University of Ioannina in 2010.
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