By Dr Jocelyn Wu Shin Yin
Consultant Ophthalmologist, Cataract & Refractive Eye Surgeon.
In conjunction with Cataract Awareness Month.

CATARACTS OVERVIEW

Cataracts are a common eye condition affecting millions of people, particularly as they age. For the majority of individuals, if they live long enough, they will eventually develop cataracts. Over time, cataracts can significantly affect vision, leading to symptoms such as blurred vision, poor night vision, or glare, which can worsen if left untreated. Vision loss may impact various daily activities, leading to potential health hazards and diminishing quality of life, especially among the elderly.

One may not be able to enjoy activities they once liked such as watching television, reading, driving, gardening, doing household chores, cooking, arts and crafts, and even socializing with friends.

Elderly individuals with cataracts are particularly vulnerable to vision-related hazards, including falls, knocking over objects, difficulty with mobility and moving downstairs, car accidents, and decreased independence. Furthermore, the impact of cataracts extends beyond physical danger, often leading to feelings of loneliness and depression due to the inability to engage in activities they once enjoyed. Unfortunately, many individuals may delay seeking treatment, further exacerbating the situation.

Life does not have to be dark, as cataract is a treatable disease. Therefore, routine yearly eye screening is important, especially for the elderly. Cataracts can be effectively treated through surgery, with potential to restore good vision in most cases.

WHAT ARE CATARACTS?

Cataracts occur when there is opacity in the lens of the eye, akin to looking through an old, stained piece of glass instead of a clear, new sheet. Our eyes function similarly to cameras, with the lens playing a vital role in focusing light onto the retina to form clear images. The crystalline lens is primarily composed of water and proteins, and while it is transparent in youth, oxidative stress with age causes cross-linking of lens proteins, resulting in clouding and reduced transparency, ultimately leading to cataracts.

CAUSES OF CATARACTS

While aging is the primary cause of cataracts, other factors can also contribute to their development. Systemic diseases like diabetes mellitus, steroid use, trauma, and ocular inflammation can all lead to early cataracts. Additionally, cataracts can also present in children such as congenital cataracts.

SIGNS & SYMPTOMS

The most common symptoms of cataracts include blurry vision and increased glare, particularly from bright lights such as oncoming vehicle headlights when driving at night. Cataracts typically progress slowly and painlessly, with individuals experiencing a gradual decrease in overall vision clarity over time. Advanced cataracts can hinder daily activities and increase the risk of accidents. Sometimes, you may find it difficult to read road signs when driving, or needing more light when reading a book.

WHEN DO PEOPLE GET CATARACTS?

Generally, cataracts may begin to develop around 40 years old, and by the age of 80, more than 70% of the general population would have visually significant cataracts.

WHEN DO YOU NEED CATARACT SURGERY?

Cataract surgery is recommended when cataracts significantly impair vision, making tasks such as driving, reading, and working difficult. Symptoms may include blurred vision even with new glasses and difficulty with night vision, leading to avoidance of nighttime driving.

WHAT SHOULD WE DO?

It is essential to undergo a comprehensive dilated eye examination by an ophthalmologist to evaluate the severity of cataracts and determine if surgery is necessary. Regular eye examinations are crucial for early detection of cataracts and other eye conditions. Do bear in mind that not all blurring of vision is due to cataracts. There are other eye diseases, such as glaucoma, macular degeneration, and diabetic retinopathy that cause blurred vision as well. Therefore, a regular eye examination at least once a year is recommended.

WHAT TO EXPECT BEFORE, DURING AND AFTER CATARACT SURGERY?

PREOPERATIVE EVALUATION

• Comprehensive dilated eye examination by an ophthalmologist to evaluate the severity of cataracts and determine if surgery is necessary. This includes eye examination with pupil dilatation to examine the health of the eye, the cataractous lens, the optic nerve and the retina.
• Eye dilation would result in eye blurriness for about half a day, therefore do arrange transportation home, or bring along someone to drive you after the test.
• Measurements of the cornea curvature and axial length of the eye are taken to calculate and select the lens implant for the surgery.
• Lay off contact lenses prior to eye measurements
• - Soft lens: 2 week
• - Hard Contact lens: 4 weeks
• Bring your glasses and prescription
• If you have prior refractive surgery or LASIK surgery, bring your records
• Bring your medical records and list of medication

DURING CATARACT SURGERY

During cataract surgery, the cloudy crystalline lens is removed and a permanent lens is implanted in the eye.

In Malaysia, cataract surgery is usually done as a daycare procedure with no overnight stay, unless indicated. Typically, only one eye is operated at a time.

Most of the cataract cases can be performed under local anaesthesia. Light breakfast would be allowed on the morning of the surgery.

There are also cases performed under general anaesthesia. For cases under general anaesthesia, the patient would have to fast (no food or drink) for at least 6 hours before surgery.

The surgery itself is generally painless. Patients will be lying supine, looking upwards into the light. The eye would be numbed with eyedrops or eye injection. A medication can be given to help relax.

You are awake during surgery and will be able to follow instructions such as looking up and down. You may see light and movement during the procedure but you will not see what the doctor is doing to your eye

Your surgeon will look through a special microscope to perform the surgery. A device (eye speculum) will be applied to support the eye and keep the lids open during the surgery. Surgery will be performed with very small instruments through tiny incisions near the edge of the cornea.

AFTER CATARACT SURGERY

• After the surgery, you will be given:
• - a clear plastic shield to protect your operated eye. This shield is required to be worn at night to bed.
• - instructions on eyedrops schedule and post-operative eye care.
• Sunglasses would be helpful as your eyes would be sensitive to light. Sunglasses also protect dusts and irritants from entering the operated eye
• Do not push the eyeball when putting eyedrops. Best to lean back on a reclining chair or lie in bed for support.
• NEVER touch or rub the eye.
• No eye make-up.
• Do not bend down with your head below the waist level.
• Do not lift heavy objects. No strenuous activities / going to the gym/ golf/ swimming
• Do not get the face wet during the first 24 hours. When shower, avoid spraying water straight into the eyes.
• Take rest from work.
• Avoid visiting dirty environments like the wet market and construction sites.
• Avoid water, dust, dirt, sweat, or soap from entering the eye.
• It is utmost important to adhere to postoperative care instructions for optimal recovery

VISION RECOVERY AFTER CATARACT SURGERY

After cataract surgery, it is natural to experience changes in vision as your eyes heal. Here is what you can expect during the recovery process:

• Immediate Post-Surgery: Your vision may be blurry immediately after the surgery. Within the first week, you should notice a significant improvement in clarity. You can resume light activities such as light reading and watching television.
• Sensations: It is common to feel mild irritation or a foreign body sensation in your eyes during the first few days after surgery. You may also experience mild eye discomfort, irritation, itching, tearing, and light sensitivity for about a week.
• Use of Sunglasses: Sunglasses can help alleviate symptoms of light sensitivity when outdoors.
• Recovery Timeline: The majority of vision recovery occurs during the first week after surgery. However, it's normal to experience small fluctuations in vision during the first-month post-surgery.
• Contact Your Surgeon: If you develop significant eye pain, redness, sudden changes in vision, or any potential signs of serious complications, contact your eye surgeon immediately!
• Stabilization of Vision: Most patients will experience stabilized vision about one month after surgery. However, a small percentage may take a few months to fully recover their vision, especially if the surgery is complex or if
there are other eye diseases present.
• Follow-up Appointments: Post-operative follow-up appointments are crucial to monitor your progress and address any concerns.

It's essential to have a thorough discussion with your eye surgeon about what to expect during your individual recovery process. They can provide personalized guidance based on your specific situation and ensure the best possible visual outcome.

This article was contributed by Dr. Jocelyn Wu Shin Yin, Consultant Ophthalmologist and Eye Surgeon at Pantai Hospital Klang. To book an appointment or learn more about Dr. Jocelyn Wu Shin Yin and her clinic, click here.