• A gradual decrease in your vision and a feeling of permanent blurring in your vision that is not improved by refractive devices such as glasses and contact lenses may be a cataract. Some types of cataracts have a much greater impact on vision
• Creating different reflections in lights or creating a bright halo around them, especially at night
• Colors are not as bright as they were before the cataract

Some types of cataracts may temporarily improve your near vision (due to the creation of myopia from hardening of the lens nucleus). Of course, this improvement is lost as the cataract worsens.

When you start to notice problems with your vision and your doctor has told you that you have a cataract, it is likely that you already have an advanced cataract ready for surgery. In some cases and depending on the type of cataract (nuclear, cortical, posterior subcapsular), the symptoms vary and are sometimes more intense and sometimes milder. Some patients complain of bright halos, strange reflections in lights and difficulty seeing at night. In others, their myopia, astigmatism or hyperopia changes and they need to change their glasses (an event that is common during development, but not in adulthood). With the modern method of phacoemulsification, we do not wait for the cataract to “mature”. This was true in the past when cataract removal was done with the extraperipheral method and the lens of the eye had to have a lot of cataract in order to be removed. Now the operation is performed as soon as it is diagnosed by the ophthalmologist and creates some of the above problems or changes in vision. After all, the more incipient the cataract is, the more the possibility of intraoperative difficulties decreases.

The lens of the eye is mainly composed of water and collagen fibers. The collagen fibers are arranged in a precise and specific way to ensure transparency in the lens, which allows light to enter the eye. With aging, proteins are deposited and accumulate in one point of the lens, eliminating the structure that ensured its transparency, and creating cloudiness in that specific point. Over time, this cloudiness grows and increasingly obscures the lens of the eye. After international studies, some factors have been found that are associated with the creation and deterioration of cataracts, and they are the following:

• Ultraviolet radiation
• Diabetes
• High blood pressure
• Obesity
• Smoking
• Long-term use of cortisone
• Statins used to lower cholesterol
• Previous injury or inflammation of the eye
• Previous eye surgery
• Hormone replacement therapy
• Alcohol abuse
• High myopia
• Family history

A growing theory is that cataracts are caused by oxidative changes in the lens of the eye. This is supported by the fact that fruits and vegetables high in antioxidants, as well as vitamin E, carotenoids, and lutein and zeaxanthin, help prevent the formation of some types of cataracts.

Modern cataract surgery is one of the safest and most effective surgical procedures performed today. It is a simple and painless procedure for the patient and restores vision to normal, providing a permanent result. During the operation, the ophthalmologist removes the cataractous lens and replaces it with an artificial lens, which is placed intraocularly and restores vision.

The entire procedure is performed on an outpatient basis (no hospitalization is required). The patient returns home almost an hour after the end of the operation. The modern method of cataract removal is performed with high-frequency ultrasound, which breaks the cataractous lens into small pieces, which are then removed with extreme precision and care with the help of suction from the ultrasound machine. This method is called phacoemulsification and technology has evolved so much that the operation is now performed with an incision in the eye of 1.7-2.2 mm., which helps in faster healing and minimizing complications such as retinal detachment. After all remnants of the cataract are completely removed from the eye, the surgeon then places an artificial lens intraocularly in place of the natural lens. In very rare cases, it may be necessary to place the new lens in front of the iris and pupil. After the lens is placed, an antibiotic is injected intraocularly. No suture is needed to close the incision, which as mentioned above is extremely small and heals almost automatically after the end of the surgery.

Yes, the surgery is usually performed with local anesthetic drops and mild sedation. This allows communication with the surgeon during the surgery, helping you to remain calm, without the risks of general anesthesia and without pain. The surgery by an experienced surgeon lasts 10-15 minutes and after its completion and a short stay in the recovery room, the patient can return home. You are not allowed to drive after the surgery, so someone must be there to accompany you.

The operation is generally painless. In addition to the use of local anesthetic drops, an intravenous anesthetic is administered, which, while you will be awake, will relax you during the operation. Most of the time, the administration of anesthesia helps you not to remember much of the operation, although you remain awake throughout. If at any time you feel even the slightest discomfort, it is possible to treat it immediately with the appropriate treatment.

After the operation, there is usually no pain. There may be a foreign body sensation during the first 24 hours from the many eye drops that have fallen into the eye, but this is tolerable.

The lenses that are placed intraocularly in cataract surgery replace the natural lens that has become cloudy due to the cataract. These lenses have the ability to also correct the eye refractively (i.e., they correct myopia, hyperopia, and astigmatism, and if they are multifocal/trifocal, then also presbyopia). In this case, the cataract surgery is called a refractive lens exchange.

Modern technology offers the surgeon a wide variety of lenses for intraocular placement. Choosing the ideal lens for you will depend on many factors, such as your lifestyle, your activities, your vision needs (a professional driver has different needs and a teacher or someone who works in IT has different needs), your desires, as well as the anatomy of your eye.

Special lenses that also correct the refractive problem of the eye are called PREMIUM lenses and have special features, more advanced than the simple single-focal lenses that were the only ones available to us until a few years ago.

The older lenses used had a spherical optical system, meaning their front surface had a uniform spherical shape from the center to the periphery (spherical lenses). However, in the natural lens of the eye, its curvature varies from the center to the periphery (aspherical). Why is this important? Because a spherical lens creates optical “imperfections” called aberrations and this can reduce the quality of vision, especially in low light (e.g. driving at night).

Unlike spherical lenses, Premium aspherical lenses, are much more similar to the shape and optical quality of the natural lens and can therefore provide sharper vision, especially in low light and for people with large pupils. There are many such lenses and they are increasingly used.

Toric lenses

Toric lenses are premium lenses that correct astigmatism along with myopia or hyperopia. These lenses have different refractive powers in their various meridians and have markings on the peripheral part of the lens that help the surgeon to place them inside the eye in such an orientation that the astigmatism is best corrected.

Before the operation, the ophthalmologist temporarily marks the surface of the cornea on the most convex meridian. The toric lens is then placed during the cataract surgery in such an orientation so that the markings on the lens align with the markings on the cornea and thus the astigmatism is best corrected.

Premium Multifocal/Trifocal Lenses

With the increasing demands of everyday life, lenses were designed that offer excellent image quality at all focal distances (near, intermediate and far). They are specially designed lenses that approximate youthful vision and help in complete independence from auxiliary glasses.

Before surgery, your ophthalmologist will ask you about your medical history and the medications you are taking (some medications, such as those for prostate hypertrophy, cause intraoperative difficulties and it is good for the surgeon to know this in advance). He will also subject you to a complete ophthalmological examination, in order to examine the health of your eyes and to find possible anatomical difficulties that must be treated with care during the operation. A complete refractive examination is performed in order to find the degrees of myopia/hyperopia and astigmatism that you may have. In addition to the above, you will undergo a special examination called biometry, which provides the ophthalmologist with valuable information about the structure of your eyes (eye length, anterior chamber depth, corneal curvature, etc.). These measurements are necessary for the ophthalmologist to choose the lens with the appropriate refractive power, to place it intraocularly in place of the cataractous lens that will be removed and in this way to give you the best possible vision postoperatively. All this is usually not done on the day of surgery, but at least one day before, so that if your eye needs a special lens, it can be ordered and made available to the surgeon in time.

On the day of surgery, you should be fasting in the morning and if you are taking any medications, then take them with a glass of water. In case you have diabetes, since you will be fasting, you should not take your antidiabetic medications, so as not to suffer from hypoglycemia.

Nowadays, there are various types of lenses available to the ophthalmologist. The selection of the appropriate lens is made by the ophthalmologist, always in consultation with the patient. So if you have astigmatism above 1 degree, then perfect vision will be provided by a special toric lens, which corrects up to 6.5 degrees of astigmatism. The toric lens that will be selected is therefore calculated with the help of biometry, but also with specially designed forms provided by the lens production companies.

If you do not mind using auxiliary glasses postoperatively, then a monofocal lens is usually placed intraocularly. This perfectly corrects your near or far vision (usually absolute correction of far vision is chosen) and thus near vision glasses are used postoperatively, which the ophthalmologist prescribes about a month after the operation.

However, if you like the idea of ​​not using glasses after cataract surgery, you can choose the monovision technique in which one eye is corrected to see far (the dominant, i.e. the stronger eye between the two) and the other to see near. In this case, one eye sees well near and the other sees well far.

Now, ophthalmologists have excellent quality multifocal-trifocal lenses at their disposal, which correct vision at all focal distances and provide almost youthful vision. Having such solutions in their quiver, the ophthalmologist can now satisfy all requirements. In fact, cataract surgery is not an operation that is performed only on people of advanced age, but is also performed on younger people who do not have much or no cataracts purely for refractive reasons. That is, it is an alternative refractive surgery for people who are not suitable candidates for LASER or who are in the 45-65 age group, who already have some degree of presbyopia and want to get rid of their glasses for life.

When the cataract surgery is uncomplicated, it takes about 10 minutes for each eye. After the surgery is completed, the patient sits for about an hour in the eye clinic so that detailed instructions for postoperative treatment can be given and a postoperative check-up can be performed before the patient leaves. Someone must be with you to accompany you home and you need to have sunglasses with you for protection. On the first day, the operated eye is slightly irritated and you may have a foreign body sensation from the eye drops that have been instilled in the eye. Vision is blurry and will improve over time. You should avoid any activity on the first day. From the second day, you can return to your activities, but without excessive weight lifting or exercise. For the first week, it is advisable to avoid activities that may expose you to dust or dirt. Water should not enter the operated eye for one week and swimming in the sea and pool should be avoided for 2-3 weeks. A post-operative check-up is usually performed on the first day after the operation and then about a month after the operation.

If you have cataracts in both eyes, surgery is usually performed first on one eye and then a few days/weeks later on the other. This allows time for vision to be restored and stabilized in one eye before the second eye is operated on. With modern surgical techniques, which are extremely safe and have a very fast recovery, it is possible to have surgery on both eyes on the same day. Studies have not shown an increase in the rate of complications with this method and, provided that the surgery is performed by an experienced surgeon, the patient’s recovery is quick and the result is the same as having both eyes operated on separately. Having surgery on both eyes on the same day is particularly helpful for people who travel a long distance to have surgery or for people who have high degrees of myopia or hyperopia (so surgery on one eye creates problems for them due to the difference in vision in one eye from the other). Therefore, these patients with major refractive problems, when the cataract is removed in one eye, can no longer wear their old glasses, and if the lens of the glass is removed from the operated eye, dizziness or problems with stereoscopic vision may occur. Therefore, in these cases, the operation on both eyes on the same day is very helpful.

After cataract surgery, there is a chance that a “secondary cataract” or “posterior capsule opacification” may develop. This is a condition independent of the surgery and is due to the growth of certain cells.

Under normal conditions, the crystalline lens of the eye is located inside a capsule called the capsule. During the surgery, an opening is created on the anterior surface of the capsule by the surgeon and through this opening the cataractous lens is removed and the new lens is placed. The posterior surface of the capsule remains intact during the surgery and the new lens is placed inside the remaining capsule. In a small percentage of patients, the posterior capsule becomes cloudy a few months or even years after the operation and this clouding is called “secondary cataract” or otherwise “posterior capsule clouding”. The vision lost from this clouding can be restored with the help of YAG laser capsulotomy. This procedure is performed in a special lamp, to which the laser is adapted in the clinic or doctor’s office and does not require admission to the operating room. It is done with local anesthesia (drops), is painless and lasts 5-10 minutes. The restoration of vision is immediate and does not require a repetition of the procedure.