Cataract

Cataract is the clouding and loss of transparency of the clear lens located just behind the pupil.

The function of the eye’s lens is to ensure that light rays passing through the pupil are properly focused onto the retina (the light-sensitive layer at the back of the eye).
If the lens loses its transparency and becomes cloudy, it will no longer be able to properly focus light on the retina, leading to blurred or impaired vision.
For the light rays from the image to be accurately focused on the retina, the lens must be completely clear and transparent.

Visual Problems in Cataract:

The common expression “it feels like a curtain has fallen over my eye” refers to the blurring, darkening, and dulling of vision.
Colors may appear faded, less vibrant, and there is a noticeable reduction in brightness.
Many patients describe their vision as if they are looking through a dirty car window.

You may not notice visual changes in the early stages of cataract, but as it progresses and visual sharpness decreases, you may begin to notice a slowdown in your daily activities.

Who Is at Risk for Cataracts?

Cataract formation is a part of the natural aging process and is most commonly seen in individuals over the age of 65.
Its prevalence increases significantly with age, affecting approximately 70% of people over the age of 75.

Symptoms

With aging, the flexibility of the eye’s natural lens begins to decrease, and as a result, its ability to accommodate (focus on near objects) diminishes, leading to difficulties with near vision.

The hardening of the lens, reduction in its transparency, and slight yellowing continue as a natural part of aging.
As the fluid content within the lens decreases and proteins begin to clump together, certain areas of the lens become opaque.
This prevents light from being properly focused on the retina.
During this stage, patients often become more sensitive to light, may see halos around lights, and experience difficulty with night vision and reading.
Some may also report seeing double in one eye.

During the early stage of cataract — referred to as the onset of cataract — if the clouding of the lens is moderate or only a small portion of the lens is affected by opacification, visual acuity may not be significantly impaired, and your doctor may recommend regular monitoring.

However, if the cloudiness becomes more severe, a noticeable decrease in visual acuity will occur, and your ophthalmologist will likely recommend cataract surgery as the appropriate treatment.

The time leading up to surgery varies from person to person. During check-ups every six months, your doctor will inform you whether the cataract is progressing slowly, rapidly, or remaining stable.

In modern cataract surgery, it is not preferred for the cataract to become too hard or dense before treatment.

Diagnosis of Cataract

Cataracts are diagnosed through a comprehensive eye examination.

After a visual acuity test is performed on both eyes, a microscopic examination is carried out.
Then, eye drops are used to dilate the pupils, allowing for a detailed examination of the back of the eye — the retina.
It is important to determine whether the cataract is accompanied by macular degeneration or any other retinal disease, and to check for any damage to the optic nerve due to glaucoma.

What Should a Patient Diagnosed with Early-Stage Cataract Do?

After the diagnosis, you should have a follow-up examination in 6 months.
Protect your eyes from UV rays. Wear a hat or sunglasses with 99% UV protection.
If you smoke, which accelerates cataract development, try to reduce or quit smoking.
Protect yourself from various health problems, especially diabetes.
Reduce night-time driving.
The only treatment for cataract is surgical removal. Do not use eye drops, as cataracts cannot be prevented or dissolved with other treatments.
Ask your doctor about the surgical technique that will be used for your cataract surgery.
Inquire about the type and function of the artificial lens that will be placed in your eye during the surgery.
Obtain information about the final refractive error that may occur after the surgery.

Types of Cataracts

Other, less common types of cataracts are those that are not related to normal aging (Senile Cataract) as described above.

Congenital Cataracts

These occur in some newborns or children and may be associated with genetic factors or other birth anomalies.
If treated early with modern cataract surgery and intraocular lenses, these babies can achieve normal vision.

Cataracts Associated with Other Diseases, e.g., Diabetes
Complicated cataracts that develop after chronic eye diseases (e.g., Uveitis) or previous eye surgeries.
Cataracts Developed After Intensive Steroid Treatment
Traumatic Cataracts
These can develop after penetrating or blunt injuries to the eye.

Cataract Treatment:

If the changes in your vision are just simple cloudiness and you can achieve better vision by adjusting your glasses prescription, you may choose to wait for surgery.
However, if, despite changes in your prescription, you still cannot achieve good vision and continue to experience blurry vision, it is recommended that cataract surgery be performed without delay.

What is Cataract Surgery?

Simply put, cataract surgery involves the removal of the cloudy natural lens of the eye and replacing it with a clear artificial lens (intraocular lens, IOL).
Modern cataract surgery is currently performed on an outpatient basis, meaning you do not need to stay in the hospital overnight.

Pre-Operative Tests for Cataract Surgery

Before surgery, the eye’s anterior-posterior length is measured with an A-scan (ultrasound) and the curvature of the cornea is measured with keratometry. This measurement, known as the Biometry Test, helps your ophthalmologist select the appropriate lens (IOL) to be implanted in your eye.
If you have previously undergone any laser refractive surgery, such as LASIK, these procedures will not prevent you from undergoing cataract surgery.

However, for patients who have had LASIK or similar surgeries, it is important to obtain the pre-LASIK measurements of the eye’s refractive error if possible, as these parameters will assist your doctor in accurately calculating and selecting the appropriate lens (IOL) for implantation.

Regular Medications You Are Using Before Cataract Surgery

Be sure to inform your ophthalmologist about any medications you are regularly taking before the surgery. If you are using or have previously used alpha-blocker medications for prostate problems (e.g., FLOMAX, CARDURA, HYTRIN, XATRAL, etc.), make sure to mention them. These medications may make it difficult for your pupil to dilate during the surgery preparation or may prevent it from staying dilated during the procedure. In such cases, the surgical procedure could become more difficult, and potential complications may arise. However, if your doctor is aware that you are taking these medications beforehand, they can take necessary precautions and use appropriate medications to ensure the surgery is completed successfully.

Cataract Surgical Procedure

Phacoemulsification (commonly known as FAKO technique) is the most commonly used modern cataract surgery method today.

Its widespread use and the fact that it is performed in a closed system are indicators of its reliability and safety.

It rapidly and effectively resolves visual complaints.

A small incision, approximately 2 mm, is made on the cornea to access the eye. Using high-frequency ultrasonic waves, the phaco instrument breaks up the cataract (cloudy lens), and these fragments are then suctioned out of the eye.

Once the cataract is removed, in the second stage, your surgeon will implant a foldable intraocular lens (IOL) into the eye using a small injector system through the same incision.

This artificial lens will become a permanent part of the eye, as it does not cause an allergic reaction or foreign body response within the eye.
In 99% of cases, the intraocular lens (IOL) is placed behind the iris, the colored part of the eye, and this is referred to as a posterior chamber lens. The natural lens of the eye is also located in this region. Sometimes, the lens is placed in front of the iris, and these lenses are called anterior chamber lenses.
After the IOL is placed in the eye, the incision is closed without stitches, and the procedure is complete.

Which Lens Option Is Best for You?

Modern cataract surgery not only removes the cataract but also allows for the correction of the eye’s refractive error with the intraocular lens (IOL) placed inside the eye. Discuss the type and selection of this new lens, which will provide optical correction, with your doctor before the operation.

If you have a condition like high astigmatism, you may consider choosing a TORIC IOL.

Monofocal IOLs are single-focus lenses and have been the most commonly used lenses for many years. By correcting distance vision alone, they will require you to wear reading glasses for close-up tasks, or glasses for distance vision when correcting near vision.

Most people prefer to select monofocal lenses that correct distance vision, so they only need glasses for reading up close. On the other hand, individuals who had myopia (nearsightedness) in their youth and wore glasses for distance vision may prefer to stay myopic after surgery. They will choose to wear glasses for distance vision post-surgery but enjoy reading without glasses because if their myopia is corrected, they will be warned by their doctor that they won’t be able to see up close.

However, for patients who do not want to remain dependent on glasses after surgery and prefer a monofocal lens, a treatment method called Monovision is applied. This involves placing a lens in one eye to correct distance vision and in the other eye to correct near vision. This approach can significantly reduce the need for glasses while reading.

INTRAOCULAR MULTIFOCAL LENSES:

For patients who do not want to wear any glasses after surgery, multifocal lenses are a good option. These lenses are more expensive than other types, and even after surgery, they do not completely eliminate the possibility of ever needing glasses.

Accommodative lenses, which have not found much use, have been largely replaced by multifocal lenses, and more recently, trifocal lenses, which are commonly used. These lenses can help address both distance and near reading difficulties. They have rings or focal zones on their surface. Depending on where the light comes from, the light passes through these rings on the lens surface, allowing people to see both distance and near objects clearly.

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