Cataract surgery

Cataract

Cataracts or cataracts are clouding of the natural lens that can only be remedied by surgical removal.

cataract surgery

During cataract surgery, the clouded natural lens is removed and replaced by an artificial lens (intraocular lens). Cataract surgery is one of the most common procedures performed on humans and is normally a routine procedure.

1. Operation process

During cataract or cataract surgery, the natural clouded lens is shattered with ultrasound and suctioned through a hollow needle (phacoemulsification). In individual, very advanced cases, the lens cannot be shattered and must be carefully pushed out of the eye (extracapsular lens removal). In both methods, the lens capsule should remain intact so that the artificial lens can later be inserted stably and correctly centered.

Femto cataract surgery

Femtosecond laser-assisted cataract surgery (femto-cataract surgery) shines with its precision. Blades are generally not used. The lens capsule is opened with a laser beam with micrometer accuracy, circular and exactly centered on the pupil. This improves the stability of the lens capsule, which later serves as a suspension for the artificial lens. Furthermore, the clouded lens is crushed with great precision, which facilitates suction and thus protects the cornea. This technique is generally more accurate and gentler than manual gray star surgery.

Anaesthetics/Anesthesia

The procedure is performed under local anesthesia (local anesthesia). Anesthetic eye drops are administered 30 minutes before the operation and anesthetic is applied to the eye during the operation itself. The anesthetist provides access to your bloodstream so that you can give sedatives or painkillers when needed.

Risks and complications

Despite all care taken, complications can occur during cataract surgery. These are very rare as this is a routine procedure and we perform between 10 and 25 such procedures every week.

Scheduling sequence

• Diagnosis or confirmation of cataracts, e.g. as part of an annual check-up, after referral from your optician, general practitioner or ophthalmologist
• Preliminary examination for cataract surgery (link) takes approx. 1-2 hours (after that, you should not drive a car for 4 hours)
• First eye surgery
• 1-day check the following day
• 1-week control
• 1-month check
• Annual check
  

Cataract surgery as a health insurance benefit

Cataract surgery is primarily used to replace the clouded lens with a clear artificial lens so that light can reach the eye unhindered again.
The old glasses usually have to be adjusted after this operation, as the refractive properties of the artificial lens do not exactly match the natural lens.

Cataract surgery with additional services

Thanks to the latest lens calculations, specially designed lens implants can compensate for existing vision defects such as astigmatism, farsightedness, nearsightedness and presbyopia. These so-called value-added lenses enable patients to see sharply at one or more distances without glasses. Unfortunately, the additional costs for this are not covered by health insurance and must therefore be charged to the patient.
Before a cataract operation, it is useful to estimate what is the best solution for you. During the preliminary examination for cataract surgery, this exact question is discussed in an overview of the condition of your eyes.

binocular long-range vision

Both eyes are corrected so that the patient can see sharply into the distance after surgery. Glasses are still required for medium and close distances.

Medium-range binocular vision

Both eyes are corrected so that you can see sharply in the middle range (newspaper/computer). Glasses are necessary for viewing in the distance (watching TV/driving).

binocular close vision

Both eyes are corrected so that you can see clearly in the vicinity (newspaper/book). You may need glasses to work at a computer. In the distance (watching TV/driving) can only be seen with glasses.

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Monovision - Seeing like Goethe

Your guide eye is corrected so that you can see sharply into the distance. The other, non-dominant eye covers mid-distance vision. You have the advantage that you no longer need glasses for most daily activities after the procedure. Conventional single-vision glasses can help you read newspapers in a relaxed way. Monovision can be simulated with glasses or with a contact lens test and provide information about compatibility.

Binocular long-range and near-vision

Looking at a distance and close without glasses, as at a young age does not have to remain a dream. There are special artificial lenses that allow both eyes to see near and far at the same time.

These special multifocal lenses do not focus light to a single point, like monofocal lenses, but to several points, which enables so-called “pseudo-accommodation.”

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Unfortunately, not all patients are suitable for implanting multifocal lenses; this is evaluated during the preliminary examination for cataract surgery (link).

Before cataract surgery

• Start using eye drops 5 days before surgery as directed
• Stop applying makeup 2 days before surgery (no mascara)
• Do not eat anything 6 hours before surgery, only drink clear liquids (tea without sugar, non-carbonated water, coffee without milk/cream)
• Do not drink or smoke 2 hours before surgery
• Take your medication as usual unless it has been paused due to surgery
• Try to urinate again just before surgery

After cataract surgery

• Have an accompanying adult pick you up, as your ability to react may be reduced by narcotics, painkillers and sedatives
• Use the prescribed medications in accordance with the medication schedule
• You should not actively participate in road traffic, work on running machines, drink alcohol for 24 hours
• 1-3 days after surgery, your eyes should not be in contact with water or steam
• 1 week after surgery, you should refrain from using cosmetics and lotions around the eyes, do not rub your eyes, apply eye protection at night
• Avoid visiting bathing establishments, saunas, contact or ball sports, or heavy physical work for 1 month
• Contact us immediately if you experience pain, eye redness, vision, urinary retention, fever (> 39°C), vomiting or severe pain
  

Overview of medications before and after cataract surgery

• 5 days before surgery: 1 Nevanac eye drop in the morning
• Immediately after surgery: 1 Tobradex eye drop every hour
• 1st week after surgery: 1 Nevanac eye drop in the morning, 15 minutes later 1 Tobradex eye drop in the morning, at noon, in the evening and before bed
• 2nd week after surgery: 1 Nevanac eye drop in the morning, 15 minutes later 1 Tobradex eye drop in the morning, at noon and in the evening
• 3rd week after surgery: 1 Nevanac eye drop in the morning, 1 Tobradex eye drop at noon and in the evening
• 4th week after surgery: 1 Nevanac eye drop in the morning, 1 Tobradex eye drop each evening

FAQs - common questions

Can cataracts be reversed?

The development of lens opacity can be slowed down by wearing glasses with UV protection and eating a healthy diet. Existing turbidity can only be treated with cataract surgery.

Who normally develops cataracts?

Most people develop lens opacity sooner or later, which is part of the natural aging process. Cataracts affect 50% at the age of 65 and almost 100% from 75 years of age. Cataracts can occur much earlier in people who suffer from blood sugar disorders (diabetes mellitus) or take cortisone supplements.

At what point is cataract surgery useful?

There are various reasons for cataract surgery:

• Vision is impaired due to lens opacity, i.e. the patient is blinded or has blurred vision, especially in the dark
• Lens opacity changes the refractive properties of the natural lens, i.e. the glasses must be adjusted every few months
• The cloudy lens thickens and the outflow channels in the eye are narrowed, which can also lead to an increase in intraocular pressure (urgent surgical indication)
• The patient has mild lens opacity and wants to live a life free of glasses and contact lenses (it should be checked here whether the health insurance company has to pay part of the operation)

How do I find the right doctor to perform cataract surgery for me?

Choosing the right ophthalmologist is decisive for the success of cataract surgery
Possible criteria are:

• tuition
• knowhow
• Experience (as a rule, the risks of complications decrease with the number of cases of the surgeon)
• Technology used

Can cataracts come back after cataract surgery?

It is not possible for cataracts to come back again. After cataract surgery, around 50% of patients experience a cataract, with individual cells accumulating and clouding on the back of the artificial lens. A short and painless laser procedure can make the lens clear again (link: YAG capsulotomy).

Can both eyes be operated on the same appointment?

Due to the immense progress made in the safety of cataract surgery, it is now possible to consider operating both eyes at the same time. Benefits include patient comfort. There are fewer follow-up checks and the patient is quickly able to return to work.
In principle, from our point of view, it makes more sense to operate on one eye first and only a week later on the second eye. This makes it possible to adjust the choice of artificial lens on the second eye if necessary and to address postoperative inflammation preventively.

Is cataract surgery painful?

No, there may only be a slight feeling of pressure for a few seconds, e.g. when the IOL is implanted or when the femtosecond laser is applied.

Will I see anything during cataract surgery?

The eye that is not being operated on is covered and therefore only sees the dark cover. The eye that is being operated on sees the light from the microscope. As a result, glare can occur for a short time. Patients often perceive the twinkling of microscope light as a kind of kaleidoscope.

How long does cataract surgery take?

Between 10 and 20 minutes, depending on how far the cataract has progressed.

How long will it take until I can work again after cataract surgery?

As a rule, work can be resumed just a few days after the operation. To be on the safe side, we issue a work reference for one week after cataract surgery. After the implantation of multifocal lenses, it usually takes several weeks to months until patients become accustomed to the new visual experience and get by without glasses.

Will I have to wear glasses again after cataract surgery?

Depending on the type of operation and the IOL used, the vast majority of everyday situations can be handled without glasses after cataract surgery. If simple IOLs are used, the progressive glasses must be adjusted.