Frequently Asked
Questions
A cataract is the clouding of the eye’s natural lens, which lies behind the iris and the pupil. It is the most common cause of vision loss in people over 40 years and the principal cause of reversible blindness in the world.
Symptoms
- Cloudy, fuzzy, foggy, or filmy vision
- Glare from lamps or the sun, which may be severe
- Difficulty driving at night due to glare from headlights
- Frequent changes in eyeglass prescription
- Double vision
- Difficulty performing daily activities because of vision problems
Detection and diagnosis
A thorough eye examination can detect the presence and extent of a cataract, as well as any other conditions that may be causing blurred vision or discomfort.
A comprehensive eye examination includes:
- Visual acuity test:
An eye chart test measures how well you see at various distances. - Pupil dilation:
The pupil is widened with dilating eye drops to allow the doctor to see more of the lens and retina and look for other eye problems. - Tonometry:
A standard test to measure fluid pressure inside the eye. Increased pressure may be a sign of glaucoma. Other tests might be necessary to determine if visual loss is because of the cataract, or some other reason, for example a problem involving the retina or the optic nerve. - Treatment
Surgery is the only option for improving vision. The cloudy lens is removed and replaced with a clear, artificial lens.
The two types of cataract surgery are:- Phacoemulsification or phaco (often called ‘laser’ surgery)
- Extracapsular cataract extraction (ECCE)
Phacoemulsification Surgery
The purpose of doing the surgery is to replace the cataract with an artificial lens (implant) inside your eye. Cataract surgery is mostly done under local anesthesia, where you will be awake during the operation. You will be aware of a bright light, but you will not be able to see what is happening. Before entering the operation theater, you will be given eye drops to enlarge the pupil. After which, you will be given an anesthetic to numb the eye. This may consist simply of eye drops or injecting local anesthetic solution into the tissue surrounding the eye. You will be asked to keep your head still and lie as flat as possible during the entire surgical procedure. The operation normally takes 15 minutes, but may take up to 45 minutes. At the end of the operation, a shield is placed over your eye to protect it, and you will need to use the shield whenever you sleep for the next 5-7 days.
Cataract Removal
Through a tiny incision made in the eye, the surgeon inserts a small (about the size of a pen tip) ultrasonic instrument that breaks up and gently removes your cloudy lens.
IOL Implantation
The cataractous lens is replaced with an artificial Intra Ocular Lens (IOL). The IOL is inserted in precisely the right spot, where the haptics or “arms”, gently unfold to keep it in place.
Vision Regained
Once the cataractous lens has been removed and replaced by the artificial lens, light once again passes through providing a range of vision.
What to expect after the surgery
It is normal to feel blocking sensation, mild eye discomfort and blurring of vision for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, your eye doctor may suggest a pain reliever. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about 6 weeks. You can take pain reliever after the surgery if you experience any discomfort in 4-6 hourly intervals apart. You will be given a couple of eye drops to reduce inflammation after the surgery. The clinic staffs will explain how and when to use them. Please do not rub your eye. You will have to put a clear plastic shield over your eye while you are sleeping for 1 week after the operation.
What exactly is a cataract?
A cataract is the cloudiness of the eye’s natural lens, which lies between the front and back area of the eye.
Are cataracts found only in older people?
No. It is shown that half of the population will have some form of cataract by the age 65, and nearly everyone over 75 has at least one. But in rare cases, infants and children can also have congenital cataracts. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy. They can also be inherited.
What causes cataract?
Generally part of the aging process, other risk factors include prolonged UV light exposure, long term use of medication and certain illnesses like diabetes. Cataract can also be present at birth or develop as a result of injury in infants or teenagers.
When do I need cataract surgery? Some say that I should wait until the cataract is ‘mature’ before doing surgery, is that correct?
The time to have cataract surgery is when the cataract causes a decrease in your vision that interferes with your normal daily activities. These activities include driving at night, reading, watching TV, artwork, etc. Just because you have a cataract doesn’t mean you have to have it removed. When you complain about your reduced vision and your doctor says that he or she cannot make you a better pair of glasses, then it’s time to seriously consider cataract surgery.
Is cataract surgery serious?
All surgery involves some risk, so yes, it is serious. However, cataract surgery is one of the most commonly performed surgeries and the success rate is over 99%.
Is the surgery painful? Would there be any stitches?
The procedure itself is considered painless. During surgery, you will be given anesthetic eye drops. You will however feel the presence of the eyelid holder to keep your eye open. Phacoemulsification surgery is a small incision surgery of less than 3mm incision therefore no stitches are needed after the surgery.
Extracapsular cataract extraction (ECCE) surgery however will need a couple of incisions after the surgery in order to ensure healing process. Your eye doctor will inform you which type of surgery will be suitable for you.
Is cataract surgery otherwise called as laser surgery?
Cataract surgery is medically termed as phacoemulsification (phaco) or small incision surgery.
This surgical technique uses ultrasound technology to emulsify the lens matter. A replacement lens (intraocular lens or IOL) is then implanted. It is commonly misinterpreted as “laser surgery” within our local Malaysian community. A replacement lens (intraocular lens or IOL) is then inserted. It is commonly misinterpreted as laser procedure in layman term.
YAG lasers are used in a later procedure to create a clear opening in the lens-containing membrane (posterior capsule) if the membrane becomes cloudy in the months or years following the original cataract removal.
What are the benefits of phaco?
- Reduced pain and discomfort after surgery
- Faster healing process with faster resuming of patient’s normal activities
- Reduced risk of infection that may lead to blindness
- Better visual results with less risk of induced astigmatism
- Less leakage risk that may lead to infection and blindness
* In traditional surgery (Extracapsular cataract extraction or ECCE), tying the sutures too tightly may create astigmatism or a distortion of vision. The patient may experience blurred vision until the sutures are removed.
Do I still need thick glasses after cataract surgery?
Cataract patients who have intraocular lenses (IOLs) implanted during surgery may need reading glasses for close vision.
In fact, you will be less dependent on reading glasses with the newer multifocal IOLs.
Discuss the pros and cons with your eye doctor before deciding upon it.
People who do not receive IOLs wear contact lenses for distance vision, with reading glasses for close up. Or they may wear multifocal contact lenses for all distances. Rarely does anyone have to wear thick eyeglasses any more.
How much does cataract surgery cost?
Though costs vary from one doctor to the next, it also depends on and the type of artificial lens (intraocular lens) used as a replacement. Discuss the options with your doctor before you choose the type of intraocular lens which best suit your needs. Most medical cards (eg. AIA, Prudential, Great Eastern etc.) will cover cataract surgery and standard monofocal IOLs, but not the cost of premium artificial lenses that simultaneously correct vision at near, intermediate and distant ranges (multifocal IOLs). You might have to top up the difference in the charges yourself (pay out of pocket).
What is the after treatment care?
To guard against infection and help your eye heal better, anti-inflammation and anti-infection eye drops will be prescribed. You may need to wear a clear shield when you sleep to prevent rubbing of your eyes for a few days. After the treatment, the doctor needs to see you again within 24 hours for an evaluation. You will be seen again in 1 week and 1 month for check up.
When can I resume normal activities?
Most of the patients can return to their normal routine activities as early as the next day after the surgery (some take up to about a week). As a safety precaution, you should refrain from contact and water sports for 2 Weeks to 1 month.
However, over the next 1-3 months, you may experience the following:
- Post-op discomfort
- Fluctuation of vision
- Light sensitivity and photophobia
- Temporary corneal haze
- Increase in eye pressure
- Adjustment period
Can I travel by airplane after the surgery?
Yes.
What is the success rate? Can I go blind?
The success rate of cataract surgery is over 99%. Though complications are possible they are extremely rare (typically less than 1%). One of the most serious complications is an infection (which may lead to blindness) after the surgery, occurring in about 0.1% of patients. There are currently no eye drops, vitamins, or medications that can reverse or cure cataracts. If left untreated, cataract can lead to blindness.
How do you calculate what lens power to use?
Since each eye is different, prior to the surgery, your eyes will be measured with specialized equipment using light-waves and/or ultra sound in just a few minutes in order to determine the lens power needed to be inserted into your eye.
What about my pre-existing eye condition?
If you have other eye problems such as Age-Related Macular Degeneration (AMD), Glaucoma or Diabetes, these may limit your vision after surgery. A majority of the patients found cataract surgery beneficial even with pre-existing conditions. Your doctor will discuss the prognosis of the surgery before proceeding (or not) with the surgery.
What is the difference between Monofocal and Multifocal IOLs?
Monofocal IOLs enable you to see the distance, but you might need a pair of reading glasses for near or intermediate computer work.
In general, Multifocal IOLs allow both up close activities like reading, and at distance activities, and you can be less dependent on glasses for most of the time
Will the cataract ever come back?
No. The cataract is completely removed except for the fine capsule that supports the artificial lens implant. In a small percentage of patients, the microscopic capsule can become slightly hazy while the artificial lens implant stays perfectly clear. In this case, a procedure is performed using YAG laser and the vision is quickly cleared. The procedure takes less than a minute.
What are the possible side effects of cataract surgery?
As with any surgery, pain, infection, swelling and bleeding are possible, but very few patients have serious problems or cataract surgery complications. Your surgeon may prescribe medications for these effects.
Retinal detachment also occurs in a few people. Be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately.
What to expect after cataract surgery?
All patients are unique and every individual will have their own unique healing profile and personal expectations for the procedure. The degree of improvement may vary from individual to individual. Consulted objectively, performed accurately and healed perfectly, cataract surgery is a safe procedure with excellent results. Like any other surgery, post operative results cannot always be predicted or guaranteed.
What are the risks?
Although cataract surgery is a very safe procedure, the patient must understand that like any other surgical procedure, it carries risks, including blindness. However, surgeons worldwide regard cataract as one of the safer procedures among surgeries.
Complications associated with surgery include:
- Haemorrhage
- Retained pieces of cataract in the eye
- Retina detachment
- Glaucoma
- Posterior capsule rupture
- Loss of corneal clarity
- Infection
- Uncomfortable or painful eye
- Double vision
Complications associated with the IOL include:
- Increased night glare and halo
- Double vision
- Dislocation of the lens
EXPECTATIONS
What happens before cataract surgery?
Prior to surgery, your eye care professional or eye doctor will do some tests. These will include tests to measure the curve of the cornea and the size and shape of the eye. For patients who will receive an IOL, this information helps your doctor choose the best type and refractive strength of IOL. Your doctor will likely ask that on the day of or prior to the surgery for you take all of your normal medications and may have special instructions depending on your condition.
What happens during cataract surgery?
When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed and sterile coverings will be placed around your head.
The operation usually lasts about 30 minutes and is almost painless. Generally, cataract surgery is done under local anesthesia where you will have an anesthetic to numb the nerves in and around your eye. You will not have to worry about holding your eye open because an instrument known as a lid speculum will hold your lids open. You will likely see light and movement during surgery, but the eye usually is not uncomfortable. You will be asked to hold your eye still during surgery if you have been given topical anesthetic (drops only).
After the operation, a shield will be placed over your eye. Most people who have cataract surgery go home the same day. Since you will not be able to drive, make sure you make arrangements for a ride.
What happens after cataract surgery?
After the surgery, your doctor will schedule exams to check on your progress. Usually your doctor will want to examine you the day following surgery, and then at one week and one month after the surgery.
You will also be given a specific schedule of eye drops to help healing and control the inflammation inside your eye. While being especially careful not to put pressure on the eye itself, the area around the operated eye should be gently cleansed in order to remove any excess eye drops or secretions. The doctor will advice you on how to use your medications, when to take them, and what effects they can have.
You will also need to wear an eye shield at night for the first few days to help protect the eye and avoid rubbing or pressing on your eye while sleeping. It is not necessary to wear the shield during the day and it is usually recommended that you wear your normal eyeglasses during the day. If the operated eye sees much better without the glasses you may wish to remove the eyeglass lens for the operated eye, or if preferred, you may choose not wear your glasses at all.
It’s normal to feel itching and mild discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, your eye doctor may suggest a pain reliever. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about 6 weeks.
Some common problems can occur after surgery. These may include increased pressure, blurring from swelling, inflammation (pain, redness, swelling), and sometimes bleeding. More rare and serious problems include infection, loss of vision, or light flashes. If you experience increasing pain or a worsening of vision after surgery, you should contact your eye doctor. With prompt medical attention, almost all problems can be treated successfully.
When you are home, do not put your fingers in your eye and do not to lift heavy objects. Lifting heavy objects will result in increase pressure in the eye. You can walk, climb stairs, and do light household chores. It is better to avoid oily, smoky and dusty areas for about a week after the operation.
It is most important to take your drops exactly as directed and be sure to contact your doctor if you experience any problems. Be sure to return promptly to the clinic for your post operation follow up check so that your doctor will know and monitor your healing process accordingly.
Sometimes, the brain does not fully acknowledge images seen by the eye due to certain eye conditions. Hence, vision development of the eye is hindered and this leads to reduced vision in one/both eyes.
Common causes of amblyopia:
- Short-sightedness, far-sightedness and astigmatism
- Difference in the power of both eyes
- Squints
- Drooping eyelid
Detection and diagnosis
Comprehensive vision evaluations are highly recommended for infants and pre-school children. Early detection of amblyopia and its management is crucial at early age (before 7-year-old) to prevent reversible vision loss.
Treatment
Normally, a patch is placed over the ‘good’ eye so that the child is forced to use the ‘lazy’ eye. Over a period of time, the child will learn to use his lazy eye and good vision will be restored.
Age-related Macular Degeneration (AMD) is a degenerative condition of the central retina (macula) that only affects the central vision, leaving the peripheral vision intact.
Risk Factors
- Advanced age
- Family history of AMD
- Smoking
- High blood pressure
Symptoms
- A blank or blind spot in your central vision
- Objects or lines look wavy or curved
Dry AMD
- 90% of all cases.
- Does not usually cause total loss of reading vision.
- May deteriorate into wet AMD
Wet AMD
- 10% of all cases, but more visually debilitating.
- Abnormal blood vessels grow beneath the macula.
Treatment
- Laser coagulation
- Photodynamic therapy
- Intravitreal injections
Prevention
- Protect your eyes from UV light with sunglasses
- Stop smoking
- Eat foods rich in vitamins and antioxidants, like fruits and vegetables such as broccoli, spinach and carrots.
Astigmatism is a refractive error, a problem with how the eye focuses light. In an astigmatic eye, light fails to come to a single focus on the retina to produce clear vision. Instead, multiple focus points occur, either in front of or behind the retina (or both).
Causes
Astigmatism is often hereditary and present at birth. It can also result from eyelid pressure on the cornea, incorrect posture or an increased use of the eyes for close work.
Common symptoms
- Blurred or distorted vision
- Eye strain and headaches, especially after reading or other prolonged visual tasks
- Squinting
Treatment
Properly prescribed glasses or contact lenses are essential. For people with only a slight degree of astigmatism, corrective lenses may not be needed at all, as long as they are neither nearsighted nor farsighted. For moderate to high astigmatism, however, corrective lenses are needed.
Refractive surgery or LASIK also corrects astigmatism. Here the shape of the cornea is changed through refractive or laser eye surgery. Refractive surgeries require healthy eyes, free from retinal problems, corneal scars and any eye disease. are recommended on an individual basis. Explore and understand the different types of refractive surgery and treatment before deciding one is right for you.
This swelling can exert pressure on the cornea and induce astigmatism as the curvature alters. The sufferer may have blurry vision either intermittently or regularly. Treatment Most chalazions go away by themselves. Like most lid-related problems, chalazia are treated with warm compresses to promote healing and circulation of blood to the inflamed area. An antibiotic drop or ointment may be prescribed to be used after the compresses. If the chalazion persists it can be removed surgically through the inside of the lid. A chalazion that recurs in the same spot on the lid may be cause for concern and it may need further testing. |
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Diabetic related changes in the retina, including damage to the blood vessels are known as Diabetic Retinopathy. These changes can lead to blindness if not controlled. Symptoms
Treatment
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The eye depends on a flow of tears to provide constant moisture and lubrication to maintain vision and comfort. A sufficient quality of tears, a normal composition of the tear film, normal lid closure and regular blinking are essential to maintain a healthy ocular surface. Excess tears Causes
Treatment
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Floaters are small dark specks floating in the jelly-like fluid (vitreous) inside the eye. They normally appear in different shapes and sizes such as dots, circles, wavy lines, commas clouds or cobweb like.
Flashes are a sensation of light and may appear a tiny bright lights or sparkles. Flashes of light usually last for a second or two.
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Causes
Some people with migraine experience flashes before the onset of a migraine headache. Treatment In most cases, floaters are harmless. But, if caused by a retinal tear or bleeding into the retina, it becomes a serious condition that requires prompt treatment. See your eye doctor if you have floaters. |
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Treatment There is no best way to correct nearsightedness. Correction depends on the individual’s eyes and lifestyle. Some methods include:
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Treatment
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This growth of pink, fleshy tissue on the white of the eye is commonly found in people who spend a lot of time outdoors. It usually forms on the side closest to the nose. It is a noncancerous lesion that usually grows slowly throughout life. It can continue growing until it covers the pupil of the eye and interferes with vision. Or it may stop growing after a certain point. A pterygium that affects both eyes, is called a bilateral pterygium. |
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Symptoms Most of the time, a pterygium causes no symptoms other than its appearance. However, a very large one may cause redness and inflammation.
Causes The cause of Pterygium is unknown (idiopathic). But most experts believe that significant risk factors include:
Occurrence is greater among people living near the equator, or in a sunny climate. Most often seen in young adults’ aged 20 to 40. Treatment See an ophthalmologist if you have symptoms of pterygium. He or she can diagnose the condition by examining the front part of your eye with a microscope called a slit lamp. Pterygium usually does not require treatment if symptoms are mild. If a temporary worsening of the inflamed condition causes redness or irritation, it can be treated with:
If the lesion causes persistent discomfort or interferes with vision, it can be surgically removed during an outpatient procedure. You and your doctor may also take into account appearance and the size of the pterygium when making a decision about surgery.
The type of surgery most commonly used today uses the patient’s own conjunctiva (surface eye tissue) or preserved amniotic membrane (placenta) to fill the empty space created by the removal of the pterygium. In this procedure, the pterygium is removed and the conjunctiva or amniotic membrane is glued or stitched onto the affected area. Pterygium surgery typically takes 30 to 45 minutes. After surgery, patients usually need to wear an eye patch for a day. But they can return to work or normal activities (avoiding swimming and eye rubbing) after a few days. Often, patients are told to use steroid eyedrops for several weeks. This will reduce inflammation and prevent pterygium recurrence. Patients need to be carefully followed for a year because 97% of recurrences occur during the first 12 months after surgery. Prevention
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