Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Naja Bertolt Jensen
Cataracts are a leading cause of reversible blindness in the world and many undergo surgery each day to have their cataracts removed and sight restored. Despite the immense amount of information available, there remains many myths about cataract surgery that people hold on to. Here are some common myths debunked to give you more clarity on the matter.
Myth 1: All cataract are the same
A cataract occurs when the naturally clear lens in the eye starts turning cloudy. In most cases, it is due to build up of protein in the lens with age, resulting in “nuclear sclerosis”. Some patients with severe nuclear sclerosis may experience an increase in the myopia over time to even more than 1000 degrees. “Cortical” cataracts are characterised by spoke-like opacities in the lens, these are commonly seen in patients with diabetes. “Anterior Subcapsular” cataracts are opacities in the front portion of the lens, typically seen in patients who have severe allergies or who have had some trauma to the eye. “Posterior subcapsular” cataracts are opacities found in the back portion of the lens. These results in increased glare symptoms, especially at night when car headlights abound. “White” cataracts are mature cataracts in which some portion of the lens has started to undergo liquefaction. This poses increased challenges during surgery and requires specific techniques to deal with during surgery. “Morgagnian” cataracts are hyper-mature cataracts that are not so commonly seen these days. They too have inherent increased risks that need special care during surgery to avoid complications. Whichever type of cataract it is, once it begins to affect vision, the treatment in short is the same; cataract surgery to remove the opacified lens and replace it with an artificial lens.
Myth 2: Cataracts can be prevented or treated with eye drops
Cataracts form as part of the aging process so unfortunately there is no escaping this reality unless a way is found to stop aging. To date, there are no eye drops that can be used to treat cataracts. With the hardening and opacification of the lens, the standard of care is removal via phacoemulsification. This involves using ultrasound energy to break up and liquify the cataract to facilitate its removal via a vacuum system. Once this is done, an artificial lens is inserted in its place. These lenses are also known as IOL (Intra-Ocular Lenses). Eye drops are needed in the post-surgical care to minimise inflammation and to aid recovery.
Myth 3: Only old people get cataract
While most people who undergo cataract surgery are generally older, they are not the only ones who get cataract. Some young people in their 20s can also get cataracts from various causes like trauma and steroid use. It is also possible for babies to have cataracts (congenital cataract) so it is certainly not only a disease of the old.
Myth 4: Cataract surgery is dangerous
The threshold for surgery has changed over the years. In the past, cataract surgery involved large wounds with multiple stitches. That is where the concept of waiting for it to “ripen” before surgery comes about to balance the benefits and the risks involved. With modern technology, cataract surgery has been safer than ever before with most surgeries taking only 10-15 minutes. No stitches are needed with the self-sealing wounds created. Most are able to see much better by the next day. There is certainly no 100% guarantee of this because all surgery has risks but in 98-99% of the time, surgery proceeds smoothly and vision is restored with many patients satisfied.
Myth 5: Cataracts can come back after surgery
Once a cataract is removed, there is no way the cataract can form again. There are however some people who develop an “after-cataract” where the capsule in which the artificial lens sits starts to become a bit “dirty”. This is due to proliferation of remnant cells in the lens bag over time. This is easily treated with a specialised laser (YAG laser) and clears this once and for all.
Myth 6: Cataract surgery is painful
Modern day cataract surgery can be done in 10-15 minutes under topical anesthesia. Numbing eye drops are given to numb the eye before surgery and this ensures a smooth, painless surgery. In some patients, intravenous sedation is given by an anesthetist to help patients feel comfortable and remove any anxiety. More often than not, patients only remember falling asleep and the next moment they are awake, they are told that surgery is completed.
Myth 7: LASIK can be used to treat cataracts
LASIK is a form of laser vision correction which reshapes the cornea to correct any refractive error present. It is able to treat myopia (short-sightedness), hyperopia (long-sightedness), astigmatism and presbyopia. LASIK surgery is not used to treat cataracts. With modern laser technology, femto-second laser has been used to aid cataract surgery by replacing specific steps of cataract surgery including wound creation, opening of the lens capsule and even softening the cataract. This is helpful for some patients as it reduces the amount of energy needed to remove the cataract. The main bulk of the surgery still requires the use of ultrasound energy to fragment the cataract to facilitate its removal.