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Cataract and Refractive Surgery
The eye is like a camera. It has an aperture, a lens and a film. The pupil is the aperture and the retina corresponds to the film. Inside each eye is a crystalline lens that bends (refracts) light rays that come into the eye and focuses it on the retina. The retina being a nerve fiber layer transmits the impulse through the optic nerve and optic tract to the brain where the image is processed.
With aging, the natural lens of the eye undergoes degenerative changes that causes breakdown of lens proteins leading to opacification or cloudiness of the crystalline lens known as cataract. This results in painless blurring of vision, “cloudy” vision, glare, poor night vision and fading of colors.
Other causes of cataracts include:
· eye trauma
· exposure to radiation
· previous eye surgery
· congenital or developmental
· prolonged use of corticosteroids
· medical problems, such as diabetes
· prolonged sun exposure exposing eyes to damaging ultraviolet (UV) rays.
A normal clear lens focuses light sharply on the retina resulting in clear vision. In contrast, an opacified lens causes dispersion of light hence the blurring of vision. If the cataract is still immature, vision can be improved with spectacle correction. With progression of cataract, surgical removal and implantation of an intraocular lens will be required to restore vision.
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Surgical correction of cataract can be done manually or with the use of an ultrasound handpiece to emulsify the lens nucleus.
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Extracapsular Cataract Extraction entails manual removal of the lens nucleus (innermost, hard part) through a 10mm incision followed by implantation of a 5-6mm rigid intraocular lens. Surgery usually takes 30minutes to about an hour. Due to the large wound, suturing is needed and recovery takes 6-8 weeks.
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Manual Small Incision Cataract Surgery also removes the lens nucleus manually which can be fragmented to 2 or more smaller pieces through a 5-7mm incision followed by implantation of a rigid or foldable lens. This may or may not require sutures depending on the size of the wound and the immediate activities of the patient.
Phacoemulsification comes from the words “phaco” (Greek term for lens) and “emulsification” (to dissolve or breakdown into finer pieces). Phacoemulsification is the state-of-the-art cataract surgery where the cataract is emulsified using an ultrasonic handpiece and aspirated through a 2.2 to 3mm incision that does not require any sutures. To maintain the small wound, a foldable intraocular lens is inserted. This procedure is done under topical “eyedrops” anesthesia and takes as short as 15 minutes. Recovery time usually takes 2-4 weeks.
Laser Cataract Surgery also known as Refractive Laser-Assisted Cataract Surgery (ReLACS) is an advanced type of cataract surgery that utilizes femtosecond laser technology in addition to phacoemulsification. The laser brings a new level of precision and accuracy in the corneal incisions, capsulotomy and fragmentation of the lens nucleus. Most of the steps are done by the machine hence more accurate. The fragmented nucleus is then removed via phacoemulsification and a foldable intraocular lens is inserted.
REFRACTIVE SURGERY
Vision correction surgery, also called refractive and laser eye surgery, refers to any surgical procedure used to fix vision problems. Recent years have seen huge advances in this field. Refractive and laser eye surgery allow many patients to see better than any other time in their lives.
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Photorefractive keratectomy (PRK) is a procedure in which the surface of the cornea is reshaped using an excimer laser. This process involves removal of the corneal epithelium followed by excimer laser. The laser, being computer driven for accuracy and precision, is programmed based on the patient’s refractive error (nearsightedness, farsightedness and astigmatism). ¹
Laser-Assisted In Situ Keratomileusis (LASIK) is a type of refractive surgery where a corneal flap is created by a microkeratome machine followed by excimer laser to re-shape the cornea to correct refractive errors of (nearsightedness, farsightedness and astigmatism). ²
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PresbyLASIK is also a type of LASIK for presbyopia (difficulty reading at near distance part of a normal aging process).
Refractive Lens Exchange (RLE) also called lens replacement surgery or clear lens extraction, may be a better option than LASIK, PRK or phakic IOL refractive surgery for people with presbyopia and high hyperopia (farsightedness). ³ This procedure replaces the crystalline lens of the eye just like cataract surgery with intraocular lens implantation but done in a clear not cataractous lens.