What is a cataract?
A cataract is an opacification / clouding of the normal clear crystalline lens in the human eye. It is not a growth that can be removed and can also not completely be corrected with glasses or contact lenses.
What causes cataracts?
The cause of cataracts is generally unknown. Some of the most common causes that have been identified include
(but are not limited to):
Nuclear sclerotic cataracts: These are mostly age related cataracts, and usually becomes significant after the age of 60 years.
Secondary cataracts: Due to a variety of environmental factors and medical conditions including, Diabetes mellitus, smoking, steroid use, certain other medications, excessive UV-light exposure.
Traumatic cataracts: Secondary to blunt or penetrating trauma.
Congenital cataracts: Some babies can be born with cataracts and requires fairly urgent attention.
What are the common symptoms of cataracts?
Most people with very early cataracts are mostly unaware that they have a cataract until they have been examined by an
ophthalmologist (eye specialist) or an optometrist, who can see the opacification of the lens through a slit lamp microscope.
If the cataract matures to become visually significant (causes a decrease in vision), patients usually complain of not being able
to perform their normal activities of daily living (ADL). These activities can include anything from driving a car to sewing a jersey.
The vision can be compared to looking through a frosted piece of glass, fog or a “piece of film” covering their sight.
Colours can seem faded and night vision can also be affected. When the cataract becomes very dense, these symptoms can
be very severe and even completely block a patient’s vision.
It is important to note that even though all these symptoms can occur with the formation of cataracts, they may also be caused
by other conditions affecting the eye, and patients are encouraged to consult their ophthalmologist for a thorough eye examination.
How can cataracts be treated?
During a comprehensive eye assessment conducted by an eye care professional, a cataract must first be diagnosed.
The examination will in most cases include a visual acuity test, anterior segment examination and tonometry
(intra ocular pressure measurement). The pupil will also be dilated to examine the fundus of the eye(s).
All of these findings will be documented and photographs will be taken with an OCT scanner in order to monitor progression
and decide on the most appropriate plan of care.
During the early stages cataracts can sometimes be treated conservatively with a change in spectacle / contact lens prescription,
but if the cataract(s) become visually significant, surgery is the only effective treatment option.
The most commonly performed procedures to remove the human crystalline lens is called phaco-emulsification.
Dr M.C. Niemandt uses the highly specialised phaco machine to do this procedure. This involves making a small incision
in the eye and breaking up the crystalline lens through sound waves, and then removing the pieces through suction.
In rare circumstances the entire lens can also be removed through a larger incision called extra capsular cataract extraction (ECCE).
The surgeon will then replace the lens with a synthetic intra ocular lens (IOL), which will focus the light entering
the eye clearly on the retina.
This lens is permanent and cannot be seen by the patient, and also does not require any care.
What to expect before, during and after the surgery
Before the surgery: After the complete examination, the eye will be measured in order to calculate the strength of the IOL
to be inserted inside the eye. The measurements are done by use of a biometry machine.
Specific types of IOL options can be discussed with Dr. MC Niemandt.
During the surgery: Dilating drops are used on the day of the surgery to enlarge the pupil and improve visualisation during
the surgery. Most patient require a local / regional anaesthesia that can either be in the form of topical drops with sedation,
or an injection close to the eye (block). Some patients require general anaesthesia in order to keep them relaxed
during the procedure.
The procedure is done in the operating theatre, under sterile surgical conditions. A sheet is used to cover the face,
and the patient’s vitals constantly monitored by anaesthesiologist.
After the surgery: The patient will be supplied with post-op medication and clear instructions on the use, what to avoid and
who to contact in case of emergency or any uncertainty. The healing process may take a couple of weeks, but mostly patients
are able to resume visual activities soon after the surgery.
What are the risks involved and what follow up is needed?
Even though cataract surgery is considered a common type of surgery and the risks are considered minimal, ALL risks and
benefits of the surgery should be discussed with your Ophthalmologist.
Serious risks include intra ocular haemorrhage, post-operative infection, raised intra ocular pressure and retinal detachment,
among others. Reasonable and professional care is always taken in order to avoid these complications, and if they do occur,
further management and intervention may be required.
Please make sure that you gather as much information as needed in order to make an informed decision
about having cataract surgery. Please feel free to contact Dr. MC Niemandt's rooms with any enquiries.