What are Cataracts?
A cataract is the loss of transparency of the natural human lens of the eye. Cataracts are a universal ageing process. This clouding happens to everyone as we get older. The human lens sits just behind the pupil. Rays of light pass through the lens to reach the retina, where the eye forms images. If the lens becomes less transparent it obstructs the passage of light. When the light is obstructed the patient experiences certain effects. These may be the progressive loss of or alteration in the quality of their vision.
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Symptoms of a cataract
- You notice that your vision is not a crisp or clear as usual especially if the ambient lighting is low. It is much easier to see black letters on a white background, but shades of grey and subtle alterations in colour become harder to see in the early stages of cataract.
- Glare is a common symptom, especially when driving at night.
- Cataracts can often be more advanced in one eye than the other. It is not a symmetrical condition. In some cases, you may not notice that one eye doesn’t see well until you happen to shut the other one. The difference can be striking and worrisome.
How we diagnose Cataracts
Cataracts are picked up at routine optician tests and when you see an ophthalmologist. It is crucial to know if the person has any symptoms or difficulties with their vision. Cataract is a normal ageing process that occurs in the lens. Most people over the age of 30 will have some minor discoloration or clouding in their human lens. But this does not mean that the cataract must be removed. Surgery is advisable only when a person has symptoms that interfere with their activities of daily living. For example, if a person drives a lorry, flies a plane for work or as a hobby. They have different visual requirements to someone who is a seamstress or doesn’t drive. They may do their shopping and cooking with a small amount of cataract. Modern cataract surgery allows us to operate on cataracts at any time.
They do no need to ‘ripen.’ Ms Crawley will discuss your individual symptoms and how your vision affects what you do every day. She will help you make the right decision about surgery.
Cataracts Treatment
There are different types of cataract, yet the treatment for all is cataract surgery.
Nuclear Sclerosis is often written as NS+ on the optician’s report. NS is the most common type of cataract. The clear lens becomes discoloured and denser through the central area. It changes colour from clear to green, yellow and finally brown. For the patient, it is just like looking through bottled glass of a similar colour.
Cortical cataract is often written as CLO+ (cortical lens opacity.) In this type of cataract, we see white spokes of the discoloured lens like the spokes of a bicycle wheel.
Posterior subcapsular cataract is usually recorded as PSC+.
This type causes a lot of glare even when the cataract is in early stages. It does this because it is a frosting across the back of the lens, right in the middle. Most of the light coming into your eye focuses through the centre of the lens. If that part is like frosted bathroom glass rather than a clear window, the image can like a blur. More so, when driving into bright light or when facing oncoming headlights in the dark. It is often more common in younger patients and in patients who take steroids.
No matter the type, your specialist will remove all cataracts by surgery. Contrary to articles published in newspapers, there are no non-surgical treatments.
Modern cataract surgery is technical and safe. It is the most common operation carried out on the NHS in the UK. The operation will lead to significant improvement in the patient’s quality of life. Better quality vision can help with many things in day to day life. Your eyesight affects independence, enjoying hobbies, reading, and quality time with friends and family.
Laura Crawley will discuss your work and hobbies with you and how your vision affects them. She will ensure your surgical plan is the most optimal for you.
Types of Anaesthesia
Most cataract surgery is done under local anaesthesia. This involves placing a local anaesthetic around the eye to ensure that you are pain-free throughout the operation. This can sting a little just like the anaesthetic you would have at the dentist. But thereafter the eye is numb and ‘asleep.’
You will be awake for the procedure and will be able to hear our team and some relaxing music if requested. This has the advantage of a faster recovery. You will be able to leave hospital 1-2 hours after the operation.
Some patients are nervous about being awake during eye surgery. In these cases, we can offer you some local sedation besides to the local anaesthesia. This is given intravenously by our consultant anaesthetist during your procedure and will help relax you. You will still be awake but relaxed.
Some of our patients prefer to have a general anaesthetic so they are asleep for the operation. Our Consultant Anaesthetist will perform this procedure and will assess you for this type of anaesthetic.
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