Cataract Procedure

Operating on any part of the eyeball requires lots of patient and skillful hands as our eyeball is really small (an average diameter of 24mm) and of course, it is one of the most delicate part of our body.  During LASIK/LASEK surgery, top corneal layer is scraped off, laser is used and then, cornea is covered with contact lenses for recovery, but for cataract surgery, the surgeon needs to create an incision on the cornea, remove the cataract, insert a new lens and then stitch up the incision.

So how does the cataract surgery go? The procedure will vary a little depending on the clinic and the machine used. After the doctor confirmed that your eyes have cataract, appointment for cataract removal will be set up and one eye is usually operated on the first day and the other on the second day. The doctor will also check with you about your medical history to make sure that the drugs you are currently taking will not interfere with the medication prescribed. Normally, you will be asked to stop taking any medication for cardiovascular diseases and eye drops will be prescribed for about 4 days to a week before the surgery. 

On the surgery day, the doctor would exam the infected eye again before the surgery and the consultant will explain the steps of taking the prescribed eye drops after the surgery.  After that, you will be brought into the surgery wearing a gown and cap and the nurse will ask you to sit on a reclining chair. With you comfortably laid down, the nurse will then disinfect your eye area including the forehead, drop some local anesthesia eye drops, cover your head and eye with a sterile covering, use a speculum to hold your eye in place and instruct you not to move your eye too much during operation. When this is done, the surgeon will come in to get ready for the surgery. 

Once the surgeon is ready, the surgeon will create 2 small incisions on your cornea using an operating microscope and inject a gel-like substance, viscoelastic, into your anterior chamber to help stabilize your eye pressure during the surgery. Next, the surgeon will insert forceps through one of the incisions to remove the top thin layer of the cataract and then by using Infiniti Vision system, the surgeon will use the Infiniti handpiece to slowly break up the cloudy lens into smaller pieces (phacofracture) and remove them through suction (less than 5 minutes) including making sure that the cataract on the edge is removed.   

Incisions are made.

Forceps used to remove top layer.

Infinite handpiece used to remove cataract.

New IOL lens inserted. 

After the cataract is removed thoroughly, a high-quality intraocular lens is inserted into your eye to replace the original lens and incision is sutured.  The type of lens inserted will depend on your eye’s needs. At present you could have lens that is for both cataract and presbyopia inserted. A protective shield will then be placed on your eye and you would be taken to the recovery area to rest for about 30 minutes.  Before you leave, the surgeon will check on your eye again and another appointment will be made for you to return for check-up on the next day. It is a painless surgery and the recovery period will take about a week with you being able to return to work on the next day.  


Just out of curiosity, I checked on a few videos on traditional cataract procedure and you could watch them on the following sites:

http://www.youtube.com/watch?v=5X_Q3lrw5JA (watch from the middle of film - couching procedure)

http://www.youtube.com/watch?v=zeBbKS0GoQs (watch from the middle of film)

Nutrition & Cataracts

When I was young, I didn’t worry much about health care as both my parents were pretty tough and healthy except for occasional coughing and cold, my siblings and I hardly visited the doctor.  Now after 30 years later, my parents are getting older and they both need reading glasses, especially for my dad, who started to wear glasses while driving as he couldn’t stay within the lines and it is dangerous driving at night if eyesight is not well. Usually presbyopia develops gradually after the age of 40 and then, cataracts will develop depending on the health of our eyes due to the decrease of our eyes’ refractive power and the flexibility in our eyes.  Slowly when we want to look at closer items, we will find it hard to focus and the items will be blurred.  In order to settle such situation, we will start to use glasses or patients with cataracts will need surgery to remove the cataracts. 

Cataracts are formed due to oxidation of lens proteins and research has suggested that dietary antioxidants may play a big role in prevention. Since taking care of our health is part of our life mission, why not think about eating healthily or taking vitamins regularly to prevent cataract formation? That’s like killing two birds with one stone. I am sure a lot of people know about that but I am also sure that there are also a lot who don’t know the relation between nutrition and cataracts or bother doing that since people are busier now. Usually we realize the existence of certain health problems only when it happens to a family member or friend or even on ourselves. Then we start to think about the prevention that may be too late for some people as the condition could have reached the final stage. Instead of waiting for it to happen, we should also think about the prevention method by doing online research or yearly health check up and not wait for others to feed us with information.      

Healthy Eye

Immature Senile Cataract

Mature Senile Cataract

Hypermature Senile Cataract

Cataract is basically a clouding that develops in the crystalline lens of the eye or in its envelope varying in degree from slight to complete opacity and it will gradually obstruct the light passage. Its category is wide from age-related to systemic conditions like metabolic and nutritional diseases depending on the position of cataract (posterior or anterior). Hydrogen peroxide present in the aqueous can give rise to reactive oxygen species such as superoxides, which can damage our lens components like crystalline proteins, lens fiber membranes and lipids, leading to lens opacities.  Due to this, many observational epidemiologic studies of dietary factors in cataract have focused on the amount of antioxidant nutrients contained in the diet by either examining the intake of specific nutrients or serum concentration of nutrients or biomarkers of fruit and vegetable intake or the development of cataract in relation to specific foods or food groups including cigarette smoking as an establish risk factor since it is an important source of oxidative stress. Evidence has also shown that smoking has a direct deleterious effect on the human lens and it decreases plasma concentration of ascorbate and indirectly aid cataract formation by lowering the plasma concentrations of nutrients that are important to the maintenance of lens transparency.

So what should we eat? Well since everyone has been talking about consuming enough vitamin C to strengthen our immune system, we could now find vitamin C in fruits, vegetables, health drinks and supplements.  It will be good to keep it up as research has shown that higher serum concentrations of vitamin C were associated with a lower prevalence of nuclear cataract in many studies. Vitamin C is well known for its antioxidant properties and it is found in high concentration within the lens, aqueous humor and vitreous humor of humans and lenses with higher vitamin C concentration were protected from oxidative damage.  Even just by consuming orange juice was also shown to increase plasma vitamin C concentration significantly and significant protective association was also found between increasing consumption of fruit juices and incident nuclear cataract. In addition, vitamin C combined with other antioxidants like vitamin E, beta-carotene and zinc, had a protective association with long term (10y) incidence of nuclear cataract which support that diet and supplement intakes of vitamin C and other antioxidants may exert age-related ocular benefits as well as beneficial effects on aging itself.  

Even if you think you are getting enough nutrients from the food you are eating everyday, the amount of daily nutrients might not be enough especially if you are a picky eater or vegetarian.  In that case, it is important to consume supplements like multi-vitamins every 2 days to make sure that your body is getting enough nutrients. There is no need to over-consume supplements if you are eating well unless you are sick or under doctor’s advice as there would be adverse effect to our body. For example, we know that we need to consume vitamin A to maintain good eyes but do you know that, if we over-consume vitamin A, our vision will start to blur?  This actually happened to one of my professor’s mom and our professor was the one who advised us on this.  So if you are not sure about the amount of nutrients your body might need, I recommend going to a dietician to get a body examination and proper advice.  Well, remember it is your body and it will be up to you to make the changes for a healthier body!