3 Types of Cataract Surgery

Comparing Three Types of Cataract Surgery: Which One Is Right for You?

Cataracts are the largest single contributor to reversible blindness worldwide. In Singapore alone, about 95 percent of our population over 70 years old and 80 percent of those over 60 likewise have cataracts. 

Fortunately, cataracts can be removed through cataract surgery, which is a clinically proven treatment for this condition. Cataract surgery is widely accepted as generally safe, with a 90% success rate, according to the National Eye Institute. 

In this blog, we will catch you up on everything you need to know if you are at risk for cataract — from signs and symptoms to treatment options and everything in between. Read on and learn more! 

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What are the Signs and Symptoms of Cataract?

Cataracts in the early stages may have little effect on your vision. The cloudiness may progress slowly, affecting only a small part of the eye’s lens, so you may be unaware of any vision loss.

As the cataract grows denser, it clouds more of your lens and distorts the light passing through the lens. This may lead to more-noticeable symptoms and affect your night vision.

If you notice any changes in your vision, make an appointment for your routine eye exam. But if sudden changes develop — such as double vision or flashes of light, eye pain, or headache — be sure to see your doctor immediately.

Other cataract symptoms you may experience include glare around bright lights, halos, distortion of vision, dull colours, dimmed vision, double vision, and the frequent need to change eyeglasses due to progressing nearsightedness.

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Learn More About: Cataract Diagnostics and Management at Our Clinic

Why is Cataract Surgery Necessary?

Cataracts often begin to develop as you get older. Over time, cataracts worsen and start to interfere with vision. As a result, you may find it challenging to perform tasks like working, reading, and driving, to name a few. If it’s left untreated, cataract can cause blindness.

Cataract surgery eliminates the cloudiness of the eye lens. The process entails artificial lens replacement to correct your vision. It’s a one-time procedure, which means that if you had cataracts removed from one eye, you won’t have the same problem in that eye ever again.

When considering cataract surgery, ask yourself these:

• Can you safely do your job and drive?
• Do you have problems reading or watching television?
• Is it difficult to cook, shop, do yard work, climb stairs or take medications?
• Do vision problems affect your level of independence?
• Do bright lights make it more difficult to see?

What is the Patient Evaluation Process for Cataract?

During a cataract evaluation, patients undergo a comprehensive eye exam that includes several tests. The tests commonly performed during a cataract evaluation are:

• VISUAL ACUITY TEST: This test measures the sharpness and clarity of a patient’s vision at different distances.
• SLIT-LAMP EXAM: This process uses a special microscope with an intense line of light to light up the front parts of the eye. It looks at the cornea, iris, lens, and other areas at the front of the eye.
• RETINAL EXAM: It is a test performed to examine the retina and optic nerve to detect any abnormalities. Eye drops are used to dilate the pupils to get a clear view of the retina.
• PUPIL DILATION: For this type of examination, the doctor widens the pupils to examine the lens and the back of the eye more thoroughly. It is a common test used in diagnosing cataracts.

Other tests that may be performed during a cataract evaluation include eye pressure measurement, tonometry, and eye measurements for cataract surgery. It is important to note that the tests performed during a cataract evaluation may vary depending on the doctor and the patient’s individual needs.

What are the Types of Cataract Surgery? 

The technology used in cataract surgery has completely transformed in the past two decades. Luckily for those suffering from this condition, the advent of clear corneal phacoemulsification and refractive surgery emerged from several improvements during this period. 

1. Phacoemulsification (PHACO)

Phacoemulsification is a surgical procedure that uses an ultrasound probe to break up the cloudy lens for removal. First, the surgeon inserts a microscopic probe into the lens where the cataract has formed, through a tiny incision into the cornea. This probe transmits ultrasound waves to break up or emulsify the cataract so the surgeon can remove it in miniscule pieces. 

The lens capsule, found at the back of your lens, is left intact so that it will hold the new artificial lens in place. Typically, the incision of this size is self-sealing, so it does not require sutures. Eliminating the need for stitches and promoting quicker healing. This means less discomfort and a faster recovery for patients undergoing this advanced procedure.

Advantages: Smaller incision, faster recovery, less trauma to the eye, and often results in better visual outcomes.
Considerations: May not be suitable for extremely dense or hard cataracts, as the ultrasound energy might not be enough to break them down.

2. Extracapsular surgery (ECCE)

This surgery is a less frequently used approach that removes the lens as one piece through a larger incision. Doctors may recommend this extracapsular technique when the cataract has become extremely dense or hard over time. The eye doctor will use surgical tools to remove the front capsule and the natural lens containing the cataract. The back lens capsule is also left in place to support the new, artificial lens.

This cataract treatment is carried out when phacoemulsification cannot break up the hard and mature cataract. Stitches are required to close the large incision. Although the recovery period may be a bit longer compared to other cataract procedures, extracapsular surgery remains a valuable option, especially for those with very advanced or hardened cataracts or other unique medical conditions affecting the eye. The end goal is to safely remove the cloudy lens and implant the new artificial lens in its place.

Advantages: Effective for removing dense or advanced cataracts that cannot be easily broken up by phacoemulsification.
Considerations: Larger incision requires stitches, longer recovery time, and slightly higher risk of complications.

3. Laser-assisted cataract surgery (LACS)

Laser-assisted cataract surgery or LACS  allows the surgeon to use the laser to make the opening in the capsule and soften the cataract. A camera or ultrasound device is placed over your eye to map out the surface. The information gathered is transmitted to a computer that programs the exact location, size, and depth for incisions. 

Instead of manual instruments, this approach uses a laser device. It will provide the same outcome as traditional cataract surgery, The key difference really lies in the tools and techniques used during the procedure itself. Whether laser or traditional method is better for you depends on several factors. Your doctor will evaluate your unique eye condition, visual needs and desired outcome to determine which approach makes the most sense.

At the end of the day, you’ll want to trust your surgeon’s expertise and recommendations. They’ll guide you towards the cataract surgery option that gives you the best result based on your individual circumstances.

Advantages: Enhanced precision and accuracy, potentially better visual outcomes, and may be suitable for certain complex cases.
Considerations: More expensive than traditional methods.

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Read: Cataract Surgery in Singapore

What is an Artificial Intraocular Lens?

After removing the cataract, it will be replaced by an artificial one called an intraocular lens (IOL). An IOL is a precisely engineered lens that is usually made of high-quality acrylic or clear plastic. It focuses the light onto the retina to improve your vision. It also comes with a special coating to protect your eyes from harmful UV rays. 

Like prescription eyeglasses or contact lenses, IOLs come in different focusing powers. To set this, your ophthalmologist needs to measure the length of your eye and the curve of your cornea. Unlike a contact lens, an IOL is fixed permanently inside the eye with no need for any maintenance. Once it is in place, you will not feel or see the lens at all.

Types of Intraocular Lenses

Although all intraocular lenses are used to restore clarity of vision, there are many types of intraocular lens choices available today, with specific functions.

Source: American Academy of Ophthalmology

Replacing a cloudy lens and wearing glasses may be enough for some people. Others prefer to get the best possible vision without any glasses. Ophthalmic surgeons will help you choose the right lens for you according to your budget, goal and lifestyle. 

Learn More About: Different Lens Technologies Offered at Our Clinic

How do you Prepare for Cataract Surgery?

Immediately after surgery, your vision may be blurry, so it’s essential to arrange for someone to take you home or help you move around.

To ensure your safety, your doctor will also ask about any medications or natural health products you are taking, as there are some that you may need to stop temporarily on or before the day of surgery. Some of these medications and supplements may increase the risk of complications during your surgery. Your doctor will outline what to avoid or provide alternatives. As such, see to it that you follow these specific instructions.

You may also be asked to hold off on any oral intake for up to 6 hours before the surgery. Failure to follow these dietary restrictions may cause the cancellation of your procedure.  

Learn More About: Cataract Surgery Recovery Timeline

What Happens during Cataract Surgery?

Besides physically preparing for cataract surgery, knowing what to expect helps ease your anxiety over the procedure. Typically, these are the following steps involved in cataract removal and lens replacement: 

• To numb your eye, the surgeon may use anaesthetic eye drops or injections, or general anaesthesia.
• A small incision is made along the side of the cornea.
• A high-frequency ultrasound device or laser breaks the cloudy lens into small fragments. 
• Once the lens is fragmented, it is gently removed from the eye using suction. 
• Once the fragments are suctioned off, the surgeon places the IOL behind the pupil, the exact spot where your natural lens was situated. 
• The incision will heal on its own without any stitches. 
• A protective shield is placed over the eye to secure it during the early stages of recovery. 
• If surgery is necessary for both eyes, your surgeon will typically wait for a few days or weeks. This time frame gives the first eye time a chance to heal and for the surgeon to understand the refractive outcome

What can be Expected after Cataract Surgery?

After cataract surgery, your vision will be blurry at first, but it will begin to improve within a few days. A cataract may mute the colours and cause your vision to appear yellow or brown-tinted, but colours may seem brighter after surgery.

You must continue to wear a protective shield for as long as your surgeon says. You may also be prescribed eye drops or medications to prevent infection, reduce inflammation and control eye pressure.

It’s normal to feel some mild discomfort and itching for a couple of days after surgery. Avoid rubbing or pushing on your eye. After a few days, most of the discomfort should disappear, and complete healing is often achieved within four weeks. 

You may be required to see your cataract surgeon a day  after surgery, the week after that, and then again after a month to monitor healing. Your doctor will let you know when your eyes have finally healed for you to get a final prescription for eyeglasses, around one to three months after surgery. 

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Finding a Cataract Specialist in Singapore

If you are looking for a cataract specialist in Singapore, consider an ophthalmology specialist that  possesses extensive training, hands-on experience, and a patient-centric approach. Dr. Lim Wei Kheong Jimmy, the best eye care specialist in Singapore who holds  credentials such as MBBS, MMed (Ophth), MRCSEd (Ophth), FRCSEd (Ophth), and FAMS. The Medical Director and Senior Consultant of JL Eye Specialists, Dr. Jimmy Lim is a fellowship-trained cataract and refractive surgeon whose expertise also covers cornea, refractive (LASIK), and general ophthalmology.

Dr. Jimmy’s approach to cataract treatment begins with a systematic preparation process, where every patient is reviewed for their comprehensive medical history, taking into account factors like medications, allergies, and any prior eye surgeries or conditions. This step helps in assessing a patient’s eligibility for the procedure. 

An eye examination is then conducted to check the overall health of their eye, note any other conditions, and determine the presence and severity of cataracts. Following these evaluations, a consultation is provided to discuss the potential next steps for cataract surgery. If the procedure is deemed appropriate, a pre-cataract assessment is conducted to decide on lens implantation. Using current technologies, Dr. Lim selects lens implants that fit each patient’s visual requirements. Calculations are then made to ensure the accuracy of the lens implants. 

If you need more information about cataracts and their treatment, we welcome you to schedule a consultation with us today. At JL Eye Specialists, we can assure that patients receive the appropriate attention and a treatment plan they deserve for their cataract concerns.