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Eye Conditions - Cataract Surgery: All You Want to Know and Should Know Eye Conditions
   Cataract Surgery: All You Want To Know and Should Know
By Dr Yeoh Phee Liang

Thousands of Malaysians undergo cataract operation. It’s a relatively simple and common procedure that carries a small risk but no real danger. Having said that, there are, nevertheless, areas and issues that one should be aware and consider before undergoing a cataract surgery.

  1. What is cataract?
  2. How is cataract surgery performed?
  3. When does one need cataract surgery?
  4. Should I trust the skill of the doctor or the technology of the machine?
  5. What lens implant should I pick for the cataract surgery?
  6. But, until recently………………………..?!
  7. Am I a good candidate for cataract surgery and multi focal lens implant?
  1. What is cataract?

    A cataract occurs when the lens becomes opaque due to the clumping of protein in the lens of the eye. Its seriousness may be classified by age, stage, type and causes.

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  2. How is cataract surgery performed?

    Mainly two ways–
    • Extra-capsular surgery where a large incision measuring about 6mm is created around the corneal and the opaque lens expressed out of the eye.
      Cataract Surgery Step 1
      Cataract Surgery Step 2
      Cataract Surgery Step 3
      Cataract Surgery Step 4
      Step 1 :
      Instrument breaking up
      and removing pieces
      of clouded lens
      Step 2 :
      Washing away
      a cataract
      Step 3 :
      IOL implanted
      Step 4 :
      Natural lens in eye

      This is followed by inserting an artificial lens into the capsular bag (bag left intact after removing the protein clump). The wound is then closed over with several stitches.
    • Phacoemulsification - the “fashionable” method used to remove cataract through a small sutureless incision. A titanium probe vibrating at ultrasonic frequencies (about 40,000cps) is used to disrupt the lens nucleus, which is expelled through the same probe.

      Again, an artificial lens is inserted into the bag, but no suture is needed. The lens used is so versatile that it can be folded and inserted through the small incision before expanding to its full size inside the very delicate intact bag. This form of surgery is commonly understood as ‘laser’ surgery, but in fact it is the application of ultrasound energy.

      Phacoemulsification has several advantages over extra-capsular surgery.

      With phacoemulsification, the wound is much smaller, thus recovery is quicker and the chance of infection is lower. Under good hands, the surgery can be completed in ten minutes or so, whereas extra-capsular takes two to three times longer. However, phacoemulsification will be more difficult to perform if the lens material is very dense.

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  4. When does one need cataract surgery?

    One should not be intimidated or coerced into undergoing a cataract surgery.  This should never be dictated by doctors but rather by the lifestyle of the patient. It depends on how much of a handicap the vision drop is causing to the patient.

    For instance, a granny may be very contented with seventy percent of vision as her lifestyle only involves playing with grand children and attending to some domestic affairs; whereas for someone who needs perfect vision for driving and close-up work, a slight drop in vision will be quite deliberating.

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  5. Should I trust the skill of the doctor or the technology of the machine?

    A modern machine with a proven record coupled with the skill of the doctor is the best combination.

    However, as technological advancement is an on-going process, and one must be careful so as not to be taken in by claims of state-of-the-art technology and new machines.  Cataract surgery, though simple, is never without any risk.  Careful assessment and proper well informed explanation must be personally attended by the doctor.

    In fact, one should also examine the person(s) attending to you and making claims – are they private investors hoping for a higher return on their investments or are they practicing ophthalmologists?  Would you prefer to be consulted by a doctor or a surgeon who operate on you or by sales team who try to impress you with the most expensive package? Bear in mind, the salesperson is not the one who is going to operate on you.

    Medicine should not be driven purely by profits.  It is not a commodity and one must be wary of those who may be “milking” the industry for their own gains.  It is a blessing that the Ministry of Health is cracking down on investors using doctors as “proxies”.

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  6. What lens implant should I pick for the cataract surgery?

    After the removal of cataract, an artificial lens is inserted into the bag. The exact power of the lens to be inserted has to be calculated prior to the surgery.  The power could restore the patient to 20/20 eyesight or contra off the long or short-sightedness.  Astigmatism cannot be corrected with such conventional lenses.

    For instance, prior to surgery, glasses worn may be -3.00 diopdre short-sighted, -0.75 diopdre astigmatism.  After surgery, the patient may be left with power of only -0.75 diopdre astigmatism. Your dependency on eye-glasses used to be one hundred percent prior to surgery, but you are much less dependent on your eye-glasses after the surgery.  In other words, you can achieve your daily tasks without glasses.

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  7. But, until recently………………………..?!
  8. A) Toric intra-ocular lens – For individual with high astigmatism preoperatively. Insertion of such lens will eliminate both short or long-sightedness and astigmatism.

    B) Multifocal lens - Wouldn’t it be a great idea if there is a kind of artificial lens that provide both distance and near correction without the dependency on eye-glasses?

    Leading artificial lens companies like Alcon and AMO have recently launched this multi-focal lens in the market. As instructed by the companies, strict guidelines and proper patient selection are absolutely vital in ensuring the success of such lenses. Pre-operative assessment must ensure that patients has little or no astigmatic error and the end post operated patient is left very close to being ‘no power’.

    Sadly, the over enthusiasm of certain doctors and individuals has led to an outcry among patients who experienced less than satisfactory rate with these new lens.

    There is a pool of patients who has been given false promises and, as a result,  complained bitterly of seeing blur both far and near after the surgery.

    I have encountered horrendous patient selection and very high astigmatic error in some complaints. Worse still, some younger patients had not even developed any sign of opacity were ‘talked into’ performing surgery with multi-focal lens implant.

    To make matter worse, it is difficult to remove such lenses without damaging the integrity of the capsule that holds the lens in proper position. Moreover, one must always perform bilateral surgery to achieve the effect of multi focal lens. Hence, the patient is in a dilemma as the lens is caught in the bag, and he/she is reluctant to have the other eye operated with a similar lens.

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  9. Am I a good candidate for cataract surgery and multi focal lens implant?

    Surgery is warranted once your lifestyle is affected by cataract. Surgery, be it cataract, eye laser or any specialty is never without any risk and should only be handled by doctors in the assessment. No one in a clear mind should allow sales person to talk them into a surgery. The business side of it should never precedence over a patient’s well being.

    If you have been encouraged to undergo any surgery such as multi-focal lens implant, at least ask ‘Can you promise clear vision at near and distance?’

    Kindly log on to www.custommatchsolutions.com for further information.

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For further information please contact:
Dr Yeoh Phee Liang, Advance Vision Eye Specialist Centre, Tel: +603 - 7724 1392
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