Cataract

The clouding of the eye lens, popular among people as a “veil” or “curtain”, has the scientific name cataract. It can be congenital or acquired. The congenital cataract is the result of anomalies in the development of the eye lens. It is rarely a hereditary disorder. Most often the congenital cataract is caused by maternal viral diseases, especially in the first trimester of the pregnancy. Children born with a cataract have low vision when the lens is partially opaque and loss of vision if the lens has a complete opacification. Such children should be operated as early as possible in order to have a normal intellectual development in the future. The acquired cataract arises in some systemic diseases (diabetes) or is due to eye injuries, radiation effects. It can appear as a complication of some eye diseases: inflammatory, such as iridocyclitis, uveitis and in some cases myopia. The most common type of cataract is the age-related one. It usually starts to form around the age of 60. Patients complain of decreased vision in one eye, rarely in both eyes. The decrease of vision is gradual and painless. Cataracts can be treated only surgically. After being diagnosed with a cataract, patients should have their vision and eye pressure checked every 3-4 months.

1. What are cataracts?
Cataracts are the main reason for loss of sight in people over the age of 55. The cataract is a clouding of the natural
lens inside the eye.
This lens, located behind the iris, acts like a camera – it focuses the light images on the retina which sends signals to
the brain.
The human lens can be clouded to such a degree that it prevents light and images to reach the retina.
Eye injuries, some diseases, even some medications can cause this clouding but most often the reason for the cataract
is quite natural – the process of aging.
2. First symptoms of cataracts.
Usually, the opacity of the natural lens is initially expressed in higher sensitivity to glare from bright light.
The same effect is achieved as if you are watching though a dirty windscreen of a car. The dirtier the glass the more is
the driver blinded at night by the lights of the opposite cars. With time, as the cataract develops, the image becomes
cloudier and more blurred.
The clouding of the lens might happen fast but it can also take many years. When a cataract is present the eye sight
can be described as watching through a curtain. Therefore in our country the cataract is called “age curtain”. The
cataract, however, is not a film over the eye so neither a diet or a laser intervention can remove it.

In short, the most important symptoms of a cataract are:
- Higher sensitivity to glare.
- Reduced contrast sensitivity.
- Possible abnormal perception of colours.
- Decreased vision sharpness.
3. How are cataracts removed?
At the early stage of cataract development, wearing glasses often improves eyesight. Some people initially see better without their glasses. Wearing sunglasses can also help at the beginning by reducing the sensitivity to light.
Severe clouding of the lens in the advanced stages of the cataract can only be corrected through surgery. It is up to you to choose the time for the operation. When you feel that the quality of your vision is insufficient for your daily activities, the right moment for the surgery has come. The procedure is described in detail in the next point. If something seems unclear, ask your doctor.
Before the operation your doctor will ask you to give your consent about it. This is a legal procedure which aims to protect both the patient and the doctor.
Unfortunately, so far there is no medication that can treat cataracts.
4. Cataract surgery: clarity in the blink of an eye?
An innovative laser with 3D visualization of the eye, used by the best eye hospitals in the world, substitutes the traditional method for cataract removal. The first in Bulgaria modern laser for cataract surgery CATALYS is already adopted in St. Nikolay Chudotvorets Eye Clinic in Varna. This laser system is a revolution in cataract surgery because it allows the surgeon to have an individual approach depending on the anatomical specifics of the patient´s eye. It is a high precision device which works at approximately a tenth of the micron; the eye pressure is not increased, it does not damage the cornea or other structures of the eye. “Laser cataract surgery is a quick, safe and effective procedure that ensures fast recovery and excellent results”, says Dr Plamen Hubanov, manager of the eye clinic.
The method has been acknowledged as the safest approach in the world for cataract patients, the intervention being painless and at half the price of other similar procedures. The laser system builds a 3D map of the eye which is used to prepare the most precise plan for the operation, then the incisions are made and the cataract is broken into pieces. In this way the amount of ultrasound energy is reduced which ensures a fast recovery and less complications after the operation. CATALYS is based on advanced technologies which allow calculating the position of the artificial lens that substitutes the natural one to microns and thus providing excellent eyesight after the operation. The equipment gives opportunity for correction of astigmatism which is necessary for premium toric lenses, accommodative and multifocal lenses.
The CATALYS system has been recognized as one of the top 100 technological innovations in the world. It consists of a state-of-the-art docking system, an integrated 3D full volume optical coherence tomography (OCT).
St. Nikolay Chudotvorets Eye Clinic continues its policy for investing in latest-generation lasers. Our clinic is the only one in Bulgaria which possesses the 4 most modern lasers of Abbott – a world leading company in ophthalmology.
5. What is a cataract surgery?

With cataract surgery the ntural lens is removed and replaced with an artificial intraocular lens. The eye cannot produce clear images without a lens. During the first stage of the operation the natural lens is broken up by ultrasound or by warmed surgical solution, a procedure safer for the patient, after which the lens is suctioned. The medical term for this process is called phacoemulsification. This modern surgical technique allows for a smaller incision (from 1.8 to 2.6 mm) compared to older techniques (8-10 mm). This method is gentler to the eye and reduces the recovery time. During the second stage of the opeeration the artificial lens is folded and inserted in the eye through the tiny incision. It automatically unfolds in the eye after which is carefully positioned by the surgeon.

6. Additional information about phacoemulsification
Breaking up of the natural lens is done by a fine probe transmitting vibrations from an ultrasound generator. Through 40 000 vibrations per second the cataract is broken up into small pieces which are then removed by the same probe. Along with that the eye is filled with sterile solution which aims to substitute the extracted fluid. Besides the necessary equipment, the process of phacoemulsification requires the surgeon´s excellent skills.
7. The artificial lens substitutes the natural one
Modern foldable intraocular lenses are biocompatible and very well tolerated by patients, providing them with optimal vision after the operation.
8. A new gentle technique
An entirely new method for breaking up the natural lens is by using warmed saline solution instead of ultrasound. This technique is still not applicable in all patients.
9. How successful is cataract surgery?
Generally cataract surgery is 98% successful. Modern achievements and advances in technologies and surgical instruments
make the procedure exceptionally safe and reliable.
10. What is an intraocular lens?
The intraocular lens is a man-made lens which is implanted in the eye during the cataract surgery. The good news is that your cataract has developed in times when the technology for making intraocular lenses is highly sophisticated.
The traditional method of cataract surgery involves a monofocal lens with a single point of focus. This type of IOL is very good for recovering functional distance vision. This lens, however, does not eliminate the need for reading glasses, glasses or additional surgery for the correction of existing astigmatism or other refractive disorders.
Advances in technology in recent years are really impressive – a new generation of artificial lenses can help you not only see well
near and distant objects without glasses or bifocal contact lenses but also correct disorders such as astigmatism, short-
sightedness, long-sightedness, etc.
11. Monofocal lenses –a single point of focus

Monofocal lenses have a single point of focus and can offer clear distance vision. In spite the improved distance vision the patient will still need glasses for certain activities, such as reading or computer work. AcrySof IQ lenses are among the most preferred monofocal lenses. The special design of the surface of AcrySof IQ improves the functional vision in unfavourable light conditions such as dusk or fog. AcrySof IQ lenses have a UV and blue light filtering.
12. Multifocal lenses

Multifocal lenses ensure good vision both for near and far. Some of the most preferred multifocal lenses are AcrySof ReSTOR Aspheric. They have a special design that allows them to replace the clouded natural lens and to correct presbyopia. You will be able to see equally well at near and far without glasses. The innovative technology of AcrySof ReSTOR Aspheric successfully mimics the accommodation of the natural lens and allows patients to see clearly after the surgery at near and far distances without glasses. The lens has a UV and blue light filtering. 94% of operated patients state that if they need they would choose again the AcrySof ReSTOR Aspheric lens to be implanted on them.
13. Lenses correcting astigmatism

A special type of intraocular lenses exist that can correct astigmatism. AcrySof Toric lenses are among the leaders regarding this type of lenses. They have been designed particularly for patients with both cataract and astigmatism. Like monofocal lenses this type provides quality distant vision with small dependence on glasses. Most of the patients, however, still have to wear glasses for reading or doing computer work.
AcrySof TORIC lenses correct astigmatism and offer good distance vision. They incorporate a UV and a yellow filter against the dangerous blue light.
The traditional intraocular lens which is implanted in the eye to replace the removed cataract helps you to restore the clear image but is unable to correct astigmatism. It is necessary to use glasses, contact lenses or even undergo additional surgery in order to correct the blurred and distorted image.
14. The advantages of the blue light filter

Intraocular lenses - AcrySof IQ, ReSTOR Aspheric and TORIC posses a specific filter against the extremely harmful ultra-violet
and blue light.
Light allows us to perceive the world around us through the visual process. Contemporary research shows that visible light and especially high energy blue light can be a leading factor for the development of retinal damage such as age-related degenerative changes. This condition is one of the most common reasons for loss of visual acuity.
At the age of 4 the natural lens has gradually developed yellow pigments. This yellowing is increased with age. It should not be confused with lens opacity (cataract). The yellow pigment of the natural lens acts as a protective filter which reduces the blue light penetrating into the eye and thus decreasing the risk of damage to the retina.
In order to prevent such damage the intraocular lenses AcrySof IQ, ReSTOR Aspheric and TORIC possess filtering properties which simulate those of the natural lens. When the natural lens is removed during cataract surgery the eye lacks its natural protective filter and should not be left unprotected to the harmful effect of ultraviolet and blue light. Blue light rays are part of the daylight spectrum but is also emitted by artificial light sources such as halogen and fluorescent lamps, studio spotlights, camera flashes, tanning lamps, electronic devices, etc. AcrySof lenses have been successfully implanted to millions of patients which makes them the most implanted intraocular lenses in the world. Their advantage to traditional lenses is that besides a UV filter they have an additional blue light filter. Thus, they protect the retina from the harmful blue light rays in the same way as the natural lens does.
15. Before and after the operation
Most people are surprised when they learn how easy and pain free the cataract surgery is. It usually takes between 20 and 30 minutes, even less sometimes, and the majority of patients return to their normal activities the very next day.

BEFORE THE SURGERY

1. Your surgeon will decide if you can have breakfast or not before the surgery.
2. Take your prescription medication as usual (for example: insulin, medicines for heart conditions, etc).
3. During the operation you should be wearing clothing that is loose around the neck and arms (if possible, wear short sleeves).
4. Leave your jewellery at home (rings, watch, necklace, earrings and so on). You can’t wear them during the surgery.
5. Take a bath or shower using shampoo before the surgery.
6. For women patients it might be painful to wear hair accessories so you should come with your long hair loose or covered with
hairnet. Do not wear makeup.
7. During the operation you should lie still for about 30 minutes and not touch your head with hands. After the surgery you need
to lie calm.

THE DAY OF THE OPERATION
Upon arriving at the eye centre they will prepare you for the operation by having your eye dilated with eye drops half an hour in advance. The cataract surgery is performed under local anaesthesia. It will make your eye and the area around it completely numb.
Then you will be taken to the operating room. Your blood pressure, pulse and blood oxygen will be monitored during the
operation.
Please, pay special attention to the following notes in order to prevent risks which can hinder your recovery:
1. You should spend the day of the operation resting – sitting in an armchair or a sofa. You can dress up or have your meals at the table as usual.
2. You must not take off the eye pad or rub your eye.
3. Typically the patient does not feel any pain after the operation but in case of need a mild painkiller can be taken.

THE DAY AFTER THE OPERATION
Note these important points:
POSTOPERATIVE TREATMENT
After the operation you will have to apply special eye drops. Several weeks following the cataract surgery you will be prescribed temporary glasses. It is important regularly to visit your ophthalmologist who will observe the process of recovering.
1. Your pad will be removed by your ophthalmologist. You will be given instructions about the treatment of the eye and how to take care of your eye in the following days and weeks.
2. One day after the operation you can do moderate-intensity activities.
3. You should still avoid touching your eye.

ADVICE FOR YOUR RECOVERY
While your operated eye is healing follow the recommendations in order to protect your new artificial lens and to enhance a more rapid adaptation:
1. Visit your ophthalmologist on the scheduled days.
2. Take your medications and apply drops in your eye as prescribed.
3. Do not lift heavy objects (heavier than 15 kg) and avoid any intense physical efforts in the first days after the operation. You can do your usual daily activities.
4. Driving is not contraindicated but you should avoid it during the recovery process.
5. Avoid rubbing the eye or applying any pressure on it for at least one month after the operation.
6. You can take showers and baths or shave as usual but your eye must not be in contact with either shampoo or soap. Take special care when removing your makeup.
7. During the first week following the operation avoid reading longer than recommended.
8. You can watch TV but try not to overstrain your eye.
9. During the first days after the operation you can work on a computer, although with some caution, depending on your condition.
10. During there recovery stage you should avoid sauna and sports such as swimming, jumps into water and cycling.
11. In case of any problems during the healing process (such as redness in the operated eye, pain or worsening of your vision) immediately contact your doctor.