MEDICAL EYE CENTRE
ST.NIKOLAY CHUDOTVORETS
phone: +359 52 630 670 
mobile phone: +352 878 630 954
Varna, 9000, 12,"Nikulitsel" Str. 
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.
- What is a cataract?
The cataract is the main cause of vision loss in people over age 55. The cataract is clouding of the eye's natural lens. This lens which lies behind the iris functions like a camera: focuses light objects onto the retina and the retina transmits signals to the brain. The human lens can become so opaque, as to obstruct light to reach to the retina. Eye injuries, some diseases and even medications can cause this lens clouding but the most common reason for cataracts is the natural process of aging.
- First symptoms of cataracts
Often the clouding of the natural lens is initially expressed in acute sensitivity to dazzling bright light. The effect is the same as if you are driving with a stained windshield: the dirtier the glass the easier you are dazzled at night by the lights of other cars. With the growth of the cataract the image becomes more blurred. The clouding of the lens can be fast or might take years. If you have a cataract you will feel as if you are looking at the world through a dirty curtain.
The cataract, however, is not a film over the surface of the eye so neither a diet nor a laser intervention can remove it.
In short, the most important symptoms of cataracts are: increased sensitivity to dazzling; reduced contrast sensitivity; problems with colour perception and reduced sharpness of vision. - How are cataracts removed?
At an early stage of cataract development wearing spectacles often improves the eyesight. Some people, however, see better without spectacles at the beginning. At first sun-glasses can also help to reduce the increased sensitivity to light. Unfortunately, there is no medication that can cure your cataract.
Before the operation you will be asked to sign a consent form. This legal procedure will protect both the patient and the doctor.
At the stage when the lens is very dark your vision can be corrected only through cataract surgery. You, as a patient, choose the time for the operation. When you notice that the quality of your eyesight is not good enough for your everyday activities it means that the time has come. The cataract surgery is described in detail below. If anything is unclear feel free to ask your ophthalmologist. - What is a cataract surgery?
With cataract surgery the natural eye 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 into tiny pieces by ultrasound or by warmed saline fluid, a procedure safer for the patient, and then suctioned from the eye. The medical term for this is phacoemulsification. This modern surgical method allows for a smaller incision (1.8 to 2.6 mm) compared to older techniques (8-10 mm). This method is safer for the eye and reduces the healing time. During the second stage of the operation the folded artificial intraocular lens is placed inside through the incision. After that it automatically unfolds in the eye and is carefully positioned by the surgeon.
- Phacoemulsification: additional information
Destruction of the natural lens is performed through the vibrations (40 000 movements per second) of a fine probe transmitted by an ultrasound generator. The cloudy lens is broken into tiny pieces which are removed by aspiration with the same probe. At the same time the eye is being filled with sterile solution which has to substitute the sucked fluid. Except for necessary equipment, a very skillful surgeon is needed for phacoemulsification.
- Artificial Intraocular Lens
Modern artificial foldable intraocular lenses are biocompatible and well tolerated by patients, giving them optimal visual results after the operation.
- A new safer procedure
A completely new method for fragmentation of the natural lens is the use of warmed saline fluid instead of ultrasound. This technique is applicable on some patients.
- What is the success rate of cataract surgery?
Cataract surgery has a success rate of 98% and even more. Constant innovations and improvements in technologies and surgical instruments allow for an extremely safe and reliable procedure.
- What is an intraocular lens (IOL)?
The intraocular lens is an artificial lens which is implanted in the eye during the cataract surgery. The good news is that your cataract has developed in times when the technologies for production of intraocular lenses are highly sophisticated.
The traditional method of cataract surgery includes a monofocal lens. This type of IOL is appropriate for the correction of distance vision. It does not eliminate the need of wearing spectacles for near vision or astigmatism or another refractive disorder.
Recent technological achievements are amazing: a new generation of IOL can help you see well without spectacles for distant and near vision and can be used to correct certain refractive errors such as astigmatism, near-sightedness, far-sightedness, etc.
Постиженията в технологията през последните години са впечатляващи – новото поколение изкуствени лещи могат да Ви помогнат освен да виждате добре наблизо и надалеч без помощта на очила или бифокални контактни лещи, допълнително да бъдат коригирани някои аномалии на очите Ви като астигматизъм, късогледство, далекогледство, и др - Monofocal lenses
Monofocal IOLs have one focus point and can offer clear distance vision. The patient, however, will need glasses for reading or computer work. AcrySof IQ lenses are among the most preferred monofocal lenses. The special design of the surface improves functional vision in challenging environments such as semidarkness or fog. AcrySof IQ has UV and blue light filtering. - Multifocal
Multifocal lenses offer both good near and distant vision. Some of the most preferred multifocal lenses are AcrySof ReSTOR Aspheric. They have a special design allowing them to substitute the clouded natural lens and to correct presbyopia. With their help you will be able to see well without spectacles both near and distant objects. The state-of-the-art technology of AcrySof ReSTOR Aspheric successfully simulates the accommodation of natural lenses and permits the patient, after the operation, to have both clear near and distant vision and no need of spectacles. The lens has UV and blue light filtering. 94% of postoperative patients state that they again would choose AcrySof ReSTOR Aspheric.
- Contact lenses for astigmatism
Special intraocular lenses for astigmatism correction are already available. AcrySof TORIC lenses are the proven leaders in this field. They have been designed particularly for patients with cataract and corneal astigmatism.
Similarly to monofocal lenses this type of lenses ensures a qualitative distant vision and less dependability on spectacles. Most of the patients, however, still need glasses for reading and computer work.
AcrySof TORIC lenses correct astigmatism and offer a good quality distant vision. They have UV and yellow filtering against the blue light hazard.
The traditional intraocular lens implanted in the eye in replacement of the removed cataract recovers the clear vision but can not correct astigmatism. Spectacles or contact lenses or even an additional surgery are necessary for the correction of blurred and distorted vision. - The advantage of the blue light filtering
Intraocular lenses AcrySot IQ, ReSTOR Aspheric and AcrySof TORIC possess a special UV filter against the highly damaging ultraviolet rays and blue light.
Light helps us perceive the world through the process of vision. Modern scientific discoveries suggest that visible light and high-energy blue light in particular can also be an important factor for the development of retinal disorders such as age-related macular degeneration. This eye disorder is one of the most frequent reasons for loss of visual acuity.
Since the age of four the light effect gradually leads to yellow pigmentation of the natural lens. The yellowing increases with age. It must not be confused however with cataract. The yellow pigment of the natural lens acts as a protective filter which reduces the blue light entering the eye and thus diminishes the risk for retinal damage.
In order to prevent such damage, intraocular lenses AcrySot IQ, ReSTOR Aspheric and AcrySof TORIC have filtering features which simulate those of the natural lens. With the removal of the natural lens during cataract surgery the eye remains without its natural filter and it shouldn’t be left unprotected against the damaging effects of UV and blue light. Blue light rays are part of the daylight spectrum and artificial light sources such as halogen and fluorescent lamps, studio spotlights, camera flashes, solarium lamps, etc.
AcrySot Lenses are implanted successfully to millions of patients, a fact that makes them one of the most implanted lenses in the world. Their advantage to traditional lenses is that they have not only UV but blue light filtering as well. So they protect the retina from blue light the way the natural lens does. - Before and after surgery
Most people are surprised when they understand how easy and painless a cataract surgery is. It usually takes between 20 and 30 minutes, even less, and most patients go back to normal life activities the very next day.
BEFORE SURGERY
1. Your surgeon will decide weather to eat before the operation or not.
2. Take your usual medicine as prescribed (for example: insulin, heart drugs, etc.).
3. During the surgery you should wear comfortable clothes that are not tight around the neck and arms (if possible wear short sleeves).
4. Leave your jewellery (rings, watch, necklace, earrings, etc) at home. You can't wear them at the time of the surgery.
5. Take a shower or a bath using shampoo.
6. To the attention of the ladies: it might be painful to wear hair clasps or other hair accessories so come to the surgery with your long hair down or covered with a net. Do not use make-up.
7. По време на операцията трябва да останете неподвижни за около 30 минути и да не посягате с ръце към главата. След операцията трябва да останете спокойно.
THE DAY OF SURGERY
When you come to the Eye Centre you will be prepared for the surgery by having your eye dilated with eye drops half an hour in advance. The cataract operation is performed under local anaesthetic which makes your eye and the area surrounding it absolutely numb and senseless. After that you will be taken to the operating room. Your vital signs will be monitored through blood pressure, pulse rate and oxygen content of the blood.
Please, pay special attention to the following remarks as to eliminate most of the risks that could hinder your recovery:
1. The same day of the surgery you should spend sitting in an arm-chair or a sofa. You can dress and prepare yourself or have your meals at the table as usual.
2. Do not, under any circumstances, take your bandage off or rub the eye.
3. Normally, the patient does not feel any pain after the operation. In case of need you can take a mild analgesic.
THE NEXT DAY AFTER THE SURGERY
Note the following important points for that day:
• POST OPERATIVE TREATMENT
After the surgery you will have to apply eye drops. A few weeks after the cataract surgery you will be prescribed temporary eyeglasses. It is important that you visit your ophthalmologist regularly so the process of recovery is observed.
1. Your ophthalmologist will take your bandage off. In the meantime you will be given instructions for the treatment of your eye and how to handle it in the following days and weeks.
2. One day after the surgery you can do moderate-intensity activities.
3. You will have to avoid touching your eye.
ADVICE FOR THE RECOVERY PERIOD
While your operated eye is healing, you should comply with the following recommendations to protect your new intraocular lens and to facilitate the quicker adaptation:
1. Regularly visit your ophthalmologist on the scheduled days.
2. Take your medicines and apply the eye drops as directed.
3. Do not lift heavy objects (more than 15 kg) and avoid any intensive physical work during the first days after the operation. You can do your usual everyday tasks.
4. Driving is not contraindicated but it would be better if you avoid driving during the recovery period.
5. Avoid rubbing or pressing the eye at least one month after the surgery.
6. You can take showers and baths or shave yourself as usual but your eye must not be in contact neither with shampoo nor with soap. Be extremely careful when taking off your make-up.
7. Avoid reading longer than recommended in the first week after the surgery.
8. You can watch TV but be careful not to overwork your eye.
9. You can work on a computer although with some caution consistent with your condition during the first days after the surgery.
10. You should avoid steam baths, swimming, water jumps and cycling in the recovery period.11. In case of whatever problems during recovery (such as redness in the operated eye, pain or worsening of your eyesight) immediately contact your doctor.
