Seeing well into old age

The main symptom is a slow deterioration of your eyesight.

Often both eyes are affected. At the start it’s like you’re looking through fog, which gets thicker and thicker over time. Sensitivity to glare often increases too. Pictures becoming increasingly fuzzy, losing their Intensity and color. It gets harder and harder to do routine activities like reading the paper, driving the car or watching TV. If a cataract remains untreated, in the end you can only recognize dark and light. In particularly serious cases, this condition can lead to blindness.

The most common cause of a cataract forming is the natural aging process and the inadequate supply of nutrients to the eye lens. The metabolism of the lens slows down, the concentration of water in the lens decreases, it becomes harder and loses its elasticity. Exposure to sunlight over the years also leads to the deposition of yellowy-brown substances and clouding of the lens.

In this case it is referred to as an age-related cataract, which usually occurs after the age of 60. However, this is already possible earlier with the appropriate assessment.

Other causes may include metabolic disorders such as diabetes, chronic eye inflammation, eye injuries, radioactive emissions or hereditary lens opacity.

For the ophthalmologist, a "cataract" is easy to diagnose. The clarity of vision is reduced and clouding of the lens can be clearly seen when examined with a slit lamp. It may be helpful to dilate the pupils beforehand using drops. In a very advanced cataract the opacity of the lens can even be seen with the naked eye.

The good news:

The good news first, a cataract can now be treated very easily with surgery. During the operation the cataract (=the clouded lens) is removed from the eye and a new artificial lens is implanted.

Cataract surgery is one of the most frequently performed operations in the world: well over 600,000 cataract operations are performed in Germany every year. It involves a gentle routine procedure with a low complication rate, which is generally carried out as an outpatient procedure using a local anesthetic.

In the past, surgery tended to be used more conservatively and was only performed once the cataract had progressed. Today, surgery is performed if the patient feels that the clouding of the eye lens is affecting their everyday life. Which is why the timing of the operation is decided individually between the patient and the ophthalmologist.

The bad news:

Medication like drops, tablets or alternative therapies cannot treat a cataract, even glasses don’t help. A cataract also cannot be corrected with glasses. A cataract may lead to blindness if left untreated.

During cataract surgery, the clouded lens of the eye is removed and replaced with a new artificial lens. If there is a cataract in both eyes, one eye is usually operated on first (usually the worst one first). As soon as the first eye has recovered well from the operation, attention will turn to the other eye.

Preliminary examinations

A few special tests are needed before the operation:

The curvature of the cornea is measured and the length of the eyeball is checked using ultrasound or modern laser technology to work out the correct strength of the new artificial lens.

In addition, your general state of health and what medication you are taking - especially blood thinners – will be checked by your own doctor. These tests are designed to ensure the highest possible level of safety.

Before the operation

As the procedure is carried out with a local anesthetic, patients can eat and drink normally up to 6 hours before the operation. Patients are only allowed to consume drinks In the 6 hours immediately before the procedure. Diabetics should discuss the medication with their own doctor.

Before the operation, patients are given medication by our anesthstist to help them relax and stay calm. The anesthetist will also monitor the patient during the operation (ECG, blood pressure and pulse). It does not require a general anesthetic. This involves using enough local anaesthetic, which is applied in the form of special eye drops, to make the eye insensitive to pain. Patients are awake and can be asked questions during the entire procedure.

The eye is thoroughly cleaned with a disinfectant solution immediately before the operation and the face is covered with sterile swabs. You will also be given pure oxygen and the swabs are suspended over your face like a tent to avoid you feeling trapped.

During the operation

The upper and lower eyelids are kept apart during the operation by a small spring (eyelid blocker), so you don’t have to keep your eye open yourself. Moistening fluid is dripped onto the surface of the eye at regular intervals to stop your eye drying out. You will feel the liquid running down your face. The operation itself is performed by the surgeon using a special surgical microscope.

Once you’ve been given the local anaesthetic, the doctor will make a very small incision of approximately 2 mm. This incision creates a small opening to provide access to the inside of the eye.

The clouded eye lens is liquefied and sucked out through the opening using ultrasound. The lens capsule remains intact during this. It surrounds the eye lens and in the next step it is also used to “support” the new artificial lens.

The new artificial lens is folded by the surgeon before it is inserted. This means that the opening through which the lens is inserted into the eye can be kept extremely small using minimally invasive surgical techniques.

The artificial lens unfolds automatically inside the lens capsule and slides into its final position. It is held in place in the capsule sac by small flexible clips. As a result, the new lens sits where the natural lens used to be.

The procedure is so gentle that the tiny incision does not need to be stitched. It seals itself, like a valve, without forming a scar. The procedure usually takes less than 10 minutes. The whole cataract operation normally involves you and your relatives staying at Smile Eyes for less than 2 hours.

For a laser operation

Laser technology is opening up a new era in terms of precision and is making the surgeon’s scalpel redundant. A computer-controlled laser measures the different structures in the eye and plans how treatment will proceed. The laser makes precise surgical access possible, cuts the opening for the lens in exactly the right place and individually calculates the position of the center of the lens. This saves unnecessary ultrasound energy and ensures the best possible fit of the artificial lens.

After the operation

After the surgery, your eye that has been operated on will be covered with a medicated dressing. This is then removed the following day and your eye is checked. After the outpatient operation, you can be driven home after a predetermined period of observation. Of course you are not allowed to get behind the wheel yourself. Please make sure you bring another person with you to the operation. You should also not be left alone at home for the first few hours after the operation.

At home

Even if you get back home quickly, your treatment will still not be over. Now you have to help yourself too. You must take things easy on the day of the operation. The best thing to do is to get rest in bed at home. Your medicated bandage is usually removed and the eye examined on the first day after the operation. Your doctor will give you medication, which you must take precisely according to their instructions.

You will usually notice a significant improvement In your vision, even in the first few days after the operation. However, initially it will be affected by some irritation of the eye for a short time. You will need to be patient until you reach your final full visual acuity.

You should pay attention to the following over the next few days and weeks

Please take the medication prescribed by your ophthalmologist regularly and on time and keep to the examination appointments carefully. If you are unable to take your eye medication correctly, make sure that you get help from your family or friends. You can also get professional support to help you with this. We are happy to help you if you have any further questions about this.

Under no circumstances should you press or rub an eye that has just had surgery performed on it. Even with a small, self-closing incision, initially your eye will not be as resilient as it normally is.

When taking a shower you should not wet your face with water for the first few days. When washing your hair you should make sure that your head is always tilted right backwards. During the first few days, you should avoid getting soap into any eye that has been operated on in as much as possible.

You should avoid physical exertion and sports such as swimming, diving, cycling or going to the sauna until your ophthalmologist tells you that you can resume these activities safely. However, this can usually be resumed again after no more than two weeks.

Your ability to work and permission to drive depend on how clearly you can see after the operation. Do not take an active part in driving again until your ophthalmologist has given you specific permission!

As the new artificial eye lens now allows more light to pass through than the cloudy natural lens, most patients prefer to wear sunglasses for the first few weeks after the procedure. They also serve as protective goggles in the event of inclement weather conditions.

Television is generally allowed - even shortly after the procedure.

You'll probably need glasses despite the cataract surgery. Your ophthalmologist will determine the strength of your artificial lens exactly according to the data obtained when your eye was measured - but the accuracy of this is limited. A frequent approach is to aim for a low near-sightedness so that the patient can manage well without glasses at medium distances (orientation in space). The best visual acuity for both distance and close-up (reading, handicrafts, etc.) is then achieved with normal thin, lightweight lenses.

What this means for you is that - just like before the operation - you will either need two pairs of glasses - one for distance and one for near vision - or just one pair of glasses with progressive lenses for distance and near vision.

If you do not want to wear glasses at all, a special premium lens, which is known as a multifocal lens, can be implanted during cataract surgery. We are also happy to provide you with personal information about this.

The costs for cataract surgery will be covered by all health insurance companies and the standard materials used are of good quality.

Today, new and innovative artificial lenses (premium lenses) are available for special requirements and individual needs, with properties that go beyond those of standard lenses. Modern laser cataract surgery also incurs costs, which your doctor will explain to you in detail in a personal consultation.

The standard costs for cataract surgery will continue to be covered by statutory health insurance even when premium lenses are used. The additional costs incurred for premium lens as well as the additional medical costs do not fall under the statutory cost coverage and must therefore be paid privately. We are happy to provide you with information about this in a personal consultation.

Various different types of artificial lenses can be implanted into the eye during cataract surgery:

High-quality standard lenses. These are usually acrylic lenses of very good quality that have been tried and tested over many years and will give you you good and safe vision for the rest of your life.
Premium lenses with special optical properties. These offer an additional extra in the quality of vision. In addition, at SmileEyes we only used tinted premium lenses. This tint provides additional sun protection for your eye and protects the retina.

Statutory health insurance will not cover the costs of premium lenses. Patients have to pay for these themselves. Private health insurance will generally cover some or all of the costs.

Premium lenses with high-quality optical properties and improved light protection

In the case of premium aspherical lenses with improved light protection, lenses with special aspherical optics are implanted. These are also used in other optically demanding systems, such as high-quality spectacle lenses or telephoto lenses and telescopes.

This gives your eye extra visual quality and the tinting acts in the eye like additional sun protection and protects your retina.

Your doctor will work out which is the correct lens for your eye and select it individually for you.

Important: Light reading glasses will still be needed for reading after the operation, even when with a premium lens implant.

Private health insurance will cover the costs.

Premium lenses with additional compensation for any curvature of the cornea

Regardless of how clouded the lens is, about a third of all patients also have some curvature of the cornea. With a "normal" cataract operation, glasses are still need to compensate for this visual defect after the operation. The curvature of the cornea can be compensated for by inserting a special lens, so that the patient is as independent as possible of distance glasses after the operation. In this case a lens is used which neutralizes the existing curvature of the cornea. This special lens is custom-made and fitted precisely. If everything proceeds perfectly, then you won’t need distance glasses any more. If the correction is not quite perfect, the remaining visual error can be corrected with a small laser procedure.

In any case, light reading glasses will be needed afterwards. However, these are straightforward and so are inexpensive to purchase, as no basic lenses or complex progressive lenses are required to compensate for the curvature of the cornea.

Private health insurance companies will cover the costs in the vast majority of cases.

Premium lenses as multifocal lenses/trifocal lenses

If you want to do without virtually any glasses at all after the operation, including reading glasses, you can use a special lens that has several focal points. This allows objects to be perceived both at distance, in the mid-range field of vision and close up without glasses. As a result, these lenses are referred to as multi or trifocal lenses. Wearing glasses with this type of lens system is only needed in exceptional situations. A small laser correction of the cornea is rarely necessary afterwards.

The benefit of almost complete freedom from glasses is achieved with a slightly reduced visual clarity. The cause is the underlying physical principle of multifocal or trifocal lenses, which constantly divide light between close up, intermediate distance and distance. For this reason, this type of correction is particularly suitable for patients who are particularly concerned about avoiding the need to wear glasses due to their active lifestyle.

Private health insurance will generally cover some of the costs.

As with any surgical procedure, complications during cataract surgery and in the subsequent healing phase are possible. However, they are the exception and can usually be treated very easily. Before the operation your eye specialist will inform you about the operation and risks and answer all of your questions.

It is important that you consult your ophthalmologist immediately if you experience pain or any further deterioration of the eye that has had the operation in the next few weeks or months.

Patients that are having a cataract operation may develop what is known as posterior capsule opacity (PCO) after the operation. This is an increase in connective tissue in the capsular sac that can lead to a further reduction in visual performance.

Treatment of PCO involves creating a central opening in the clouded posterior capsule using laser surgery. This means that the optical axis in the eye is free and visual performance increases again. This procedure only takes a few minutes and can be carried out in the consultation rooms.