Cataract arises with advancing age and consists in the progressive opacification of the lens, reducing the perceived image quality. The crystalline lens is a lens placed inside the eye, behind the iris and its function is to help the cornea focus on objects and allow the focus of nearby objects (accommodation).
The most common symptom of cataracts is progressive visual clouding, linked to a phenomenon of diffusion and diffraction of light. The extent of the visual loss depends on the type and location of the opacification: more irregular and central opacities tend to be more disabling; vision is particularly disturbed in bright lights, for example during evening and night driving.
Other symptoms of cataracts can be double vision in a single eye, the appearance of colored halos around light sources, the need to change glasses frequently, a paradoxical visual improvement that allows you to remove the glasses used for near or far vision.
In most cases, the first risk factor is age, affecting to some extent about 80% of people over 60. Other risk factors are diabetes, exposure to sunlight, the use of corticosteroids, dehydration, smoking and alcohol, trauma. Concomitant eye diseases such as uveitis, glaucoma, degenerative myopia or previous intraocular surgery can also induce cataracts, or anticipate their onset.
Congenital cataracts are present at birth or are diagnosed in the first 6 months of life and are responsible for approximately 10/15% of all childhood blindness. Small point opacities of the lens that do not significantly interfere with transparency and, therefore, with adequate visual development, are present in 0.4% of newborns.
Juvenile cataracts can result from the progression of an opacity of congenital origin or be caused by drugs, trauma, ocular or systemic diseases.
The different types of cataracts can be:
- Senile cataracts: most cataracts are related to age.
- Congenital cataract: Some newborns have a cataract at birth or develop one shortly after. If cataracts are thought to affect the baby’s vision, this needs immediate treatment.
- Secondary cataracts: Some cataracts develop easily in patients who have other problems, such as diabetes or who need prolonged cortisone therapy.
- Traumatic cataracts: A cataract can develop soon after a trauma or even years later.
The only effective therapy in cataracts is surgery, aimed at removing the opaque lens.
Usually the surgery is performed on an outpatient basis and hospitalization is not necessary. After the removal of the cataract, a short rest period is recommended and will be suggested by the ophthalmologist together with the anesthetist.
It will be up to the surgeon to determine the choice of the most appropriate type of artificial lens. It is important to remember that cataract surgery is not a purely refractive procedure, that is, aimed at correcting visual defects to reduce dependence on glasses. It is in fact normal for a modest visual defect (myopia, farsightedness, astigmatism) to remain after the surgery, involving the use of glasses.
The removal of cataracts, in most cases, is performed by phacoemulsification, that is, with a probe that shatters and aspirates the lens. The lens is wrapped in a thin envelope (capsule) that holds it in place. The capsule is left in its place because it is needed as a support for the artificial lens and keeps the posterior portion of the eye (vitreous and retina) separate from the anterior one.
The operation is microsurgical as it requires the use of the operating and micro-invasive microscope, because it involves entering the eye through 2-3 mm incisions, which usually do not require the use of sutures.
After the cataract has been removed, the patient may have a sensation of a foreign body, burning, discomfort, tearing, photophobia, blurred vision and sometimes headache.
Vision will improve depending on the preoperative clinical situation.
Femtosecond laser to cure cataract
The latest evolution in cataract surgery is the femtosecond laser. Compared to the traditional intervention, this technique does not require the use of a scalpel, therefore it involves less trauma for the ocular tissues and guarantees faster healing.
The patient is positioned under the optical coherence tomograph (OCT), a system already in use for years in ophthalmology, which allows better guidance of movements; then, the surgeon schedules the operation. Once the calibration has been completed, the femtosecond laser emits low energy pulses and with maximum precision cuts first the cornea, then the cataract envelope. During the procedure, the patient feels light pressure on the eye and may hear an intermittent “beep”. Once the laser has been applied, the surgeon removes the already fragmented material and implants the artificial lens, ending the operation.
The femtosecond laser allows an accuracy not achievable by the human hand. The circular opening of the capsule, for example, is perfectly round and centered; this factor is very important in the post-operative phase, since it allows a better centering of the artificial lens. The result is a more precise intervention than what can be obtained with previous systems.
Furthermore, the eye operated with the laser presents ideal conditions for receiving artificial lenses with complex optics, suitable for correcting visual defects such as astigmatism and presbyopia.
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