Cataract Extraction & IOL - Laser Eye Surgery Guide

Cataracts appear to become a problem for some people as they age. The disorder is characterized by the lens of the eye clouding up due to the build up of protein. As the protein accumulates, it can interrupt the person's vision. To resolve this, treatment is available, which includes the use of specialized glasses as well as cataract surgery.

What are cataracts?

Three different types of cataracts have been identified so far; these being subcapsular, cortical and nuclear. Firstly, the subcapsular cataracts can be a result of disorders such as diabetes, severe presbyopia and retinitis pigmentosa and these cataracts tend to begin at the back of the lens. Secondly, cortical cataracts are most often seen in patients who suffer from diabetes and are defined as forming in the lens's cortex. Finally are nuclear cataracts. This type of cataract is classed as the most obvious and noticeable as they are initiated in the middle or the lens in an area known as the nucleus.

Why do cataracts occur when we get older?

It is not entirely clear exactly why our lens alters as we age through life. Despite this uncertainty, experts have been able to compile a list of potential triggers, which include:

  • If an individual is a sufferer of diabetes
  • Exposure to radiation including chemical and light (UV)
  • A high salt diet
  • The use of products such as tranquilisers, diuretics or steroids
  • Smoking either directly or passively
  • Pollution
  • Excessive alcohol intake

What symptoms are associated with cataracts?

There are a number of symptoms that may indicate that a cataract is forming. These signs tend to be related to vision change. One potential symptom is that you may experience a decrease or blurriness in your night vision. Alternatively, a more rare symptom is that you may notice you have double vision or your sight may become tainted with a yellow colour. Also, another symptom that may occur is a constantly changing eyesight prescription.

If you notice any of the symptoms listed or are just concerned that you may be vulnerable to developing a cataract, then do not hesitate to contact your doctor or optician.

The option of cataract surgery

As previous mentioned, there are a couple of treatment options available if you develop cataracts: glasses or surgery. The surgical option is classed as extremely successful, with patients often ending up with either near perfect or perfect vision.

The key part of the cataract surgical procedure involves the surgeon removing the clouded up lens and replacing it with something called an Intra-ocular lens (or IOL).

What is an IOL?

An IOL is a transparent, plastic lens that is implanted in the cornea. The IOL will reside behind the iris where the clouded lens previously existed alone. This synthetic lens may be used in addition to your natural lens or it may be employed as a complete lens replacement. If the latter is the procedure you are undergoing, then it is often referred to as a refractive lens exchange (RLE).

At present, there are three types of IOL available:

  • Phakic: This version of IOL is employed to resolve refractive eyesight problems like astigmatism or short/long-sightedness. When this type of IOL is used, the natural eye lens is not removed and replaced.
  • Aphakic: These IOLs are used as part of a procedure known as clear lens exchange (CLE), where they actually replace your natural lens due to it being missing or inhibited.
  • Pseudophakic: Like with the aphakic IOL, the pseudophakic type are also employed when the natural eye lens needs to be replaced due to a problem or disease. This is often done during the procedures CLE or RLE.

Of the three types listed above, the most prevalently used is a phakic IOL called the 'Artisan' lens. This design of lens can be further separated into two different shapes – spherical or slightly cylindrical (toric). Alternatively, a different phakic IOL sometimes used is called an implantable contact lens (ICL), which comes in a variety of designs such as the STAAR ICL.

The key difference between an IOL and ICL is that the IOL is employed by surgeons to replace the patient's lens if it has become cloudy or faulty. On the other hand, an ICL tends to be implanted in addition to the natural lens.

What does an IOL treat?

If you have been refused to undergo laser eye surgery then the IOL procedure may be deemed a good alternative for you. IOL surgeries can be effective in the treatment of visual refractive errors including long-sightedness and short-sightedness. As a result of this operation, you may no longer require the use of visual aids such as glasses or contact lens. Due to this outcome, some consider the IOL to be a permanent version of the contact lens.

More serious conditions that the IOL can treat include cataracts as well as abnormal corneal disorders.

Am I a suitable candidate for an IOL?

If you have be told that laser eye surgery is not a suitable procedure for you, then you should question your surgeon about the IOL option. This procedure is considered a safe and effective way of correcting eyesight problems that can eliminate the inconvenience of having to wear glasses or disposable/cleanable contact lenses.

Once choosing to undergo the IOL procedure, you must then determine which of the two IOL types you should obtain. The two types of IOL that are available for you to choose from are a monofocal (single vision) IOL or a multifocal (presbyopia-correcting) IOL. Your surgeon will analyse areas of your life such as your age, health and lifestyle in order to determine which of the two is best for you.

Potential risks associated with an IOL

In general, the IOL procedure is very safe, although as with all other surgery there is potential for a risk or complication to occur. Although the chance of such an unfortunate event happening is low, the risks are still worth considering before you commit yourself to undergoing the procedure. Some of the risks that you should mull over are:

  • The development of glaucoma
  • Your iris becoming inflamed
  • Retinal problems
  • Your cornea may degrade or decompose

In the CLE and RLE procedures, there is also a risk of further problems. One such potential complication is fluid penetrating the retinal tissue. Another risk to consider that is related to these procedures is the possibility of the vitreous jelly, which exists behind the eye, becoming detached.

Complications and risks that are specifically associated with cataract surgery include:

  • The development of an eye infection
  • The retina may detach from the eye and so its function is inhibited. This can result in complete loss of vision if not treated in a timely manner.
  • The lens may move out of its correct position
  • Inflammation may occur
  • Your vision may become cloudy or blurred; a disorder that is called posterior capsule opacity
  • Your eyelid may droop (ptosis)
  • The air pressure within the eye may increase

There is one further important factor that is relevant to men, which may increase the probability of a complication occurring. If you are taking prostate drugs then it heightens the risk of you suffering a complication known as 'Intraoperative Floppy Iris Syndrome' or IFIS. Not only this, but it also increases the chances of your retina detaching from the rest of the eye. Therefore, it is vital that if you are taking any form of prostate drugs, that you inform your surgeon prior to the procedure.

Furthermore, you must also let your surgeon know if you are taking any type of alpha-blocker. This may be for a disorder such as high blood pressure, urinary problems, kidney stones or hypertension.

If you are unsure as to whether your medication will influence your risk of developing complications after cataract surgery, consult your doctor or surgeon.

Benefits of an IOL

There are a number of benefits associated with an IOL procedure. The most key advantages include your vision improving in quality significantly as well as durability and the ability to get the procedure reversed. Therefore, the vast majority of patients leave feeling very satisfied with the outcome of their IOL procedure.

If you suffer from cataracts, then the IOL procedure that may be the best option for you is an RLE. This is because the surgery involves the removal of your clouded lens as it is then replaced with a synthetic version.

Your IOL consultation

You should enter your consultation with a clear idea of the questions that you feel are vital for your surgeon to have an appropriate answer to. The key questions that you should consider asking involve the qualifications, experience and skills of your surgeon. You should also find out about the procedure in detail; the recovery period; how successful the results are at that particular clinic; how much the surgery will cost; and the realistic outcome that you can expect.

For further ideas of the types of questions that may further enlighten you about the IOL treatment, please see out 'Laser Eye Surgery: General FAQs' segment.

The cost of the IOL treatment

At the end of your consultation, your surgeon should be more than capable of providing you with an accurate quote as to how much your procedure will cost. The price will vary between clinics so you may wish to "shop around" to find the best deal before committing yourself.

The price will also vary depending on the type of IOL you require. To give you a rough idea of the kind of money you should prepare to part with, below is a short list of average prices:

  • Cataract surgery - £1,900
  • Spherical phakic IOL - £2,750 per eye
  • Toric phakic IOL - £3,150 per eye

The IOL procedure

The IOL treatment is performed on an outpatient basis so you should be able to return home on the same day as your surgery. It will be requested that you do not consume any food or drink on the day that your procedure will take place. You should also avoid wearing any make up.

To prepare you for the surgery, you will be administered a sedative. This will subsequently be followed by the application of eye drops composed of local anaesthetic, which will act in numbing the eye. The sedative/eye drop combination will minimise any pain or discomfort that may otherwise have been felt during the procedure.

The next step involves the surgeon thoroughly cleaning around the eye to sterilise it. An ultrasonic piece of equipment will then be used to break down the protein accumulation that composed the cataract. Once this has been done, the material can then be removed from the eye by suction.

Once the cataract has been completely removed, the surgeon can then insert the IOL into the eye. The lens is first inserted in a folded way, but once in position the IOL will fall into its natural shape.

The actual procedure tends to take up to 30 minutes to complete. Once done, a shield will be placed over the eye for protective purposes. You will then be required to stay in hospital for a few hours after the procedure so you can be monitored. After this time you will be allowed to go home. It is important that you have a friend or family member to drive you home, as you will not be capable of handling a vehicle.

Usually, the surgeon will only operate on one eye at a time. This is to ensure that there are no complications. Once this has been observed, you can get yourself booked in for your other eye to undergo the treatment.

As a whole, cataract surgery is classed as extremely successful and the results seem to be life-long. For further details on exactly how long you can expect the results to last for, you should raise the issue during your consultation.

The recovery period after the IOL procedure

The recovery time will commence in hospital, where you will be monitored for a few hours immediately after surgery. Before leaving, you will be supplied with eye drops, which act in warding off infections. You should listen carefully to the instructions of use and ensure that when you get home you use them as advised.

For the first 24 hours after your surgery, you will be required to wear an eye patch to protect your eye from the environment and any potential damage. Following this day, you may be advised to wear sunglasses for a week to shield you eyes from direct sunlight.

Your IOL package should include a number of aftercare appointments at the clinic to monitor your progress and healing. The first appointment will take place the day after your surgery. After this, the visits will be less frequent over the coming months. It is important that you attend all of these appointments as you may suffer a complication that only your surgeon will see.

During your recovery, you should try and avoid doing anything strenuous, such as sport. You should also apply a clean covering to your eye prior to washing. Your surgeon will give you a list of instructions and recommendations about your recovery time either at your consultation or after your surgery. These recommendations will include aspects such as when to return to work and when you can drive again.

Contact your surgeon at any point if you are concerned during your recovery.