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Cataracts are believed to be a disease of elderly people over the age of 65. Meanwhile, even 40-year-old patients visit the doctor more and more often, who noticed that their eyesight was getting worse.
Fortunately, today cataract treatment is very effective, and the patient immediately after the surgery sees the world sharply and full of colors. Some of them don’t even need to wear glasses.
Cataracts – by the medical definition – are gradual, painless deterioration of vision caused by clouding of the lens. The sick person has poor vision, both up close and from a distance. It cannot be corrected with glasses.
The task of the lens is to focus the light rays entering the eye so that they are on the photosensitive retina. From there, the signals travel through the optic nerve to the brain. If the lens is not clear, vision is disturbed. At first, patients feel as if they saw the world through a dirty glass or thick foil that does not transmit light. The colors are losing their intensity. Sometimes the first symptom of a cataract is stumbling over objects that the patient stops noticing.
The lens loses its clarity with age, this is a physiological (natural) process. In a cataract, however, it is significantly accelerated. The disease usually affects people over 50 (more than 90% of cases are called senile cataracts), but it also happens in 30- or 40-year-olds. People with diabetes, sarcoidosis or rheumatoid arthritis are more likely to suffer from cataracts.
Cataracts can be treated at any age, even in their nineties. At this age, it is difficult to find a person whose lens is not cloudy to some degree. The National Health Fund does not limit access to cataract removal procedures due to age.
Before the operation
Since lens clouding is a natural process, there is no way to avoid it. However, we can regularly examine the eyesight so that if it worsens, treatment can be started quickly. Some doctors prescribe special drops. There is no evidence that they help, but they certainly do not. However, in the case of cataracts, the only effective treatment is to get rid of the cloudy lens and replace it with an artificial lens.
The procedure takes no more than half an hour, usually 10-15 minutes. However, in order for it to occur, the patient must undergo a qualification.
It begins with a visit to your ophthalmologist – you do not need a referral for this doctor. If he discovers a cataract that interferes with everyday life or makes it difficult to assess the fundus (in diabetics), he refers the patient to surgery. Nowadays, there is no waiting for cataracts to “mature” (ie the lens is very cloudy) because the operations are safe enough to be performed early.
Then the patient registers at the clinic at the hospital where the operation will be performed (zoning does not apply). Here, the doctor conducts a thorough interview (asking, among others, about accompanying diseases, allergies, etc.) and a detailed examination of the eyes. It includes:
* assessment of visual acuity and the anterior and posterior segment of the eyeball;
* measurement of intraocular pressure;
* refractometry and keratometri;
* biometry with the calculation of the power of the intraocular lens.
In case of additional medical indications, an ultrasound of the eyeball and a gonioscopy (examination of the angle of filtration) are also performed.
After the visit, the patient receives a list of tests to be performed. These are i.a. basic blood and urine analyzes, sugar levels, electrolytes. Vaccination against hepatitis B is required, as well as consultation with a cardiologist with an ECG examination, a dental consultation and a specialist, e.g. diabetic clinic, if the patient is being treated there. With a complete set of examinations, the patient reports to the hospital outpatient clinic for an anaesthesiological consultation within the prescribed period. If it is successful, i.e. there are no contraindications to the procedure (mainly anesthesia), the patient waits for the date of the procedure. Usually, he is informed about it by phone. The waiting time for surgery – from the moment of admission – from 2 weeks to a month, depending on the hospital.
Procedure
Cataracts have been fought since antiquity. The operation consisted in inserting a knife into the side of the eyeball and rupturing the lens ligaments. The lens remained inside the eye, but no longer stood in the way of the light rays. Even 30-40 years ago, the lens and the bag around it were torn out by freezing it with the tip of a special (strongly chilled) tool.
Modern treatments are completely different. Today it is used, among others ultrasound and lasers. For such a procedure, local anesthesia is usually performed using drops or periocular injection.
In the ultrasound method, the doctor makes two incisions: two and one and a half millimeters. It introduces a device emitting ultrasounds through the larger one, and a suction device for a broken lens through the other. Sometimes a fluid is used instead of ultrasound. All this so as not to damage the tissues surrounding the lens.
The most recent method is to use a femtosecond laser. It was introduced in 2012 by the team of prof. Jerzy Szaflik, as the first in Poland and one of the first in Europe. The femtosecond laser also corrects corneal astigmatism during cataract surgery, if such a patient has it.
Cataract femto-phacoemulsification is a very precise technique. The laser practically replaces the hand of the surgeon who had to make “entrances” for the instruments with standard phacoemulsification. Now it is the laser that performs the so-called ports in the cornea, precisely separates the cloudy lens from the anterior chamber, carefully cuts and then breaks the cloudy lens. Then it is removed (suctioned) with a classic phacoemulsifier. After removing the cloudy lens, a new, artificial one is inserted – it has the form of a self-developing roll – says Professor Jerzy Szaflik.
These modern lenses have changed a lot in just a few years. First there were the so-called white, then yellow appeared (with a UV filter protecting the retina from harmful radiation). But lenses with several functions at the same time became a hit: filter, vision correction, astigmatism correction, presbyopia correction (they replaced reading glasses). Such have appeared in the last few years. The first toric lens in Poland was implanted by professor Jerzy Szaflik and his team at the Eye Microsurgery Center in Warsaw. It was 2008.
Then they began to implant multifocal or multifocal lenses, for good vision both near and far – without the need for glasses.
A novelty that is just entering the market are bioaccumulative lenses – almost as perfect as natural, human, young, that is, the same as a man at the age of 35 years.
The National Health Fund only finances good quality single vision lenses with a UV filter. Unfortunately, you cannot pay extra for others in state hospitals. They can only be obtained at commercial centers.
Privately, you have to pay about 4 for the operation. for one eye (the price for an operation with a monofocal lens) or about 7 thousand. (for surgery with a multifocal lens).
After the surgery
The patient can leave the hospital on the same day, after 2-3 hours. After the procedure, he must go to a check-up as recommended by the ophthalmologist and use the prescribed medications (eye drops and gels).
The patient usually receives all other information on discharge from the hospital.
Tekst: Iwona Janczarek
Consultation: prof. Jerzy Szaflik, Eye Laser Microsurgery Center