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Every year the number of Poles who see the world through the “foggy glass” grows. We wait a long time for the most frequently performed ophthalmic procedure – up to one and a half years. We ask the ophthalmologist prof. Andrzej Grzybowski.
Professor, let’s say I’m 60 years old and I have cataracts in both eyes. Should I be getting ready for surgery?
Not necessarily, not all cataracts are eligible for surgery. Cataracts, i.e. clouding of the lens, are a natural symptom of eye aging. It most often affects people over 60 years of age, and the older we are, the greater the probability of its occurrence – in 90-year-olds it is already 90%. The clouding of the lens can take different forms – sometimes it develops over several months, and sometimes over many years. Very often XNUMX-year-old cataract patients see very well for the next decade. In their case, the operation will not be of any benefit. It is the result of the disease, i.e. the deterioration of vision in the eye, that is an indication for surgery.
Can we determine the visual acuity at which a patient should be operated?
There is no arbitrary visual acuity that determines surgery. Each time, the patient’s needs and expectations, his age and professional activity should be taken into account. A 80-year-old who works and needs to see well not only in the conditions of an ophthalmological office has a different life situation, but an 80-year-old patient has different expectations and visual needs. Older people often see up to XNUMX percent. optotypes on the Snellen chart and do not want to undergo surgery, experience stress or discomfort associated with it. Although cataract surgery is associated with a very low risk, at the moment we cannot completely eliminate it.
Has the Professor ever operated on a patient who had 100 percent visual acuity?
Yes, I operated on such patients several times. An example is people who can see everything in the conditions of an ophthalmological office, but clouding of the lens means that they cannot drive a car at night. This shows that each patient should be approached individually.
Can we talk about risk factors in the case of cataracts?
We need to distinguish between two categories of age-related senile cataracts and cataracts secondary to the diseases or events that have occurred. While we cannot prevent age-related cataracts, in the case of secondary cataracts we can talk about factors that increase the risk, such as: diabetes, steroid use, eye or head trauma, smoking. Generally, it should be assumed that cataracts up to the age of 55 are not natural and its cause should be sought. For example, it can be a symptom of general diseases, which is why in such cases I refer my patients to an internal medicine consultation.
Let’s say the fear of surgery paralyzes me, can I buy cataract drops?
There are no pharmacological methods of inhibiting or treating cataracts, and all the proposed pharmaceuticals, both by pharmacies and advertising, e.g. on radio and television, are worthless in this regard. The only treatment option is surgery, which is very well designed and carries a low risk of error. The procedure is performed using the so-called phacoemulsification, which consists in breaking the cloudy lens with the help of ultrasound and removing it to the outside. A small surgical incision usually does not require stitches and enables quick visual rehabilitation of the patient. Such operations can be carried out under the so-called one-day surgery.
How long does it take to operate the other eye?
This is usually done 14 days after the first operation. From the point of view of visual rehabilitation, the less time elapses between the operation of the first and second eye, the better. Especially in the case of people who, apart from lens clouding, have other visual impairments.
Dlaczego?
Suppose a patient has cataracts in both eyes and myopia has -5 diopters. During the operation, we can implant a lens for him, thanks to which he will get rid of the refractive error. As a result, after the first treatment, the difference between one and the other eye is large enough to prevent good binocular vision. That is why today more and more popular is the Immediately Sequential Bilateral Cataract Surgery (ISBCS). In Finland, 50 percent is performed simultaneously. treatments, in the Canary Islands as much as 80 percent. From the point of view of visual rehabilitation or hospitalization costs, it is a beneficial solution.
So why are ophthalmologists afraid of simultaneous binocular cataract surgery?
We can talk about two dangers that have been feared for years. The first concerns the risk of infection inside the eyeball, i.e. endophthalmite, which is very rare but is a serious condition with the risk of losing the affected eye. Most often it is caused by exogenous factors after cataract surgery or after intraocular injections. ISBCS critics believed that there was a risk of bilateral endophthalmitis in the case of concurrent binocular cataract surgery. Today, however, we know that if we approach concurrent binocular surgery in accordance with international standards, i.e. we follow surgical procedures and treat the second eye surgery as for the other patient, it is completely safe.
And the second threat?
It concerns a certain group of patients for whom the risk of measurement error is higher when calculating the power of the implanted lens. Currently, the measurement tools at our disposal allow us to achieve accuracy in the range of ± 0,5 D to ± 0,75 D. However, in the case of patients not cooperating with the operator, with uncoordinated movements or with undersized eyeballs, the risk of error is even ± 1,5 D. This naturally translates into poorer vision without correction and less satisfaction with the surgery. In such situations, operating at greater intervals is beneficial – when examining the patient after the first eye surgery, we check what mistake we made and draw conclusions to calculate the power of the lens for the other eye.
Is simultaneous binocular cataract surgery reimbursed today?
As a member of the International Society for Binocular Cataract, I have been trying for years for a refund of this treatment in Poland. This is primarily of great benefit to the patient. We accelerate the patient’s visual rehabilitation and solve numerous problems related to the stay in the center performing the surgery and follow-up visits. I also see an element of savings in this – a patient admitted to the hospital during a three-day stay has both eyes operated on. At the same time, we reduce the number of control visits, not to mention faster convalescence and reduced absenteeism. At the beginning of this year, the National Health Fund introduced the reimbursement of simultaneous binocular cataract surgery, but unfortunately it was unprofitable. I think that ophthalmologists choose it nowadays in exceptional situations, e.g. under general anesthesia, which carries the risk of more frequent side effects. Such anesthesia is reserved for restless patients suffering from neurological and mental disorders, which may result in a lack of cooperation during the operation.
Do I have to wear glasses after cataract surgery?
No, it is not always necessary. As a standard, the patient’s expectations in terms of vision without glasses are determined before the operation with the patient, and the patient indicates to the doctor whether he wants to see up close without glasses after the operation and wear glasses for walking or vice versa, read with glasses and walk without glasses. This situation is typical of single vision lenses that provide only one vision distance: far or near. These are the basic NHF reimbursement lenses, but even between single vision lenses there are some differences.
What?
Lenses differ in terms of properties and the materials they are made of. Aspherical lenses, compared to spherical lenses, provide better optics. Unfortunately, due to the price, not all hospitals decide to buy them. On the other hand, hydrophobic lenses are slower than hydrophilic lenses lead to clouding of the posterior lens bag. It is one of the complications of a properly performed cataract surgery, causing a decrease in visual acuity. The procedure used in the treatment of clouding of the posterior capsule is a capsulotomy, which consists in making an optical slit in the central area of the opacified capsule with the use of a YAG neodymium laser. This procedure is completely painless, does not require anesthesia and allows the patient to immediately regain visual acuity.
CBOS research has shown that Poles with cataracts are uninformed. Half of them do not even know what lens will be implanted …
That’s very bad. The implanted lens remains in the eye for life and should guarantee good vision at all times. The patient not only has the right, but should know what type of lens will be implanted and verify the opinions about it. As in the case of various technologies on the European market, high, medium and low quality products are allowed for sale, which is reflected in the price. The highest quality lenses usually come from the United States and Western Europe. In contrast, lower quality lenses are imported from India or other Asian countries. We choose products from reputable companies that have years of experience behind them. Our Foundation will soon prepare a guide on the various properties of intraocular lenses for patients and we will publish it on our website.
Besides single vision lenses, there are also multifocal lenses. What’s the difference?
Multifocal lenses, also known as multifocal or pseudo-accomodation, imitate accommodation and allow you to see at variable distances: close, far and intermediate distances. By implanting multifocal lenses, we can correct presbyopia, i.e. get rid of reading glasses. Unfortunately, they are available as part of a full-paid procedure, despite the fact that ophthalmologists have been applying for additional payments for an above-standard lens for years. Patients in the Netherlands, the Czech Republic, Germany and Turkey already have this right. In Poland, people opting for multifocal lenses have to use the private market and pay twice as much: for surgery and for the lens. It is very unfair.
You can now buy cataract treatment, tailored to your needs, on Medonet Market. An ophthalmological consultation will be necessary before the operation. Check the qualification offer for cataract surgery from Eyemed.
Prof. extra dr hab. med. Andrzej Grzybowski – Head of the Department of Ophthalmology at the University of Warmia and Mazury and President of the Foundation for the Development of Ophthalmology «Ophthalmology 21» (http://okulistyka21.pl/). Laureate of prestigious domestic and foreign scientific awards. In 2017, in recognition of his scientific activities, he received the Achievement Award from the American Academy of Ophthalmology. Member of many scientific societies, including the European Society for the Examination of the Eyesight (EVER), the European Society of Cataract and Refractive Surgery (ESCRS), the European Academy of Ophthalmology, the American Academy of Ophthalmology (AAO), board member of the European Retinology Society (Euretina). Author of over 350 scientific articles in peer-reviewed international scientific journals. Co-author of the book «OCT in Central Nervous System Diseases. The Eye as a Window to the Brain ».