Today, the only curative treatment is surgery. It consists of replacing the crystalline lens with an intraocular implant in order to compensate for its decreasing refractory power.
In general, cataract treatment is not an emergency operation. The decision to operate will depend on the seriousness of your complaints and the extent of your vision loss. Your ophthalmologist will also take into account your socio-professional background and the presence of other concomitant factors which affect your visual acuity. There is no visual acuity threshold which clearly indicates surgery, but generally a surgical intervention is proposed when your visual acuity is less than 4 to 5/10ths.13
Three different techniques may be employed to extract the cataract:
Intracapsular extraction involves the creation of a wide opening in the cornea in order to remove the entire crystalline lens with an instrument called a cryode. Thereafter, an intraocular implant is put into place. Today, this technique is no longer used.
Extracapsular extraction involves a longer incision on the side of the cornea, and removes the crystalline core and cortex with a spatula-shaped tool, while leaving the capsule in place. Following this, the surgeon introduces the intraocular implant into the capsule. This technique is now used less and less frequently, as it has been replaced by the following procedure, but it is still employed when the cloudiness is very dense.
Phacoemulsification is the technique of choice in industrialized countries for several reasons: it is effective, success is relatively positive, and, as it involves only a very small incision, recovery of vision is very quick12. During phacoemulsification, a small incision is made on the side of the cornea, and a tiny probe is inserted into your eye. This device emits Ultrasound waves that soften and break up your lens, allowing it to be removed by suction without displacing the lens capsule. An intraocular implant is then put into place.
As the surgical intervention is most often conducted under local anaesthesia12, it can be performed as an outpatient procedure. Note, however, that you will not be allowed to drive on the day of the procedure, so you should make appropriate provisions.
The day after the surgery, you will have to return to see your surgeon, who will examine the state of your eye. Regular visits on a schedule determined by your ophthalmologist will be necessary thereafter as part of a long-term follow-up.
In general, results are very positive. In the majority of cases, vision recovers within 4 days of the operation12 and more than 90% of patients achieve visual acuity greater than or equal to 5/10ths without corrective lenses.2
Cataract surgery is usually very well tolerated. Note, however, that any surgical intervention carries a risk of complications. If you notice a sudden decrease in your visual acuity or if your eye becomes painful or red, you must consult your ophthalmologist immediately.
Potential complications include an eye infection called endophtalmia, glaucoma, retinal detachment, implant displacement, or macular oedema. However, these complications are very rare2.
Another, more common complication of cataract surgery is the development of a secondary cataract, called a posterior capsule opacification. In this case, the crystalline capsule which surgery left in place becomes cloudy again and symptoms reappear. This complication is observed in 18% of patients within 1 year after surgery and in 38% within 9 years1. Secondary cataracts develop gradually and progressively with time, usually occurring between 3 months and 4 years following surgery1. Laser treatment, called capsulotomy, is the treatment of choice in the case of this complication.1
1 Affsaps, Haute Autorité de Santé. Mise au point sur les implants intraoculaires monofocaux utilisés dans le traitement chirurgical de la cataracte. Avril 2008. p. 14.
2 The Royal College of Ophthalmologists. Cataract surgery guidelines 2004. p. 6.
12 Ancel JM. Les progrès de la cataracte en 2008. E-mémoires de l’Académie Nationale de Chirurgie 2008;7:43-44.
13 Baudouin C, Félix D. Sur quels critères l’ophtalmologiste prend-il la décision de proposer une intervention ? Dans: Cataracte - Guide à l’usage des patients et de leur entourage. Bash 2008, p. 69-70.
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