Cataract surgeon Melbourne
Everything you need to know about cataract and cataract surgery
Cataracts are common, and are caused by clouding of the natural lens in your eye. Cataract surgery replaces your cataract with a clear lens implant, thus restoring your vision so you can see clearly again.
Eye surgeon Melbourne
Dr Brian Ang in a nutshell
In United Kingdom, Switzerland, New Zealand and India
Cataract disease
What is a cataract?
The eye has a clear natural lens that focuses light onto the retina. Over time, the lens becomes cloudy and more opaque, resulting in less light being focused onto the retina. Having a cataract means having a cloudy and opaque lens in your eye.
"It is common, normal even, to eventually develop cataracts in your eyes. While not everyone with cataract requires surgery, the great majority of those that do undergo cataract surgery experience a significant improvement in their vision."
Modern cataract surgery will improve your vision by allowing more light to enter the eye and be more sharply focused onto the retina. Depending on the overall health of our eyes, surgery can even restore your vision so you don’t have to wear spectacles.
You’re not alone. Cataracts are very common and virtually everyone will develop cataracts as they grow older.
Over time, the cataracts worsen and start to interfere with your daily life activities such as driving, reading, working, and your hobbies. If left untreated, cataracts will eventually cause vision impairment and blindness.
Cataract symptoms
The main symptoms are:
- blurry vision
- glare
Many patients decide to have cataract surgery once they no longer feel safe when driving or when they are told that their vision no longer fulfils legal driving requirements.
When you have a cataract, a typical landscape will look like this. Move the slider to see how it will look after cataract surgery.
A cataract usually develops slowly, thus decreasing your vision gradually. However, there are certain situations where a cataract develops more rapidly, such as following eye surgery or ocular trauma.
Cataract causes
Cataract surgery Melbourne
The only way to treat cataracts is with cataract surgery
There is no other way to treat a cataract apart from cataract surgery. Essentially, the cloudy lens is removed and is replaced with a clear artificial lens implant or intraocular lens (IOL).
Did you know?
The first intraocular lens was implanted in 1949 by Sir Harold Ridley, an English ophthalmologist. During World War II, he treated Royal Air Force pilots with fragments of plastic and glass in their eyes from shattered aircraft cockpit canopies. He observed that these splinters did not trigger inflammation as long as there was no iris touch. This led him to investigate the use of artificial lens implants to replace the cataractous lens.
The current gold standard technique for cataract surgery is phacoemulsification.
"Your eye will be fully anaesthetised, so you will not feel any pain by the time I start making the first micro-incision in the eye. It is then common to hear a buzzing noise - this is the sound of the high-frequency ultrasound breaking up the cataract into smaller pieces for removal.
Finally, the artificial intraocular lens implant, which has been specifically customised to best suit your eye, will be carefully implanted. During the cataract surgery procedure, you may see bright, swirling colours but don’t worry, you won’t be able to see any sharp needles or instruments coming towards your eye!
Depending on the clinical circumstances, it may be appropriate to use a more traditional technique called ‘manual small incision cataract surgery’. This is where the cataract is removed in its entirety via a larger wound, instead of being broken up into smaller pieces first.
Once the cataract is removed, the artificial clear lens is implanted. Very occasionally, suturing of the incisions may be necessary.
Cataract surgeon Melbourne
"After the cloudy lens is replaced with a clear intraocular lens implant, more light is able to enter your eye. You will notice that colours are brighter and your vision becomes sharper. Depending on the overall health of your eye, your vision may even be restored to 20/20 without spectacles. The great majority of patients are delighted with the successful outcome of their cataract surgery. One of the more memorable comments that I have received was: ‘I can see colours so brightly and vividly now - I just wish my wrinkles weren't so clearly seen!’"
Cataract surgery is usually performed in day surgery under local anaesthesia.
Research
Dr Brian Ang has published scientific papers on both phacoemulsification and manual small incision cataract surgery.
Yes, but you will be sleepy due to sedating medication that the anaesthetist will give you.
Artificial lenses for cataract surgery
There are 4 main types of artificial lens implants that you can choose for your cataract surgery:
- Monofocal lens
- Multifocal lens
- Extended depth of focus lens
- Toric lens
Monofocal lens implants:
Monofocal lenses are designed to provide the best vision at one distance (focal point) only, usually for far distance vision. This means that you will need spectacles for both intermediate vision (computer work) and near vision (reading).
Image courtesy of Johnson & Johnson Pty Ltd
You might decide that you prefer not to wear glasses for your near vision activities, so near vision monofocal lenses can be implanted instead. This means that you will need spectacles for distance vision (driving) and intermediate vision (computer work).
You might also choose to have monovision, where the monofocal lens in the dominant eye corrects for distance vision, while the other eye is corrected for intermediate/near vision.
Multifocal (trifocal) lens implants:
Multifocal lenses are designed with additional focal points to correct your vision at multiple distances (distance, intermediate, and near). So you will have clear distance vision (for driving), good intermediate vision (for looking at your computer or car dashboard), and comfortable near vision (for reading). Thus multifocal lens implants provide the highest chance of achieving complete spectacle independence.
Image courtesy of Johnson & Johnson Pty Ltd
However, they are not suitable for everyone and may have visual quality problems, such as glare, haloes, and reduced contrast sensitivity. These problems are difficult to correct with spectacles and often require surgical replacement of the multifocal lens implant with another type of lens implant.
Extended depth of focus (EDoF) lens implants:
Extended depth of focus lenses are becoming increasingly popular because of the ability to achieve good distance and intermediate vision, but without the visual quality issues associated with multifocal lenses. This means that your vision will be good enough for most day to day activities, such as driving and working on the computer, without the need for spectacles. However, you will still need spectacles for reading and for fine close-up work.
Image courtesy of Johnson & Johnson Pty Ltd
Toric lens implants:
Toric lenses have an extra built-in correction for corneal astigmatism. You can think of it as having 2 different strengths in the one lens. Having a toric lens implant means that you will have sharper vision without requiring spectacle correction. These lenses may be suitable if you have astigmatism greater than 0.75D. Toric lenses are available in multifocal and extended depth of focus designs.
Cataract surgery specialist Melbourne
"It’s understandable that you may have a lot of questions about the lens implant options; we will discuss this during your consultation. It’s my job to guide you to the best solution based on your individual needs. Modern cataract surgery has a very high success rate of over 98%. You can rest assured that I will perform my utmost to achieve the best possible outcomes for you."
Cataract surgery recovery
After surgery
There will be a pad and shield placed over your eye, which you can remove a few hours after surgery or the next day.
When you remove your pad:
- your vision will be blurry
- your eye will feel uncomfortable
- you may notice some double vision
This is a normal part of recovery. You will find that the vision will gradually improve on a daily basis. It can take up to 3 to 4 weeks for the eye to fully heal.
In general, there will be a first postoperative review within 1 week, and then another postoperative review 3 to 4 weeks later.
You will have two different eye drops to use after surgery 4 times daily. The antibiotic can be stopped after 1 week, but the steroid drop needs to be continued until you are instructed to stop. If you use eye drops for other eye conditions, you can continue using them unless you have been informed otherwise. Your individual needs will be discussed with you during your consultation.
Driving, exercising, taking a shower, working?
- Drive: when you feel comfortable and safe to drive, usually after 1 week
- Exercise: gentle exercise after 1 week; more vigorous exercise after 1 month
- Take a shower: the next day
- Go back to work: depends on the nature of the work, but usually after 1 week
Yes, cataract surgery is very safe. It has a success rate of around 98%. The risks include:
- The need for a second surgery or procedure to fix any unforeseen issues encountered during the initial cataract surgery
- Unexpected refractive outcome (such as becoming short-sighted despite choosing a lens implant for distance vision)
- The need to wear glasses after surgery
- Prolonged recovery period requiring more drops than usual
- General risks such as bleeding and infection
- The risk of a catastrophic complication causing blindness (such as severe infection) is less than 1 in 1,000 (<0.1%).
You will not need to have cataract surgery again. However, in some people after cataract surgery, scar tissue can grow behind the artificial lens implant. As a result, less light enters the eye, thus mimicking the effect of cataracts.
This is called posterior capsular opacification and occurs fairly commonly. The good news is that posterior capsular opacification is easily treated with a painless 2-minute laser procedure called laser capsulotomy. Laser capsulotomy is performed as an outpatient procedure in the consulting rooms.
Yes. It is now common to combine cataract surgery with a MIGS (minimally invasive glaucoma surgery) procedure. The two commonest MIGS devices in Australia are the iStent and the Hydrus microstent. These tiny stents are implanted to help reduce eye pressure by draining aqueous fluid out of the eye. There is no change to the way cataract surgery is performed. The stent is implanted after the artificial lens implant has been inserted. This adds an extra 5 to 10 minutes to the overall cataract surgery time without any significant added risk. The stents are MRI-safe.
There is no specific time frame when it comes to wearing sunglasses. You can wear sunglasses for as long as you feel comfortable wearing them.
Cataract surgery costs
How much does cataract surgery cost?
The cost of cataract surgery depends on your health fund. There will be an out-of-pocket fee for the initial consultation, as well as for any other tests that may be required during the consultation (such as an A-scan and OCT-scan).
In general, there will be a gap fee for the surgery and also for the anaesthetist. There may also be an initial excess fee charged by the health fund. Please confirm with your health fund that you are covered for cataract surgery – the Medicare item number for cataract surgery is 42702.
The cost of cataract surgery for uninsured patients depends on a few things, including the selection of the artificial lens implant, choice of operating facility, and the complexity of the surgery. The surgical bookings manager will be able to discuss costs in greater detail once you have had your comprehensive eye examination.
Benefits of private cataract surgery
The main benefit of having cataract surgery privately is that you know who your surgeon is, and that your surgeon knows you and your individual case and preferences.
You also have more choices as a private cataract surgery patient:
- You can choose when you have surgery
- You can choose the type of artificial lens implant to use
With public hospitals, surgery is free but you cannot choose your surgeon or lens implant, and the waiting time can be long. Most public hospital wait times are at least 1 year at a minimum, with some exceeding 2 years. In contrast, private cataract surgery can be scheduled as early as 3 to 4 weeks.
