During the surgery, an opening is made into the eye so that the nucleus and cortex can be removed. The capsule of the lens is retained so as to provide support for the artificial lens implant, after which the incision wound is closed with very fine sutures.

Removing the Cataract

The eye specialist may use one of two methods of removing the cataract. One method involves a longer surgical incision than the other. The benefit of having a smaller incision is a shorter recovery period, although this method is more expensive. The two methods are:

Extracapsular cataract extraction

In this method, the surgical incision or cut, about 10mm long is made on the white of the eye above the iris. The cataract is removed in one piece through this surgical opening. The anterior lens capsule is also removed in the process but the posterior lens capsule is left in place.

Phacoemulsification

A smaller surgical opening about 4 to 5 mm long is made on the eye. A small, narrow probe with an ultrasonic tip is inserted into the lens. The ultrasonic waves emitted from this probe break the cataract up into tiny pieces. The anterior lens capsule is also removed in the process. These tiny pieces are then removed using a small suction device.

Implanting the Artificial Lens

Actual size of artificial lens

After the cataract has been removed, by either of the above methods, the eye specialist will then insert the artificial lens implant into the eye. The new lens will remain in the eye permanently. The lens implant is inserted in the space between the iris and the posterior lens capsule. It is held in position by special loops that are part of the design of the lens implant.

In some rarer cases, the lens implant may have to be positioned in front of the iris as the posterior lens capsule is damaged or not present.

After the Surgery

The operation will be over in about half an hour. However, you will be asked to remain in the day ward for a few hours. This is to make sure that you have fully recovered from any after-effects of the pain killers or sedatives. An eye patch and an eye shield will be placed over the operated eye to protect it. We suggest that you do not drive immediately after the surgery and if possible, arrange to have someone accompany you home. You will be required to come back to the clinic the next day to have the dressing removed.

• You may have some discomfort in your eye because of the sutures, but you must avoid rubbing your eye. Wear the eye shield at night for two to three weeks after the operation.
• Avoid strenuous physical activity e.g. jogging, swimming, tai-chi. Light household tasks, short walks, climbing a short flight of stairs are alright, but do be careful.
• Avoid bending, lifting or carrying heavy objects. When picking anything up from the floor, do so by keeping your back straight.
• Avoid bending your head downwards to avoid exerting pressure on the eye.
• Avoid bending down to put on your shoes. Sit on a stool and lift up your feet to put on shoes or have someone put them on for you.
• Avoid close contact with or carrying children as they may unwittingly poke at your eye.
• Avoid getting soap, shampoo and water into your eyes when washing your face and hair for the first few weeks. You may choose to have your hair washed in a hair salon. Alternatively, you can purchase a shampoo basin* to wash your hair with your head tilted slightly backwards as in a hair salon.
• Avoid driving for at least 6 weeks after your operation.
• You may resume your normal diet. Eat more vegetables and fibre-rich foods to prevent constipation and straining to move the bowels.
• Take all prescribed medicines and apply eye drops as instructed.

* Inflatable Shampoo Basin can be purchased from The HomeCare Place at Changi General Hospital, Unit #01-07 at $27.90 .

1. Wash your hands with soap and water
2. Tilt your head back
3. Pull the lower eye lid downwards
4. Squeeze one drop from the bottle into the eye. Take additional care not to let the tip of the eye drop bottle touch the eye
5. Close the eye for a few seconds
6. If a second type of eye drop is required, wait for five minutes before applying the second drop
7. Do not touch the tip of the eye drop bottle with your fingers

• increasing pain and redness of the eye
• discharge from the eye
• sudden blurring of vision
• or swelling of the eye

If you notice any of these signs you should see your eye doctor immediately. After the surgery, when the eye has completely healed, special glasses may be prescribed if necessary.

The first lens implant was carried out forty years ago and the patient is doing well.

2. Can everyone have the lens implant?

Implants are safe and can be implanted in almost everyone. Your eye specialist will advise you if the implant is not suitable for you.

3. Will the cataract grow back?

The lens implant will not get cloudy over time. However the posterior lens capsule, which remains intact in the eye, may become cloudy with time. You will notice this happening if your vision was first clear after the operation but has become blurred again with time.

]The clouding of the lens capsule can be treated using laser treatment which is carried out painlessly by the doctor at the eye clinic.

4. What can go wrong with the surgery?

Cataract surgery is a simple and safe operation for most people. However, as in all surgery, there is a small chance that problems may arise. The two main kinds of problems are:

• Allergy to the medications used for pain relief
  Some people may be allergic or develop side effects from these medications such as nausea and vomiting, difficulty in breathing, rashes, swelling of the face and lips and possibly fits.
• Surgical complications
  here is always a possibility of infection with any operation. If a severe infection develops, the eye may become blind. Other problems that may occur and cause poor vision are, bleeding and damage to the cornea or retina. These may require further operations.

5. Who is not suited For cataract surgery?

Age itself is not a problem. Cataract operations have been performed on infants and people in their 90's as long as they do not have other illnesses such as severe heart disease, poorly controlled high blood pressure or diabetes. You may be asked to see your own doctor for control of these problems before the surgery.

6. Can I Eat Prawns, Crabs and Other Seafood After the Operation?

There is no food restriction after the operation unless you are already allergic to seafood.

7. How Soon Can I Return to Work?

You would normally be given 1 month of medical leave. This is to ensure that the wound has healed sufficiently before you resume your normal work routine.

8. Do the sutures have to be removed?

The sutures can be left in the eye in most cases. They only need to be removed if:

• they become loose or break
• infection sets in the tissue around it
• they are too tight

Illustrations : Dr Choy Mei Yee