Cataract surgery

1. Every year, 140,000 people in the Netherlands undergo cataract surgery. When is it necessary to have such an operation performed? And do you need glasses afterwards? Ophthalmologist Bart Zijlmans of the Rotterdam Eye Hospital answers.

1. What is cataracts?

1. Directly behind the pupil is a transparent lens. To be able to see properly, it must be clear. With aging, the lens becomes stiffer and harder. The proteins that make up the lens clump together, resulting in cloudiness and reduced incidence of light. That's called cataracts or cataracts. In the vast majority of cases, old age is the cause. Sometimes, however, cataracts can also be congenital or the result of damage to the eye or a disease, such as diabetes. Certain medications, such as prednisone, can increase the risk of cataracts.

2. What will I notice?

1. That depends on where in the lens of the eye the cloudiness develops and how large it is. If only the edges of the eye lens are affected, you will not notice it. If the cloudy spot is in the middle, complaints will arise. For example, you will see double or blurred vision, especially in the distance. Colors can appear duller and duller. People with cataracts often become very sensitive to backlighting; that works dazzling or causes glare in the eye. In the house they therefore sit with their backs to the window, outside they avoid bright sunlight. If you suddenly need much stronger spectacle lenses in a short time, this can also indicate cataracts. The condition is not painful.

2. That depends on where in the eye lens the cloudiness develops and how large it is. If only the edges of the eye lens are affected, you will not notice it. If the cloudy spot is in the middle, complaints will arise. For example, you will see double or blurred vision, especially in the distance. Colors can appear duller and duller. People with cataracts often become very sensitive to backlighting; that works dazzling or causes glare in the eye. In the house they therefore sit with their backs to the window, outside they avoid bright sunlight. If you suddenly need much stronger spectacle lenses in a short time, this can also indicate cataracts. The condition is not painful.

3. How many people suffer from it?

1. Cataracts are by far the most common visual disturbance. In 2003, an estimated 120,900 men and 222,800 women in the Netherlands were affected. That number is increasing rapidly due to the aging population. Every year, around 140,000 patients are operated on for the condition in the Netherlands. 70 percent of people who are treated with cataracts are over 70 years old.

2. Cataracts are by far the most common visual disturbance. In 2003 an estimated 120,900 men and 222,800 women in the Netherlands were affected. This number is increasing rapidly due to the aging population. Every year around 140,000 patients are operated on for the condition in the Netherlands. 70 percent of people who are treated with cataracts are over 70 years old.

4. Can we predict who will be affected?

1. Anyone can suffer from it, because cataracts are a result of the natural aging process. The older, the greater the chance of complaints. Cataracts are more common in women than in men.

5. How does the condition develop?

1. That is very slow. Most people don't notice it at first. Only when a larger part of the lens of the eye is affected does vision deteriorate and problems arise. Usually the cataracts are in both eyes, but usually one eye is more affected than the other. Why is not known.

6. How is the diagnosis made?

1. An optician can recognize cataracts but cannot treat them. The ophthalmologist can. To make the diagnosis, he performs several (painless) examinations. It measures how sharp you see near and in the distance. With a so-called slit lamp, he checks whether the eye lens is clouded. Finally, he performs an ocular mirror examination to assess the quality of the retina.

2. An optician can recognize cataracts, but cannot treat them. The ophthalmologist can. To make the diagnosis, he performs several (painless) examinations. It measures how sharp you see near and in the distance. With a so-called slit lamp, he checks whether the eye lens is clouded. Finally, he performs an eye mirror exam to assess the quality of the retina.

7. Can I still drive with cataracts?

1. Cataracts can make the headlights of oncoming traffic dazzling. This is especially difficult in the dark. If vision is affected to such an extent that it no longer falls within the standards of the Central Bureau for Driving (CBR), you are no longer allowed to drive a car. This can only be examined with a so-called vision test and a visual field examination. If you suffer from cataracts, it is wise to have this test performed by the ophthalmologist just before the expiration date of the driver's license.

2. Cataracts can make the headlights of oncoming traffic dazzling. This is especially difficult in the dark. If your eyesight has been affected to such an extent that it no longer falls within the standards of the Central Bureau for Driving (CBR), you are no longer allowed to drive a car. This can only be examined with a so-called vision test and a visual field examination. If you suffer from cataracts, it is wise to have this test performed by the ophthalmologist just before the expiration date of the driver's license.

8. Is there anything I can do to prevent cataracts?

1. You cannot prevent it, but you can reduce the chance of it a little by not smoking, not drinking too much, eating healthy and especially wearing sunglasses. Long-term exposure to bright sunlight can accelerate the development of cataracts.

2. You cannot prevent it, but you can reduce the chance of it a little by not smoking, not drinking too much, eating healthy and especially wearing sunglasses. Prolonged exposure to bright sunlight can accelerate the development of cataracts.

9. What can I do to slow down development?

1. No more than stated above. In the early stages of cataracts, you can improve visual acuity by wearing (stronger) glasses and using extra lighting. But such measures only work temporarily. It has been said that certain dietary supplements that are high in antioxidants would help, but there is so far insufficient scientific evidence for that.

2. No more than stated above. In the early stages of cataracts, you can improve visual acuity by wearing (stronger) glasses and using extra lighting. But such measures only work temporarily. It has been said that certain dietary supplements that are high in antioxidants would help, but there is so far insufficient scientific evidence for this.

10. Can cataracts be cured?

1. There are no medicines for cataracts. The only solution is surgery to replace the affected cloudy lens with a clear artificial lens. Incidentally, such an operation has nothing to do with a laser treatment, which is sometimes used to help people get rid of their glasses or contact lenses.

11. When is it necessary to have cataract surgery?

1. If the complaints become so annoying that you are bothered by them during your daily activities. It differs from person to person when that point is reached. Operating earlier does not lead to better results. Waiting does increase the chance of complications slightly because the lens of the eye becomes harder.

12. Can both eyes be operated on at the same time?

1. No. There is a minimum of four weeks between the operation of the first and second eye. That time is needed for the first eye to fully recover. Only then can the ophthalmologist assess the final result and determine how strong the lens in the second eye should be.

13. What if I don't do anything about it?

1. Untreated cataracts can eventually lead to blindness. Worldwide there are about 17.5 million blind people due to cataracts. That is almost half of the total number of blind people. Fortunately, blindness due to cataracts is almost never again in the Netherlands.

14. How does cataract surgery work?

1. Before the operation it is calculated how strong the artificial lens must be to get the best possible result. Unless you prefer a general anesthetic yourself, the procedure will be performed under local anesthesia. The doctor makes a small cut in the eye. With special equipment, he pulverizes the cloudy lens and vacuums it away. Then he places the artificial lens in the eye through the same cut. The wound is so small that it almost never needs to be stitched. In total, the operation takes 20 to 30 minutes.

15. What are the developments in that field?

1. With the help of new devices, the surgical technique has been continuously improved in recent years. Nowadays an ophthalmologist only has to make a very small incision - varying from 2.2 to 2.8 millimeters - in the eye. This reduces the risk of complications and speeds up recovery. The artificial lenses themselves are also getting better. For example, it is already possible to use a multifocal artificial lens - for far and near sharp vision -. A toric artificial lens can correct the vision of people whose cornea is not nicely round, also called a cylindrical deviation or astigmatism.

16. Will I be off my glasses after surgery?

1. That is the aim. An artificial lens - unlike your own eye lens - is incapable of adapting to distance. That is why some people who can see clearly in the distance after cataract surgery still need reading glasses. The other way around also occurs. Patients who opt for multifocal artificial lenses are 'glasses-free' after surgery in about 85 percent of the cases (no figures are available for toric lenses). Regardless, in almost all cases (97 percent) cataract surgery provides a significant improvement in vision. How much depends, among other things, on how far the cataract was developed before the operation and whether you have other eye conditions. In less than 1 percent of patients, vision deteriorates permanently. This is usually the result of a complication after surgery or another eye condition. [! 191819 => 1130 = 17!] 17. Do I have to be hospitalized for the operation?

1. That is not necessary. In total, the hospital stay will take approximately two hours. After the operation, the treated eye will be taped. Because you cannot estimate depth and distances as well with one eye, you are not allowed to drive yourself.

18. What complications can arise?

1. Cataract surgery is a very safe operation with little chance of complications. If they do occur, they are generally easy to fix and usually do not cause lasting problems. Examples of possible complications during or after surgery are: a break in the lens capsule (1 to 2 in 100 cases), fluid under the retina (1 in 100 cases), an infection in the eye (1 in 1000 cases), a bleeding during surgery (1 in 2000 cases) or retinal detachment (1 in 3000 cases). In 10 to 20 percent of the patients, a few months or even years after the operation, opacities in the eye develop again. That is called afterwards. After surgery, a painless laser treatment can be used to remedy this. An unknown number of patients see a black band or sickle on the edge of the visual field after the operation (negative dysphotopsia). This â € “harmless â €“ effect cannot be treated unfortunately. It usually disappears over time as the brain adjusts to the new image.

19. What should I pay attention to after the operation?

1. The ophthalmologist prescribes eye drops and / or ointment, which you should use for three weeks to reduce the risk of infection. The wound in the eye needs time to heal. That is why it is advised not to do heavy work or exercise for a week. Walking, climbing stairs and showering are no problem. Unless the ophthalmologist prescribes otherwise, you can go back to work immediately. During the first two weeks you wear your own glasses or sunglasses during the day and a protective eye cup at night. After the operation, the doctor will advise you when you can drive again.

20. How long will it take before my vision is completely clear again after the operation?

1. In some patients it is already after a few hours, in others it takes a few days. If vision remains blurred after a few days, contact an ophthalmologist.

21. What is a so-called â € staarstraatâ € ™?

1. In a â € ˜staarstraatâ € ™ a hospital or eye clinic tries to organize all necessary consultations and examinations in one day in a row. In concrete terms, it means that if the ophthalmologist recommends cataract surgery, the necessary follow-up steps - from preliminary examination and blood tests to a meeting with the anesthetist and planning the operation - are immediately arranged. The big advantage of this way of working is that you don't have to go to the hospital (back) several times.

22. What about the waiting lists for cataract surgery?

1. They vary widely. According to the websites www.kiesbeter.nl and www.independer.nl, the waiting time for cataract surgery varies between one and twenty weeks. If you think the waiting time is too long, you can find another hospital yourself. You can also have the healthcare mediation department of the health insurer do that for you.

23. Besides hospitals, there are more and more specialized private clinics that perform cataract operations. How do I know where to go?

1. At www.kiesbeter.nl and www.independer.nl you will find a quality assessment of hospitals and clinics that perform cataract surgery. This shows that the vast majority scores average or good. Cataracts in private clinics are generally reimbursed by health insurance companies.