Cataract Surgery

'SURGERY', this word itself always frightens the daylights out of me!

But I was more afraid when I learnt that unattended cataract can lead to blindness. My vision was blurring progressively for about a year and it was being more of a nuisance and discomfort when watching movies or working on the computer. Thus, I went for a thorough eye check and was diagnosed as having posterior cataract on my right eye and a very slight cloudiness on my left eye. The options were to have a cataract surgery for the right eye and let the left eye be as is for the time being.

Anyway, after hearing the detailed explanation as to the simple surgical procedure involved, its benefits and easy after-care, etc. from the surgeon and his nurses and equipped with more knowledge sourced from the internet, I was reassured, calmed and prepared to go ahead with the cataract surgery for my right eye. It was set for Monday morning, the 5th of January, 2009.

The surgery was skillfully performed by Dr. Wong Yiing Cheong at his Specialist Eye Centre (WYCEC), located just opposite the Pantai Cheras Medical Centre, using the phaco (short for phacoemulsification) technology and implanted the Zeiss Optic aspheric intraocular lens (XLStabi-ZO) in my eye as desired.
(Patients have the option to choose one of the 3 kinds of intraocular lenses offered here, either an ordinary one from India, or Alcon lens from USA or Zeiss lens from Germany, costing RM2,150/=, RM2,500/= and RM2,700/= respectively, which include the lens, cataract surgery and 2 kinds of eyedrops but exclude charges for the pre-op and post-op checks.)

No stitches or large incision, no pain or long hours! Surgical procedure under topical eye-drop anaesthesia (needing no eye injections) was super-fast, lasting just about 20 minutes though the whole process which included the pre-preparation and post-waiting-adjustment took about 1 hour in all, still considered very short anyway! The best deal was, it was painless, fast and you get an almost clear vision right away after the operation at an affordable price.

Praise and thank The Lord that it was a success! He sure was with me throughout, during which I was conscious as I uplifted the whole surgical procedure into His healing hands. And, a big thank you to Dr. Wong and his team too!

The post-operative (or aftercare) instructions given by his nurse is as important to ensure a speedy recovery and a full success. So, sharing here some pointers for interested persons and a reminder too for myself for the eventual left eye surgery :

1. Follow frequency for instillation of eyedrops (was prescribed 2 kinds of eyedrops) as follows :
   i) Spersadex comp. (a steroid and antibiotic combination) - 1 drop hourly for 1st day, and 1 drop 3 hourly for subsequent days for 2 weeks; followed by 1 drop 3 times a day for another 2 weeks.
   ii) Zymar (gatifloxacin ophthalmic solution) 0.3% (an antibiotic) - 1 drop 3 hourly for 2 weeks.
   
   Here's how to apply eye drops:
   Wash your hands first. Do not let the dropper tip touch any surface to avoid contamination. Tilt your head back, gaze upward and pull down the lower eyelid to make a pouch. Place the dropper directly over your eye and instill the prescribed number of drops. Look downward and gently close your eye for 1-2 minutes. Place one finger at the corner of the eye near the nose and apply gentle pressure to prevent medication from draining away from the eye and into mouth, leaving a bitter taste. Try not to blink and do not rub the eye. Do not rinse the dropper. If you are using another eye drop, wait at least five minutes before applying the next.
2. Need for night application of 'Clear Eye Shield', for 2 weeks to prevent involuntary subsconscious rubbing of operated eye.
3. Cleanliness and hygiene is paramount, to prevent eye infection :
   i) Always wash hands before touching the operated eye to avoid germs. There is 1:1000 risk of getting eye infection with highest risk between day 3 to day 5 and symptoms are drop in visual acuity, swollen red eye and eye pain (excluding the first night), so seek immediate medical attention if infection occurs;
   ii) Wash face with either boiled water which has been cooled down or saline water, for 2 weeks;
   iii) Wash hair with head tilted backwards, saloon-style and be mindful that no soap or water get into operated eye.
4. Wear sunglasses for the first few days after surgery, especially in bright environment or outdoors;
5. Daily activities such as cooking, light exercises, bending forward, carrying light load, watching TV, working on computer are allowed, though a little caution and restraint will help. Know your limits and do not strain.
6. No restriction on food and oral medications. But, do abstain if you're allergic to certain food and medications.
7. To return to eye-clinic on the 3rd day after surgery for post-op check.
   

Some of my experiences after cataract surgery:

• attained about 80-90% clear vision immediately after surgery, and progressively improving each day. I can even read and work on the computer without needing glasses now. In fact the new right eye lens gives better vision than the natural one in my left eye which is already slightly cloudy;
• teary and watery eyes on first day of surgery, which disappeared on second day onwards. However, some wetness in the eye persist until now, probably because application of eye-drops is continuing;
• slight scratchy sensation when I blinked on 1st day, but gone the next day;
• the Zymar gatifloxacin eyedrops stings slightly upon instillation on 1st day, but not on subsequent days;
• there's a fine circle or halo around the eye, more on the outer area. I was informed by eye surgeon that this is due to some water 'injected' into the eye during surgery and told not to worry as circle would be gone within 3 weeks or earlier. (P/S: It did not. Refer to March 15 update below);
• colors are a little different, with a bluish tint. I understand that it's normal;
• rashes appeared on both of my legs on the 6th evening after surgery. Surgeon confirmed that it is not an allergic reaction to the eye drops as my operated eye is fine, neither swollen nor red; hence to continue with the prescribed eye medications. Anyway, I consulted a GP and was prescribed Calamine Lotion and Piriton tablets (antihistamine) and rashes disappeared by 4th day.

More related external links:
1) Cataract surgery factsheet by Bupa health care organisation
2) FAQs on Cataract surgery by St. Luke's Cataract & Laser Institute

In addition, I'd like to record here too what was printed on the Zeiss brochure regarding cataract and the Zeiss Optic aspheric intraocular lenses.

What is cataract?
It is the most common form of eye disorder. In a healthy eye, the crystalline lens is transparent, letting light rays pass through onto the retina to produce a sharp and clear image. A cataract is an opacification or clouding of the crystalline lens that impairs normal vision. Fewer light rays are able to pass through the eye, resulting in reduced vision. The sharpness and brightness of images is significantly diminished, very similar to looking through a very dirty window. Opacification of the crystalline lens is progressive, if not treated, cataracts can lead to blindness.

What are the causes?
Cataracts are not a form of eye disease. The most frequent cause of cataracts is aging of the eye. It is a natural occurrence in approximately 18 to 29% of individuals between the ages of 65 to 74, increasing to roughly 65% beyond 85 years of age. Cataracts are also caused by other factors such as drugs, eye impairments and perforations, diabetes, long-term exposure to ultraviolet light without adequate protection.

How are cataracts treated?
Today, the only efficient form of treatment is intraocular surgery, which consists of removing the opacified crystalline lens and replacing it with an artifical crystalline lens, a so-called intraocular lens.

What is an intraocular lens (IOL)?
An intraocular lens is a permanent prosthesis implanted in the eye. It is generally folded when inserted into the eye through a small incision to replace the crystalline lens. An intraocular lens is only a few millimeters in size.
There are different types of intraocular lenses, including spherical and aspheric IOLs. Both are designed to restore patient sight. Aspheric lenses, however, are the latest innovation on the market.

How is a cataract surgery performed?
Cataract surgery is a safe, pain-free and fast surgical procedure. In most cases, patients are able to go home within a few hours of the surgery. With the patient under local anaesthesia, the old crystalline lens is fragmented into small pieces with an ultrasound probe and aspirated through a small incision measuring only a few millimeters. The surgeon then inserts the transparent artificial crystalline lens in its place through the same incision. The small size of the incision generally does not even require suturing. Visual recovery is almost immediate and patients are able to return to their normal daily activities within 2 to 3 days.
There are many intraocular lenses on the market today. After a careful examination of your eye, your surgeon will decide which implant is best suited for you. You may also want to consult the physician whether an aspheric lens would be appropriate to help you enjoy better vision.

What are the advantages of aspheric intraocular lenses? .......
Why choose a Zeiss aspheric IOL (XL Stabi ZO or Invent ZO)? .....

......go to www.meditec.zeiss.com/zo for more information.

Update: March 15
6 weeks after cataract surgery, I still experience some discomfort - 1) wetness in the eye, though very nominal, it's as if something unusual is in the eye; 2) seeing a fine quarter-halo or circle lining the outer and lower area of my eye, as if seeing a little of its side and my cheek. Otherwise, vision is almost perfect. So, on February 26th I returned to Dr. Wong and after thorough checking, I was told that I may need yag laser surgery to correct that. What, so soon, I asked in shock and disbelief? He explained about potential space between lens and capsule, likened to secondary cataract or posterior capsule opacity and even went further to suggest that I was being too sensitive and detailed so as to imagine that presence of a quarter-circle (that was unacceptable...if I'm imagining, why suggest yag surgery then?)
Googling for answers today, I came across this article on Cataract Surgery Complications and it was an eye opener. If interested, read further on demystifying dysphotopsia at Review of Ophthalmology for added knowledge.

I'll probably go for a second opinion in two weeks time, when John and I will accompany his mother for her final post-op check after cataract surgery at Eye Specialist Clinic Kok & Kok. Praying that my eye problem will disappear before then as it will be almost 3 months after my cataract surgery and I understand that is the estimated time for a full recovery.

Update: April 26
A month ago, I did seek a second opinion from Dr. Kok Howe Sen of Eye Specialist Clinic Kok & Kok. After checking, he assured me that there was no need at all to do a YAG laser and the halo that I'm viewing is a very common occurence after cataract surgey that will probably disappear over time. That's fantastic news, no laser required! I'm still hoping the halo will be gone soon though...??
And, Dr. Kok remarked that the slight unusual wetness that I'm experiencing is due to eye dryness. Unfortunately, I was so joyful to know that no laser need to be done that I was unaware that he gave no solution to this other problem. Aargh...I will need to consult him again later as this condition still persists till today. I'm hoping that this too will itself disappear eventually.
Some information on dry eye syndrome at All About Vision.

Update: October 29, 2009
So joyful to observe that for about a month since, the wetness in my cataract-operated eye had disappeared totally. Praise and thank God! However, the half-circle on the outer side of eye (like seeing the right corner rim of one's spectacles) still exist though I'm learning to ignore it and will continue to pray for full recovery.

Last edited: 31 Oct. 2010