High myopia is covered in health insurance
Cataract surgery - do you still need glasses?
Cataracts can be divided into different stages depending on the severity of the cloudiness:
- Stage I: incipient cataract, slight opacity of the lens, visual acuity 80-90%
- Stage II:immature cataract, clear clouding of the lens, visual acuity 45-50%
- Stage III:mature cataract, the lens is completely clouded, visual acuity 20%
- Stage IV:Overripe cataracts with complete blindness are very rare in the western world
Different forms of lens opacification
The lens opacity can take different forms. It can be located in the lens nucleus or in the anterior or posterior lens cortex (lens shell). The most common lens opacities are found in the lens nucleus and are responsible for most cataract operations.
Certain forms or typical positions of the lens opacity often reveal the cause (diseases, injuries, etc.) of the opacity. For example, long-term high-dose cortisone treatment causes opacity in the posterior lens cortex. In congenital cataracts, the opacity is mostly localized in the anterior part of the lens. A lens clouding caused by injury (e.g. after a blow to the eye) has a typical flower-like appearance (contusion rosette). Whether and to what extent vision is impaired depends on the degree and location of the lens opacity.
When is cataract surgery necessary?
In the past, you waited until the cataract was "ripe" before cataract surgery. Today other criteria that are more important for the patient are used.
The focus is onSuffering of the patient. There are people who already feel very uncomfortable with a visual acuity of 60%, others get along very well with it. A visual acuity of at least 60% is required for the driver's license. Older drivers often use this as an opportunity to opt for cataract surgery. A visual acuity of a maximum of 40% already severely restricts those affected in everyday life, for example due to insecurity when walking.
With existingComorbidities of the eye, such as age-related macular degeneration, glaucoma, or diabetic retinal disease, the operation does not improve visual acuity very much. Here it must be discussed with the patient whether the possible improvement through the cataract operation is worthwhile.
TheVisual acuity of the partner eye is also a decisive factor in the necessity of cataract surgery. Often the partner eye compensates for deficits in the diseased eye so well that the person affected hardly or not at all suffers from the cataract.A good help: Cover one eye to see what and how well you can see and then do the same with the other eye.
Further criteria are theGeneral condition of the patient as well as additional surgical risks related to the eye (e.g. concomitant diseases).
General data and facts about cataract surgery
There are around 50 million blind people worldwide. Cataracts are the cause in around 15 million. An operation could therefore help a good third of the blind. In the western world, cataract surgery is one of the most common surgical interventions; Around 60,000 cataract operations are performed in Switzerland every year. It is now considered a practically risk-free routine operation. The operation is usually performed on an outpatient basis and under local anesthesia. An inpatient stay is only necessary in rare cases.
The cataract surgery - yesterday
The cataract operation is one of the oldest operations of all and is still the only treatment option for a cloudy lens today.
A little history - the star stitch
The star stitch was the most common form of treatment for cataracts well into the 19th century. So-called "star stingers" pierced the eye with a special needle and pressed the clouded lens into the vitreous or into the inside of the eyeball. The cataract was only pushed out of the visual axis, but not removed. If the cataract was successful, most of the patients could see light and objects again. However, the success was usually not permanent. As a result of high complication rates (infections), many people later became completely blind.
So-called intracapsular cataract extraction was then used until around 1986/87: the entire lens, including the capsule, was removed from the eye through a larger corneal incision. The operated on remained lensless. The lack of a lens and the resulting missing 12 diopters for vision had to be replaced with special star glasses or contact lenses. But star glasses also have their disadvantages. Contact lenses were not tolerated by all patients and were often problematic to use, especially for older patients. In such patients, a so-called secondary artificial lens can still be retrofitted with a relatively uncomplicated procedure.
Modern cataract surgery
Today the cloudy lens is removed from the capsular bag and an artificial lens (intraocular lens) is inserted into the remaining capsular bag. Modern cataract surgery is now considered very safe. Serious complications with permanent functional damage are extremely rare. In 99% of the cases, the operation proceeds without any serious problems.
Preparing for the operation
Immediately before the operation, the eyes and lids are carefully disinfected and covered with sterile cloths so that only the eye to be operated on is exposed. The eye is held open during the operation with a light eyelid retractor. The vital functions (pulse, blood pressure, oxygen saturation in the blood) are monitored via a monitor during the short duration of the operation.
Cataract surgery in 4 steps
- 1st step: Local anesthesia of the eye with eye drops (called drop anesthesia). This makes the operation practically painless, but the eye remains mobile. To avoid uncontrolled eye movements, the patient must fix a point of light. In some cases, local anesthesia of the eye and the surrounding area with a syringe or even general anesthesia can be useful. This completely numbs the eye and makes it immobile.
- Step 2: Lens removal: The lens is removed with the so-called «phaco machine». Using the «Phakotip» - the actual surgical instrument for removing lenses - the clouded lens is crushed by ultrasound and suctioned off at the same time. This only requires a very small incision of just over 2 mm on the edge of the cornea. The tiny cut on the eye is self-sealing at the end of the operation, so there is usually no need to sew.
- 3rd step: The folded artificial lens is inserted into the remaining capsular bag via the same incision.
- 4th step: In the capsular bag, the artificial lens unfolds by itself and sits exactly in the same place as your own lens before. To protect against unintentional contact, the eye is protected with a bandage at the end of the operation.
Day one after the operation
The eye bandage is removed on the first day after the operation. The ophthalmologist checks the irritation of the eye and checks the position of the lens. For the further healing process, eye drops are required, which should be used according to the ophthalmologist's instructions.
After the operation - do you still need glasses?
The power (refractive power) of the artificial lens to be used must be calculated individually for each patient and for each eye. A previously existing ametropia - farsightedness, nearsightedness and astigmatism - can also be completely or partially compensated for. Because of presbyopia, reading glasses are usually still required after the operation for the very small writing.
Before the operation, the doctor measures the eye. Together with these values and with the help of a few questions to the patient, he can choose the right artificial lens. This includes questions such as: at what distance do you prefer to see well without glasses or whether you no longer want to wear glasses. Later, you can see clearly at all distances with slightly corrected additional glasses.
These questions can be as follows:
- Do you mind the glasses?
- Would a life without glasses or almost without glasses be a gain for you?
- Do you mind reading with glasses? There are patients who are used to reading with glasses and do not want any corrections for close up.
- Would you like to drive a car without glasses?
- What is your main activity, job?
- Do you often work on the computer?
- Would you like glasses with only one distance (near or far) after the operation
- Do you no longer want glasses?
Which lenses are available?
Today the doctor has three different lenses to choose from:
Spherical lenses: correction of nearsightedness or farsightedness
The spherical lenses are now standard lenses. They enable the correction of nearsightedness / farsightedness and thus enable sharp distant vision. The setting in the vicinity is also possible on request.
The decision whether you want to see more closely or in the distance must be made before the operation. Reading glasses against presbyopia will still be necessary. An additional curvature of the cornea (astigmatism) cannot be corrected with these standard lenses. Today, standard lenses are often also equipped with a UV filter (yellow filter) to protect the retina from the potentially harmful UV light.
Costs: The spherical lens is completely covered by the basic insurance.
Toric lenses: near or far function plus astigmatism
The toric lenses are used for additional corneal curvature from a height of 1 diopter. This enables sharp and undistorted vision; Reading glasses will still be necessary against presbyopia. These special lenses are also equipped with a UV filter.
Costs: Since this is a special lens, the costs (around CHF 1,000 per lens) are not covered by the basic insurance.
Multifocal lenses: correction of near and far vision plus presbyopia
These lenses correct both nearsightedness and farsightedness plus presbyopia. The patient thus achieves absolute freedom from glasses. However, some disadvantages have to be accepted for this.
If the curvature of the cornea is greater than 1 diopter, these special lenses are not suitable.
Disadvantage: At dusk and at night, these lenses cause glare sensitivity and scattered light; there are, for example, annoying halos around light sources. This can be very irritating, especially for drivers at night. The average visual acuity is also not optimal with these lenses: for example, the displays on the speedometer are not very sharp. Working on the computer can also be difficult.
Costs: A lens costs 1,800 francs and is not covered by basic insurance.
Alternative to multifocal lenses: monovision
With monovision, each eye is set separately to a different distance. Without glasses, one eye sees objects in the distance sharply and the other eye sees objects close by. As a rule, everyone has one dominant eye, which is then focused on the distance with monovision. The brain merges the two slightly different images so that one always sees a sufficiently sharp image both in the distance and in the vicinity.
Disadvantage: This restricts spatial vision somewhat. The smaller the difference between the two eyes, the better the spatial vision.
Summary: which lens is suitable for whom?
- Standard lenses: Reading glasses are still necessary
- Multifocal lenses: no additional glasses necessary. Warning: not suitable for night drivers (e.g. taxi drivers).
- Toric lenses: still requires reading glasses
- Monovision: This is where toric lenses are used
Before the operation, the visual impression after the operation can be imitated with the special contact lenses.
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