Cataract Surgery

What is cataract?

Cataract is a disease in which the originally transparent crystalline lens becomes cloudy in grayish white or brown.
The lens acts as a camera lens and has the function of refracting light coming in from the outside to focus on the retina, which is a very important tissue for seeing things.
The lens is made up of water and protein, which gradually denatures and becomes cloudy due to oxidative stress such as aging and long-term exposure to ultraviolet rays.

Causes of cataracts

Cataracts are congenital, associated with systemic diseases such as diabetes and atopy, associated with uveitis, side effects of drugs such as steroids, and those that occur after eye surgery such as retinal detachment and fundus hemorrhage. There are various things such as those caused by trauma, but the majority are caused by aging.
Age-related cataracts increase in risk with age from the late 40s, with 40-50% in the 50s, 70-80% in the 60s, and 80-90% in the 70s, this is a disease that most people will get.

Classification by opaque part of the lens

Anterior subcapsular cataract: A type in which turbidity appears under the anterior capsule of the crystalline lens
Cortical cataract: A type in which turbidity appears in the cortex closer to the center than the lens sac
Nuclear cataract: A type in which the nucleus in the central part of the crystalline lens becomes cloudy
Posterior subcapsular cataract: A type in which turbidity appears in front of the posterior capsule of the crystalline lens

Anterior subcapsular cataract

cortical cataract

nuclear cataract

subcapsular (posterior subcapsular) cataract

Cataract symptoms

Symptoms of cataracts are typically hazy, blurry and double-looking, and poor eyesight, but there are also symptoms that are easy to get tired, dazzling in bright places, and bleeding at night.
As cataracts progress, not only do they become hazy and their eyesight deteriorates, but they also develop myopia and become difficult to see even when wearing glasses or contact lenses.
Cataracts usually progress slowly, so it often has few subjective symptoms and is unaware in the early stages, or even if one eye has cataracts and his eyesight is impaired, he is often unaware that the other eye is visible.
Whether or not you have cataracts cannot be determined from the subjective symptoms of the person, so it is often found only after seeing an ophthalmologist due to poor eyesight at a medical examination.

Double vision

dazzling

halo

Prevention and treatment of cataracts

1. Prevention of cataract

Cataracts are caused by oxidative stress degeneration of crystalline lens proteins, so when you go out, use sunglasses, a wide-brimmed hat, a sunshade, etc. to prevent ultraviolet rays from entering your eyes, take care of eye strain, rest your eyes. Preventing lifestyle-related diseases such as diabetes and diabetes, actively ingesting vegetables and fruits containing vitamin E, B2 and C, eating a balanced diet, and quitting smoking to prevent oxidative stress and delay the occurrence of cataracts.

2. Eye drop treatment for cataract

In the early stages of cataract, medication may be given with eye drops (Cataline®, Curry Uni®, Tathione®, etc.).
These eye drops are said to have the effect of slowing the progression of cataracts by inhibiting protein denaturation of the crystalline lens, but it is currently no cure for cataracts.
In other words, the turbidity of the crystalline lens does not return to its original state, so when cataracts occur, surgery is performed to replace the turbid crystalline lens with an intraocular lens, which is an artificial crystalline lens.

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（＊）Copyright: Santen Pharmaceutical Co., Ltd.

3. Types and characteristics of intraocular lenses used for cataract surgery

1. Mono-focal intraocular lens and multifocal intraocular lens

Intraocular lenses used during cataract surgery include mono-focal intraocular lenses and multifocal intraocular lenses. The only lens that can be used in normal medical insurance is a mono-focal intraocular lens, and if you adjust the distance so that you can see it with the naked eye after surgery, you will need reading glasses for the near side, and conversely, if you adjust it so that the near side can be seen with the naked eye. Myopia glasses are required in the distance.

Intraocular lens selection
(mono focal / multi focal)

3. Non-insurance multifocal intraocular lens

Non-insurance cataract surgery is expensive, but it can be done with state-of-the-art laser cataract surgery, which uses a laser without a scalpel, and all types of intraocular lenses are also state-of-the-art.
Non-insurance cataract surgery can treat not only myopia, hyperopia, and astigmatism but also presbyopia.
In addition, some lenses are completely made-to-order, and the power of the lens is highly accurate according to each eye (as opposed to normal intraocular lenses, which are corrected in 0.50D units like eyeglasses and contact lenses. It is possible to create and use a lens with 50 times higher accuracy (correction in 0.01D units is possible).

Intensity

With five focal points, a smooth and continuous view can be obtained from far to near.

FINE VISION

The focus is far, medium, and near.
Most proven in multifocal intraocular lenses. (compared to our hospital)
Nighttime halo and glare can be reduced.

LENTIS Mplus X

You can see far and near with a bifocal lens.
It can correct the strongest myopia and can be made to order even for myopia and astigmatism.
Good eyesight is obtained even with mild glaucoma and macular disease.

What is laser cataract surgery?

In conventional cataract surgery, the surgeon manually performs the entire process of creating a wound, incising the anterior capsule (transparent shell) of the crystalline lens, dividing the nucleus of the crystalline lens, ultrasonically emulsifying and aspirating the crystalline lens, and inserting an intraocular lens.
Therefore, the operation time varies from a few minutes to 20 minutes depending on the skill of the surgeon, and the postoperative results also differ depending on the surgical invasion.
On the other hand, laser cataract surgery performs from the first wound incision to the anterior capsule incision of the crystalline lens and nuclear division with a laser, which makes it possible to perform surgery that is as beautiful as or better than a surgeon who excels in cataract surgery.
And above all, it is a laser surgery that does not use a scalpel, so there is an advantage that patients can undergo surgery with peace of mind.
As will be described in detail in the section on benefits, laser cataract surgery has the advantage of maximizing the effects of multifocal intraocular lenses.

Laser cataract surgery process

STEP 1 Anesthetic

Only ophthalmic anesthetics (eye drops) are used to induce anesthesia.

STEP 2 Initial incision made

Scan the eye three-dimensionally and create a wound (2.2mm-2.6mm) with very high accuracy

STEP 3 Incision made in the crystalline structure shell (anterior capsulotomy)

Using the laser, a highly accurate incision is made based on image analysis. The method yields greater accuracy than yield with a trained ophthalmologist using a scalpel.

STEP 4 Hardened core of the crystalline lens is crushed (Nuclear division)

A laser is used to finely crush the nucleus of the lens that become cloudy and brittle

STEP 5 Cortex suction

The crushed lens nucleus and the tissue of the surrounding area are suctioned off.

STEP 6 Prosthetic lens is inserted in the eye

The multifocal intraocular lens is inserted into the clear shell that remains.

*Intraocular lens
adopted in our hospital

・Multifocal intraocular lens:
　　Trifocal lens: Fine vision (PhysIOL)
　　Bifocal lens: LENTIS Mplus X (Oculentis)
・Multifocal lens for astigmatism correction:
　　Trifocal lens: Fine vision Toric (PhysIOL)
　　Two focus lenses: LENTIS Mplus X Toric (Oculentis)

It is possible to correct not only myopia, hyperopia and astigmatism but also presbyopia.
In our hospital, we select the lens most suitable for the patients request and condition.

Flow to laser cataract surgery

① First visit reservation using the online booking form

Please select your desired date and time.

② Receive an email confirmation of first appointment reservation

③ Initial indication examination with limited wearing of contact lens

Do not wear soft contact lenses for 2 days before your examination, and stop wearing hard-or continuous wear contact lenses for 2 weeks before your examination.
If you have follow the wearing contact lenses limitation, please contact us.
If you are receiving treatment at another department, please bring your doctor's medical information provision form.
In order to check if you are eligible for surgery, we will examine your eyes and also check for eye diseases. You will not be able to drive a car after the eye examination (the pupil is dilated with eye drops and then examined).
Since mydriasis (dilating the eyes with eye drops for inspection) and fundus examination is performed, you cannot drive a car for 3 to 4 hours after the examination.
Please note that it will be difficult to see nearby.
After the indication test, you will be examined by an ophthalmologist certified by the Japanese Ophthalmological Society, and we will show you the current eye condition, details of laser cataract surgery, and recommended multifocal intraocular lenses for that person.
You may ask questions or concerns you may have to us and our Ophthalmologists who are certified by the Japanese Ophthalmologist Society or one-on-one counseling.

⑤ On the day of surgery for one eye

Contact lenses can be worn until the day before surgery, but please visit us wearing glasses on the surgery day.
You can go home alone after the surgery, but please be careful as you will be wearing an eyepatch on the day of the surgery.
If you are worried about returning home alone, we recommend that you bring your family with you.
I don't have any pain because I have an eyepatch, but I feel awkward and heavy, so go home early and rest your eyes.

⑥ Examination of the next day after surgery and surgery for another eye

We will remove the eyepatch after your visit, it looks a little blurry but pretty clear.
After the eye surgery that was performed yesterday, you will have another eye surgery, and you will be asked to wear an eyepatch and return home as you did the day before.
Eye drops are very important from the day after surgery, so use them firmly.

⑦ Postoperative examination

After your visit, the eyepatch will be removed and both eyes will be examined.
Start instilling protective sunglasses as soon as you wake up from this day.