Cataract and Lens Replacement Surgery

The natural lens is composed of the lens nucleus and the lens cortex. It is located within the lens capsule, which is suspended by the zonular fibers from the ciliary body.

When the lens is clear, light passes unobstructed to the back of the eye, where it is converted into a neurological signal and transmitted to the brain.

Congenital and Juvenile Cataracts

In rare cases, lens clouding is present from birth (known as congenital cataract) or develops in the first years of life (known as juvenile cataract). To ensure normal visual development, a cataract operation should be performed as soon as possible in the case of significant lens clouding.

The Lens Over a Lifetime

Throughout life, new layers constantly accumulate on the lens. As a result, the softer lens cortex becomes thinner while the harder lens nucleus becomes larger and denser.

Reduced Near Vision
By middle age, the increased rigidity of the lens becomes noticeable. Many people find that they have difficulty reading up close or working on the computer and begin to use reading glasses.

Glare
The increasing cloudiness of the lens leads to greater scattering of incoming light. This can be particularly bothersome when driving at night, as the widened pupils allow more light from oncoming cars to enter the eye.

Loss of Contrast
People with lens clouding gradually perceive contrasts less clearly and colors more faintly. Since the development of cataracts is a slow process for most people, they often notice these changes only when specifically asked.

Reduced Visual Acuity
If cataracts remain untreated (e.g., in developing countries), there is a decline in visual acuity, which can eventually lead to complete blindness.

Cataract Surgery

Cataract surgery is, in most cases, an outpatient procedure that only takes a few minutes.

After arriving at the outpatient surgery center, your eye will be prepared for the procedure with eye drops. The first drops dilate the pupil to allow easy access to the lens behind it. The second drops numb the surface of the eye, ensuring the procedure is painless.

Once the preparations are complete, you will be taken to the operating room, where your surgeon will be waiting for you. The eye and surrounding skin will be disinfected, and a sterile drape will be placed over your face. A small nasal cannula will provide you with additional oxygen so you can breathe comfortably under the drape.

Next, the operating microscope is positioned over your eye. The bright light from the microscope may be glaring at first. The surgery then begins, and in several steps, the natural lens is removed. During this part of the procedure, you will hear various sounds and the computerized voice of the surgical devices. At the end of the surgery, the new artificial lens is implanted into your eye.

After the surgery, it is important not to touch or rub your eye.

At the reception, in the pre-operative area, and immediately before the surgery, you will be asked your name and date of birth several times. This is part of the safety protocol.

Intraocular Lens Implants

There are a variety of different implants available with various optical properties (e.g., aspheric, EDOF, multifocal, toric).

Discuss with your eye surgeon which implant and strength (target refraction) are ideal for your needs.

To prepare, consider the following questions:

• How did I see in my youth? Did I need glasses and, if so, in what situations?
• In which situations do I want to be as glasses-free as possible (e.g., driving or reading)?
• What potential disadvantages am I willing to accept (e.g., certain visual aberrations or contrast loss, but more freedom from glasses)?

Laser-Assisted Surgery

Phacoemulsification is an established method that has been used for many years. In this procedure, the lens nucleus is broken up and removed using ultrasonic waves. With increasingly smaller incisions and innovations in ultrasound tips, the technology has been continuously improved.

In addition to the ultrasound method, there are various laser-assisted methods for fragmenting the lens nucleus, such as femtosecond laser-assisted cataract surgery (FLACS) or nanolaser cataract surgery.

Laser-assisted cataract surgery involves greater technical complexity and significantly higher costs, which must be borne by the patients themselves. In recent years, large studies have shown that such procedures, at least for FLACS, do not lead to better surgical outcomes and do not further reduce the already very low risks associated with cataract surgery.

Clear Lens Extraction (CLE)

CLE is an early surgery on a still clear lens, before cataract has developed. The surgery is an alternative to other refractive procedures – those that alter the eye’s refractive power to correct vision errors (e.g., laser eye surgery for freedom from glasses) – and is primarily considered for patients who are no longer young enough for other refractive procedures. By using the appropriate lens implant, a refractive error can be corrected. When combined with the use of special lenses (e.g., EDOF, multifocal), significant freedom from glasses can be achieved. CLE is not covered by health insurance.