Cataract

Cataract is the clouding of the natural lens of the eye which results in unclear vision.

The most common cause is that as you get older, the lenses of your eyes gradually become less transparent, which is a natural consequence of ageing. The first symptoms of cataracts are vision problems at dusk, such as blur, haze and glare, and the need for more light to read. If left untreated, cataracts become increasingly cloudy and dense, which can ultimately reduce vision to a point where a person becomes blind. Fortunately, cataract surgery enables people to regain their vision. Thereby, the cloudy lens is replaced with a new artificial intraocular lens (IOL). Modern cataract surgery and advanced, premium IOLs can correct for many other vision disorders like long or short-sightedness and astigmatism, so in many cases patients have the option to become far less reliant on wearing spectacles after the surgery.

As cataracts are not exactly a disease, but rather part of the normal ageing of the body, it is very common amongst the population above the age of 50. 1 in 5 people aged between 65 and 74 have cataracts, and above this age, the proportion rises to 1 in 2.

The word “cataract” comes from the Greek for “waterfall”, καταρράκτης, as rapidly flowing water in waterfalls appears to be white, just like advanced cataracts appear in the eye.

What causes cataracts?

Ageing is responsible for around 90% of cases of cataract but there are several other risk factors that can cause cataract or contribute to its formation. These include:

  • Age above 50 years
  • Smoking
  • Poor glucose control in diabetes
  • Injuries to eye
  • Invasive eye surgeries (e.g. vitrectomy)
  • Diseases that cause eye inflammation
  • Long-term corticosteroid use
  • Exposure to ionising radiation (e.g. ultraviolet [UV] light or x-rays)
  • Malnutrition
  • Hereditary factors

Very occasionally, children are born with cataracts, often to mothers who are infected with measles or rubella during pregnancy.

Can I prevent or delay cataracts?

As the lens ages with the years, just like the rest of the body, almost every person will eventually get cataract. However, there are a number of steps you can take to slow the development of cataracts. These mainly include avoiding the risk factors:

  • Avoid exposure of the eyes to UV-light, e.g. by wearing sunglasses on sunny days. Good sunglasses block UV light from reaching your eyes, which is especially important at a young age.
  • Don’t smoke. Smoking accelerates the ageing process – and this includes cataract development.
  • Steroid use; If you have to take corticosteroid drugs for a long time, consider asking your doctor if there are non-steroid alternatives that you can take instead.
  • Pregnancy; If you are not already vaccinated against measles and rubella, consider doing so before becoming pregnant, as these diseases can cause cataract in the unborn child.

What are the symptoms of cataracts?

The first stages of cataract formation are often not noticeable. However, vision slowly gets worse, and images start to become blurry. People usually first notice this at dusk, as glare, halos and blurring are most noticeable. People often describe their vision as looking through fog, and people tend to report needing more light in order to read.

As your cataract continues to develop, your contrast sensitivity starts to get worse, making it harder to read texts, that are not pitch black on white. If the cataract is advanced enough, it can eventually be seen through the pupil of the eye, as a grey, cloudy substance. At this point, a person is close to blindness.

Normal vision

Early-stage cataract

Advanced cataract

How are cataracts treated?

The clouding of the lens itself cannot be reversed. However, it is very well possible to remove the cloudy lens and replace it with an artificial intraocular lens (IOL). This is a very quick surgery, which immediately eliminates the symptoms you have due to the cataract. Nowadays, there are many different types of intraocular lenses, and choosing the right one for you is crucial. If a cataract has been diagnosed we carefully evaluate the right time for the procedure, as well as the right IOL and type of surgery. Many measurements of your eye are made in order to calculate the “refractive power” that your eye needs.

Please remember, that the cataract might not be the only factor in the eye that reduces the visual acuity. The surgery might therefore provide a person with a better vision, but still not with 100% visual acuity.

When is the time right for surgery?

Cataract is diagnosed and graded by an eyecare professional. It is also evaluated, how much the visual acuity decreases in the presence of glare. If it is medically necessary to do the surgery (e.g. in very advanced cases, if the cataract poses a risk to the eye), the doctor will recommend it. If it is medically not necessary yet, the choice on when to do the surgery is mainly based on how much a patient is restricted and disturbed by the decreased vision.

The surgery

Cataract surgery is a day surgery and usually takes about 20 minutes per eye. The operation is performed under local anesthesia with light sedation and assisted ventilation under the supervision of an anesthesiologist. General anesthesia is necessary only in exceptional cases.

The natural, cloudy lens of the eye sits in a capsular bag. Under the microscope, this capsule must be opened so that the lens can be broken into smaller pieces and removed. In order to reach the lens with the instruments, three small incisions are made at the edge of the cornea. The artificial clear lens (intraocular lens, IOL), which will take over the function of the normal human lens, is then also inserted through these.

There are two main ways of performing cataract surgery: manually, and with a femtosecond laser.

Manual surgery

In manual surgery, the incisions in the cornea to introduce surgical instruments and the new lens, are performed manually by the surgeon. Then the surgeon uses an instrument to tear an approximate 8-mm-diameter circular hole in the capsular bag that contains the lens; this process is called capsulorhexis. The surgeon then liquifies and breaks down the lens with ultrasound energy in a process called phacoemulsification, and removes the lens fragments through suction. The new lens is placed into the bag through the circular hole, and the optical part of the lens is positioned so it fits in the middle of the hole.

Femtosecond laser surgery

Femtosecond laser surgery involves the use of a laser to make all of the incisions with micrometer precision, as well as making a perfectly circular opening in the capsular bag to place the lens inside. Furthermore, the laser pre-cuts the cloudy lens, so that less ultrasound-energy is required to break down the lens. Ultrasound energy can damage cells at the base of the cornea, so it’s important to keep the amount of energy delivered into the eye to liquify the lens as low as possible.

The precision of the laser ensures that the lens fits as perfectly as possible in the hole, and some premium lenses require an extremely precise fit. Having the laser perform this step is also a safer method of making this opening, essentially reducing the possibility of something going wrong, like the formation of a radial tear which compromises the formation of a required circular hole.

Types of artificial lenses (IOL)

Monofocal lenses are an excellent option and give you a good vision at one distance, if your eyes are otherwise healthy. The distance, where the clear image is, can be chosen and usually lies in the far distance. Spectacles / reading glasses will be necessary for you to see at other (closer) distances.

Multifocal lenses involve splitting the light that comes into the eye into two or more sharp images, e.g. near and far, or near, intermediate distance, and far. Your brain then chooses the image you want to see in focus. The trade-off is that incoming light is split between the images, and this reduces your contrast sensitivity (although it will be better than before surgery).

Extended depth-of-focus (EDOF) IOLs use specialized optics to spread the sharp image focus along a greater range of distances. Again, this can come with the drawback of reduced contrast sensitivity, and depending on the design of the lens, glares and halo.

Toric lenses are designed to also correct for any astigmatism in your eye. These exist in monofocal, multifocal and EDOF forms.

Aspheric
EDOF

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Augeninstitut ELZA
4.8
Based on 107 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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