Cataract Surgery

Cataract surgery is a precise and highly specialized ophthalmic procedure designed to restore vision by removing a cataract-affected lens and replacing it with an artificial intraocular lens (IOL). Cataracts occur when the eye’s natural lens becomes cloudy, leading to a significant decline in visual acuity. This condition interferes with the normal refraction of light, reducing contrast sensitivity, impairing color perception, and causing glare sensitivity, particularly in bright light or at night. Left untreated, cataracts can result in total vision loss.

Surgical intervention is the only definitive treatment for cataracts, as no pharmacological or non-invasive approach has been proven to reverse the opacity of the lens. Cataract surgery is considered a gold-standard procedure in ophthalmology due to its high efficacy, safety profile, and long-term benefits. The procedure has evolved into a minimally invasive operation with a high success rate and relatively short recovery period.

Why Cuba

In Cuba, cataract surgery is expertly performed by highly skilled ophthalmic specialists using advanced techniques to ensure optimal visual outcomes and patient safety. With a strong emphasis on precision, surgeon carry out a comprehensive preoperative assessment to help determine the best surgical approach and IOL selection, ensuring personalized treatment. Both traditional extracapsular extraction and minimally invasive phacoemulsification techniques are available, tailored to individual patient needs. Postoperative care is meticulously managed to promote fast recovery, prevent complications like posterior capsule opacification, and optimize long-term vision. Cuban medical institutions prioritize patient-centered care, offering continuous monitoring and customized vision rehabilitation to enhance overall visual quality and quality of life.

Importance of the Eye Lens

The lens of the eye plays a crucial role in vision by focusing light onto the retina, enabling clear and sharp images. It is flexible and transparent, allowing for precise adjustments in focus, a process known as accommodation. However, with aging or certain medical conditions, the lens may lose its transparency, leading to visual impairment. Since the lens does not regenerate once damaged, surgical intervention is the only option for restoring vision when clouding occurs due to cataracts.

Conditions That Require Cataract Surgery

Cataracts can develop due to various causes and are classified based on their location within the lens and their etiology:

Nuclear Cataract: Develops in the center (nucleus) of the lens, commonly due to aging.
Cortical Cataract: Affects the outer edge (cortex) of the lens and progresses toward the center, often seen in diabetic patients.
Posterior Subcapsular Cataract: Forms at the back of the lens and progresses rapidly, often linked to diabetes or steroid use.
Congenital Cataract: Present at birth or develops in early childhood due to genetic factors or infections during pregnancy.
Traumatic Cataract: Caused by direct injury to the eye, leading to lens opacity.
Radiation Cataract: Results from prolonged exposure to UV rays or radiation therapy.

Causes of Cataracts

Several factors contribute to the development of cataracts, including:

Aging: The most common cause, leading to gradual protein degradation in the lens.
Genetics: Family history can increase susceptibility.
Diabetes Mellitus: High blood sugar levels accelerate lens protein glycation, leading to clouding.
Prolonged Corticosteroid Use: Associated with posterior subcapsular cataracts.
Smoking and Alcohol Consumption: Increase oxidative stress in the eye.
Ultraviolet (UV) Exposure: Chronic exposure can damage lens proteins.
Eye Trauma or Injury: Direct impact can lead to cataract formation.
Previous Eye Surgery: Certain procedures may induce cataract formation as a complication.

Symptoms of Cataracts

Cataracts typically develop slowly, and symptoms may vary based on severity.

Common symptoms include:

Blurred or dim vision
Increased sensitivity to light and glare
Difficulty seeing at night
Fading or yellowing of colors
Seeing halos around lights
Frequent changes in prescription glasses
Double vision in one eye

Pre-Surgical Diagnosis of Cataracts

Before surgery, an ophthalmologist performs a series of diagnostic tests to assess the severity of cataracts and determine surgical eligibility:

Visual Acuity Test: Measures how well the patient can see at various distances.
Slit-Lamp Examination: Uses a microscope to inspect the lens for clouding.
Retinal Examination: Conducted after pupil dilation to assess retinal health.
Tonometry: Measures intraocular pressure, ruling out glaucoma.
Optical Coherence Tomography (OCT): Provides detailed imaging of the retina and macula.
Posterior Segment Evaluation: Identifies any pre-existing retinal or optic nerve diseases that may affect vision after cataract surgery.
Tear Film and Ocular Surface Evaluation: Assesses dry eye disease (DED), which can impact keratometry accuracy and IOL calculation.

Tests to Determine the Correct Intraocular Lens (IOL)

Selecting the appropriate intraocular lens (IOL) for cataract surgery requires precise preoperative measurements and calculations. Various diagnostic tests are performed to determine the best lens power, type, and placement, ensuring optimal postoperative vision.

Biometry (Ocular Axial Length Measurement): Measures the length of the eye (axial length) to calculate the IOL power accurately.
Keratometry (Corneal Curvature Measurement): Measures the curvature of the cornea to determine its refractive power.
Corneal Topography and Tomography: Creates a detailed map of corneal shape and curvature to detect irregularities.
Anterior Chamber Depth Measurement: Determines the space between the cornea and the lens, helping decide the best IOL placement.
White-to-White Measurement: Measures the horizontal diameter of the cornea (limbus-to-limbus) to help size the IOL.
Pupil Size Measurement: Determines the ideal IOL design based on pupil dynamics in different lighting conditions.

Types of Cataract Surgery

Cataract surgery is recommended when the condition significantly impairs daily activities such as reading, driving, or recognizing faces. Candidates for surgery include:

Patients with vision loss that interferes with daily life
Individuals experiencing glare sensitivity or poor night vision
Patients whose cataracts prevent a clear view of the retina for diagnosing other eye conditions
Those with secondary complications like increased intraocular pressure

The choice of procedure depends on factors such as cataract severity, eye health, and the patient’s overall medical condition. Below is an overview of the primary types of cataract surgery and how each is performed.

Phacoemulsification (Minimally Invasive)

This is the most common and advanced technique used for cataract removal.

Procedure:

A tiny incision is made in the cornea.
An ultrasound probe breaks the cloudy lens into small fragments.
These fragments are suctioned out.
An intraocular lens (IOL) is implanted through the same incision.

Extracapsular Cataract Extraction (Traditional Surgery)

This method is used for advanced cataracts that are too dense for phacoemulsification.

Procedure:

A larger incision is made to remove the entire cloudy lens in one piece.
An IOL is inserted into the remaining capsule.
Sutures may be needed to close the incision.

Intracapsular Cataract Extraction (Rarely Used)

An older technique in which the entire lens and capsule are removed through a large incision. It is now rarely used due to a higher risk of complications. However, it may still be performed in specific cases, including:

Severe Lens Dislocation or Zonular Weakness
Extremely Hard or Mature Cataracts
Severe Ocular Trauma
Complicated Cataract Surgery Cases

Procedure:

The entire lens and its capsule are extracted.
An IOL is placed in front of the iris or in the posterior chamber.