How soon should one have cataract surgery?

Advancing age inevitably takes its toll on eyesight, and for many, a common problem is cataracts.

Ageing brings with it all sorts of unwanted changes, but perhaps the most apparent affect the eyes.

The first sign of ageing eyes is when we can't read small print, or we have to put the print at a distance to be able to read it. This is called presbyopia. It is due to the inability of the internal eye muscles to hold and change the shape of the lens.

It is also due to the lack of elasticity of the crystalline lens to change its shape in order to focus on close objects.

The condition may occur as early as the mid-40's. It can be easily treated by using reading glasses.

But as we age further, we may experience difficulty seeing well in bright light. Later, distant and near objects become a blur. This is probably due to cataracts, an ageing process where the crystalline lens in the eyes becomes opaque.

When the cataract is mild, glasses may help improve vision. However, when the cataract becomes denser, one will need to undergo surgery to remove the lens and replace it with an artificial intraocular lens (IOL).

How soon should one have cataract surgery?

This depends on how the person copes with the symptoms. If you can't stand the early symptoms of glare, or if your job demands sharp vision, then surgery can be carried out early.

The lens can be removed manually through a wound made on the cornea or at the junction between the cornea (transparent front part of the eye) and sclera (white part of the eye). The procedure is called extracapsular cataract extraction (ECCE).

The lens can also be fragmented into small pieces using an ultrasonic or laser probe (this is called phacoemulsification or phaco), with the lens fragments aspirated out from the eye.

An intraocular lens is then inserted to replace the original lens so it can focus images onto the retina to provide good vision.

For ECCE, a non-foldable or rigid intraocular lens is used, while for phaco, a foldable lens which is flexible in order to negotiate through the small wound is inserted.

Phaco has become the more common procedure because it only leaves a small wound of less than 3mm, which often does not require suturing.

However, ECCE is still carried out depending on various circumstances.

To regain good vision, an intraocular lens is needed. People with very high myopia may not need glasses, but even then, an intraocular lens without power or a plano lens is often inserted as the artificial lens acts as UV light protection on the macula to prevent age-related macular degeneration.

Types of IOL

There are monofocal and multifocal IOLs. Monofocal IOL allows one to see clearly at one distance, either far, intermediate or near. But usually, most patients choose to see clearly at distance and wear reading glasses for reading.

Multifocal lens allows one to see objects clearly at different distances. For people who have refractive errors such as myopia, astigmatism and presbyopia, they can choose a multifocal IOL that allows them to see objects clearly at more than one distance and also overcome eyestrain and glare due to astigmatism.

People who have been wearing glasses for refractive errors their whole life may consider this IOL, sometimes referred to as a "premium lens".

Patients have to express their visual needs clearly to the eye specialist. That is to say, if one chooses monofocal IOL, do they want clear vision at distance and wear reading glasses for reading, or do they want sharp vision for reading and wear glasses for distance?

Patients must provide such information so that the eye specialist can help them make the correct decision on the type of surgery and IOL so as to avoid dissatisfaction and unrealistic expectations after surgery.

The cataract surgical fee at public hospitals is RM103, and patient needs to purchase his/her own IOL .

Anyone above the age of 50 should have their eye assessed by either an optometrist or ophthalmologist.

This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice.