Tag Archives: Cataracts

Eye Health – Cataracts

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

Ipoh Echo’s Eye Health series continues with Consultant Eye Surgeon Dr S.S. Gill, who gives us a final checklist on cataracts.

Cataracts occur when the normally transparent natural lens in our eye becomes cloudy. In Malaysia, cataracts are the leading cause of poor vision in patients above the age of 55.

Some causes of cataracts:

  • Aging:  The commonest cause. Occurs in every person at some stage of life
  • Secondary cataracts: Due to diabetes, steroid drugs, radiation, UV exposure.
  • Trauma: Injury by blunt objects & sharp ones.
  • Congenital cataracts. Babies may be born with cataracts due to infection or injury.

Symptoms may be:

  • Blurry vision is commonest. Sometimes described as foggy, filmy, or cloudy.
  • Hard time seeing at night, glare, hazy in bright sunlight.
  • Colours seem washed-out and dull.
  • “Second-sight of aging”: paradoxical improvement in near vision which may be a sign of early cataract.
  • Frequent change of spectacles, dissatisfied with new spectacles.

Cataract Eye Examination

  • Vision check, eyelid and front of eye check, eye pressure check, then dilating your pupils with eye-drops for the full cataract and retina (nerve at back of eye) examination.
  • Remember: Takes 30 to sometimes 90 minutes (especially for diabetics) to dilate pupils. Be prepared for the wait. Bring sunglasses with you to wear after eye check.
  • Check eyes annually after 40 years of age especially if diabetic.

Choosing your Artificial Lens (Intraocular Lens or IOL)

  1. Monofocal: Commonly used. Affordable. Improves vision for only distance.
  2. Astigmatism-correcting monofocals: Treats Astigmatism and distant vision.
  3. Presbyopia correcting: Corrects Near & Far vision. Pricy but worth it.
  4. Presbyopia & Astigmatism correcting: Corrects Near, Far & Astigmatism.
  5. (All lens types are subject to suitability – best to discuss with doctor.)

Preparing for Cataract Surgery

  • Arrange time from work: avoid unfinished business that may distract rest.
  • Arrange for a driver: this is always helpful. If staying very far, ward stay is best.
  • Review all medications: Check with surgeon to see which ones need to be stopped temporarily during surgery.
  • Eating and drinking: find out whether op under Local or General Anaesthesia.
  • Hygiene: Wash face thoroughly, no cosmetics or eyeliners, hair-wash. Inform eye surgeon if your eye is red with any unusual eye discharge on morning of op or if you feel unwell for any reason.

On the Day of Surgery

  • Remember: To fast from water & food if surgery planned under General Anaesthesia (G.A.)  Light meal if surgery under Local Anaesthesia (L.A.)
  • First, eyelids will be cleaned and eye-drops instilled until pupils fully dilated.
  •  If under L.A., eye-drops to numb the eye will be instilled. You are fully awake during the surgery. Cooperate with surgeon by not moving head during the surgery.
  • If under G.A., you will be unconscious during the surgery.
  • After surgery, once you have been given a meal, you may go home to rest. If the eye is padded, do not remove it or get it wet. If not on eye pad but on eye shield, you will need to instil eye-drops. Follow all instructions given strictly.

After the Cataract Surgery

Remember to strictly instil eye-drops regularly as instructed; Inform eye surgeon immediately if you develop any eye pain, undue redness or blurring vision; Do not miss any postoperative appointments given to you; Do not rub your eye or wet your eye; Keep the eyelid area clean and avoid eye make-up until instructed; Never stick your fingers into the corners of your eye; Avoid heavy exercise, swimming, prolonged computer use, excessive smoking or alcohol intake; Wear sunglasses when you go outdoors under the sun; Be patient as healing duration may vary from person to person depending on age, health and associated conditions like diabetes, etc.

May you have a speedy recovery with a good visual outcome!

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Health – Cataracts

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Dr. S.S. Gill, Consultant Ophthalmologist

Ipoh Echo’s Eye Health series continues with Consultant Eye Surgeon Dr S.S. Gill talking to us about artificial lens implants during cataract surgery.

The Intraocular Lens (IOL)

Dr Harold Ridley stumbled upon the idea of implanting an artificial lens (intraocular lens or IOL) after an intern asked him why he was not replacing the cloudy natural lens (cataract) that he had removed during cataract surgery.

Ridley noticed that RAF pilots of World War II who had pieces of shattered canopy fragments accidentally pierce their eyes in battle had no inflammation. This made him realise that the material was inert and could be used to make the artificial lens (IOL). He then embarked on implanting the first IOL in 1949 using similar material to that of the airplane canopy. The rest is history with implantations of IOLs being routinely performed restoring vision to millions throughout the world especially so since 1977.

Once implanted into the eye, the lens implants (IOL) requires no after-care at all and generally last a lifetime. To the question a patient might ask “What kind of IOL should I choose?” the many varieties of intraocular lenses in the market today can be broadly classified as follows:

  1. Monofocal IOLs,
  2. Astigmatism-correcting monofocal IOLs (Toric IOLs),
  3. Presbyopia correcting IOLs,
  4. Presbyopia & Astigmatism correcting IOLs
Acrysof IQ Lens (pic courtesy of Alcon)

Monofocal Intraocular Lens

These are the most commonly used type of IOL implants worldwide. The monofocal IOL is basically a single focus lens. Unlike the natural lens of the eye, a monofocal intraocular lens cannot alter its shape to bring objects at different distances into focus. Hence, it improves vision for only one distance – either near, intermediate or far vision. This vision is still heaps better than seeing through a cataract!

Most of the time, the eye surgeon generally selects a lens (IOL) that will provide good distance vision, and the person then resorts to wearing reading glasses for the near vision. If you do not mind wearing reading glasses for near, then these IOLs will do fine. A patient who has monofocal IOLs implanted in their eyes may have to wear spectacles at least part of the time, either for near vision or distant vision. Most patients usually just go back to wearing similar multifocal spectacles that they used to wear before the operation. A small number who may be happy with their distant vision may just make spectacles for reading near only (presbyopic glasses).

Monovision Correction

The other thing that may be planned for a patient who is going to undergo cataract surgery is something called monovision correction where the monofocal IOL implanted in one eye corrects for clear distant vision while the IOL implanted for the other eye is corrected for near vision. This is called monovision and the patient slowly gets adjusted to seeing clearly for distance with one eye and reading near clearly with the other eye. This kind of correction requires a little patience on the patient’s part as he or she gets adjusted to the monovision correction. Monovision correction is good when you do not want to wear spectacles and at the same time do not want to spend so much money on IOLs. The cost of these IOLs is relatively affordable for most.

Dr Gill will discuss more on IOL’s in the next issue of the Ipoh Echo.

For more information, contact Gill Eye Specialist Centre at
05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

The Right To Sight

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Visual impairment is a term used to describe any kind of vision loss to the extent that even with conventional forms of correction or treatment, the person’s vision remains poor.

“Being visually impaired can be frightening, especially when it affects those who once had good vision,” says Dr. Gill, who is based in Hospital Fatimah in Ipoh. “In fact, just taking into cognizance the facts on visual impairment should send the message that we cannot take our eyes for granted”.

Dr. S.S. Gill Resident Consultant Ophthalmologist
What Causes Visual Impairment?
Many factors can cause visual impairment. “Cataracts, or the clouding of the eye’s lens preventing light from passing through to the retina, are common causes for loss of vision,” says Dr. Gill. “Because cataracts form slowly, causing gradual vision loss, it may not be noticeable to the patient”. Cataracts usually affect people in their 60s and 70s, but may sometimes appear earlier in people who are excessively exposed to sunlight.

“Many of my patients who present early are golfers and sports people who are not in the habit of wearing sunglasses. The general rule is that you should always wear good sunglasses whenever you go out during daylight hours.” Symptoms of cataract include double vision, cloudy or blurry vision, difficulty seeing in poorly lit spaces, and when colours seem faded. Early detection and replacement of the eye’s natural lens with an intraocular lens (IOL) implant through cataract surgery usually restores vision in these cases.

“If you have diabetes, you need to be screened regularly for Diabetic Retinopathy, which is a condition where the tiny blood vessels in the retina (back of the eye) are damaged due to diabetes. People with retinopathy may not have any problems seeing at first. But if the condition gets worse, they can become blind.” To help prevent retinopathy, people with diabetes should avoid smoking, keep their blood pressure under control, and keep their blood sugar at an even level.

Another common cause is Glaucoma, a condition where an increase in pressure inside the eye impairs vision by damaging the optic nerve. “Any damage to the optic nerve is irreversible so it is important to find out if there is any history of glaucoma in your family as the condition is hereditary. Early detection and treatment is crucial or the vision will gradually deteriorate over time to a small tunnel vision, and then blindness can occur,” emphasizes Dr. Gill.

Most people may also find it surprising to note that injury is one of the commonest causes for vision loss. Examples like getting hit with a hockey ball or a shuttlecock, or children playing with sharp objects, and injuries from car accidents are common factors. These incidents are potentially devastating and a drastic accident can cause blindness. “I always advise parents to avoid buying toys with sharp edges and prevent children from playing with chopsticks or pencils. Prevention is always better than cure!”

Macular degeneration is a gradual deterioration of the macula (centre point at the back of the eye), which is the most sensitive region of the retina. The condition leads to progressive loss of central vision (the ability to see fine details directly in front). Excessive exposure to sunlight and smoking can increase the risk for age-related macular degeneration. Symptoms may include increased difficulty reading or watching TV, as vision becomes distorted and straight lines appear wavy or objects look larger or smaller than normal.

In children, amblyopia or “lazy eye” in early childhood can drastically reduce vision in an eye if the weak eye is not corrected. It is important to detect and treat the lazy eye before the age of 7 or 8 years, before the “vision centre” in the brain completes development.

Preventing Visual Impairment
For a large number of people who develop visual impairment in their 50s and later, it usually begins with a preventable disease, unless vision loss is caused by cataracts which can be reversed with surgery. A disease like glaucoma for instance, has to be detected early and treated or damage is irreversible.

Some final words from Dr. Gill: “Many people will have some type of visual problem at some point in their lives. It is important that if you have an underlying condition like diabetes, hypertension or glaucoma that you visit your ophthalmologist regularly and comply with prescription medication and eye drops to prevent further vision loss.”

For more information, contact 05-5455582 or email gilleyecentre@dr.com or visit: www.fatimah.com.my.

The World Health Organisation (WHO) facts:
* Approximately 314 million people are visually impaired worldwide and 45 million of them are blind.
* Every 20 seconds, someone in the world becomes visually impaired.
* Most people with visual impairment are older, and females are more at risk at every age, in every part of the world.
* Cataract remains the leading cause of blindness globally, except in the most developed countries.
* Correction of refractive errors (short and long sightedness) could restore normal vision to more than 12 million children between the ages 5 to 15.
* About 85% of all visual impairment is avoidable.

Next Issue: Part 2 – Tips on How to Look After Your Eyes and Maintaining Good Eye Sight