Clearing cataracts and poor vision

Thursday, 16 l 06 l 2011 Source: Mind Your Body; The Straits Times
By: Ng Wan Ching

New lenses fitted during cataract surgery can correct other vision woes too, reports Ng Wan Ching

Having a cataract leaves one in a blur but surgery could also offer the sufferer a chance to get perfect eyesight again. Lens implants have progressed so far that it is now possible not only to replace the eye’s cloudy lens with a clear one, but also with one that corrects for up to three other conditions at once. They are either myopia (short sightedness) or hyperopia (long sightedness); presbyopia (laohua in Mandarin) and astigmatism.

These newer lenses have been available here for the past 1 1/2 years, doctors said. Each costs up to $1,800 more than the standard lens which corrects only myopia or hyperopia. In 2004, 23,259 cataract operations were done here.

At Singapore National Eye Centre, which did about 10,500 cataract operations last year, 80 per cent of patients choose standard lenses. About half of the patients treated at Shinagawa Lasik Centre choose the newer lenses. Previously, all lens implants were of a type called a monofocal lens implant. It provided good vision after cataract surgery – but at one set distance, usually for seeing objects at a distance, which corrects either myopia or hyperopia. The patient would still need to wear glasses for any type of near vision activity, such as reading, sewing, playing cards or keeping a golf score.

Today, eye surgeons can offer patients the choice of a multifocal lens implant, which can correct a combination of defects. There are different manufacturers who make these lenses, such as AMO, Carl Zeiss and Alcon. The price differs, depending on the company and on the type of lens, with the most complicated being the most expensive.

Someone who opted for a multifocal lens was Mr Wong Chee Seng, 49, a manager. He began developing cataracts in his 40s, a relatively young age, after years of playing sports without wearing sunglasses to protect his eyes from the sun’s ultra-violet rays. He found out about his cataracts when he saw a general practitioner about an unrelated problem with his eye. The doctor checked his eyes and told him to see an opthalmologist for his cataracts. The problem he had been having suddenly became clear to him. “A couple of years ago, I started having blurry vision when I was outdoors or driving at night, but I just brushed it off,” he said.

Dr Jovina See, then at the National University Hospital, diagnosed him with subcapsular cataract, which causes blurriness and glare, especially in sunny conditions. She operated on his right eye in January last year. She removed his clouded lens and replaced it with an individually fitted lens implant which corrected his slight myopia and presbyopia. Two months ago, she did the same for his left eye. Now he has perfect eyesight. “I have no problems reading or seeing into the distance,” he said. He has, however, acquired some new spectacles – sunglasses. “I now have four pairs because there are other eye conditions to protect against,” he said. Dr See, who is now in private practice at Shinagawa Lasik Centre, said Mr Wong’s best visual acuity before his surgery was 6/9 and he had presbyopia. “His visual acuity after surgery is now 6/4.5 in both eyes,” she said. That is better than 6/6 vision.

She used a technique called phaco emulsification, in which a very small self-healing cut is made in the cornea, through which a tiny probe is inserted, transmitting ultrasound waves to break up the cataract. The emulsified lens is then sucked out through the probe. The implant is then inserted with a special lens implant injector. The surgery takes less than 30 minutes, with only light sedation and eyedrops to numb the eye. If a cataract is more advanced, a larger incision would be needed. This requires stitches which can take up to eight weeks to heal.

Dr See said it is a common misconception that cataracts have to be advanced before they need to be corrected. “Many people here still wait until they have no choice, when the cataract is very ‘ripe’ and their eyesight is very bad, before they go for cataract surgery,” she said. She recommends surgery as soon as a cataract interferes with normal activities, including driving, watching television, climbing stairs, playing sports, cooking and reading. “There is no need to wait,” she said. The National University Hospital is seeing more younger patients come for cataract surgery, said Dr Clement Tan, a consultant at its department of ophthalmology. “Patients have higher visual demands these days, both for work and leisure, so they are more likely to be bothered by symptoms when they have early cataracts,” he said.

Like Mr Wong, they can choose to have their sight corrected to perfect vision again, without any need for glasses. Dr See said: “The choice of lens will depend on the patient’s needs. For example, if there is significant astigmatism, or if the patient doesn’t want to wear reading glasses, prices will differ.” These lenses last forever. But there are risks to the surgery including infection, which may lead to blindness, retinal detachment and macular swelling. Dr See tells patients that there is a 3 per cent risk of complication for any cataract surgery. Patients can resume most daily activities on the same day of their surgery, such as watching TV or doing computer work. For vigorous activity such as jogging, it is advised that they wait for a week to prevent infection from the perspiration running down the forehead to the eye during exercise, said Dr See. “There is no need to suffer bad eyesight at all, especially with new artificial lenses today which can correct all types of poor vision,” she said.

Where to get lens implants and the costs

Subsidised patients at National University Hospital (NUH) and the Singapore National Eye Centre (SNEC) are limited to standard lenses which correct myopia or hyperopia. Private patients at both centres can have a choice of intraocular lenses that correct myopia or hyperopia, astigmatism and presbyopia. These include new multifocal lenses that can correct both myopia and presbyopia; and the latest lens, which corrects myopia or hyperopia, presbyopia and astigmatism at the same time.

At NUH, If they want the newer lenses, subsidised patients can opt to be upgraded to become private patients for the cataract surgery and revert to being subsidised after cataract surgery for other medical or hospitalisation needs. They cannot opt for subsidised surgery and pay full price for their intraocular lenses. But SNEC said that it will offer subsidised patients with special conditions such as high astigmatism after trauma, the multifocal lenses that they need.

Not all patients may benefit from some of these more expensive specialised lenses, and total spectacle independence would not be possible in some patients, said Associate Professor Chee Soon Phaik, a senior consultant ophthalmologist who is co-head of the cataract service at SNEC. Patients with more than one condition can also opt for monovision – correcting separate defects in each eye – that would allow them to be less dependent on reading glasses. “The master eye is corrected for distance vision and the other eye for near vision using the monofocal lens implants,” said Prof Chee. This allows for some degree of spectacle independence when seeing objects at both near and far range.

At SNEC, for subsidised patients using standard lenses, cataract surgery costs $1,284 per eye performed by any surgeon. For private patients using standard lenses, the fee depends on the seniority of the surgeon doing the operation. It starts from $2,100 for an associate consultant, $2,810 for a consultant and $3,200 for a senior consultant. Standard lenses are generally priced at $250 or under, while non-standard specialised lenses may cost between $800 and $2,500, depending on the type.

At NUH, the cost of the surgery and lens implant ranges from $3,697 to $5,217. In private practice, the total surgical fee starts from $5,000 to $6,000 and can go up to $8,000 to $10,000 per eye, depending on the surgeon and the type of lens one chooses.