If you are alarmed because your doctor has told you you have a cataract, don't be. Half the people over age 65 have some degree of cataract development and most cases can be treated with surgery.

A cataract is a clouding of a part of your eye called the lens. Your vision becomes blurry or dim because light cannot pass through the clouded lens to the back of the eye. Cataracts can develop over periods ranging form a few months to many years. Sometimes the cataract stops developing in its early stages and vision is only slightly impaired. But if it continues to develop, it will interfere with vision. The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the centre of the lens, you may not be aware that a cataract is present.

Common symptoms include

• A painless blurring or dimming of your vision
  
• Glare, or light sensitivity
  
• Frequent eyeglass prescription changes
  
• Double vision in one eye.
  
• Needing brighter light to read
  
• Poor night vision
  
• Fading or yellowing of colours

Misconceptions about cataracts:

• It is not growth or film over the eye
  
• It is not caused by overusing the eyes
  
• It is not a cancer, tumour or infection
  
• It is not spread from one eye to the other
  
• It is not a cause of irreversible blindness

What causes cataracts to develop? Cataracts usually develop as part of the ageing process, but can also come from:

• Eye injuries
  
• Certain chronic diseases such as diabetes
  
• Medications
  
• Genetic inheritance
  
• Long-term, unprotected exposure to sunlight
  
• Previous eye surgery

Cataracts are diagnosed when a thorough eye examination with an instrument called a slit lamp microscope detects the presence and extent of a cataract, as well as any other conditions that may be causing blurred vision or discomfort.

The cataract may need no treatment at all if the vision is only a little blurry. A change in your prescription may improve vision for a while.

There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. When you are not able to see well enough to do the things you like to do, cataract surgery should be considered. It is not true that cataracts need to be "ripe" before they can be removed. Surgery can be performed when your visual needs require it. You must decide if you can see well enough to do your job and drive safely, if you can read and watch television in comfort. Can you perform daily tasks, such as cooking, shopping or taking medications without difficulty?

Procedure on the day

A Our staff member and a driver will collect you to allow enough time for admission to the hospital and for the administration of eye drops. You may be asked to skip breakfast the day of surgery. You must please take your blood pressure medication the morning of surgery.

Surgery is done under topical or local anaesthetic, which makes the operation almost painless. Usually the surgeon uses topical anaesthesia and this means only with eye drops, no injection or general anaesthesia. You will not have to worry about keeping your eye open. You may see light and movement during the procedure, but you will not be able to see the actual surgery.

The procedure used for removing cataracts is phaco-emulsification, which involves a small incision in the side of the cornea, through which the surgeon applies a tiny, high-frequency ultrasound instrument. High-energy sound waves break up the centre of the lens into microscopic particles, which are then gently suctioned out through the incision.

After the cloudy lens has been removed, it will be replaced with a silicon or alternative intra-ocular lens (IOL) implant, through a 3.2mm incision. This new lens allows light to pass through and focus clearly on the retina. The IOL becomes a permanent part of your eye.

After using this special small incision, you will not receive any stitches. The incision is self-sealing, stronger, heals faster and remains tightly sealed as a result of the natural outward pressure from your eye.

After the procedure

A patch or shield may be placed over the eye. Surgery does not require an overnight stay in hospital, but you will be required to stay in hospital for a short time and then be allowed to go home.

Complications can occur during and after the surgery and as with any surgery, a good result cannot be guaranteed. Infection, bleeding and swelling or detachment of the retina, are some of the more serious complications that may affect your vision, but these are extremely rare.

Even if the surgery itself is successful, the eye may still not see as well as you would like. Other problems with the eye, such as macular degeneration (ageing of the retina), glaucoma and diabetic damage may limit vision after surgery. Even with such problems, cataract surgery may still be worthwhile.

Many patients report immediate improvement in their vision. Most patients return to their normal work and lifestyle routines within a day or two.

In some cases, the posterior capsule that supports the IOL becomes cloudy several months or years after the initial cataract removal. This is called an "after cataract" or Capsule Sclerosis. If this occurs and blurs your vision, an opening in the centre of the membrane will be made with the Yag laser. This procedure, called a posterior capsulotomy, is painless and takes about 15 minutes and requires no recuperation. Most people who wear bifocals or reading glasses for near vision before surgery still need to wear glasses after surgery.

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For over 25 years doctors placed incisions in the cornea to treat nearsightedness, farsightedness, and astigmatism. In the early 1980's, they began looking at lasers to improve the precision and predictability of altering the shape of the cornea.

Researchers found that the Eximer laser could remove tissue with up to 0.25 microns of accuracy. Now, in its second decade of use, the technologically advanced Eximer laser has added a tremendous amount of precision, control and safety to the surgical correction of vision errors. Using this remarkable technology, the cornea is reshaped to conform to your glasses or contact lenses's prescription, thereby reducing or even eliminating a lifetime of dependence on corrective lenses for hundreds of thousands of people every year. our ophthalmologists use the latest generation lasers
and all of them have performed thousands of Lasik procedures.

Lasik, or Laser in-Situ Keratomileusis, offers a number of benefits because it is performed under a protective layer of corneal tissue. As a result, there is less surface area to heal, less risk of scarring, less risk of corneal haze, less postoperative discomfort, less postoperative need for medications, and vision returns more rapidly, often within a day or so. Lasik can treat a high range of vision errors. Although postoperative results vary, most patients are able to pass a drivers license test without their glasses or contact lenses. This procedure is very successful and has been described as "magic" for the patient and the surgeon.

The results of Lasik are as follows: For prescriptions of up to –6.00 diopters, 98% of patients fall within 1 diopter of normal (emmetropia or 0 diopters). For prescriptions of –6.00 to –10.00 diopters, 94% of patients fall within 1 diopter of normal, and for prescriptions above –10.00 diopters, 40-50% of patients fall within 1 diopter of normal. Although Lasik can usually be performed for prescriptions above –10.00 diopters, contact lens implants are often the preferred procedure of refractive surgery, because it gives better results.These are just general guidelines as your surgeon will determine just how effective Lasik will be for you. South African Lasik practitioners are amongst the best in the world.

Zyoptix is a new excimer laser technology, where a personal and unique laser vision correction is designed for each individual eye. Up till now, a –2.00 diopter treatment for 2 different people, has been the same. But no 2 people's corneal curvatures and aberrations are exactly the same, and with Zyoptix this uniqueness is taken into account when designing a personalized laser pattern. It therefore makes sense that better results are expected for each individual with this program, especially for those with irregular astigmatism.

Special equipment, namely Aberrometry is used to measure the unique aberrations of each eye. This information, together with other specialized tests like the Orbscan II corneal topography is then used to calculate and design the individual laser pattern.

Advantages of Zyoptix include fewer problems with night driving, less chance for revisions, and less cornea has to be lasered for the desired effect.

Who may have LASIK?

• People who are nearsighted, farsighted or astigmatic
  
• People of 18 years or older
  
• People whose prescription has been stable (without significant changes) for at least 12 months
  
• People who have had previous RK (Radial Keratotomy) and who have not attained their desired results are also possible candidates for Lasik

The decision to have Lasik is an important one that ultimately, only you can make. It is important that you have realistic expectations and that your decision is based on facts, not hopes or misconceptions. The goal of Lasik is to reduce your dependence on corrective lenses. Lasik does not always create 20/20 vision, and results cannot be guaranteed.

It cannot correct a condition known as presbyopia, or aging of the eye. Presbyopia is a normal age related change in the eye that starts around the age of 45, and affects everyone. It causes difficulty focusing close-up and requires reading glasses. Monovision, where the dominant eye is fully corrected for distance vision and the non-dominant eye is undercorrected for near vision, is an option, which will reduce your dependence on reading glasses. People who are normal sighted in the distance but are presbyopic, may wish to have one eye done to make it moderately nearsighted so they are able to read with that eye.

Who is not suitable for LASIK?

Patients with the following conditions, or using the following medications, are not suitable for Lasik:

• AIDS
  
• Cancer treatment
  
• Cortisone treatment
  
• Poor wound healing
  
• Immune suppressors
  
• Uncontrolled Diabetes
  
• Advanced Cataracts

The procedure

First a basic evaluation is done. Depending upon the surgeon, there will be one or two comprehensive evaluations (including a medical check-up from our in–house physician). These may include watching a short explanatory video, the recording of patient history, measurement of visual acuities, autorefraction, keratometry, tonometry, corneal topography and pachymetry, manifest refraction and cycloplegic refraction. Then the surgeon will do a final assessment for suitability for Lasik, although in the majority of cases your suitability will have been determined before your arrival in Cape Town.

A Our staff member and a driver will accompany you for the first evaluation appointments, because your pupils will be dilated and your vision will therefore be blurred for ± 8 hours.

If you wear contact lenses, they must be removed before the first evaluations and not be worn even for a few hours* for the following periods of time:

• Disposable soft contact lenses: at least 3 days
  
• Permanent soft contact lenses: 2 weeks
  
• Hard / RGP contact lenses: at least 3 weeks

*Contact lens wear causes swelling of the cornea, which will give inaccurate test results.

If both eyes need surgery, they are usually done on the same day, unless the surgeon chooses to do them separately.

There are no restrictions on eating, drinking or medications before surgery. Alcohol and medications that may cause drowsiness should be avoided. No eye make-up is permitted on the day of surgery. Wear comfortable clothing. Keep in mind that the operating theatres are air conditioned, and it is therefore advisable to bring a long sleeved top.

You will be given a specific admission time, and you will be at the clinic for ± 3 hours and a Our Staff member and driver will accompany you.

Eye drops will be administered one hour before the procedure time. These will include drops to anaesthetize the eye, to prevent infection (antibiotic) and to reduce light sensitivity. It is very rare to have a reaction to any of these eye drops.

After your eyes have been completely numbed using the eye drops, you will be taken into theatre. You will lie on the patient bed and have your untreated eye covered. The bed is then adjusted to align your eye with the aiming system. Here an eyelid holder/speculum will be placed between your eyelids to prevent you from blinking. This is painless.

The surgeon will talk you through each step of the procedure. He will mark the area where the surgery will be performed with a circular zone marker.

Next, an instrument known as a microkeratome makes a protective flap in the superficial cornea. During this procedure you may feel some pressure on the eye, but no pain. The flap is then lifted and you will be asked to look directly at a target light. Although the laser is equipped with an eye tracker to compensate for slight movement of the eye, it is very important to keep the eye absolutely still during this time.

The laser is a cool ultraviolet laser, which is non-thermal. There is no burning. The laser makes a clicking or snapping sound and produces debris, which has an unpleasant smell. The laser is performed in a few small steps, each taking 5 to 20 seconds. This technique helps provide a better contour for the cornea. The total time taken to complete most surgical procedures is less than 30 seconds of laser per eye.

After the laser has been completed, the flap is placed back into position where it bonds securely without the need for stitches. Now the eyelid speculum will be removed. The laser will now be reset for your other eye, and the whole procedure is repeated on your other eye.

The total time spent in theatre is ± 20 minutes.

You will spend some time in the recovery room after which you can go home.

After the procedure

Follow-up appointments will be made for 1 day, and 1 week after the procedure. After these follow-up visits, the surgeon wants to see you once a year for a peripheral retinal examination or will refer you or revert back to your own specialist for appropriate follow-up intervals. You should plan on staying in Cape Town for 10 days if you are considering Lasik.

You will be off work for 3 days after the procedure. If you need an illness certificate for work, please ask the surgeon for one.

You will be given eye drops to use after surgery to prevent infection and to reduce swelling of the cornea. Instructions on how to use these drops will be given on the day of surgery. Although most people don't experience any postoperative pain other than slight discomfort, you will also be given painkillers to use should it be necessary.

The most important thing is not to rub, touch, bump or to have any pressure on the eye after surgery. You will be given plastic eye shields/covers, which must be placed over the eyes before you go to sleep at night, to prevent accidental rubbing or pressure. Sleep with these shields for at least one week. You will also be given a Solarshield, which you must wear for 6 weeks after surgery whenever you go outside into bright sunlight.

What you may experience

• Your vision will be a bit blurry for the first few days and you may experience some difficulty with reading
  
• You may feel that your eyes get tired more quickly during the first week or two, especially after prolonged close-up work like reading or computer work
  
• You will experience some light sensitivity and your eyes may tear more than normal
  
• You may experience some problems with night glare and halo's around lights
  
• Your eyes may feel a bit scratchy and dry during the first few days
  
• Your vision may fluctuate during the first few weeks
  
• Visual recovery is rapid and relatively painless

All of the above mentioned symptoms are normal and any discomfort you have will become less each day as the eyes heal.

Possible side effects and complications

• Postoperative pain may occur in some individuals. Take the painkillers as prescribed.
  
• A few patients will report poor night vision, but this is unusual especially with the latest generation lasers.
  
• As with all surgical procedures there is always a possibility of infection, although the chances are very slim. If you should get an infection in the eye, it will be treated with additional eye drops.
  
• With LASIK, as with all other refractive surgery procedures, there is a possibility that the desired refractive outcome is not attained, leaving you with the need for repeat lasik or corrective lenses. Results thus cannot be guaranteed.

If your eye/s show a yellow discharge or if you experience severe pain or reduction in vision, contact the surgeon.

As we get older we lose the ability to focus at near and intermediate distances. As a result, after 40 years of age, every person's ability to read starts to deteriorate and by the age of 50 nearly everyone will need glasses for reading and intermediate vision. This condition is called "presbyopia". It is a normal age-related change of the eye and is slowly progressive until the age of about 65. There is no medication or eye exercise to treat or prevent this condition. Bifocal, multifocal, or reading spectacles are usually prescribed to enhance intermediate and near vision.

Cataracts (see section on cataracts) can develop over periods ranging form a few months to many years. Sometimes the cataract stops developing in its early stages and vision is only slightly impaired. But if it continues to develop, it will interfere with vision. Cataracts contribute to the presbyopia (reading problems). The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.

If you suffer from presbyopia and/or cataracts (which both affect the natural crystalline lens of the eye), you can benefit from the procedure called Prelex.

Prelex is refractive eye surgery, where the natural crystalline lens of the eye is removed and replaced by a man-made multifocal intra-ocular lens. The power of this lens is determined pre-operatively to give you good vision for distance, near and intermediate distances without spectacle lenses.

Multifocal intra-ocular lenses were first introduced during the early 1990's, and surgical techniques and the quality of the lenses have improved significantly to make Prelex surgery highly successful.

Not everybody is a suitable candidate for Prelex surgery and the surgeon will perform certain preliminary tests to determine suitability. Refractive contra-indications are macular problems, uncontrolled diabetes, diabetic retinopathy, abnormal pupils, glaucoma, keratoconus, irregular corneas such as corneal grafts, previous radial keratotomies and recurrent inflammatory eye disease. Good candidates include special patients, such as Alzheimer sufferers, young patients with unilateral cataract, people with neck arthritis who battles with bifocal and multifocal spectacles, people with hearing aids who cannot wear spectacles and people with allergies to spectacle frames.

It is very important to have realistic expectations. With any kind of surgery, results can never be guaranteed. The surgeon will take every precaution by utilising a double-checking system to ensure accurate biometry readings. Should the post-operative result not be satisfactory, LASIK eye laser surgery may be necessary to refine the refractive result (see section on LASIK surgery). Even with a very good refractive outcome, you may still need spectacles for special tasks, such as fine needlework or night driving.

It is important to realise that you will experience some degree of post-operative glare and halo's around lights at night for the first few months after surgery. This is normal, and will diminish after a period of about 3 months, and will eventually disappear.

The non-dominant eye will be operated first and the second eye within one to two weeks.

The procedure

You will be collected by our staff member and a driver in order to arrive at the specified time to allow enough time for admission to the hospital and for administration of eye drops. You may be asked to skip breakfast the day of surgery. You must please take your blood pressure medication the morning of surgery.

Surgery is done under topical or local anaesthetic, which makes the operation almost painless. Usually the surgeon uses topical anaesthesia and this means only with eye drops, no injection or general anaesthesia. You will not have to worry about keeping your eye open. You may see light and movement during the procedure, but you will not be able to see the actual surgery.

The procedure used is phaco-emulsification, which involves a small incision in the side of the cornea, through which the surgeon applies a tiny, high-frequency ultrasound instrument. High-energy sound waves break up the centre of the lens into microscopic particles, which are then gently suctioned out through the incision.

After the crystalline lens has been removed, it will be replaced with a multifocal silicon or alternative intra-ocular lens (IOL) implant, through a 2.8 to 3.0mm incision. This new multifocal lens allows light to pass through and focus clearly on the retina. The power of the new IOL is determined pre-operatively to give good vision without spectacles at far, near and intermediate distances. The IOL becomes a permanent part of your eye.

After using this special small incision, you will normally not receive any stitches. The incision is self-sealing, stronger, heals faster and remains tightly sealed as a result of the natural outward pressure from your eye. Sometimes combined astigmatism surgery will be performed or stitches will be placed to correct the shape of the cornea to improve vision.

After the procedure

A patch or shield may be placed over the eye. Surgery does not require an overnight stay in hospital, but you will be required to stay in hospital for a short time and then be allowed to go home.