Our site offers a list of German clinics, specializing in the field of ophthalmology and refractive surgery, with the range of services covering the treatment of such common disease as cataract. As an example, we describe the activity of only one ophthalmic center. This should give you only brief information about the field of expertise of a modern eye center in Germany and the methods of cataract treatment.
Cataract: facts and figures
According to the WHO, half of the cases of blindness in the world are conditioned by cataract. In the age group of 50-60 years old, cataract is detected in 15% of the population, 70-80 years old ‒ in 26%-46%, over 80 years old ‒ in almost everyone. You can find ophthalmologists collaborating with GMG here
Between the ages of 52 and 64, 50% of the population have a cataract without noticing visual disturbances. Between the ages of 65 and 75 it is well over 90%, with half of them experiencing impaired vision when they reach the age of 75.
The number of cataract surgeries in Germany is estimated at a total of 700,000 to 800,000, of which approximately 100,000 are hospitalized.
Serious complications relevant to the patient and the result are in the hands of an experienced surgeon in the alcohol range. Around 90% achieve visual performance of 50 to 100% after the operation.
Cataract (from the Greek word “katarrhaktes” which means “waterfall”) is opacity or discoloration of a part or the entire lens, leading to a decrease in its light conductivity and decrease in visual acuity.
What concerns congenital eye diseases, cataract also takes a leading position. The high prevalence of the disease and its social consequences make cataract one of the most urgent problems of modern ophthalmology.
The lens is part of the dioptric (light conductive and light refractive) apparatus of the eye, located behind the iris, opposite the pupil. Structurally, the lens includes a capsule (a bag), the capsular epithelium and the lens substance. The surface of the lens (the front and the back) has a spherical shape with a different radius of curvature. The diameter of the lens is 9-10 mm. The lens is an avascular epithelial mass; nutrients enter it by means of diffusion from the surrounding intraocular fluid.
According to its optical properties, the lens is a biological convexo-convex transparent lens, the function of which is to refract the rays within it and focus them on the retina of the eye. The refractive power of the lens is dissimilar in thickness and depends on the state of accommodation (in a resting state ‒ 19.11 dioptre; in a state of tension ‒ 33.06 dioptre).
Any change in the shape, size and position of the lens leads to a significant disturbance of its functions. The anomalies and pathology of the lens are aphakia (the absence of the lens), microphakia (a smaller size), coloboma (the absence of a part of the lens and its deformity), lenticonus (protrusion of the surface in the form of a cone) and cataract. Cataract formation can occur in any of the layers of the lens.
The normal functioning of the lens is maintained for as long as the percentage balance of the substances that make up the lens is kept. The cataractogenic process is characterized by numerous biochemical factors ‒ a change in the amount of water entering into the lens composition, potassium loss, an increase in the calcium level, a decrease in the amount of oxygen and ascorbic acid, as well as glutathione and hexose. The transparency of the optical lens of the eye ensures the water solubility of proteins within its structure. With age, the processes of chemical oxidation of the membrane substances begin to dominate in the lens of the eye, which in turn leads to the self-destruction of proteins. Therefore, proteins gradually turn from water-soluble into water-insoluble.
This chain of pathological processes leads to the loss of transparency of the lens, that is, to its opacity. Lenticular opacity is a response from the lens substance to a variety of unfavourable factors or modification of the components that make up the intraocular fluid, which is the medium surrounding the lens.
There are several degrees of cataract and, depending on the degree, the symptoms will vary. However, the main ones are:
Cataract symptoms are the appearance of stripes and flickering spots or various balls. Ancient Greeks called this disease a waterfall, because with a cataract people get the feeling that their eyes are covered with a veil, as if they look through misted glass.
When the cataract occurs, it is difficult to read, write and work with small details. As the cataract “matures”, the coloor of the pupil becomes white instead of black.
The first factor that makes it possible for a doctor to suspect that the person has a cataract is the patient’s age of over 60 years old. In this case, the clinical picture has characteristic features. During examination an ophthalmologist observes opacities that can be located in different parts of the eye ‒ in the peripheral part of the lens or opposite the pupil. The opacities are greyish, sometimes with a white hue.
Depending on the type of the cataract, the ophthalmologist will observe a diverse clinical picture, accompanied by the following signs:
These are the most common signs that help to detect a cataract and reckon its particular type.
There are several factors that determine the etiology of the onset and progression of a cataract. They are as follows:
According to some sources, the disease has become the cause of blindness for more than 20,000,000 people in the world.
Poor ecology, poisoning with various toxic drugs, ultraviolet or radiation exposure, as well as microwave and smoking can also be causes of cataracts.
In ophthalmology cataracts are divided into two large groups ‒ congenital and evoked. Congenital cataracts, as a rule, are limited in size and are stationary (not progressing). With evoked cataracts changes in the lens progress.
Depending on the etiology, evoked cataracts are senile (age-related ‒ about 70%), complicated (with eye diseases ‒ about 20%), traumatic (with eye injuries), radiation (with X-ray, radiation, infrared radiation damage to the lens), toxic (with chemical and medicinal intoxications), cataracts linked with systemic diseases.
According to the localization of the opacity in the lens, there are:
Congenital cataracts can be of any of these morphological forms, while evoked cataracts can be nuclear, cortical and complete.
This type of the eye disease is a consequence of the natural decrepitude of the body. In the initial stage of the immature cataract, objects gradually lose their clear outlines. As the disease progresses, dark dots and spots float before the eyes, images can often appear double. Near vision becomes problematic. As the cataract matures, the pupil of the eye becomes white. With a nuclear cataract, the focus of the opacity forms in the centre of the lens, acquiring a brown color. Gradual induration of the nucleus leads to high level of myopia.
The age-related cataract progresses faster if there are primary eye diseases that provoked its development. Hereditary predisposition can affect. Sometimes injuries of the eye, mechanical or chemical, become the cause of cataracts in old age. There is a high risk of this disease in diabetics, as well as in heavy smokers. In these cases cataracts are often found after the age of 55.
In its maturation, a cataract goes through 4 stages:
In the initial stage of cataract maturation, the lens hydration takes place, which is characterized by the accumulation of excess fluid between the fibres of the cortical layer with the formation of the so-called “water fissures”. The opacities in the initial stage are localized in the cortex, on the periphery, outside the optical zone of the lens, and therefore do not affect visual acuity.
The stage of the immature cataract is characterized by the progression of the opacities that affect the central optical zone of the lens. Biomicroscopic examination reveals lens opacities that alternate with transparent areas. In this stage of cataract maturation, an appreciable decrease in visual acuity is observed.
In the stage of the mature cataract, induration and complete clouding of the lens substance is observed. The lens nucleus and its posterior cortical layers are not visible during biomicroscopy. An external examination reveals a pupil of a milky-white or grey color. Visual acuity with mature cataracts varies from 0.1-0.2 to the level of light perception.
In the stage of the hyper-mature cataract, the disintegration of the lens fibres, the liquefaction of the lens cortex and the capsule shrinkage occur. The cortex becomes a homogeneous milky white shade. The nucleus, having lost its support, goes down. The lens becomes like a bag filled with a cloudy liquid, with a nucleus at the bottom. This hyper-mature cataract is called the Morgagnian cataract. This stage corresponds to complete blindness.
The hyper-mature cataract can be complicated by phacogenic (phacolytic) glaucoma, bound with the clogging of the intraocular fluid outflow natural pathways by macrophages and protein molecules. In some cases, a rupture of the lens capsule can occur with the release of protein detritus into the eye cavity, which leads to the development of phacolytic iridocyclitis.
Cataract maturation can be rapidly progressive, slowly progressive and moderately progressive. In the first case, 4-6 years pass from the initial stage to the extensive clouding of the lens. Rapidly progressive cataracts develop in approximately 12% of cases. Slowly progressive cataracts mature within 10-15 years and occur in 15% of patients. Moderately progressive cataracts mature within the period of 6-10 years and occur in 70% of cases.
Congenital cataracts account for more than half of all congenital defects of the organ of vision. A cataract in newborns is caused by genetic changes in the structure of proteins necessary to ensure the transparency of the lens. Causes of cataract in children under one year of age can be diabetes in the mother, infectious diseases in the first trimester of pregnancy, the intake of certain medications.
The main thing in this case is the early diagnosis of congenital cataracts. If the localization and size of the opacities in the lens do not interfere with the proper development of the organ of vision, such a cataract does not require emergency surgical treatment. If the opacity prevents the light from reaching the retina and hampers the development of the central vision in the infant, it is necessary to remove this obstacle as soon as possible so that the child’s visual system can develop properly. The treatment of congenital cataracts is carried out even in very young children, starting from the age of three months.
Of the congenital cataracts the most common are:
If the cataract is not diagnosed in time and not treated, it can lead to such complications as:
To avoid such terrible complications, the disease must be diagnosed and treated in time under the guidance of professional doctors. You should consult a specialist as soon as the first symptoms become apparent.
Detecting a cataract in the patient’s eye is not particularly difficult. Difficulties arise when the ophthalmologist is faced with the task of determining the stage, the localization, the etiology of the opacity and, most importantly, establishing the necessary scope and approach of surgical intervention. Difficult diagnosis of a cataract is explained by the fact that pronounced opacities in the lens make it very difficult, and sometimes impossible, to examine the condition immediately behind the lens, as well as the vitreous body and the retina.
All the methods of examining a patient with a cataract can be divided into four large groups:
All the examination methods included in this group are necessary to estimate the necessary parameters of the eye, making it possible to accurately calculate the optical power of the artificial lens that will be implanted during the operation (intraocular lens). All the data is processed by using a computer, which makes possible the immediate correction of hyperopia and myopia.
The treatment of the initial stages of the age-related cataract is based on the use of various drugs, mainly in the form of eye drops ‒ Catachrom, Vita-Iodurol, Vitaphacol, Viceinum and a number of others. It is known that the use of these agents does not lead to the resorption of the opacities that have already formed, and at best, only slightly slows down their progression.
The main difficulty of the conservative treatment of cataracts is associated with the uncertainty of the etiology of age-related cataracts. Recently, the role of antioxidants in quenching free radicals and protecting lens proteins has been intensively studied. Research is being conducted aimed at clarifying the role of hereditary factors, environmental factors, the general condition of the body, the state of ocular hydro and hemodynamics in the progression of a cataract.
The data obtained will serve as the basis for the effective prevention and treatment of age-related cataracts.
For conservative treatment of cataracts, the so-called replacement therapy is widely used. It consists in the following: substances the lack of which is associated with the development of cataracts are injected into the body.
Vitamins (riboflavin, ascorbic acid, nicotinic acid, potassium iodide, etc.) are used especially widely. Their solutions are instilled in the conjunctival sac.
Nicotinic acid which enters into the composition of the drops, promotes the penetration of ascorbic acid into the anterior chamber of the eye. It is advisable to use these vitamins in 2-5% glucose solution, as it improves the nourishment of the lens.
Of the other drugs used as means of replacement therapy, medications that contain potassium, calcium, magnesium, glutathione, cysteine, etc. should be prescribed.
This treatment helps to completely deliver a person from a cataract, since during the operation the cloudy masses of the lens are removed. But after the cataract surgery the person cannot see, because the lens will be simply destroyed, so the mandatory second part of the surgical intervention is fitting a prosthesis that will make it possible to see.
Currently, both stages of the operation ‒ the removal of the cataract and the intraocular lens (lens prosthesis) fitting are performed during the same intervention. In other words, in one operation the person gets rid of the cataract and receives a prosthesis that makes it possible to see normally. The artificial intraocular lens which is often called an “artificial lens” has an unlimited service life. Therefore, cataract removal followed by an artificial lens fitting is considered to be a complete cure for the eye disease.
It is recommended to refrain from surgery and perform conservative treatment of cataracts in the following cases:
Surgery for cataracts must be performed in the following cases:
In all other cases, the decision whether to operate a cataract or come to nothing more than conservative treatment is made by patients themselves.
Before the operation, each patient should go through a thorough examination of both eyes (the methods are mentioned in the section “Cataract Diagnosis”. The general condition of the whole body should also be assessed. It is necessary in order to correctly forecast the results of the operation, to prevent all sorts of complications for the operated eye and the body as a whole, as well as to determine the functional ability of the eye after the operation.
If during the examination, inflammatory processes are found in the eye, or in the organs and tissues located in the vicinity of the eye, before the operation it is mandatory to perform the inflammatory foci sanation plus anti-inflammatory therapy. Directly on the operating table, the preparation of the patient consists of instilling disinfecting drops into the operated eye, as well as drops that widen the pupil. Anesthesia depends on the type of the surgery to be performed. It may be local or general (intravenous administration of anesthetics).
Currently, the following types of operations can be performed for cataract removal:
The best options for cataract surgery are ultrasound and femtolaser phacoemulsification. If possible, it is better to perform femtolaser phacoemulsification. But if there is no such possibility (for example, there are no funds for the operation, or there is no necessary equipment in the medical centres within reach), ultrasonic phacoemulsification can be safely performed.
The patient is introduced to the stages of the surgery. They are told how important it is not to worry and to carry out the doctor’s commands ‒ to look straight, without blinking, to look down, to focus on a certain point.
1-2 hours prior the surgery drops are instilled to dilate the patient’s pupils. When the drops start working, the doctor invites the patient to the operating room. The patient should be dressed in a short-sleeved T-shirt for constant pressure control. A sterile outfit is also required. Prosthetics is performed on the operating table. The total time of the procedure rarely exceeds 30 minutes. Drops with anesthetic are instilled, in rare cases the anesthetic is injected.
Modern procedures are based on the principle of ultrasonic or laser phacoemulsification. The essence of the surgery is the grinding of the lens and its exhaustion from the chamber.
At first, through a micro incision (2 mm) a special fluid is introduced into the anterior chamber of the eye. It must protect the tissue from radiation, especially the cornea. Then the surgeon performs the procedure called capsulorhexis ‒ opening the lens chamber and partially removing it.
After that, a device with an ultrasound-emitting tip or a laser is inserted into the lens. The grinding process begins. The lens turns into a liquid emulsion. The patient does not feel any pain. They may see flashes of light, red laser lights, etc. The destroyed lens tissues are removed with an aspirator.
Then a tube in which a folded artificial lens is placed is inserted into the incision. The lens gets smoothed out on its own, the doctor can only slightly adjust the process. The patient will feel it as a slight pressure, stroking the eye. Suturing is not required. After the surgery the patient goes home right away.
Selection of an intraocular lens is a rather complicated and time-consuming process, and most importantly the most important factor for a successful surgery, since the quality of the patient’s vision after the operation depends on the correct lens. Individual selection of the lens is carried out by a specialist with the help of specialized equipment (the methods are described in the section “Cataract Diagnosis”). The choice also depends on the patient’s desire to see well without glasses at near or far distances. Careful selection of an intraocular lens is so important because all the lenses are different, so you need to make the only right choice for your eye.
At present, the following types of lenses are used in ophthalmology:
The best lens is an accommodative one. A multifocal lens is a little inferior to it. But these types of lenses are very expensive, so not everyone can purchase and have them implanted. In principle, in terms of price/ comfort, the best lens is aspheric ‒ it is fairly cheap and provides good vision in any lighting conditions. Besides, the need for additional use of glasses is not too burdensome, because the person, as a rule, has already got used to wearing them.
After the operation is completed, a sterile dressing is applied to the operated eye. A few hours after the surgery the operated eye has a sufficiently good vision, and within a week the visual functions come to normal for good.
If the patient did not have any complications during the operation and in the early postoperative period, he is discharged home the next day. It is necessary to avoid excessive eye strain, lifting weights and abrupt movements. The patient should also maintain eye hygiene, avoid sudden temperature drops and refrain from alcohol for at least 3-4 weeks after the surgery.
On returning home, the patient reverts to the usual way of life. Reading, writing, watching TV, etc. are allowed. Individually, the doctor prescribes eye drops to reduce the recovery period, and also informs the patient about the need for preventive examinations.
According to the American Society of Cataract and Refractive Surgery, in the USA about 3 million cataract surgeries (IOL implantations) are performed annually (there are no data for Russia). The number of successful operations is more than 98%. The resulting complications are currently in most cases successfully cured by conservative or surgical means.
The most common complication is clouding of the posterior lens capsule or “secondary cataract.” It has been found out that the frequency of its occurrence depends on the material the lens is made from. So, for IOL from polyacryl it makes up to 10%, while for silicone it is already about 40%, and for those made from polymethyl methacrylate (PMMA) 56%. The true causes of this complication and effective prevention methods have not been established yet.
It is believed that this complication may be due to the fact that the lens epithelium cells remaining after the removal migrate into the space between the lens and the posterior capsule and, as a result, form deposits that deteriorate the image quality. The second possible cause is fibrosis of the lens capsule. The treatment is carried out by using a YAG laser, with the help of which a hole is formed in the central zone of the opacified posterior lens capsule.
In the early postoperative period intraocular pressure may increase. The reason for this may be incomplete wash-out of viscoelastic (a special gel-like preparation injected into the anterior chamber of the eye to protect its structures from damage) and its penetration into the drainage system of the eye, as well as the development of the pupillary block when the IOL shifts to the iris. In most cases, it is enough to use antiglaucoma drops for several days.
If there is a risk of developing cataracts, it is important to use comprehensive means of prevention. These include the use of eye drops (Quinaks, Taufon, Vicetin, etc.), after prior consultation with the doctor.
The remaining preventive measures are as follows:
However, doctors note that there are no universal methods for preventing the disease. Therefore, persons over 65 should definitely visit an ophthalmologist regularly and, if lens opacities are detected, treat this pathology promptly. As for people who have not crossed this age threshold, they need to visit a doctor at least once in 4 years and have a balanced diet.
If you have found symptoms of cataracts in yourself or your relatives, it would be right to listen to the following tips:
The prices for cataract operations different depending on type of surgery and clinic but in Europe the average costs 30-60 per cent lower than oversea.
Applying via GMG you have possibility to choose among the best clinics in Germany. Please ask for details and qualified ophthalmologists explain you the whole process and give you affordable quotation.
|Cataract surgery, per eye (including surgery, IOLS and postoperative care)||1750€||3478$ / 3150€||2406£ / 2675€|
*All the prices are based on a few estimations from different sites and could not be an offer. Please enquire to clinics for precise pricing
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