Cataract (Grey Star) Treatment

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Get information about cataract surgery. Learn how the procedure is performed, what to expect before and after surgery, risks, complications, side effects, causes. 2020-03-10 Cataract (Grey Star) Treatment
All you need to now about Cataract (Grey Star) Treatment

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.

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.

Cataract Symptoms

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.

Cataract Signs

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.

Cataract Causes

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.

Cataract Classification

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.

Senile Cataract

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:

  1. Initial,
  2. immature,
  3. mature,
  4. hyper-mature cataract.

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 Cataract

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:

Cataract Complications

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.

Cataract Diagnosis

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:

  1. Standard (routine) methods, mandatory for each patient:
    • Visometry ‒ estimation of visual acuity.
    • Estimation of binocular vision ‒ assessment of three-dimensional, stereoscopic vision with both eyes at the same time.
    • Perimetry ‒ assessment of visual fields.
    • Tonometry ‒ measurement of intraocular pressure.
    • Biomicroscopy ‒ a method of microscopic examination of eye tissue that makes it possible to examine in detail the anterior and posterior segments of the eyeball, regardless of the lighting in the room. Biomicroscopy is the most important stage in the examination of a patient with a cataract, with which the ophthalmic surgeon selects the most effective method of cataract removal. Biomicroscopy is carried out by using a special device called a slit lamp. The examination is conducted under conditions of medical mydriasis (dilation of the pupil by using medications).The following characteristics are evaluated: the size and density of the nucleus, the stage of dystrophic changes in the capsule, the location of the lens, the presence of pronounced or hidden lens subluxation caused by dystrophic changes, the destruction of the ligament fibres holding the lens.
    • Ophthalmoscopy ‒ a method of examining the retina, the optic nerve and the choroid in the rays of light that are reflected from the fundus of the eye. Sometimes, because of the strong opacification of the lens, the implementation of this method is difficult. At the same time, ophthalmoscopy is very informative when examining the eyes of patients with diabetes, uveitis, myopia, pigmentary retinitis.
    • Gonioscopy ‒ measuring the angle of the anterior chamber of the eye. This method is crucial in determining the tactics for the surgical treatment of patients with lens pathology in combination with glaucoma.
  2. Additional methods, they are also required for each patient:
    • Refractometry ‒ determining the refraction of the eye (the refractive power of the optical system of the eye). The method is necessary to determine the degree of hyperopia, myopia and astigmatism.
    • Ophthalmometry ‒ is an eye examination with a special device ‒ an ophthalmometer. By using this device, an ophthalmologist can measure the radii of curvature of both the cornea and the lens surfaces.
    • Determining the anterior and posterior size of the eyeball.
    • Skiascopy ‒ the method of determining the refraction of the eye, which consists in observing the movement of shadows in the area of ​​the pupil, while a beam of light directed at the eye is reflected from the mirror.
    • Electrophysiological examination of the eye ‒ is used to assess the lability and sensitivity threshold of the optic nerve.

    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.

  3. Additional methods, prescribed by the doctor:
    • Densitometry
    • Ultrasound biomicroscopy
    • Endothelial biomicroscopy
  4. Laboratory methods of examination:
    • Prescribed to patients before hospitalization for surgery or directly in the hospital. Mandatory for all patients are: complete blood count and urine test, glycemia, coagulogram, blood test for HIV, hepatitis B and C, syphilis. Biochemical analysis of blood is carried out on doctor’s prescription in case the patient has associated concomitant diseases. In the case of congenital cataracts, in order to find out its etiology, the mother’s and the child’s blood serum and lens substance must be tested to detect hepatitis B virus markers.

Conservative Treatment of Cataract

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.

Cataract Surgery

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:

Indications for Surgery

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.

Preparation for Cataract Surgery

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).

Types of Cataract Surgery

Currently, the following types of operations can be performed for cataract removal:

  1. Intracapsular extraction of the lens ‒ the lens is removed along with the capsule through a large incision by using a special device, a cryoextractor. This technique is quite traumatic for the eye, so at present it is practically not used. Usually, an indication for such an operation is a traumatic cataract, when it is not possible to preserve the integrity of the lens capsule, or lens luxation, when the threads (chords) that suspend it are damaged.
  2. Extracapsular extraction of the lens ‒ during the operation the outer part of the capsule and the entire substance of the lens are removed, but the back part of the capsule is retained, which preserves the barrier between the vitreous body and the cornea. When the lens is removed, a prosthesis, an intraocular lens, is inserted and fixed instead of it. This operation is performed relatively rarely, because it is traumatic due to the large incision in the cornea and suturing. Currently, extracapsular lens extraction is being replaced by less traumatic phacoemulsification.
  3. Femtolaser phacoemulsification ‒ lens removal by using ultrasound. Its advantage is that the operation is performed through a micro incision from 2.2 to 5.5 mm, depending on the selected intraocular lens. The surgery is performed under local anesthesia, which makes it possible for the surgeon to maintain contact with the patient throughout the operation. There is no need for postoperative suturing. The surgery does not take more than 15 minutes. It is absolutely painless and safe. The risk of postoperative complications is minimal. The patient is quickly rehabilitated. Capacity for work is fully restored 10 days after the surgery.
  4. Ultrasonic phacoemulsification ‒ during the operation a special device is introduced into the anterior chamber of the eye through a small incision (1.8-3 mm), which destroys the lens substance, bringing it to the consistency of emulsion. Then this emulsion is removed through special tubes. That is, during the operation, the substance and the front part of the lens capsule are removed. The posterior lens capsule remains and acts as a barrier between the iris and the vitreous body. After the removal of the destroyed lens mass, the remaining posterior capsule is polished in order to destroy the epithelium present on it. When polishing is completed, an intraocular lens is inserted into the eye instead of the removed lens, and the incision is sealed without stitches. Ultrasonic phacoemulsification is the “gold standard” in modern surgical treatment of cataracts, since the technique is simple, widely available and rarely causes complications.

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.

Cataract Surgery Procedure

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.

Types of Intraocular Lenses

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 Surgery

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.

Complications of Cataract Surgery

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.

Cataract Prevention

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.

Our Advice

If you have found symptoms of cataracts in yourself or your relatives, it would be right to listen to the following tips:

Average Cataract Surgery Cost

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.

*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.

Price, EUR* Germany US UK
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

The air tickets prices from US to Germany starts as low as 490 EURO when buying in advance, and the prices for a flight from London to Germany starts from 48 EURO.

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Latest News in Cataract (Grey Star) Treatment

Cataract surgery can make it fit to drive


With increasing age, almost everyone develops a cataract. A team from the Medical University of Innsbruck was able to show that a bilateral operation significantly increases the driving safety of older road users.

The ability to drive a vehicle is important for many older people in order to be able to lead an independent life. But ultimately, cataracts mean that the older generation is often left behind in traffic. Experts assume that affected motorists are twice as likely to be involved in collisions as people who have undergone cataract surgery. Claus Zehetner and his team at the University Clinic for Ophthalmology and Optometry Innsbruck show in a new study that a bilateral lens replacement significantly improves both visual acuity and contrast vision. Using an experimental driving simulator, it was shown that the reaction and braking times of the treated subjects improved significantly. "The results of this study underline the importance of cataract surgery for the road safety of older road users," says Zehetner.

A total of 107 drivers license holders took part in the study. All passed a vision test and a driving simulation at a car seat and pedals developed and calibrated by the Innsbruck University Clinic for Orthopedics and Traumatology.

In addition to eyesight and contrast vision, the neurological and total reaction time were also tested. A bilateral cataract operation was performed in 53 study participants and retested one month later. With the operated license holders: inside compared to the non-operated ones, the braking distance was shortened by the width of a zebra crossing (2.3 meters) at an initial speed of 50 kilometers per hour. In addition, the contrast vision was improved compared to the participants in the comparison group.

"From a scientific point of view, what is new for us is that contrast vision has such a great influence on reaction time. The increased sensitivity to glare in a cataract has a blatant impact on braking time," says Zehetner. The results of the study would show the need for older road users to include contrast vision in the treatment decision before cataract surgery.

From around the age of 40, the eye lens of every person gradually becomes stiffer, then more cloudy. A cataract is developing. As a result, cataract operations are the most common surgical interventions on the human eye. Under local anesthesia, ultrasound and the smallest incisions are used to crush the cloudy lens and replace it with a clear plastic lens. The process takes about 15 minutes per eye and is usually carried out in a day clinic a few days apart.

Cataract surgery - New drops for inflamed eyes


By Sven Siebenand / The cataract is not uncommon. Around 550,000 cataract surgeries are performed annually by doctors in Germany. The treatment of postoperative inflammation is often with non-steroidal anti-inflammatory drugs. With immediate effect Bromfenac, a new representative of this class, is available.

The turbidity of the eye lens experts usually call cataract. But also common is the colloquial name cataract. But the whole thing has nothing in common with a colorless bird. Rather, the name is derived from two typical hallmarks of the disease: gray, because the pupil looks like this in the advanced stage of the disease, and rigid because of the staring eyesight of the visually impaired. The main symptom of cataracts is the slowly progressive vision loss. In addition, patients complain more and more about blurry images, their visual acuity subsides and the sensitivity to glare increases.

There is usually no way around an operation. After the procedure inflammatory processes on the eye can occur. Because shortly after cataract extraction patients are more prone to it because of the surgical interruption of the blood-eye barrier. Anti-inflammatory drugs make it possible to minimize the risk of surgery-induced ocular inflammatory complications, such as cystoid macular edema.

Fast absorption due to high lipophilicity

With Bromfenac (Yellox® 0.9 mg / ml eye drops) a new non-steroidal anti-inflammatory drug for ophthalmology is now available. COX inhibition disruptes the production of prostaglandins involved in the inflammatory process. The active ingredient was created by bromination of the NSAID Amfenac. As stated by manufacturer Bausch + Lomb, twice daily use of the new eye drops for two weeks leads to the control of the inflammation. So far available drugs in Germany provide for a four-week therapy with three to four times daily use. The reason: Bromfenac is characterized by a particularly high lipophilicity. This leads to improved penetration and absorption by the cornea and the underlying eye tissues. After single administration of the ophthalmic solution, absorption takes place within 15 minutes. The already reached peak concentrations in the aqueous humor persist for more than twelve hours; Thus, a twice-daily application to maintain the anti-inflammatory activity is sufficient. Patients who regularly use other eye drops should maintain a time interval of at least five minutes between doses.

Stem cells against the cataract


New method makes the eye to form a new lens itself

Physicians have developed a new healing method for cataracts: instead of replacing the clouded lens with an artificial lens, they cause eye cells that occur in the eye to generate a new lens themselves. In a pilot study, this gave children with a natural cataract their eyesight within a few months, as the researchers report in the journal "Nature".

Cataract is one of the most common causes of blindness worldwide. In this disease, the lens diminishes more and more, until finally no more light reaches the retina. While cataracts are most prevalent among older people, many children in developing countries are affected by this eye disease.

So far, there is only one treatment for the cataract: The clouded lens is removed by a cut in the cornea and instead used an artificial lens made of plastic. However, this procedure can cause inflammation and scarring and can not be performed on children under the age of two.

Stem cells in the lens case

Kang Zhang of the University of California at San Diego and his colleagues have therefore been looking for a gentler therapeutic method. Your idea: Why not make the inherently existing in the eye stem cells to produce even a new lens. Lens epithelial stem cells, which reproduce lens cells throughout our lives, sit in the envelope of the eye lens.

Clouded eye lens in a cataract patient.

So far, this lens cover was removed in gray-star surgery, because you wanted to prevent disordered growths of this tissue. But Zhang and his colleagues have now developed a microsurgical method in which only a very small incision is made laterally in the eye. Through this, the clouded lens material is sucked in without damaging the lens cover.

Lenticular tissue grows by itself

The remainder now happens by itself - through the self-healing power of the body: "Four to five weeks after the procedure, new lens tissue grew symmetrically from the sides of the lens capsule into the interior," the researchers report. After seven weeks, a translucent, biconvex lens had emerged from this tissue. Their refraction was as good in testing as that of a normal, healthy eye lens.

But would this work for humans? To find out, Zhang and his colleagues conducted a pilot study of 12 infants suffering from an innate cataract. The clouded lens was also gently removed so that the stem cells could become active.

First tests with children successful

And indeed: Three months after the procedure, a new, healthy lens had formed in the children as well. Thin at first, she grew to the normal shape and strength of a healthy eye lens over the course of eight months. "The children's eyes regained their function as soon as the new lens completely filled the eye capsule," the researchers report.

The visual acuity of the children improved as much as by the conventional implantation of an artificial lens, as an eye test showed. At the same time, however, fewer complications such as inflammation and scarring have occurred because of the smaller incision than in conventionally treated patients.

Cataract: drug could replace surgery


So far only one operation could prevent the blindness by cataract. Now researchers have discovered a possible alternative. A substance could prevent the lens opacity and even improve afterwards.

Cataract is the leading cause of blindness. Half of all people over the age of 70 are affected by lens opacification worldwide. So far, only surgery using an artificial lens implant could prevent cataract blindness. But possibly the disease can also be treated with medication in the future. A research team led by PhD Jason Gestwicki of the University of Michigan, Ann Arbor, has recently discovered an active ingredient that prevents and even improves the opacification of the lens in the laboratory and in mice. Their results published the researchers in the journal "Science".

Drug prevents clumping of proteins

The refractive power of the eye lens is generated by highly concentrated proteins. These proteins must remain in a dissolved state so that the lens remains transparent. This is ensured by the two protective proteins A-crystallin (cryAA) and B-crystallin (cryAB). If these crystals fail, the proteins clump together and the lens becomes cloudy. The team around Gestwicki was now looking for substances that stabilize the protective proteins and thus prevent misfolding.

They found a substance that prevented the formation of protein clots in the laboratory and even dissolved existing lumps. The researchers first tested this substance on genetically modified mice that developed early cataracts due to a cryAB defect. As it turned out, the condition of the lenses could be significantly improved by the treatment within two weeks. In addition, the researchers confirmed the effect also on mice with a cryAA defect as well as on ordinary mice that develop the cataract due to age.

Finally, the scientists tested the substance in the content of eye lenses that had been removed from older people. Again, it was found that the amount of all soluble proteins could be increased, after all, by 18 percent. According to the study authors, the drug may thus be a promising lead to non-surgical therapy, both in hereditary and age-related cataracts.

Cataract treatment: What's new?


According to the Oxford Dictionary, the word "cataract" derives from the Latin word "cataracta", meaning "waterfall", and the Greek word "cataractes", which means "falling down". Cataract is a condition in which there is a progressive clouding of the natural eye lens. The latter works much like the lens of a camera, bundling the light, throwing it onto the retina for a clear view. Moreover, it can change its curvature and refractive power to be able to see clearly at any distance. The eye lens consists mainly of water and crystalline proteins, which are arranged in a precise pattern which causes their transparency. The crystalline proteins clump together, altering their geometric arrangement and forming insoluble amyloids, making the lens dull.

Cataract is the leading cause of blindness worldwide and the leading cause of visual impairment in over-40s. In 2010, 5% of patients aged 50-54 years and 68% of those over 80 years old had cataracts, according to the US National Eye Institute. According to estimates by the association "Prevent Blindness America" ​​in the USA, by the year 2020, 30 million Americans will be suffering from cataracts. Visual impairment results in high costs for both the patient and the healthcare system.

The efficacy of cataract extraction was confirmed in a prospective, longitudinal, population-based cohort study in 190 patients in Sweden with a 15-year follow-up. Fifteen years after surgery, the corrected distance vision had deteriorated on average from 20/20 to 20/25. In elderly patients, the decrease in subjective vision was higher. The most common reason for this was age-related macular degeneration, followed by glaucoma.

Advances in cataract surgery

In the first stages of the disease visual acuity can be improved by using glasses, contact lenses, enlarging with bifocal eyeglasses or adjusting the light intensity. If these non-surgical measures are no longer sufficient, a cataract surgery is required.

Cataract surgery is the most common surgical procedure in the US. According to the American Society of Cataract and Refractive Surgery, more than 3 million surgical procedures are performed every year, with a success rate of at least 98%. Cataract can be removed manually (extracapsular cataract extraction) or by phacoemulsification using radiofrequency ultrasound with or without femtolaser (FL) -assisted surgery. In most cases, an intraocular lens (IOL) is inserted into the capsular bag. Often, the procedure is performed on an outpatient basis.

Today's cataract surgery is safe and effective. Nonetheless, ophthalmologists and industry are constantly striving to optimize results by improving the material of the IOL, the diagnostic instruments, the laser and phacoemulsification technology, or the properties of the IOL.

Recently, the "U.S. Food and Drug Administration (FDA) has approved some FL to assist surgeons in cataract surgery. With their ultra-fast 10-15 second frequency and low energy consumption, they may cause less damage to the surrounding tissue. The lasers can be used to make the first incision on the eye, open the anterior capsule, fragment the lens nucleus, and make precise incisions on the cornea in patients with astigmatism.

They allow for more precise incisions than manual technique, as well as a well-tuned and uniform central capsulotomy with less displacement and tilting of the IOL and better centering, resulting in a more accurate postoperative refraction. In addition, optical coherence tomography (OCT), which is integrated into some FLs, improves operational safety in difficult cases with poor visibility. The use of FL may be particularly useful in patients with endothelial corneal dystrophy, where the least or no ultrasound energy should be used. In the future, the FLs are likely to be smaller and connectable to the surgical microscope, allowing a combination of cataract surgery with corneal and vitreous surgery. Nonetheless, FL can not replace all stages of surgery. The removal of the lens nucleus, rinsing of the cortex and capsule, and the use of the IOL must continue to be performed by a surgeon..

Patient Comments

Maria F.
I felt very well looked after from the beginning to the end of the treatment. The result of my cataract surgery leaves nothing to be desired. I am more than satisfied and can only recommend Dr Ruefer and his entire team!
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Jessica Ford
I had surgery on my right eye a week ago. Unfortunately, the cataracts had progressed so far that I had to accept severe visual impairments in recent years. Dr Bueren felt that cataract surgery was necessary and recommended a multifocal lens to replace my cloudy lens. Even though I'm a big scaredy-cat, I immediately felt that I could trust this Doc. Today I am very grateful to Dr Bueren and the entire team that I can see well again. It really is like a miracle and I am happy to recommend this practice to others.
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Glorian G.
I received an appointment for my cataract surgery as quickly as possible. Everything was very well organized and the staff was very friendly. Thanks to Dr. Mietz's sure manner, I wasn't afraid at all. I could see much better the next day. I had no pain during the operation. The next day I went to Dr. Mietz for a follow-up check, everything was OK and I am very satisfied.
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David D.
On January 7th and 28th, 2021 I went to Dr. Neuhann in Munich for cataract surgery. I would like to thank you again for the very good treatment. Despite many patients, Dr Knothe and his team were very friendly and there was no rush. I felt very comfortable and had great confidence. I am very satisfied with the performance of the surgery and the result and can recommend this practice without reservation.
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Jennifer Daven
Dr. Berens is a very competent and trustworthy ophthalmologist. He always takes the necessary time. Very clear explanation. My husband's cataract surgery was painless, problem-free and without complications with the best results. My mother also received follow-up care after cataract surgery - everything was fine.
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