Cataracts are one of the leading causes of blindness, affecting millions of people globally.
Moreover, you're more likely to get them as you get older, so everyone should be informed about the condition! Read on to find out more about:
- what a cataract is,
- the 3 types of cataracts,
- the common causes of cataracts,
- the treatments available,
- possible complications after surgery,
- the costs of treatment.
A cataract forms when the naturally clear lens in the eye becomes cloudy or opaque as a result of its proteins breaking down and clumping together. As a result, you will experience blurry or decreased vision. Contrast and colour perception may also be affected during the early stages.
As you age, you become more likely to get the condition . In fact, those who are aged 40 and above have an increased risk of developing cataracts.
In Singapore, older age groups have a higher proportion of cataract sufferers:
- 45 to 59 years old: >30% of demographic
- 60 to 69 years old: ~80% of demographic
- Above 70 years old: ~95% of demographic
According to a study, Malays in Singapore have a higher chance of getting cataracts than their Chinese and Indian peers . The same study also showed that up to 68.8% of Singaporean adults have a visually significant cataract that they are not even aware of.
The study was done on people above 40 years old across ethnicities.
There are 3 main types of cataracts. To list, they are :
These are the most common type of cataracts that are associated with old age. Often, patients with nuclear cataracts experience a gradual loss of vision, which progresses slowly. It may take several years before it affects your vision.
Some patients may experience an increase in their level of short-sightedness, also known as myopia.
Posterior subcapsular cataracts
These arise when an opaque area forms at the back of the lens. They can occur in individuals who are on prolonged use of steroids and/or who have diabetes.
Posterior subcapsular cataracts are more common in younger adults, and the effect on vision occurs at an earlier stage of the cataract's development.
These arise when spoke-like opacity occurs on the cortex or periphery of your eye lens. However, the opacity does not stop there, and will work its way to the centre.
Apart from blurry vision, these type of cataracts can lead to problems related to glare or increase in far-sightedness.
A cataract is largely an age-related condition , so those over the age of 40 should pay increased attention to their eyesight.
As a way of prevention, you should go for regular eye check-ups nevertheless.
How do I know if I have a cataract?
Early stages of cataract may have minimal or no symptoms . However, as the condition advances, you may notice that your vision is being gradually affected.
In some severe cases, it may be hard to complete daily tasks such as reading or recognising street signs.
- Cloudy, hazy, misty or blurry vision
- Seeing a "film" over the eye, i.e. a brown or yellow tinge to your vision
- Halo effects caused by bright or glaring lights
- Difficulty in seeing at night
- Colours look faded
- Double vision
- Frequent changes in your eyeglass prescription
If you are experiencing any of these signs, be sure to consult an eye doctor.
Note that cataracts are usually not painful. In fact, they hardly cause discomfort to the eye. However, in some cases they are linked to increased intraocular pressure, leading to symptoms of pain and nausea.
What are the ways to diagnose cataracts?
In my practice, here are the ways I diagnose a cataract:
- Review symptoms and medical history
- Visual acuity test
- Slit lamp examination
- Pupil dilation
- Retinal exam
The slit lamp examination is a test to confirm if there are cataracts in your eye.
After eye drops are used to dilate the pupil of your eye, the doctor uses a slit lamp to look for signs of a cataract. The doctor will also check for any other eye conditions .
Should I check for cataracts only?
If and when you are in your 40s, be sure to go for regular eye check-ups. Apart from cataracts, there are other conditions that may affect your vision. They include:
- retinal tears,
- refractive errors and
- macular degeneration.
Hence, it is better to have a full eye check-up! Other conditions can be addressed together with the cataract during surgery.
Can I leave my cataract untreated?
So, when is a good time to have surgery?
You may delay surgery if your cataract is in its early stages, but should get surgery if the cataract is impairing your vision so much that it disrupts your daily activities.
Cataracts can also affect your spectacle prescription. Therefore, be sure to have your vision checked if you notice a change in your prescription.
It may take several years before it becomes difficult for you to go about your daily tasks.
The progression is irreversible, but it can be slowed down.
Here are some tips that can help decelerate it:
Consult your eye doctor regularly
Early diagnosis allows for better management of cataracts.
Eat a balanced diet
Be sure to include these in your diet:
- leafy vegetables;
- whole grains and nuts;
- citrus fruits; and
- fish that is rich in omega-3 fatty acids.
Wear proper headgear and eyewear
Headgear such as caps with long visors, wide-brimmed hats or eyewear like sunglasses with UV ray protection can help protect your eyes from the sun .
Cut alcohol intake and smoking
Always consume alcohol in moderation. Smoking may speed up the deterioration as it reduces blood and oxygen supply to the eyes, leading to the accumulation of heavy metals in lenses. This results in the early formation of cataracts .
Declare prescribed medication
Be sure to inform your doctor about the medications that you are on. This is to ensure that they do not have side effects relating to cataract development.
Additionally, if you have diabetes, you should inform the doctor about your condition.
What are the different types of cataract surgeries?
Micro-incision phacoemulsification surgery
This involves using ultrasound energy to liquefy the cataract in the lens of the eye. The emulsified cataract will be removed through a small 2-3mm incision.
As the wounds are self-healing, sutures are often not required. The small incision allows for faster recovery and lower rates of infection.
Extracapsular Cataract Extraction (ECCE)
ECCE is for those who have hard and dense cataracts. It involves a larger incision in the cornea to remove the lens as a whole.
Through this incision, the surgeon opens the lens capsule, removes the lens and leaves the capsule in place.
This approach may be used if your cataract has advanced to the point where phacoemulsification is unable to break up the clouded lens.
Laser-assisted cataract surgery
Adopting the same technology used in LASIK, this procedure involves the use of a femtosecond laser to create the incision and fragment the cataract.
Some surgeons deem laser-assisted surgery as :
- minimally invasive;
- favourable for improved wound construction;
- allowing for more accurate lens positioning; and
- ideal for complex surgeries.
Too long and you're only curious about the cost? Read: LASIK Costs In Singapore: An Eye Doctor Tells All
The different types of lenses used in cataract surgeries
There are broadly 2 types of intraocular lens (IOLs):
Considered the standard IOL, it has one focusing distance for near, mid or distance vision .
A majority of patients have them set to offer a clear distance vision. With that, they will require reading glasses to do close work.
For multifocal lenses, the IOL has different optical powers in different areas, providing both distance and near focus vision simultaneously. Multifocal lenses can correct presbyopia.
Besides monofocal and multifocal lenses, there are also toric lenses, which help address astigmatism .
Astigmatism occurs when the cornea or lens is irregularly shaped. Toric IOLs have different powers in different meridians of the lens. When properly aligned, they can provide optimal correction for those with astigmatism.
Although uncommon, it is possible for a small percentage of patients to have residual refractive errors after surgery regardless of the type of IOL used. If so, the patient can still opt to use glasses, contact lenses or consider having laser vision correction such as LASIK.
What happens during cataract surgery?
Done in a hospital setting, the cataract surgery takes roughly 30 minutes for one eye . Some surgeons may operate on both eyes on the same day.
On the other hand, some may prefer to work on each eye on separate days so as to minimise the risk of surgery to one eye at a time.
Before an anaesthetist administers intravenous sedation to help you relax or fall asleep, you must undergo a pre-op electrocardiography and blood test to ensure that your body is suitable for sedation.
Anaesthetic eye drops will be applied to numb your eye and ensure your comfort. However, you might feel coldness and pressure around your eyes and eyelids.
Most patients find the whole procedure to be relatively painless.
On the day of surgery
Before the surgery, you are required to fast for at least 6 hours.
As you will be staying for a least half a day in the hospital, do make arrangements for someone to take you home after surgery; you should not drive.
After the surgery, your eyes may be sensitive to bright lights. Hence, do bring sunglasses to protect your eyes after being discharged.
With advances in technology, cataract surgery can be considered low risk. Infection occurs in about 1 in 1,000 people .
Other side effects include:
- Dry eyes
- Night vision problems (glares, haloes, etc.)
These 2 side effects can last up to 3 months.
On top of that, there are some very rare but serious complications that require immediate medical attention. They include :
- Endophthalmitis — happens when bacteria gets into the eye, causing an infection. If left untreated, it can cause vision loss. You will require urgent care.
- Posterior capsular rupture — happens when some fragments of the cataract fall to the back of the eye. When this occurs, you may need another surgery.
- Posterior capsular opacification — may occur a few months or even years after the surgery. It happens when the cells grow towards the back of the lens capsule, causing it to thicken and become cloudy. If vision is affected, a treatment option is YAG laser capsulotomy, a 5-minute laser procedure that restores normal vision to patients by the next day.
As mentioned earlier, complications are rare. That said, it is very important to monitor your condition. If you get blurry vision, swelling, or pain after cataract surgery, do see your eye surgeon as soon as possible.
In the first 24 hours:
- Avoid reading and use of electronic devices
- Do not drive or operate heavy machinery
- Sleep as much as possible
In the first week:
- Use the provided eye shields when you sleep
- Avoid travelling
- Stay away from dusty and smoky areas to prevent eye irritation
In the first 2 weeks:
- Stay indoors as much as possible
- Wear sunglasses when you are outdoors
- Wash your hair with care to prevent water from getting into your eyes
- Do not use eye makeup
- Avoid cooking
In the first month:
- Avoid swimming, hot tubs, hot yoga, jacuzzis and saunas
- Avoid contact sports and heavy lifting
- Use a headband when you exercise to prevent sweat from getting into your eyes
- Follow all instructions from your doctor, especially with regards to medication
There are a few factors that will affect the cost:
- Private or public hospital
- The complexity of your condition
- Seniority and experience of your surgeon
- Number and type of assessments conducted
- Type of IOL used
- Type of medication prescribed
Singaporeans who are eligible for the subsidised price should expect to pay around S$1,200 to S$1,300 for each eye.
On the other hand, you can expect to pay S$4,000 to S$5,500 for each eye without government subsidy.
These amounts are inclusive of the operation fee and the implant, as well as other fees such as the for the facilities and anaesthetics. For more information, check out the MOH website.
The range can vary from S$4,500 to S$10,000 per eye. The fee is broken down into:
Cataract surgery (1 eye)
Can I use Medisave and insurance for cataract surgery?
You can claim up to S$2,450 per eye from your Medisave account. You can also tap your spouse's or child's Medisave account to pay for the surgery.
On top of that, most private insurance policies provide coverage for cataract surgery. The amount will depend on your exact policy, so do check with your agent or provider.
Which doctor should I go to for cataract surgery in Singapore?
When you are considering your options, take note of:
- Your surgeon's willingness to listen to your needs and expectations
- Whether or not he/she is able to provide an unbiased consultation
- The range of treatment available in the clinic. You should check out all the treatment options. The approach to your treatment should be customisable and individualised to your needs.
- Transparency in pricing
- Any hard-selling/upselling
- Experience and credentials of your surgeon and the clinic
All in all, the most important thing is to find an eye surgeon that you can trust. If necessary, you can also get quotes and consultation from different clinics.
Your eyesight is precious, so you should do research and get consultations before choosing the doctor and treatment. This is to ensure you get a positive outcome and better vision.
Dr David Chan is the medical director of Atlas Eye Specialist Centre. He has been in ophthalmology practice since 1999. Dr Chan was previously a surgical instructor at the Singapore National Eye Centre and the University of Calgary, Canada. In his free time, he enjoys digital photography.
Would you like to ask any related health questions?
1. Cataracts | National Eye Institute. Nih.gov. Published 2019. Accessed November 22, 2019.
2. Chua J, Lim B, Fenwick EK, et al. Prevalence, Risk Factors, and Impact of Undiagnosed Visually Significant Cataract: The Singapore Epidemiology of Eye Diseases Study. Pan C-W, ed. PLOS ONE. 2017;12(1):e0170804. doi:10.1371/journal.pone.0170804
3. Allen D, Vasavada A. Cataract and surgery for cataract. BMJ. 2006;333(7559):128-132. doi:10.1136/bmj.333.7559.128
4. Vashist P, Talwar B, Gogoi M, et al. Prevalence of Cataract in an Older Population in India. Ophthalmology. 2011;118(2):272-278.e2. doi:10.1016/j.ophtha.2010.05.020
5. Cataracts - Symptoms and causes. Mayo Clinic. Published 2018. Accessed November 22, 2019.
6. Cataracts. Vic.gov.au. Published 2012. Accessed November 22, 2019.
7. Liu X, Jiang J, Zhang K, et al. Localization and diagnosis framework for pediatric cataracts based on slit-lamp images using deep features of a convolutional neural network. Pan C-W, ed. PLOS ONE. 2017;12(3):e0168606. doi:10.1371/journal.pone.0168606
8. Recognizing Cataracts. NIH News in Health. Published May 30, 2017. Accessed November 22, 2019.
10. Ali M, Javaid M, Jamal S, Butt N. Femtosecond laser assisted cataract surgery, beginning of a new era in cataract surgery. Oman Journal of Ophthalmology. 2015;8(3):141. doi:10.4103/0974-620x.169892
11. de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews. December 2016. doi:10.1002/14651858.cd003169.pub4
12. Milasi A, Razmjoo H, Ghoreishi M, et al. Toric Intraocular Lens for Astigmatism Correction in Cataract Patients. Advanced Biomedical Research. 2017;6(1):123. doi:10.4103/2277-9175.216777
13. Woodcock M. Recent advances in customising cataract surgery. BMJ. 2004;328(7431):92-96. doi:10.1136/bmj.328.7431.92
14. Stein JD. Serious adverse events after cataract surgery. Current Opinion in Ophthalmology. 2012;23(3):219-225. doi:10.1097/icu.0b013e3283524068