Cataract Surgery in Turkey

Cataract surgery is a procedure in which the natural lens of the eye, which has lost its transparency and become cloudy, is carefully removed using microsurgical techniques and replaced with a transparent artificial intraocular lens that focuses light correctly. Cataract treatment, which enables the optical system that has deteriorated over time to be repaired, greatly helps individuals perceive their surroundings clearly again. Planned to support eye health and allow people to continue their lives actively, this operation offers patients a comfortable recovery process thanks to the opportunities provided by current medical technologies. The intervention, which aims to prevent a decline in visual quality, is a highly important medical solution that contributes to individuals returning to their daily lives independently and safely.

What Is Cataract Surgery?

If we compare the structure of the eye to a camera, the natural lens where the cataract develops is a very important lens located at the front of this camera and serves to focus incoming light. During youth, this lens is highly flexible and as transparent as glass, allowing incoming rays to fall clearly and directly onto the nerve layer at the back of the eye. However, due to factors such as advancing age, many years of exposure to the sun’s ultraviolet rays, diabetes, previous trauma, or long-term use of certain medications, the protein structure inside this lens begins to change. As a result of this structural change, the lens first becomes slightly yellow, then loses its flexibility, hardens, and gradually becomes cloudy.

Because light cannot easily pass through this clouded layer and reach the back of the eye, vision gradually becomes blurred. Colors lose their former vividness and take on a pale, yellowish appearance. When driving at night, the headlights of oncoming vehicles begin to cause much more glare than before, and stronger lighting is needed while reading. This is not a process that can be reversed simply by changing eyeglass prescriptions or using various eye drops. The most established and permanent treatment for this clouded tissue is to replace the nonfunctional lens with a transparent artificial lens through a surgical intervention.

When and How Should the Decision for Cataract Surgery Be Made?

With older surgical methods used in previous years, the lens was expected to become very hard, in other words, the cataract was expected to fully mature before surgery could be performed. However, this old approach has been abandoned in today’s modern microsurgical methods. In fact, waiting for the cataract to become excessively hard before intervention may technically make the surgical procedure more difficult and may undesirably prolong the recovery process.

Today, the most appropriate time for intervention is when the decline in visual quality begins to restrict a person’s daily life activities. If a person has difficulty reading books or newspapers, cannot distinguish subtitles on television, experiences problems with depth perception when going up or down stairs, or has safety concerns while driving at night, the time for intervention may have arrived. The decision is made when the patient’s social life, occupational needs, visual expectations, and examination findings are evaluated together. Because visual loss progresses slowly and insidiously, individuals may sometimes become accustomed to the condition and fail to recognize the seriousness of the problem. Therefore, regular eye examinations are of great importance for monitoring the progression of the process and determining the most appropriate timing for surgery.

Why Are Eye Measurements Performed Before Cataract Surgery Critical?

The foundation of a successful operation lies not only in the surgical stage but also in the meticulous measurements and evaluations performed beforehand. The eye structure of every individual is completely unique, just like a fingerprint. The curvature of the transparent layer at the front of the eye, the depth of the anterior chamber, and the total length of the eye from front to back must be measured with very high precision. These measurements are performed quickly and without any contact with the eye using advanced laser devices called optical coherence biometry.

The power of the artificial lens to be placed inside the eye is calculated using the obtained data and special mathematical formulas. In individuals whose eye length is longer or shorter than normal, new-generation calculation formulas are used to minimize the need for distance glasses afterward. In addition, if structural astigmatism is present, a map of the cornea is created and it is planned how this astigmatism can be corrected with the lens. At this stage, not only machine measurements are performed; the supporting structures of the eye, cellular structure, and the dilation capacity of the pupil are also examined in detail under a microscope. In this way, anatomical difficulties that may be encountered during surgery are anticipated and a personalized surgical strategy is determined. The main elements evaluated during this process are as follows:

• Corneal thickness
• Corneal curvature
• Axial length
• Anterior chamber depth
• Lens thickness
• Degree of astigmatism
• Intraocular pressure
• Endothelial cell density
• Pupil diameter
• Retinal health
• Macular condition

How Is the Intraocular Lens Selected During Cataract Surgery?

After the clouded natural lens inside the eye is removed, artificial lenses placed into this space are manufactured from special biocompatible materials. These lenses provide a high level of compatibility with tissues and are generally designed to remain in the eye for life while maintaining their transparency. There are lens designs with different features that can be preferred according to the patient’s lifestyle and eye structure. Monofocal lenses support clear distance vision but may require the use of reading glasses for intermediate and near distances.

Newer-generation lenses with extended depth of focus provide clarity at intermediate distances such as computer distance or vehicle dashboards and offer significant convenience in daily life. Trifocal smart lenses, on the other hand, aim to provide clear vision at distance, intermediate, and near ranges simultaneously, with the goal of making the patient largely independent of glasses. If significant corneal astigmatism is present, this problem can also be corrected during the same surgical session thanks to toric designs integrated into the lenses. Lens selection is made through a joint decision by considering the individual’s hobbies, occupation, frequency of night driving, and overall retinal health. The types of lenses that may be preferred are as follows:

• Monofocal lenses
• EDOF lenses
• Trifocal lenses
• Toric lenses
• Aspheric lenses
• Hydrophobic lenses
• Hydrophilic lenses

How Is Sutureless Cataract Surgery Performed with the Phaco Method?

In current practice, the technique that forms the basis of surgery is phacoemulsification, which makes use of the power of sound waves. This procedure is based on microsurgical principles, generally does not require sutures, and is extremely tissue-friendly. The process begins painlessly with anesthetic drops applied to the eye; except in special or necessary circumstances, injectable anesthesia or general anesthesia is not required. After the eye is thoroughly numbed, a very small incision of approximately two millimeters is made at the edge of the cornea to enter the anterior chamber. Transparent, gel-like supportive substances are injected into the eye to protect the internal structures and maintain its natural form.

Next, a circular opening is created on the front surface of the membrane-like capsule surrounding the cataractous lens. Using the gentle force of water, the lens is freed from the capsule in which it is located. At this exact stage, the special phaco device comes into action. A thin, pen-like instrument that emits ultrasonic vibrations from its tip divides the hardened cataractous lens into small pieces inside the eye in a controlled manner and emulsifies it. At the same time, the device supplies fluid into the eye to balance intraocular pressure and removes these emulsified particles by vacuum. After the interior is carefully cleaned, a transparent and emptied natural capsule membrane remains. The new foldable artificial intraocular lens is advanced into the eye through the same small incision using a special injector system. Once inside the eye, the lens slowly unfolds on its own and settles securely in the center of the natural capsule. After the protective gels inside the eye are removed, fluid is applied to the incision sites to support the tissues in sealing themselves.

What Innovations Has Femtosecond Laser Technology Brought to the Cataract Surgery Process?

Rapid technological developments in medicine have also introduced femtosecond laser-assisted surgical systems in addition to conventional methods. In this advanced technology, certain delicate steps that are manually performed by hand are carried out by a computer-controlled laser system. Before the patient even moves to the standard operating table, the entry incisions in the cornea are created with micrometer precision without the use of a blade, with the help of the laser device. The circular opening that must be created on the capsule of the natural lens is prepared by the device with very high symmetry.

This symmetry provides important advantages, particularly in ensuring that multifocal or astigmatism-correcting lenses are placed in a balanced and precisely centered position inside the eye. Another important function of the laser is to divide the intact hard cataract into small pieces using harmless externally delivered laser beams before any instrument enters the eye. Because the initial fragmentation is performed by the machine, less ultrasound energy is used inside the eye when cleaning is subsequently performed with the phaco device. Reduced ultrasound energy helps protect the delicate corneal layer more effectively and supports faster recovery. The main innovations offered by this laser system are as follows:

• Blade-free incisions
• Automated capsulotomy
• Laser nucleus fragmentation
• Reduced ultrasound use
• Corneal endothelial protection
• Astigmatism-correcting incisions
• Precise lens centration
• Computer-assisted planning
• Low tissue trauma

Can Glaucoma and Cataract Surgery Be Performed at the Same Time?

Because cataracts generally become more pronounced with advancing age, some individuals may also have glaucoma, commonly known as high eye pressure, at the same time. Glaucoma is a condition in which pressure increases because the fluid inside the eye cannot drain sufficiently and gradually places pressure on the optic nerve. If a person has both conditions, advanced surgical techniques generally make it possible to address both during a single surgical session.

Along with removing the cataract and implanting the artificial lens, microchannels can be created or special tiny tubes can be placed to facilitate the drainage of excess fluid from inside the eye. Due to the nature of the operation, when the age-related thickened cataractous lens is removed and replaced with a much thinner artificial lens, the anterior chamber of the eye becomes somewhat wider and the pathways through which fluid circulates naturally become more open. This alone may provide a mild beneficial reduction in intraocular pressure. In cases where it is considered necessary, special drainage procedures added to the operation may significantly reduce the number of pressure-lowering drops required afterward or allow the pressure to be controlled much more stably.

How Long Does Cataract Surgery Take and What Should the Patient Expect?

The surgical process can generally be described as a calm, comfortable, and relatively short experience for patients. Thanks to surface anesthesia provided only with eye drops, the person remains awake during the procedure and can hear conversations around them, but generally does not feel pain or discomfort in the eye. A delicate wire device is placed around the eye to prevent the eyelids from blinking involuntarily as a reflex.

The procedure itself, although dependent on the hardness of the cataract and the anatomical condition of the eye, is usually completed within a relatively short period of approximately fifteen to thirty minutes. Throughout the surgery, the person mainly perceives the bright light of the microscope and may see moving shadows or color changes caused by fluids; the fine instruments used cannot be seen clearly. A slight pressure sensation caused by the supportive fluids introduced into the eye during the procedure is expected and normal. After the intervention is completed, the eye is generally covered with a protective transparent bandage or shield. Without the need for prolonged hospitalization, individuals can walk home after a short period of rest. Resting calmly at home on the day of surgery and avoiding physical exhaustion contributes positively to the body’s healing process.

What Should Be Considered During the Recovery Process After Cataract Surgery?

Thanks to the advantages offered by modern and sutureless methods, the initial recovery process after surgery progresses quite rapidly. When the protective bandage is removed the next day, a noticeable improvement in brightness and visual comfort is experienced. However, because a microscopic intervention has been performed inside the eye, it takes several weeks for the tissues to settle and for the new lens to adapt to the surrounding tissues.

The most important issue to pay attention to during this period is using the prescribed eye drops very carefully according to their scheduled times. The drops are given to suppress the risk of infection and balance the tissues’ natural healing response. During the first few days, it is very important to prevent tap water or soap from entering the eye and to tilt the head backward while bathing. Scratching the eye or applying physical pressure to it must definitely be avoided. Regular rest and attention to the hygiene rules specified by the physician are the main keys to an uncomplicated recovery. The daily rules recommended during the recovery process are as follows:

• Regular use of eye drops
• Not rubbing the eye
• Not scratching the eye
• Preventing water from entering the eye
• Avoiding contact with soap
• Not lifting heavy objects
• Not sleeping face down
• Avoiding strenuous sports
• Staying away from dusty environments
• Using glasses in windy weather
• Not applying eye makeup
• Not swimming in pools or the sea

What Conditions May Be Encountered During the Recovery Period After Cataract Surgery?

As with every surgical procedure, certain normal bodily reactions may occur after eye surgery. Due to the drops used and the ultrasonic interactions during the procedure, very mild fluid retention may develop in the corneal layer. Although this may cause vision to feel as though one is looking through foggy glass during the first few days, vision becomes clearer within days as the tissues recover.

As the tiny incisions made on the surface of the eye heal, individuals may experience a slight stinging sensation as if a fine particle of dust or an eyelash has entered the eye. In addition, because light enters the eye much more intensely and without the previous filtering effect thanks to the newly implanted transparent lens, noticeable sensitivity to light during the first few days is normal. It is also common for colors that appeared yellowish for years because of the clouded lens to be perceived as much more vivid, bright, and slightly bluish after surgery. All these processes are expected parts of the brain and eye adapting to the new clear visual state. Normal conditions that may be experienced during this adaptation period include:

• Mild stinging sensation
• Foreign body sensation
• Watery eyes
• Light sensitivity
• Colors appearing very bright
• Temporary blurred vision
• Mild discharge in the mornings
• Eye redness
• Dry eyes
• Halos around lights
• Wavy vision

What Is Secondary Cataract After Cataract Surgery and How Is It Treated?

In the months or years following treatment, some patients may notice that their vision is gradually becoming cloudy again and may understandably worry that “my cataract has returned.” However, once cataract tissue has been removed from the body, it is not possible for it to form again. The condition known as “secondary cataract,” or medically as “posterior capsule opacification,” has a completely different basis.

During the procedure, microscopic epithelial cells may multiply over time on the transparent natural capsule membrane that is intentionally left in place to support the artificial lens placed inside it, causing thickening. While the artificial lens maintains its own transparency, this thin membrane immediately behind it becomes cloudy, preventing light from passing easily to the back of the eye again and causing a decline in vision. From a medical perspective, this is a very common condition and its treatment is highly practical. The patient does not need to return to the operating room or have another incision made in the eye. In a standard examination room, after anesthetic drops are applied to the eye, a permanent and clear opening is created in the clouded membrane within a short time using a special laser device. Thanks to this practical procedure, during which the individual generally feels no pain and which takes only a few minutes, clear vision is restored within a very short period.

What Should Patients with High Myopia Pay Attention to During the Cataract Surgery Process?

Patients with high myopia, whose eyes are longer from front to back than normal values, require a somewhat more meticulous examination during the surgical process due to their structural characteristics. In these individuals, the retinal layer covering the inner surface of the eye may be anatomically more stretched, thinner, and more sensitive. During surgery, removing the bulky natural lens that has been present in the eye for years and replacing it with a much thinner artificial lens may cause the gel-like fluid inside the eye to shift forward.

Because this movement may cause traction on previously weakened retinal tissue, it is extremely important for individuals with high myopia to have their pupils dilated before the procedure so that the retinal layers can be examined down to the finest detail. If a thin, weak, or tear-prone area is detected, these regions can be strengthened and secured with laser treatment a reasonable period before the cataract intervention. After the procedure, these individuals are also thoroughly informed that they should undergo an eye examination without delay if they suddenly notice flashes of light or numerous floating black spots in their vision. With regular follow-up and a meticulous preparation process, patients with high myopia can also achieve highly effective and safe results from this treatment.