2023-08-08 11:35:20
Thanks to Dr Damien Gatinel, head of service at the Adolphe de Rothschild Ophthalmological Foundation Hospital
If the cataract is not very disabling at the beginning, once you feel discomfort on a daily basis it is imperative to go through the surgery box. With more than 25 million acts per year, thecataract surgery is the most common surgical intervention … but we rarely go there completely zen. We tell you everything you need to know to approach the operation more serenely.
When is the best time to have cataract surgery?
Cataract is a gradual clouding of the lens (kind of lens located behind the pupil). Often due to age, it results in a somewhat “washed-out” vision, difficulty seeing at night and against the light. Visual acuity declines slowly, but continuously, and only the replacement of the lens by an implant can reverse the process. No need to wait until you can no longer see clearly to have the operation: the intervention is recommended (and effective) as soon as the sight begins to deteriorate. Currently, ophthalmologists tend to operate on patients aged 60 to 70 years old than 80 year olds. Conversely, the intervention is not urgent: the disease progresses slowly, which leaves months to find the date and the right practitioner.
Beyond improving visual function, cataract surgery can also be indicated preventively (to avoid complications leading to glaucoma) or to facilitate examination by the ophthalmologist (cataracts can sometimes prevent an examination satisfactory from the fundus).
How is the surgery performed?
The surgeon generally allows a few weeks to pass between the intervention on the first eye and that on the second eye in order to avoid any risk of infection which would affect both eyes simultaneously. Although this type of infection is treatable, it is better to be careful. Complications are extremely rare (drooping eyelid, hematoma, etc.), more frequent in diabetics, the immunocompromised and those already suffering from a eye condition. An appointment with a anesthesiologist prior to the operation is necessary.
The cataract operation is carried out under local anesthesia and on an outpatient basis: we arrive in the morning and, generally, we can go out the same day. You can’t drive out of the clinic, but the next day.
During Covid-19, we got into the habit of operating on both eyes at the same time to limit the time spent in the hospital and reduce the risk of contamination.
What exactly is the intervention to treat cataracts?
It will involve extracting the cloudy lens and replacing it with an artificial lens – also called intraocular implant -. We are talking about refractive cataract surgery. The operation is performed under local anesthesia.
During the operation, the surgeon makes a small incision of about 2 mm, in the area surrounding the lens. He introduces a small probe there which will aspirate the contents of the crystalline sac before introducing a 6 mm implant, rolled up on itself, which will resume its shape once in the eye. The wound closes immediately, without sutures. Most often it is not necessary to make additional stitches, which reduces the risk of complications. The procedure lasts between 15 and 20 minutes.
Is cataract surgery painful?
The area is anesthetized with drops, and if you are really very anxious, you can have a small injection of sedative to let go. If necessary, we take paracetamol when we leave. It is rarely necessary because we feel more “heaviness” in the eyes than pain.
What results can be expected after cataract surgery?
The period of time depends on the individual, but 48 to 72 hours after the operation, you can really see better. Both colors and contrasts, even when the light is low. Sometimes, the change is even more important because, from now on, the implants can correct a possible myopia, farsightedness or presbyopia.
- L’iclassic monofocal implant makes it possible to correct vision at a defined distance, either near or from afar ; it is particularly indicated for people who do not suffer fromastigmatism.
- L’implant multifocal allows you to correct vision at several distances. It improves far and near vision, without glasses.
- L’toric implant simultaneously corrects astigmatism.
After the operation, severe complications are rare but other complications can occur: displacement of the implant, scar that is not tight enough, visual disturbances… Sometimes, we can observe an opacification of the lens at the back of the eye. implant: we speak of secondary cataract. This leads to a decline in the quality of sight and requires further surgery, most often by laser.
And after the operation, what are the consequences?
We leave the clinic with a plastic shell to protect the eye, to be removed the next morning. After 15 days, the sight is stabilized, we can equip ourselves with adapted glasses. After the operation, we put anti-inflammatory and antibiotic eye drops for 1 month and we can also be recommended to keep the protective shell for the night.
For a week, care must be taken not to rub your eye and not to wear make-up.
After the operation, regular checks are carried out. The first takes place between 2 and 6 days after the operation, a second is organized 1 month after the operation.
Cataract surgery, what treatment?
The cost of the operation depends on the establishment in which it is carried out and the sector of the surgeon. In some cases, the surgery may result in a fee overrun. Doctors in sector 2 may overcharge fees which are not covered by Social Security.
Social Security pays 100% for cataracts – on the condition that the intervention is prescribed by the attending physician -.
For a classic implant, the health insurance covers the surgery, the anesthesia and the implant on a fixed basis of 379 €.
However, there may be a balance if you need a multifocal implant – more complex – which corrects several visual defects at the same time. The coverage of the Health Insurance amounts to 270€ per eye but the cost of this type of implant is higher than that of a classic implant and it is up to the patient to assume the rest; this varies between €50 and €600 per eye. Some mutuals cover part of the costs, it is better to inquire with yours.
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