Dr. Chameen Sams

Cataract and RLE 

Blurry Vision | Near-sightedness | Farsightedness

What is Cataract ​?

A cataract is a condition where the normally clear eye lens is clouded. It can interfere with a person’s ability to carry out usual activities easily, like driving a car, having difficulty reading, etc. Although very common in people above 60 years of age, it can also be found in some younger children. Some babies are even born with congenital cataracts. Cataracts can be found in one or both eyes at the same time. If left untreated for long, it can result in blindness.

Cataract surgery involves breaking up the affected lens using ultrasound, laser, or micro-incision technique, removing the broken pieces from the eye, and inserting an artificial replacement lens accurately in the eye. The procedure lasts for about thirty minutes.

RLE, or Refractive Lens Exchange, uses the same technique to remove a dysfunctional natural eye lens (without cataracts) and replace it with IOL or an artificial intraocular lens to correct vision.

What Are the Symptoms of Cataracts? 

For people who have cataracts may experience a series of symptoms including: 

  • Clouded, blurred, or dim vision 
  • Fading or yellowing of colours 
  • Double vision in one eye 
  • Need for brighter light for reading and other activities 
  • Sensitivity to light and glare 
  • Trouble seeing at night 
  • Seeing “halo” around lights 
  • Frequent changes in eyeglass  

At first, clouded or blurred vision might seem like a need for prescription change but if you notice sudden vision changes like sensitivity to light, sudden eye pain, or a headache, you might be having a cataract and it’s best to see an eye doctor for an evaluation ASAP.  

What are the Stages of Cataracts?   

Regardless of the type, all the cataracts progress through four stages: early, immature, mature, and hypermature. These stages also help an ophthalmologist or an eye surgeon to understand the severity of the cataract and guide treatment decisions. 

Stage 1: Early Cataracts 

Early cataracts are usually not severe. It occurs at a young age and causes minimal symptoms such as slightly blurred vision, increased sensitivity to light, and mild or frequent eye strain. In early cataracts, the lens remains mostly clear and the symptoms can be managed using brighter lighting when reading and wearing sunglasses to reduce glare. 

Stage 2: Immature Cataracts 

Immature cataracts occur when an individual starts experiencing partial clouding. It happens when proteins in the eye start to group and cause more noticeable symptoms, such as fading or dulling of colours, difficulty seeing in low light or at night, more blurred vision, increased flare or halos around lights that begin to interfere with daily activities. In this case, eye doctors may prescribe eyeglasses with anti glare features. While using brighter lights at work and home reduces eye strain, wearing contact lenses may also help improve night vision. However, cataracts will continue to progress. 

Stage 3: Mature Cataracts 

At this stage, the lens becomes visibly cloudy and light doesn’t pass through, causing severe vision impairment. With symptoms such as significant vision loss, difficulty reading or driving, trouble distinguishing colours, halos around lights, and double vision, the quality of life is severely compromised. And unlike immature cataracts, at this stage, the eye doctors recommend cataract surgery rather than prescribing eyeglasses. Consulting with an eye surgeon like Dr. Chameen Samarawickrama can help determine the best treatment options and intraocular lens (IOL) selection to support your vision goals.  

Stage 4: Hypermature Cataracts 

Hypermature cataracts are more complex and can cause potential complications like glaucoma or lens dislocation if not addressed soon. In this condition, the cataract becomes dense and the lens may begin to shrink, causing inflammation and increasing intraocular pressure. Also, eye surgery is critical at this stage to restore vision. However, hypermature cataracts are not easy to operate. Symptoms of hypermature cataracts include reduced vision acuity, eye pain or redness, severely impaired vision, and a white or milky appearance of the pupil.  

Types of Cataracts? 

There are six types of cataracts, based on their cause and location within the eye’s lens. 

  • Nuclear Cataracts

Commonly occurring at an old age, nuclear cataracts form in the centre of the lens. It affects the colour perception and clarity of the lens by causing gradual yellowing or browning of the lens. Also, it may initially improve close-up vision but worsens over time. 

  • Cortical Cataracts

Cortical cataracts often occur in people suffering from diabetes. In this condition, the cortex of the lens appears to be white with wedge-like streaks or spokes and moves inward. People with cortical cataracts often cause light sensitivity and difficulty with night vision and glare. 

  • Posterior Subcapsular Cataracts

Another type of cataracts is posterior subcapsular cataracts which is more common in younger individuals, people with diabetes, and those on long-term steroid use. This type of cataract develops at the back of the lens, near the capsule that holds it in place. It develops quickly and affects near vision. Other symptoms of posterior cataract include difficulty with glare and seeing halos around lights. 

  • Congenital Cataracts

Congenital cataracts or paediatric cataracts affect babies. It either presents at birth or develops in early childhood due to genetic causes, infections during pregnancy, or metabolic disorders. To prevent vision impairment, early surgery is recommended. 

  • Traumatic Cataracts

Traumatic cataracts usually develop after an eye injury caused by blunt force, penetration, or chemical exposure. It forms immediately or years after the trauma. 

  • Secondary Cataracts

Secondary cataracts can be caused due to diseases or medical complications. It can also occur after cataract surgery and require laser treatment. Diseases like diabetes, glaucoma, and prolonged steroid use are often linked to the development of secondary cataracts. 

Treatment of Cataracts   

Cataracts cannot be reversed but can be managed to stop further progression. A few treatment procedures include: 

  • Treatment at Early Stage of Cataract

If the symptoms are mild, the cataracts can be treated without eye surgery. Stronger glasses and Contacts can be used to improve vision while better lighting is recommended to reduce eye strain. Most ophthalmologists also prescribe anti-glare lenses to minimize the glare and magnifying glasses to help with detailed tasks. Also, making a few lifestyle changes like taking a healthy diet rich in oxidants, quitting smoking, and managing diabetes can slow the progression.  

  • Cataract Surgery

When the symptoms become severe and start affecting the quality of life, surgery is the only permanent solution to treat cataracts. Two types of surgery include: 

  • Phacoemulsification (Phaco Surgery): This procedure ensures quick recovery with minimal complications. Most common to perform, phacoemulsification is minimally invasive and uses ultrasound waves to break up the cloudy lens, which is then removed and replaced with an artificial intraocular lens (IOL).  
  • Extracapsular Cataract Extraction (ECCE): ECCE is performed when the cataract problem is dense and advanced. In this procedure, a larger incision is made to remove the lens in one piece before placing the IOL. Also, it takes longer than Phaco surgery to recover.   
  • Laser Cataract Surgery

Laser cataract surgery is performed when an individual is unable to see, read, or judge clearly. During this surgery, a laser is used to create precise incisions and soften the lens for removal. Also, it is more accurate but costlier than traditional methods of removing the cataract. 

Whatever surgery you undergo, it is important to follow the post-surgery care tips which include regular use of eye drops to prevent infection and inflammation, avoiding strenuous activities like heavy lifting or rubbing the eye, and regular follow-ups to monitor healing and ensure proper vision correction. However, if you experience worsening symptoms and don’t know which cataract surgery is the best for you, contact Dr. Chameen Samarawickrama to determine the best treatment plan.  

Who is at Risk of Cataracts?   

Though cataracts can affect anyone, they mostly affect people over 60. But old age isn’t the only cause of developing cataracts, people with poor lifestyle, poor nutrition, smoking and drinking habits, and those who experience prolonged sun exposure remain at risk. Family history of cataracts could also be the reason for many people. For instance, some infants are born with congenital cataracts due to genetic disorders.  

On the other hand, medical conditions like diabetes, hypertension, and obesity and long-term use of medications especially steroids, cholesterol-lowering drugs, and hormone therapy can also cause cataracts in young people.  

What is Refractive Lens Exchange (RLE)?

Refractive Lens Exchange or RLE is the procedure of replacing the eye lens with an artificial intraocular lens in order to improve vision. Though it sounds like cataract surgery, it isn’t. It is performed to reduce the dependence on eye glasses or contact lenses.  

It is usually performed on people with Presbyopia, a condition where an individual faces difficulty focusing on near objects, people with Hyperopia where LASIK or PRK isn’t suitable, patients with early cataracts to prevent future cataract development and people with thin corneas.  

In the RLE procedure, the numbing drops are first applied on the eyes to ensure a painless experience and then an incision is made at the edge of the cornea to remove natural lens through phacoemulsification. Later, the IOL is inserted. Different types of IOLs can be used: 

  • Monofocal Lenses – Clear vision at one distance. 
  • Multifocal Lenses – Correct near, intermediate, and distance vision. 
  • Toric Lenses – Correct astigmatism. 

Benefits of RLE  

Refractive Lens Exchange is an excellent alternative to LASIK surgeries. Whether you have a thin cornea or have hyperopia and other eye conditions, RLE offers transformative benefits and turns your life around. A few benefits of RLE are: 

  • Quick Recovery 
  • Reduces or eliminates the need for glasses 
  • Can correct Presbyopia 
  • No risk of losing corrective effect 
  • Doesn’t alter corneal thickness 
  • No need of cataract surgery in eyes treated with RLE in the future 

Risks & Complications   

Whenever a surgical procedure is performed, it automatically comes with certain risks. RLE is also a surgical procedure that implants IOLs deeper in the eye and can cause significant risks, such as: 

  • Infection 
  • Glaucoma 
  • Under-correction 
  • IOL dislocation 
  • Over-correction 
  • Retinal detachment 
  • Bleeding 
  • Posterior capsular occlusion (i.e., a new cataract forms) 

Are You the Right Candidate for Cataract/RLE Surgery?

If you have blurry vision or want to get rid of contact lenses or glasses for good, cataract/RLE surgery is the answer to all your problems. However, surgery is not recommended for you if you have a detached retina, advanced macular degeneration, and are less than 21 years of age. 

For Cataract Surgery:

  1. Blurry vision, increased color distortion, or impaired depth perception
  2. No medical conditions that interfere with wound healing
  3. Patients with autoimmune diseases
  4. Patients with lupus, diabetes, rheumatoid arthritis, or glaucoma

For RLE Surgery:

  1. Around 40 years or older
  2. Stable vision for at least six months
  3. No history of eye disease
  4. Do not qualify for laser vision correction treatments like LASIK

Estimated Cost Involved

Cataract surgery’s cost depends on a few factors like the condition of the eye, whether only one or both eyes are affected, etc. However, the costs average around $1600 – $3500 per eye. Some insurances do cover this condition and can thereby help you attain good vision without any extra cost. 

RLE surgery usually costs higher than cataract surgery. The average cost can range anywhere between $2500 to $4500 per eye. Since this is an optional treatment, insurance might not cover it. However, we do offer varied payment options. 

Procedures

Istent Extraction

FAQ's

Both these procedures basically involve the same process where the natural lens of your eye is removed and replaced with an artificial lens. However, RLE is an elective procedure that is performed to decrease the need for corrective glasses, and cataract surgery is performed for an inadequate vision that interferes with day-to-day activities. 

The basic ones include increased light sensitivity for the first few weeks, difficulty in seeing at night, driving at night, and functioning adequately in low lighting conditions. Sometimes, you may also see rings or halos around lights and glare at night.  

Both Cataract and RLE surgery can take about 30 minutes. There’s a pre and post-op recovery period for which you’ll have to have at least 2-3 hours of spare time on your hand.  

Performed under the effect of anesthesia, patients can barely feel any pain or discomfort during their surgery. Mild eye irritation symptoms in the first few hours post-surgery are normal. Your doctor may prescribe you ibuprofen to get through a day or two after the procedure. 

All the side effects usually vanish within a day or two. However, it can take 4-6 weeks for your vision to recover fully. 

Monofocal – Focuses on near-sightedness or far-sightedness, not both. 

Multifocal – You can read and see as near and far as possible without the use of any glasses. Can correct astigmatism. 

Yes, in most cases, patients can get both their eyes treated on the same day. Do consult with your personal doctor before opting for this option, though. 

We recommend taking the rest of the day off. The ideal time off should be 48 hours. Also, don’t forget to get someone to drive you home post-surgery.