Cataract, what it is, how to treat it and when to undergo surgery

“Atcataract surgeryeveryone sooner or later must undergo: today we do it in 20 minuteswe have very advanced crystalline prostheses that even solve previous vision problems, we make 600 thousand of them a year”.

In these words of Teresio Avitabile, President of the Italian Society of Ophthalmological Sciences (SISO) and Professor of Ophthalmology at the University of Catania, there are the numbers of a very frequent pathological condition. But other needs also emerge from the congress of SISO specialists. We need to streamline the approach to this intervention, always maintaining maximum safety for patients.

Abolish pre-operative tests and simplify the rules: the proposals

“On the one hand we are seeing wonderful advances on a scientific and clinical level, on the other we have regulatory problems that make us risk not being able to assist Italian patients with everything that medicine makes available to us today – comments Avitabile. The remedies? First, abolish pre-operative tests: although mandatory, they are useless, except in particular cases, as stated by numerous scientific works and international guidelines. Second, rationalize the presence of the anesthetist during the operation: adverse events are very rare and to deal with them all you need is one anesthetist per hospital, available in case of need. His constant presence during the operation, as well as the pre-operative examinations, are to be reserved for patients with comorbidities and complex situations. Recent scientific studies also confirm this. In short, while respecting patient safety, it is necessary simplify the rules. Also to the benefit of the collective interest: carrying out useless tests then forces other patients who need them more to wait for long periods. For the same reasons we need new, more streamlined rules also for other types of therapies and pathologies, for relations between public and private. Italian ophthalmology is at the forefront of the world, everyone recognizes this, but we must be able to bring these skills, this excellence to all citizens, and in a reasonable timeframe”.

How long do I have to wait for the surgery?

Experts fear that the healthcare system may continue to support all cataract surgeries. According to what emerged at the conference, they exist high-tech artificial crystallines which also allow the correction of visual defects present before cataract surgery and also the presbyopia.
The single vision lenses that we plant today cost approximately 50 euros each, the technologically advanced ones, 500 euros. What can happen?

“We are seeing a gradual exit of Ophthalmology from the National Health System – comments Francesco Bandello, Director of the Ophthalmology Unit of the S. Raffaele Hospital in Milan. This phenomenon is advancing in a subtle way, never clearly stated but unequivocal. The new Lea (Essential Levels of Assistance) in fact provide for a substantial reduction in reimbursement of important performances and among these thecataract surgery which will be reimbursed with 800 euros. This is clearly an insufficient sum to guarantee adequate reimbursement to the structures that provided this service. This means that in some regions such as Lombardy – which has already said it is available – will be there an integration of the sum in order to allow the tariff to be adjusted to the costs. But there are other regions, such as Campaniawhich do not provide for integrations of this kind and will be seen there inevitably lengthen waiting lists: the patient, who would now have to wait a year and a half, two years to get a cataract, will have to wait three, four or even five. This will cause a huge number of visually impaired people which will burden the INPS and the NHS, social problems will increase, many people will be isolated in a fragile age group, this situation will produce many handicaps. The decision maker, having available reduced budgets, must make choices, identifying priorities. And ophthalmology will not be among these priorities because people do not die from eye diseases. But these choices cannot be made without everyone knowing, they must be shared and declared openly, because solutions need to be found.”

How cataracts arise

What happens if a magnifying glass gets dirty? Simple. It becomes impossible to see the fixed objects well, the dimensions of the contours are lost and everything appears more nuanced. Something similar can also happen to the human eye, which has a pair of lenses capable of allowing perfect focusing of the objects being fixed. But if one of these lenses is not perfectly “clean”, vision can also have problems.

The two natural lenses of the eye are called cornea and lensand can cause vision problems if they become opaque. In particular, if the crystalline lens is not perfectly transparent, cataracts can occur, i.e. an opacification of the crystalline lens itself which prevents light from reaching the retina, i.e. the “nervous” area in which visual stimuli are transformed into nervous signals capable of be decoded by the brain.

The cataract it is almost always age-relatedand is particularly frequent in elderly people, in which it often depends on a real “aging” of the crystalline lens. But in some cases it can manifest itself even in young people, especially if they suffer from diseases such as diabetes, or even in children, in the congenital form. The only solution to cataracts comes from surgery which can be performed in different ways and must be recommended by an expert.

What happens if the lens becomes cloudy

At birth the lens is normally perfectly clear and elastic. This conformation means that you can see very well, and that the lens adapts to the needs imposed by the eye to allow objects to be focused. In fact, the crystalline lens is made up of a basic area, called the transparent central nucleus, from which they branch out transparent concentric layers which are instead defined as cortex. This natural lens is kept in place by another structure that functions as a sort of transparent “wrapping paper”, which is in turn kept in its natural location by a series of very thin ligaments that prevent the crystalline lens from moving inside. of the eye.

However over time the crystalline lens tends to lose its natural characteristics. That is, it becomes more rigid and therefore less adaptable to the stimuli imposed by the eye which must focus on objects, and above all it can become less and less transparent. The result of this opaque condition the light stimuli that enter the eye are not able to go directly to the area of ​​the retina which has the task of receiving and decoding them for the brain, but are dispersed “far” from the center where the focus is ideal. Which leads to the progressive sensation that everything you look at is not clear, but clouded. Dimensions are lost, objects and people are not recognized when they are at a distance. And above all, your eyesight can play tricks on you, both because you don't have precise color vision and because very bright light can dazzle your eyesight, completely eliminating the eye's protective “filters”. Initially the lenses of the glasses can help vision, but over time their effect tends to fade and only the “replacement” of the lens can allow a return to normal vision.

What cataracts involve and how to deal with them

As we said, cataracts are linked to the clouding of the transparent lens inside the eyeball: the lens is like a biconvex magnifying glass. When the crystalline lens becomes opaque, the images of the affected eye may appear blurry, shrouded in fog, sometimes doubled, with faded colors.

Cataract treatment is exclusively surgical: consists of the removal of cataracts with microprobes through microincisions in the cornea and the implantation of an injectable artificial lens. The specialist may decide to operate on cataracts if the lesion causes such an alteration in vision as to interfere with normal activities.

Be careful though: experts warn that Those who suffer from the discomfort do not always notice it, therefore it may also happen that the operation is requested in an apparent state of visual well-being. In other cases, then, the removal of the lens may be required to resolve other visual defects and to better deal with real pathologies such as glaucoma. In the initial forms, however, the problem is often solved by changing glasses or increasing the ambient lighting. But often, as mentioned, we are not satisfied. And we resort to surgery.