Cataract is a very common, easily diagnosed and readily treatable eye condition that causes deterioration of vision due to clouding of the normally transparent, natural lens, inside the eye., Cataract is a normal age-related change that eventually affects everybody., The natural lens normally focuses light inside the eye allowing sharp vision., Over time, the lens becomes gradually hazy. A hazy lens is referred to as a ‘cataract’., Light through a hazy lens is ‘scattered’ and the quality of the vision deteriorates, often as though one’s spectacles were becoming dirty., Common symptoms include foggy vision and glare or dazzle in the sun, from car headlights or from reflective street signs when driving at night, especially on rainy nights. Cataract sufferers may frequently clean their spectacles trying unsuccessfully to improve their vision., Because vision loss is gradual, those affected often forget how good their vision once was, or think they are “just getting older”, not realising how bad their vision has become or that normal vision can easily be restored with cataract surgery., Whilst in the early stages, sunglasses can reduce glare, the only way to treat significant cataract to regain normal vision, is with cataract surgery., Standard Eye Charts typically have high contrast black letters on a white background and can be a very poor way of assessing the quality of vision in the presence of cataract. Vision tested on an eye chart might still seem quite good and a person with quite marked cataract can often still read quite small print on an eye chart, yet still be disabled by poor quality vision, with poor contrast, glare with bright lights. Quality of life gradually suffers and affected people can become a danger on the road and be at increased risk of car crashes, falls and hip fractures ., Symptomatic patients are sometimes told that their cataract is “not yet bad enough to treat”, especially if they can still make out smallish print on an eye chart; however cataract is ‘bad enough to treat’ when symptoms begin to interfere with everyday activities such as driving, reading and whenever cataract affects quality of life., There is no advantage in waiting until cataract becomes advanced or ‘mature’. Cataracts never grow back: the new lens lasts a lifetime. Removing a cataract is one of the most common and successful operations performed., Most cataract surgery is performed on those over the age of 50. About 10 per cent are in their fifties, 20 per cent in their sixties, 35 per cent in their seventies and 35 per cent are over the age of 80., Almost everybody over the age of 60 is affected by cataract to some degree. Cataract slowly worsens and virtually everyone over the age of 80 would see very much better following cataract surgery., Specialist Cataract Surgeon Dr Brett Rogers can safely remove the cloudy cataract using microsurgery and can replace the cataract with a clear, foldable, intraocular lens (IOL) to restore normal vision., Most of Dr Rogers’ cataract surgery is performed under local anaesthesia., Surgery takes 20-30 minutes and the total time in hospital is only 2-3 hours., Modern techniques and state-of-the-art equipment mean recovery is quick and you can be back to normal activities within days., Cataract surgery can also eliminate short-sightedness (myopia) and long-sightedness (hypermetropia) and Dr Rogers often corrects another very common spectacle problem called astigmatism (caused by an oval curvature of the surface of the eye) by using a ‘premium toric’ lens not normally used in public hospitals. This lens can give even better distance vision without spectacles than ordinary IOLs., Following such surgery, one can expect to have both excellent distance and reading vision, and to see well enough to safely drive without spectacles (even if one has worn strong spectacles since childhood)., Public hospitals use a questionnaire and its ‘points’, to determine whether or not you can receive publicly funded cataract surgery. It is often wrongly assumed that a low ‘score’, means that the cataract is ‘not bad enough' to treat; however the public hospital ‘threshold score’ is determined by available funding and those missing out often have Dr Rogers perform their cataract surgery at Southern Cross Hospital where ‘scoring’ and rationing does not apply and where surgery can be done within a week or two if required., Diagram showing effect of cataract (PNG, 2.6 MB)

These three spectacle ("refractive") conditions all cause distance blur, however all three can be eliminated with refractive cataract surgery where Dr Rogers aims to reduce or eliminate dependence on spectacles for clear vision following cataract surgery. In short-sighted eyes (myopia), the eye has a resting focus at a near distance so myopic people see objects more clearly at a distance close to them, but distance vision is blurry. Hyperopia (long-sightedness) also causes distance vision blur but this often does not become noticeable until the eye starts to lose its ability to change focus, frequently in middle age. Distance and near vision are both reduced but near vision is even worse. Astigmatism causes an image to be blurry at all distances, and can significantly affect the clarity of images for both near and distance. Patients undergoing cataract surgery with Dr Rogers can have all of these refractive conditions corrected during the operation, regardless of how much myopia, hypermetropia or astigmatism is present before surgery and even if this has been present since childhood. This means you can expect to be able see well enough to drive a car without spectacles. There are also options to enable you to also see clearly for near vision without spectacles, following cataract surgery. Short-sightedness and long-sightedness are both corrected with a 'regular' intraocular lens (IOL). Astigmatism is corrected with an (optional) premium 'toric' IOL. Presbyopia can be helped by various types of lenses (IOLS) to improve near vision without spectacles. Some suitable patients with significant refractive (spectacle) problems choose to have a 'clear lens exchange', which is essentially a cataract operation done at an earlier stage, mainly to correct significant spectacle problems. Clear Lens Exchange is a better alternative to Lasik in many patients and is particularly suitable for longsighted (hypermetropic) people with mild cataract, but sometimes even with no cataract at all. (Once treated, such patients of course will never develop cataract in the future.)

Toric intraocular lenses These are a 'premium intraocular lens' option, which in experienced hands can be used in more than 50% of eyes undergoing cataract surgery. Toric intraocular lenses look similar to ‘regular’ IOLs, however are designed with a curved (‘toric’) surface. They must be precisely aligned inside the eye at a specific angle, depending on the shape and the 'total' power of the eye's astigmatism. Correction of astigmatism can allow much better quality vision and less dependence on glasses. Dr Rogers has had more experience than most, having used toric intraocular lenses for 15 years. He is the only cataract surgeon in Southland/Otago using “Swept Source OCT” Laser Biometry which measures both the inside and the outside surfaces of the cornea to obtain the ‘total power’ of the cornea for more precise IOL measurements and better visual outcomes. This is particularly important when deciding on the patient's suitability for a toric IOL, when calculating which Toric IOL power to use and the precise alignment of this toric IOL. https://www.youtube.com/watch?v=8D-GI331l18

Not uncommonly, at some time following routine cataract surgery, the normally-transparent thin membrane called the 'posterior capsule', which lies behind the intraocular lens, can thicken and become hazy. This can cause symptoms that are similar to cataract symptoms, however the treatment of 'posterior capsule haze' is much easier and involves simply clearing the membrane using "YAG" LASER. YAG LASER CAPSULOTOMY CAN BE PERFORMED BOTH IN INVERCARGILL AND IN QUEENSTOWN The procedure takes only a few minutes and gives an almost immediate return of vision to the state it was in following the original cataract surgery, even if that surgery was many years ago. (The YAG Laser is also used to perform several other types of eye procedures.)

Glaucoma is a group of diseases that can damage the eye’s optic nerve and may result in vision loss and blindness. Multiple factors are often important in causing glaucoma, but it is most commonly related to in an increase in pressure in the eye. Symptoms are generally absent until the condition has progressed to an advanced stage. Very occasionally, a rarer form of glaucoma can develop suddenly and symptoms may then include: headaches and aches around the affected eye, seeing halos around lights, sensitivity to light, blurred vision, nausea and vomiting. You may be more likely to develop glaucoma if you: have someone else in your family with glaucoma already have high pressure in your eye have experienced injury to your eye have or have had certain other eye problems have migraine or circulation problems. Glaucoma is more common in people over 50 years of age and more common in women than men. Diagnosis usually comes after consultation with an eye doctor. Signs of glaucoma may also be picked up at an optometrist’s eye examination. The following tests are used to diagnose and monitor glaucoma: Tonometry – measures eye pressure. It is often the first screening test for glaucoma. The eyes are numbed with eye drops and then examined. Dilated eye exam - this is done with an ophthalmoscope (which is a medical instrument that allows the doctor to look through the pupil to the back of the eye).The retina and optic nerve are then examined for any sign of damage. Visual acuity test – test to check distance vision using an eye chart. Visual field test – test to measure side (peripheral) vision. Pachymetry – test to measure the thickness of the cornea. Many other new techniques are emerging to help identify the likelihood of glaucoma and help determine its rate of worsening. Although glaucoma cannot be cured, early treatment can prevent further worsening of the condition and vision loss. Regular eye examinations will need to be continued life-long. Eye drops to decrease eye pressure are the most common early treatment. Surgery may be required, especially if medications are not taking adequate effect. Laser trabeculoplasty, in which a surgeon uses a laser to help the fluid drain from the eye, may be considered in some cases, but has limited effectiveness. More commonly, a trabeculectomy may be performed when other methods have failed to adequately control pressure. This is a medium length operation that makes a new opening for fluid to drain from the eye.

Both Cataract and Glaucoma are common with increasing age and many people over 60 have both. Are those with glaucoma at higher risk of developing cataracts? Those with glaucoma are not usually at higher risk of developing cataracts. Both eye conditions are more common with age, which is why many who have one disease may develop the other. How will cataract surgery affect the glaucoma? Cataract surgery can cause a change in eye pressure. In general, it is not possible to predict whether the eye pressure will rise, fall or stay the same after cataract surgery; however, most people have slightly lower eye pressure following cataract surgery. This is often not permanent and the pressure may increase again later. Increases in eye pressure immediately after the surgery are called ‘pressure spikes’ and sometimes occur in patients 1-2 days after cataract surgery. Usually these are short-lived and can be easily treated with medications. Dr Rogers may give you tablets or eye drops to use following surgery to prevent these pressure rises. Is there a need to change glaucoma medication after cataract surgery? After cataract surgery Dr Rogers might reassess the need for glaucoma drops. In some instances, glaucoma drops can be decreased.

This is a "YAG Laser" procedure that Dr Rogers performs at his private rooms on patients who are at risk of developing a relatively uncommon type of glaucoma known as 'narrow-angle' or 'angle-closure' glaucoma.

Some suitable patients with refractive errors (such as hypermetropia or high myopia) choose to have a 'clear lens exchange', which is essentially a cataract operation done at an early stage, mainly to correct significant refractive errors (just as 'Lasik' is used to correct significant refactive errors), Clear Lens Exchange is often a better alternative to Lasik in selected patients and is particularly suitable for longsighted hypermetropic patients with early cataract - or sometimes even with no cataract at all. (Once treated, such patients will of course never develop cataract in the future.)