Cataract Surgery

Types of Cataracts

• Nuclear Cataract: This type forms in the central (nuclear) part of the lens and is often associated with aging. It can cause nearsightedness and a gradual yellowing or browning of vision.
• Cortical Cataract: Affects the lens cortex, characterized by white, wedge-like opacities that start at the lens edge and work their way to the center. It can cause glare and loss of contrast.
• Posterior Subcapsular Cataract: Develops at the back of the lens and progresses quickly. It often affects reading vision and causes glare or halos around lights.
• Congenital Cataract: Present at birth or develops during childhood, often due to genetic factors, infections during pregnancy, or metabolic disorders.

The Diagnostic Journey: What to Expect at Your Consultation

If you are experiencing symptoms, a comprehensive eye examination is necessary to confirm a diagnosis. The decision to proceed with surgery should only be made after a thorough consultation with an eye specialist.  

During your check-up, the ophthalmologist will perform several tests to assess the health of your eyes and the extent of the cataract. This typically includes a  slit-lamp examination, where a specialised microscope with a bright light is used to examine the structures at the front of your eye, including the lens. To get a clear view, your pupils will be dilated with eye drops. This allows the doctor to detect any cloudiness in the lens and check for other potential eye conditions.  

Modern Surgical Procedures Explained

Cataract surgery is the only definitive treatment for cataracts. The procedure involves removing the clouded natural lens and replacing it with a clear, artificial intraocular lens (IOL). In Singapore, two primary surgical techniques are used, both of which are highly successful day-surgery procedures.  

• Phacoemulsification: This is the most common method used for cataract surgery. The surgeon makes a very small incision (1.8mm to 3mm) and inserts a small probe that uses ultrasonic power to break up, or emulsify, the cataract into tiny pieces, which are then suctioned out. Because the incision is so small, it usually heals on its own without needing stitches, allowing for a fast recovery. The procedure is highly successful (over 90-95% success rate) and typically takes only 15-20 minutes.  
• Femtosecond Laser-Assisted Cataract Surgery (FLACS): This is an advanced type of cataract surgery where a precise laser is used to perform several steps that are traditionally done manually by the surgeon. The laser can be used to create the corneal incision, make a perfectly circular opening in the lens capsule, and soften the cataract, breaking it into smaller fragments. This technology aims to increase the precision of the surgery and the placement of the intraocular lens.  

For patients with very advanced and dense cataracts, a more traditional technique called Extracapsular Cataract Extraction (ECCE) may be performed. This involves a larger incision and requires a longer period for visual rehabilitation.

Cataract Surgery in International Eye Clinic

We offer the latest technique of cataract removal, which is phacoemulsification of the cataract. This is followed by implantation of an intraocular lens.

A Comprehensive Guide to Intraocular Lenses (IOLs)

A critical part of cataract surgery is choosing the right replacement lens, known as an intraocular lens (IOL). The type of IOL you choose will determine how you see after surgery and your dependence on glasses. Your lifestyle and visual needs are important factors in this decision.  

Here are the main types of IOLs available in Singapore:

• Monofocal IOLs: This is the standard IOL and provides clear vision at a single, fixed distance—usually far vision for activities like driving. Patients who choose monofocal lenses will typically still need reading glasses for near tasks like reading or using a phone.  
  • Monovision: An alternative strategy using monofocal lenses is “monovision,” where one eye is corrected for distance vision and the other is corrected for near vision. This can reduce spectacle dependence, but it is not suitable for everyone and may compromise depth perception.  
• Multifocal IOLs (Bifocal/Trifocal): These advanced lenses have multiple focal points to provide clear vision at different distances (near, intermediate, and far), reducing the need for glasses after surgery. However, they can be associated with side effects like glare and halos around lights, particularly in dim conditions, and may require bright light for comfortable reading.  
• Extended Depth of Focus (EDOF) IOLs: EDOF lenses are a newer technology that provides a continuous range of vision from distance to intermediate, such as computer work. Compared to multifocal lenses, they may cause less glare and halos, but reading glasses are often still required for fine print up close.  
• Toric IOLs: These are specialised lenses designed specifically to correct pre-existing astigmatism, which is an imperfection in the curvature of the cornea. A toric IOL can be monofocal, multifocal, or EDOF.

The Patient’s Surgical Journey: Pre-Op, Surgery Day, and Recovery

Understanding the entire process from start to finish can help you feel more prepared and at ease.

Pre-Operative Preparations: Before your surgery, your doctor will perform tests to measure your eye to ensure accurate IOL calculation. You will be given specific instructions, which may include:  

• Stopping the use of contact lenses for at least one week (soft lenses) or two weeks (hard lenses) prior to your assessment.  
• Informing your surgeon about any previous eye surgeries, like LASIK.  
• Using antibiotic eye drops for a day or two before the procedure.  
• Fasting (no food or drink) for at least 6-12 hours before surgery.  
• Temporarily stopping certain medications that could increase bleeding risk.  

On the Day of Surgery: Cataract surgery is performed as a day surgery procedure, meaning you can go home the same day.  

• The procedure itself is quick, usually taking 15 to 30 minutes.  
• You will receive local anaesthesia in the form of eye drops or an injection to make the surgery painless. You may also be given a sedative to help you relax.  
• You will not be able to drive home, so it is important to arrange for someone to accompany you.  

Post-Operative Care and Recovery: Proper care after surgery is crucial for a smooth recovery and successful outcome.

• You will be prescribed antibiotic and steroid eye drops to use for several weeks to prevent infection and control inflammation.  
• You will need to wear a protective eye shield, especially while sleeping, for the first week or two to avoid accidentally rubbing or pressing on the eye.  
• For the first few weeks, be careful to avoid getting water, soap, or dust into the operated eye.  
• Follow-up appointments are typically scheduled for one day, one week, and one month after the operation to monitor your healing

Navigating Costs & Medisave in Singapore

Financial considerations are an important part of planning for surgery. In Singapore, there are several schemes to help make cataract surgery affordable.

• Cost: The cost of surgery will depend on the density of the cataract, the type of anesthesia used (a small minority of  patients prefer to have the operation done under general anaesthesia , the preferred type of intraocular lens, etc). Please feel free to get in touch with us for a better understanding of your condition and the cost involved.  
• Medisave: Singapore Citizens and Permanent Residents can use Medisave to help pay for the procedure. You can claim up to $2,450 per eye for cataract surgery from your own or an immediate family member’s Medisave account.  
• Insurance: If you have an Integrated Shield Plan, it can provide additional coverage for treatment in private hospitals, potentially covering a significant portion of the bill. Our clinic staff can assist you in checking your insurance coverage and navigating the claims process.

An Honest Discussion of Risks

While cataract surgery is considered very safe and has a high success rate, all surgical procedures carry some level of risk. Though rare, potential complications can include infection and bleeding. Following your surgeon’s post-operative care instructions carefully, especially regarding eye drops and hygiene, is the best way to minimise these risks.  

Choosing Your Surgeon

The success of your cataract surgery depends significantly on the skill and experience of your ophthalmologist. When making your decision, it is important to choose a surgeon who is transparent, uses modern technology, and takes the time to understand your lifestyle and visual goals.  

We encourage you to ask questions about your surgeon’s qualifications, their experience with different surgical techniques and IOLs, and how they manage potential complications. A thorough discussion will ensure you feel confident and informed.  

To learn more about the credentials of our specialists, please visit our doctor profile page. For a detailed guide on what to look for in a specialist, please see our page on “How to Choose an Eye Specialist in Singapore.”