A cataract develops when the eye's natural lens loses its transparency. This leads to a decrease in eyesight due to less light entering the eye. This usually happens as a part of the natural ageing process.

Less commonly, cataracts can develop in younger people due to eye trauma, systemic diseases such as diabetes or due to certain types of medications (steroids).

In most cases, cataracts progress slowly over time and don't interfere with your vision in the beginning. It is only later that people with cataracts start to notice their eyesight deteriorating. Symptoms of cataracts include blurry vision despite wearing the correct prescription spectacles, difficulty seeing and driving at night, glare or excessive sensitivity to light, halos or a continuous change in your prescription glasses. With time, some people might experience a gradual improvement in their near sight.

Not all cataracts need immediate treatment. If it only has a minor impact on your activities of daily living, it is acceptable to manage them conservatively in the beginning. With time, though, most cataracts will require surgery. Optometrists are often the first eye care professionals people with cataracts present to. They are well-trained and equipped to diagnose cataracts and know when to refer them to an ophthalmologist for treatment. At Paarl Eye Centre, we work closely with the optometrists in our referral area to ensure a multidisciplinary approach for our clients.

Once your cataracts become symptomatic and start to affect your quality of vision, our eye surgeons at Paarl Eye Centre will recommend treatment. Surgical removal of the cataract and replacing it with an artificial acrylic lens is the only treatment option. This operation is also known as a lens replacement or Phacoemulsification. We use sophisticated, modern equipment and calculations in our clinic to ensure that you get the correct type and strength lens for your eye. Our eye surgeons continuously audit their cataract surgery outcomes to ensure that they get outstanding and reproducible visual results.

The procedure is performed as a day case at Paarl CURE Day Clinic. It’s centrally located in Paarl to ensure that our patients don’t have to travel long distances for their surgery and follow-up appointments. We pride ourselves on having the most up-to-date surgical equipment and techniques to ensure that you get the best possible outcomes after surgery.

Before the operation, you will receive eye drops to numb your eye and dilate your pupil. Our skilled anaesthesiologists in Paarl will then administer a conscious sedation, which will help you relax and make the procedure a pleasant experience. The procedure takes approximately 20 to 30 minutes, and we do the two eyes a week apart.

Our eye surgeons access the cataract through a 2mm incision in your cornea. This entry wound is so small that it doesn't require suturing, and it seals spontaneously after the operation. A microscopic ultrasound probe is then used to emulsify/break the cataract into numerous smaller pieces inside the eye before they are aspirated. The last step is to replace the cataract with a high-quality acrylic lens specifically made for your eye.

As a rule, the eye is comfortable and white after surgery, but some people might experience mild scratchiness. Vision in the operated eye typically recovers quickly, and most patients are able to do most activities, including walking, driving and working, within the first week after surgery.

At Paarl Eye Centre, our doctors go out of their way to tailor each client's outcome to suit their individual needs. We believe in open and honest conversations with our clients, and after a thorough history taking, eye examination and special investigations, we will advise you on what the best and safest options for you as an individual will be.

It is not always possible to get everyone 100% spectacle independent. Every person’s eyes, visual requirements and expectations are unique. We do, however, strive to reduce spectacle dependence as much as possible through the utilization of a wide variety of lenses and surgical techniques.

Your dominant eye provides your brain with more accurate visual information. It is usually the eye people use to look through a microscope or telescope. Monovision is when the surgeon aims to get the vision in the dominant eye clear for distance and then intentionally renders the non-dominant eye nearsighted to allow it to see close by. With both eyes open, the person will then be able to see clearly in the distance as well as near. It may seem like a bizarre concept, but the brain blends these two different images so well that patients are often unable to tell which eye they use for distance and which one for near when both eyes are open. This technique is also referred to as blended vision.

Not everyone can tolerate monovision, and it's therefore very important to select your candidates carefully. Our experienced on-site optometrist, Maretha Basson, performs a series of tests with special lenses to induce monovision and to determine the maximum difference in lens strength successful candidates can tolerate. If there is any doubt, we will induce monovision with contact lenses for a few days before committing to surgery.

The drawbacks of monovision might include a mild decrease in your depth perception. This becomes more prevalent if the focus point between the two eyes is too far apart. “Mini-monovision” is where the focus points between eyes are closer to each other. This is often a good option to give you clear distance vision and some degree of near vision. In these cases, reading glasses for small print will often still be required.

Monovision is also a popular choice for younger people with presbyopia, where their cataracts per se don't necessarily interfere with their vision. Presbyopia is a natural process where most people in their mid to late 40s start losing their sight. Presbyopia is the reason why most people over the age of 50 require reading glasses.

These premium lenses have a wider range of focus than the traditional mono-focal lenses and can potentially lead to better depth perception in monovision candidates. The concept of monovision, however, stays the same.

EDOF lenses are a great option for people with active lifestyles, allowing for crisp distance vision during sporting activities and driving but also good enough near vision to see on their computers and mobile devices. Candidates usually still require reading glasses for fine print and to perform closeup tasks such as knitting.

Despite not having the precise near vision that can be obtained with multifocal lenses, EDOF lenses are more forgiving in terms of unwanted side effects such as halos, glare and decreased light sensitivity and don't compromise your distance vision.

Toric lenses are used to correct people with cataracts and pre-existing astigmatism at the same time. Astigmatism, together with far-sightedness and near-sightedness, is a refractive error that causes blurry vision. Glasses or contact lenses are needed to obtain clear vision in people with astigmatism. To put it simply, astigmatism is caused by an irregular surface of your cornea.

Not only do toric lenses improve vision by replacing the clouded lens or cataract, but it has the additional advantage of improving the blurry vision caused by pre-existing astigmatism. These lenses will allow people with astigmatism to regain clear distance vision after cataract surgery, often without the need for spectacles.

Reading glasses will usually still be necessary after toric lens implants.

Phacoemulsification is the standard surgical technique used for cataract surgery. During the operation, all the operative steps are performed manually by the surgeon, who then utilises ultrasound to emulsify or break up the cataract inside the eye before removing it.

Femtosecond laser-assisted cataract surgery (FLACS) is a technique where some of the steps during cataract surgery are automatically performed by using a computer-controlled laser. This novel technique has the potential for better precision and reproducibility during the operative steps it’s utilized for. It can also be used to treat corneal refractive errors in the same setting. The surgeon, however, still needs to perform most of the operation manually and often still needs to use ultrasound to remove the lens.

The current literature has not demonstrated FLACS to be superior to phacoemulsification. Some of the outcomes studies looked at when comparing these two techniques were the final vision after surgery, quality of life, complications during surgery and cost-effectiveness.

Other factors leading to low uptake in FLACS include longer surgical times and higher costs involved when compared to Phacoemulsification.