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Prof. Dr. Ahmet AkmanPROF. DR.AHMET AKMANEye Health and Diseases SpecialistGlaucoma, Cataract, Medical Retina

Cataract Surgery Turkey

Cataract Surgery Turkey

What is a cataract?

Cataract is the loss of transparency of the lens in our eye. As a result, the image and light cannot pass into the eye. The clarity and quality of vision decreases, vision becomes hazy.

Cataract is not a disease, it is the completion of the life of the lens of the eye, which is an average of 65-70 years. Every individual who lives long enough will have cataracts. Depending on genetics cataracts can be seen at an earlier age in some families.

As the success of cataract surgery was low in the past, surgery was postponed until the vision decreases to very low levels, but nowadays, cataract surgery is performed much earlier with the development of highly successful less invasive techniques. In fact, since new methods treat the cataract in the eye by dissolving it, the chance of success decreases if the surgery is delayed and the cataract becomes hard as the precious cells in the eye are damaged more.

With the cataract surgery, artificial intraocular lenses such as smart lenses are placed in place of the cataractous lens, which allow the patients to see clearly without using glasses.

Since cataract surgery is performed on every individual of a certain age, it is the most performed surgery in the world. 500.000 cataract surgeries were performed in our country every year.

What is the optimum time to perform cataract surgery?

When to perform cataract surgery depends on the joint decisions of the eye surgeon and the patient. Factors such as the patient's occupation, expectations, sociocultural level, and vision requirements are important.

For example, a cataract should be operated on, as it will be difficult for a pilot to perform his profession safely even when his vision decreases by 10%. On the other hand, the level at which an average individual starts to feel discomfort due to cataract is when the vision drops below 70%. When the vision reaches 60%, the subtitles of the television cannot be read, and the quality of life begins to be affected.

Cataract Surgery Ankara Turkey

The only treatment for cataract is surgery. One of the most experienced specialists in cataract surgery in Turkey, Prof. Dr. Ahmet Akman, MD recommends surgery when the patient's vision level drops below 70%. In addition to the level of vision, delaying cataract surgery in some types of cataracts and in some eyes with certain anatomical conditions may increase the risks of surgery and complicate the surgery. In such cases, it may be necessary to perform cataract surgery even when the vision is above 70%.

In addition, modern cataract surgery is done with phacoemulsification technique which is also known as suture-less cataract surgery, shock waves occur during the dissolution of the cataract in the eye. A soft cataract dissolves as easily as digging soft soil and produces very few shock waves. In delayed cataracts, the cataract hardens like concrete and requires much higher energy to dissolve. This high level of energy creates more shock waves and damages the endothelial cells in the eye that do not regenerate when they die. As a result, the eye is more damaged during surgery.

In order to achieve the goal of spectacle free life after surgery, we have to measure the required power of the artificial intraocular lens (IOL) power before the surgery. Modern and accurate IOL measuring devices best work on early and moderate cataracts. In very advanced and delayed cataracts, these modern devices cannot measure artificial lens power very accurately, it becomes difficult to use technologies such as smart lenses in these eyes and the possibility of spectacle dependence increases after surgery.

As a result, the correct timing of surgery is determined by considering, visual requirements, vision level, eye and cataract features of the individual eye. Prof. Dr. Ahmet Akman, MD plans surgery for cataract patients in his clinic in Ankara in the light of this information. Cataract Surgery is also performed in Izmir. 

Trifocal intraocular lenses, which have become fashionable in the recent years, which are also called smart lenses, can be applied to people who do not have cataracts in order to get rid of the reading glasses, this is called refractive cataract surgery. The aim here is to provide near and far vision without glasses, which laser, LASIK or corneal refractive surgeries cannot provide. This surgery is generally reserved for people after the age of 45 as the presbyopia, which is the medical term for the need for reading glasses

Refractive cataract surgery and the placement of smart (trifocal) lenses are the best alternatives to get rid of glasses, especially in individuals after the age of 45 with eye disorders or near vision problems.  As it can be seen from the patient comments on our website, Professor Ahmet Akman, MD is one of the most experienced surgeons in cataract surgery and smart lens (trifocal) surgery in Turkey. He has implanted around 2000 smart (trifocal, EDOF) and toric (astigmatism correcting) intraocular lenses in over 50000 cataract surgeries he has performed.

Cataract Symptoms

The main symptom is poor and blurred vision. Cataract develops slowly and gradually impairs vision. When it progresses at the same rate in both eyes, the patient may not be aware of the visual deterioration. It is easier for the patient to notice when it develops unilaterally. In addition, in the early stages of cataract development, the patient's eyeglasses can change rapidly. One may start reading without glasses as cataract causes myopia.

Patients generally like this condition, which occurs as a result of myopia due to cataracts, and they become happy when they can read without reading glasses. However, this is the result of decreased vision that cannot be corrected with glasses in the distant vision. When vision decreases, it becomes more and more dangerous to drive, climb stairs, and walk on the street. When vision drops below a certain level, the risk of falling and hip fracture increases. For these reasons, when the visual acuity drops below 70%, the cataract should be surgically removed and replaced with a new artificial intraocular lens. In this way, the individual can reach 100% vision level again without glasses.

In addition to blurred vision and haze, cataracts can cause discomfort from lights, glare, and double vision. Every person over the age of 60 should have their eyes checked for cataracts once a year.

Can Cataracts Be Treated Without Surgery?

The only treatment available for cataracts is surgery. There is no non-surgical cataract treatment. The deteriorated lens of the eye has lost its transparency and there is no medicine yet to correct it. Natural treatments, alternative medicine methods cannot make this lens transparent again.  The only solution is to replace this lens with a new artificial one.  Alternative medicine methods, herbal remedies, natural treatments or medicines cannot fix the already formed cataract, nor can they stop the progression of the cataract that has already started. What happens if I don't have cataract surgery? The answer to the question is the loss of sight.

How Is Cataract Surgery Performed?

Cataract treatment is performed by surgery in which the lens with cataract is removed and a new artificial one is placed. The process of absorbing the cataract lens from the eye by melting is called phaco or phacoemulsification method. This method, popularly known as suture-less laser cataract surgery, is the most advanced cataract surgery method today. The tip of the phaco device, which is inserted into the eye through a 2.2 mm incision, melts the lens with the ultrasonic vibrations it creates, while pumping liquid into the eye and sucking it through another hole, in this way, the cataractous cloudy lens in the eye is cleaned and a new artificial lens is implanted.

katarakt ameliyatında fako yöntemiAerticial lens opening in the eye.

Cataract surgery with the femto laser assisted phacoemulsification method

Femto laser-assisted cataract surgery, which has been applied for the last four or five years and called bladeless cataract surgery, is not a completely new method.

Prof. Dr. Ahmet Akman is one of the surgeons who applied this method most frequently in Turkey with over 700 femto laser assisted bladeless cataract surgeries.

What is required for successful cataract surgery?

Although cataract surgery has high safety and success, it is more complex and more difficult to learn than all surgeries applied in medicine.

While the surgeon uses the device, which has a very strong disintegrating effect in the eye, with both hands in a 2mm space without damaging either the posterior membrane or the anterior corneal layer, one foot controls the microscope and one foot controls the phaco device. While the surgeon coordinates his hands with the three-dimensional image he sees through the microscope, he uses both feet to control the microscope and the phaco device, while listening to the sounds coming from the phaco device and adjusting the vacuum and melting amount.

As a result, the surgeon's two hands, two eyes, two feet, two ears, and the eye seen under the microscope must work in coordination in order to operate successfully. For this reason, cataract surgery is one of the most difficult to surgeries to learn and master in medicine. Apart from the experience and skill of the surgeon, the quality of the devices used, the protective drugs given into the eye, and the lens placed in the eye significantly affect the success of this surgery.

Prof. Dr. Ahmet Akman uses Alcon Centrion phacoemulsification device in cataract surgeries in Ankara. This device is the only device that can adjust the fluid according to the intraocular pressure (active fluidics). In this way, a much safer surgery and successful outcome is possible.

Katarakt AmeliyatıCataract Surgery by Professor Akman

Another important point is the viscoelastic materials used to prevent intraocular damage during surgery. The insufficient use of these costly substances can lead to corneal deterioration and even the need for corneal transplantation 5-10 years after the surgery.

Prof. Dr. Ahmet Akman uses USA made Viscoat and Provisc viscoelastics in cataract surgeries which are te best quality products available. In addition to these, the sterility of the operating room and the disposable material used are necessary to reduce the risk of infection. We perform cataract surgeries in our contracted hospitals in Ankara, which meet these conditions in the best way possible.

It should be remembered that a person's vision for the rest of his life depends on the correct planning of this cataract surgery, which lasts for 15 minutes and is not given much importance in the society. For best results, the use of quality materials and lenses, and the experience of the surgeon performing the surgery is very important.

Why is cataract surgery done?

There is only one answer, to fix the deteriorated vision. Cataract is the aging of the lens of an individual's eye, becoming a frosted glass or curtain. What needs to be done is to replace this lens with a new one. There are many different lenses for this purpose. The important thing is for an experienced surgeon to choose which lens is suitable for the patient's eye and to place a quality intraocular lens for this purpose.

Sometimes patients can not fell that their vision is impaired. The measurement of visual acuity is done by your ophthalmologist and, with some exceptions, if your vision with glasses is worse than 70% and the reason for this is cataract, surgery is recommended. In some cases, the patient's ophthalmic findings may also cause surgery to be recommended for eyes with better vision.

Secondly, cataract surgery can be performed in individuals over the age of 50 who wear glasses, to get rid of glasses. While it is possible to get rid of glasses with laser in young people, since cataract surgery is already on the horizon after the age of fifty and trifocal (smart) lenses can provide glasses-free vision both at distance and near / reading, which laser cannot provide, a procedure called clear lens removal instead of laser, which is actually an early standard cataract surgery. The patient's lens is removed by phacoemulsification and an intraocular lens that’s diopters is adjusted according to glasses-free is inserted into his eye.

What is cataract surgery planning?

When the decision for cataract surgery is made, after the detailed eye examination is completed, the power of the cornea layer in front of the eye in the form of a watch glass and the length of the eye are measured with modern laser-operated devices, and the power of the lens to be placed in the eye is determined by complex mathematical formulas. At this stage, the surgeon's knowledge and technical equipment is very important in providing clear vision without the need for glasses after surgery. The data obtained as a result of the eye examination and lens measurement determine which type of lenses are suitable for the patient and which types of surgeries can be performed.

katarakt ameliyatında lens seçimiLens Selection in Cataract Surgery

Today, there are many different options such as multifocal lenses called smart lenses, single focal lenses, astigmatism correcting toric lenses, EDOF lenses. Among these options, choosing the most suitable one for the patient is very important for a successful, trouble-free, clear vision in the long term, and most importantly, for a surgery where the patient's expectations are fully met.

After the lens selection is made, the day of surgery is determined, the drops to be used before the surgery are explained to the patient, the diabetes drugs used by the patient are evaluated, and if necessary, blood thinners are stopped for a day or two. It is recommended that the patient apply to the hospital at the specified time on the day of surgery.

What kind of lenses are used in cataract surgeries?

The artificial lens to be replaced by the eye lens, which is removed from the eye due to cataract, provides a clear image by focusing the image on the retina, that is, the retina.

The more precisely the power of the lens placed in the eye is determined, the less likely the need for glasses will arise after the surgery.  For this purpose, Professor Akman prefers the Zeiss IOLMaster 700, which he has published research papers internationally . We can basically divide the modern intraocular lenses used today into four groups.

1- In the first group, there are single-focal lenses called standard lenses. When these lenses are adjusted in a far-focused way, they can show the distance clearly without glasses, but for near vision, that is, the reading distance, the patient must wear glasses.

2- In the second group, there are toric or astigmatism correcting single focus lenses. Unlike the standard lenses above, these lenses also correct the patient's distant astigmatism. Patients with single-focal toric lenses, even if they get rid of their distance astigmatism, have to wear near glasses to see up close.

IOLMaster 700 göz içi lens ölçüm cihazıIOLMaster 700 Intraocular Lens Meter

3- Trifocal lenses, also called smart lenses, are in the third group. These lenses can actually be thought of as three lenses joined together. The first lens focuses the distance, the second lens focuses the computer phone distance, and the third lens focuses the reading distance clearly. In this way, patients with smart trifocal lenses have the chance to see clearly without using glasses at a distance, at a distance from the computer and nearby.

4- In the fourth group, there are toric models of smart trifocal lenses, which are fitted to patients with astigmatism in their eyes. In patients with astigmatism, these lenses both correct astigmatism and provide vision without glasses at near, middle and far distances.

Porfessor akman is one of the most experienced surgeons especially in astigmatic lenses, smart lenses and astigmatic smart lenses. In addition to applying such lenses frequently and being experienced in this regard, there are scientific lectures given by Professor Akman about correct usage of these lenses at national and international level and trainings given to other ophthalmologists.

How long does cataract surgery last?

In a problem-free eye, an experienced surgeon can complete this operation in as little as 15 minutes. However, time is not everything, because it is a very complex and demanding operation, sometimes it is necessary not to rush. Surgery may be prolonged in cases such as non-enlarging pupils, poor patient compliance, device malfunctions.

Remember that it takes a few seconds for a plane to land, but this is an unmistakable phase that requires a very high concentration of pilots and everything to go well. Although the duration is short, cataract surgery is a difficult-to-learn surgery among all surgeries in which the stress is most intense and requires the full concentration of the doctor.

While the doctor's two eyes are looking through the microscope, his two hands work with a disintegrating device inside the eye, while one foot controls the device, the other foot adjusts the microscope. Meanwhile, he listens to the sounds of the phaco device he uses with both ears, indicating the vacuum and shredding values. In short, cataract surgery is a very intense 10-15 minutes in which the surgeon's two hands, two eyes, two feet and both ears work in harmony with the device.

What should be considered when deciding on cataract surgery?

In the light of the information we have explained above, in order to have a successful cataract surgery and to minimize the risks, an experienced surgeon, meticulous preoperative lens power measurements, a well-equipped operating room, adequate use of drugs to prevent damage to the eye, regardless of the cost, and a quality lens are needed.

Among the issues that patients should ask their doctors, there should be basic issues such as which type of lens will be used, in which country this lens is manufactured, whether it is FDA approved, which device the surgery will be performed on, and from which countries the protective substances to be given into the eye come from.

Even in the most experienced centers, cataract surgery has certain risks. There is no risk in this surgery, it will end in 10 minutes, everything will always be perfect, there is no need to pay any fees, etc. should always arouse suspicion in the patient.

It should be noted that cataract surgery is a very serious operation in which the main part of the eye is replaced.

If the surgery is not successful, the patient may lose his vision.

Cataract Surgery Prices 2022

In our country, the Social Security Institution pays around 1000 TL to hospitals for cataract surgery. Even the cost of dyeing hair at a hairdresser in metropolitan cities is higher than this. People pay high prices for dental treatments, spend thousands of liras for state-of-the-art televisions and phones to see clearly, and even a broken eyeglass costs 2000-3000 liras after being used for a year or two, while in cataract surgery, which will provide vision, which is our most important sense for life, without paying extra. You must not run away.

The cost of a successful eye surgery that will allow you to see clearly for life cannot be measured in money. However, surgeries to be performed with high-quality surgical devices, quality measuring devices and high-quality lenses manufactured in the United States or Europe, which have been approved all over the world, will inevitably have a cost.

For this reason, our patients should prioritize quality and experience, not the cost, when deciding on cataract surgery. If you want to get information about cataract surgery fees and smart lens prices in Ankara, you can call us without any hesitation.

Is cataract surgery risky?

The answer to this question is both yes and no.

Yes it is risky! Because there is no guarantee in any health-related situation and unexpected situations can arise at any time. However, these risks can be greatly reduced thanks to the experience of the surgeon, the cleanliness of the hospital and the capacity of the device, the disposable and high quality of the materials used, and not trying to save money on materials and drugs by considering the cost. However, all of these conditions come with serious costs. 

No, it is not risky! Every person who lives enough has to have cataract surgery. Because it is the most performed surgery in the world (500,000 every year in our country, 3,000,000 in the USA) and the most successful surgery. Eyes without any other disease, with a smooth operation, a good lens, and 70-80 years old, have the same vision as 18-year-olds. For this reason, as stated above, the risks are greatly reduced if the necessary conditions are taken into account, an experienced surgeon is visited, and a certain cost is taken into account, considering that lifelong vision depends on this surgery.

Will there be stinging after cataract surgery?

Cataract surgery is a serious operation in which your eye lens, which is an important tissue in the center of the eye, is removed by melting and a plastic intraocular lens is placed in its place. Although the risks have been greatly reduced with today's technology, an experienced surgeon, a very clean operating room, absolutely disposable and high quality materials and a reliable intraocular lens are needed for a problem-free cataract surgery. When all these factors come together, a stinging sensation is not expected after cataract surgery. However, there are a few exceptions to this situation.

  • There may be some stinging on the first night and the next day until the incisions in the eye for surgery heal.
  • Secondly, in individuals with dry eyes, and especially in regions with a continental climate and dry air, such as Central Anatolia, post-operative stinging that requires the use of tear drops may occur.
  • Thirdly, stinging may occur in some sensitive eyes due to the irritation or allergy of the drops after use.
  • A fourth reason could be some complications from the surgery.
  • Finally, very rarely, the herpes virus (herpes simplex),which is already in our body and is dormant after the surgery, can be activated and cause a feeling of stinging.

If you feel stinging after surgery, your doctor may call you for a checkup and usually recommend tear drops if there is no serious problem. Do not hesitate to contact your doctor for the stinging problem, which is a rare condition that bothers the patient.

How long is the recovery time after cataract surgery?

The recovery time after cataract surgery, which is an important surgery performed by melting your eye lens and replacing it with a new lens, depends on the hardness of your cataract and the amount of energy used accordingly, the quality of the eye protective drugs used in the surgery, and the experience of the surgeon.

After an uncomplicated, problem-free operation, problems such as stinging and pain are not expected, except for the first night. Vision may be blurry for the first few days, but it gets better each day, usually clearing in 3-5 days. It may take up to 1 month for vision to become clearer.

In terms of functions such as anatomical healing, closure of wounds, easy movement, bending, and bathing, the eye is generally considered to have healed in the first week, and everything is released to the patient. As a result, recovery after cataract surgery is usually completed around 1 week.

What are the problems after cataract surgery?

Cataract surgery is one of the most serious operations of the eye and there is a low risk of losing sight. This risk is higher in centers where cheap materials are used, the same material is applied to many patients without changing it, where it is tried to save on eye protection drugs and where poor quality intraocular lenses are used.

The most important problems that can be experienced are bleeding that may occur during surgery. Although very rare, in some cases the eye can be lost before the doctor can do much. This risk is higher especially in obese individuals with hypertension. The second major problem is infections.

In centers that pay attention to cleanliness and use disposable FDA-approved materials, this risk is minimized with the help of intraocular antibiotics. Many preventable problems such as cataract falling into the eye, difficulties in placing the intraocular lens, and lens number errors due to not using the latest technology devices can occur during cataract surgery.

What needs to be done to avoid these problems is to decide not according to the cost, as in every important job, but according to the experience of the doctor, the conditions of the hospital and the quality of the materials used. It should not be forgotten that the individual's vision for the rest of his life depends on the success of this surgery and quality imported materials have a cost. It is not possible for centers that operate very cheaply to use such quality materials, to prefer disposable materials and to use quality intraocular lenses.

Ahmet Akman, M.D.Prof. Dr. Ahmet AkmanEye Health and Diseases Specialist
(Glaucoma, Cataract, Medical Retina)
0546 616 8483 - Türkçe