Dr. Teodor Holhoș: “Cataract occurs in about 60% of patients over 70 years of age. There are times when I operate on 20-40 cataracts every day.”
- The important thing is to see your doctor on time and undergo surgery to replace the affected lens when recommended.
- Dr. Teodor Holhoș has a great experience in performing this surgery: this year, the doctor has performed more than 1,700 cataract surgeries, while in 2022, more than 2,600. In total, he has performed more than 20,000 surgeries during his career.
Among the diseases that most commonly affect vision, cataract is probably the most common. After the age of 40, the lens of the eye, the gelatinous lens without which the eye cannot focus the image projected onto the retina correctly, slowly and irreversibly deteriorates. The lens plays the role of the lens assembly in the camera lens and is located just behind the iris, in a central position.
For most people, this lens ageing process is not a problem. With the help of glasses, most of us can use our vision well into old age. Even if we can’t see as well as we did in our youth, we can still get by in everyday life without any problems.
“But in a significant proportion of the middle-aged and elderly population, the protein chains that form the lens begin to break down, so that the lens begins to lose its transparency,” explains Dr. Teodor Holhoș, founder of the “Dr Holhoș” Network of Ophthalmology Clinics, which operates in the units in Cluj-Napoca, Sibiu, Alba Iulia, Turda and Mediaș. “From that point on, the process is irreversible and can only be stopped by surgically replacing the lens with an artificial lens, also called an intraocular lens.”
How does cataract occur?
The first symptom is that the glasses no longer help your vision. Then there may be a feeling of blurred, fuzzy or poor vision, colors seem faded, lights seem to have halos at night, or the patient becomes sensitive to light (photophobia). Sometimes patients may have frequent changes in diopters, or find that their near vision suddenly improves, but then rapidly deteriorates.
“Cataract is a disease caused by ageing. In time, we all get cataract if we live to a sufficiently old age; the question is not whether, but how severe the disorder will be for each of us”, says Dr. Holhoș.
The main risk factor is age, followed by other factors such as family history (parents or grandparents with cataract), long exposure to the sun without wearing UV protective glasses, some associated diseases (diabetes, glaucoma, chronic uveitis) or long-term treatment with corticosteroids.
How is cataract treated?
Untreated, the disease can progress to complete loss of vision. Fortunately, it is easily treatable, but only through surgery to replace the affected lens with an artificial one, an intraocular lens made of silicone.
The result is excellent: vision becomes clear and at the same time the need to wear glasses may disappear. Depending on the type of lens implanted, the patient will either only need one pair of glasses (in the case of monofocal lens), or they can renounce to them permanently (if they choose multifocal lens). Also, some lenses – called toric lenses – can correct astigmatism, a vision defect in which the image projected onto the back wall of the eye does not fall perfectly on the retina.
There is no age limit for the surgery. There is no centralized national data for Romania, but in the US, for example, the average age of cataract surgery patients is 77. However, at older ages (and/or associated diseases such as high blood pressure or diabetes) the risk of complications increases.
Doctor Teodor Holhoș has performed over 20,000 cataract surgeries until present. The oldest patient was 93 years old.
How is the surgery performed?
Cataract surgery is one of the safest and most effective eye surgeries; only about 1-2% of cases have complications, but these are usually minor. The procedure is simple, painless and takes only a few minutes and is performed outpatient, with local anesthesia, so the patient can go home within 20-30 minutes of the surgery.
“During the procedure, we fragment the lens using ultrasound, extract the fragments by suction, and then implant the new lens into the empty capsule. The incisions are very small, only a few millimeters, so they close by themselves, there is no need for sutures,” explains Dr. Teodor Holhoș. The procedure ends with the local administration of an antibiotic and an anti-inflammatory and the application of an eye dressing.
After the operation, vision may be restored not immediately but gradually. “The patient does not have to observe any particular restrictions, but must follow a treatment with eye drops for 45 days. During this period it is also recommended to avoid physical effort, exposure to dust, contact of the operated eye with water and/or soap, as well as rubbing or pressing on the eye”, says Dr. Holhoș.
In general, cataract affects both eyes, although not necessarily to the same degree. So, even if both eyes will eventually need lens replacement, a rest period is needed between the two surgeries. Although it is possible, it is not recommended to operate on both eyes on the same day.
What complications may occur?
Complications are rare or very rare, and cataract surgery is one of the most commonly performed procedures in ophthalmology. Complications can also be successfully treated in most cases.
The surgeon’s experience is very important. For example, Dr. Teodor Holhoș has a great experience in performing this procedure. This year alone, the doctor performed more than 1,700 cataract surgeries, while in 2022 he performed more than 2,600 such surgeries, well above the national average for such surgeries.
Post-operative, complications occur especially if the patient does not follow the postoperative indications completely. Secondary cataract, i.e. clouding of the capsule that houses the lens, can occur some time after cataract surgery. This is not a complication as such, but rather a side effect of the surgery. It can be treated very quickly with YAG laser treatment in the examination room.
Where is cataract surgery performed and how much does it cost?
Cataract treatment with the help of lens implants is the most requested intervention in the “Dr. Holhoș” Network of Ophthalmology Clinics. However, the cost of the surgery depends mostly on the type of lens chosen by the patient. There are three types of lens:
- Monofocal. Corrects only one type of diopter, usually the patient will need glasses to see well at distance or near, as appropriate)
- Bifocal. It corrects both distance and near vision, although depending on the case the patient may still need a pair of glasses.
- Trifocal. This type of lens is the most expensive, but generally eliminates the need for glasses completely.
There are also mono-, bi- and trifocal toric lenses, designed to correct astigmatism, if any.
The price of cataract surgery varies depending on the type of lens and its brand. The Dr. Holhoș network also offers affordable options, starting at lei 1,500/eye, which is practically very close to the price at which lenses are also available in the state system, paid for by National Health Insurance House. For trifocal lenses, however, the price can go up to lei 10,800/eye for the toric trifocal version, which completely eliminates the need for glasses.
Each patient receives a lens recommendation based on the type of case – age, other associated disorders, daily activities, lifestyle and not least, their finances.