Definition : replacement surgery of the opacified crystalline lens with an intraocular implant. Ultrasound phacoemulsification + implant placement.
Price : surgery covered by INAMI. Additional fee for premium implants (multifocal, toric, EDOF).
Recovery : functional vision the day after, stabilisation in 2 to 4 weeks.
Indications : opacification of the crystalline lens significantly affecting vision, generally after age 65-70.
Choice of implant : monofocal, multifocal, EDOF, toric depending on visual profile.
Key point : one of the most commonly performed surgeries worldwide, very low complication rate.
Understanding
What is a cataract exactly?
The crystalline lens is the natural lens of the eye. Transparent at birth, it provides focusing at all distances. With age, its proteins gradually change and aggregate, making the lens increasingly opaque. This is cataract.
Vision resembles looking through a windscreen that fogs up gradually and that nothing clears. Light still enters, but it is scattered, diffracted, veiled. The image loses its sharpness, its contrasts, its bold colours.
Before. The lens has clouded. Light scatters as it passes through, contrasts fade and colours dull.
After. The clouded lens is broken up by ultrasound and aspirated, and a clear implant takes its place in the capsular bag, held by two flexible haptics.
No medical treatment can restore transparency to a clouded lens. The only solution is surgical, and it is today remarkably predictable. Cataract is the leading cause of reversible blindness worldwide.[1]
It affects almost everyone over 70 years of age, to varying degrees. What determines when to operate is the functional impairment experienced.[4]
What it changes in daily life
Night vision and driving. Halos around headlights, glare, loss of contrast in the dark. Many patients give up driving at night before even realising that cataract is responsible.
Colours that fade. The clouded lens progressively filters blue light: whites turn yellow, colours lose their vibrancy. This change is so gradual that most patients only notice it after surgery.
Reading and detail tasks. Blurry vision, letters slightly doubling, rapid visual fatigue. Symptoms often attributed to age or poorly adjusted glasses, when they signal an evolving cataract.
Prescriptions that change constantly. Corrections change more and more frequently, without ever truly stabilising vision. It is often this sign that prompts a consultation.
The procedure
Cataract surgery is the most performed surgical procedure in the world. It lasts about twenty minutes. The patient goes home the same day.
The technique used is phacoemulsification: the clouded lens is fragmented by ultrasound through a 2.2 mm micro-incision, then aspirated. An artificial, transparent and permanent intraocular implant is deployed in its place. The micro-incision closes by itself, without sutures.[2]
Anaesthesia: the most common concern
It is the most frequent question in consultation: will I feel anything during the procedure?
The procedure is performed under assisted topical anaesthesia, which combines several levels of protection. The surface of the eye is anaesthetised with drops. The inside of the eye is anaesthetised by a product injected at the start of the procedure, which suppresses any sensation of pressure or internal manipulation. An anaesthetist is present in the operating theatre throughout the procedure and can administer a light anxiolytic or sedative if needed.
The patient remains awake, can speak. But feels nothing.
The choice of implant
Modern cataract surgery goes beyond treating an opacity: the choice of implant determines the quality of vision for the decades to come.
Monofocal implants. Correct vision at a single distance, usually far. Excellent visual result for the chosen distance, with glasses required for reading. Ideal for patients who prefer optical simplicity.
Multifocal and trifocal implants. Designed to simultaneously correct far, intermediate and near vision. The vast majority of patients operated on with this type of implant no longer need glasses in daily life. Point to note: they can generate night-time light halos in the first weeks, which gradually fade with neuroadaptation.[3]
EDOF implants. Extended Depth Of Focus: a technology between monofocal and multifocal. It offers an extended range of vision from far to intermediate, with fewer halos. Ideal for patients who drive a lot or work on screens, and accept light reading glasses for fine print.
References
WHO. World report on vision. Geneva: World Health Organization, 2019.
Lundström M, Barry P, Henry Y, Rosen P, Stenevi U. Visual outcome of cataract surgery; study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2013;39(5):673-679. doi:10.1016/j.jcrs.2012.11.026.
Cochener B, Lafuma A, Khoshnood B, Courouve L, Berdeaux G. Comparison of outcomes with multifocal intraocular lenses: a meta-analysis. Clin Ophthalmol. 2011;5:45-56. doi:10.2147/OPTH.S14325.
HAS. Indications and contraindications for age-related cataract surgery: appropriateness of care sheet. Saint-Denis: Haute Autorité de Santé, 2019.
There is no fixed age. It is the impairment experienced day to day that justifies surgery, more than a figure for acuity.
Is cataract surgery reimbursed in Belgium?
Yes. The procedure is reimbursed by the health insurance. Premium implants involve a non-reimbursed supplement.
Can one stop wearing glasses after cataract surgery?
Yes, with a multifocal or trifocal implant. The vast majority of patients no longer need glasses in daily life.
Is cataract surgery painful?
No. It is performed under topical anaesthesia with eye drops. You are awake but feel nothing.
Can one wait before operating? Cataract progresses at very variable rates depending on the individual. When it does not significantly affect quality of life or driving ability, waiting is possible. But indefinitely postponing the procedure exposes one to a very advanced ("white") cataract, technically more difficult to operate on and associated with less predictable recovery.
Is the surgery painful? No. Anaesthetic drops are enough, and an anaesthetist stays in the room throughout the procedure. It lasts about 20 minutes and is performed as a day case. The vast majority of patients describe an experience that is barely or not at all painful.
Good to know
Cataract and previous refractive surgery
Patients who have had refractive surgery (Femto-LASIK, PRK) in the past must imperatively mention this during the cataract consultation. Standard implant calculation formulas give less precise results after corneal surgery. Adapted formulas and additional examinations are necessary to optimise the implant choice and obtain an optimal refractive result postoperatively.
Cataract surgery is one of the most performed procedures in the world, with a very well-documented safety and efficacy profile. In Belgium, it is reimbursed by the compulsory health insurance once the cataract sufficiently affects vision. Premium implants (multifocal, EDOF) involve a non-reimbursed supplement that will be detailed during the preoperative exam.
Author of this page
Dr Serdal Sanak
Ophthalmic surgeon · Refractive and cataract surgery
CHIREC Hôpital Delta, Brussels
Graduated from the ULB, trained at CHU de Liège and CHIREC. European Diploma in Ophthalmology (FEBO). Refractive and cataract surgery make up the bulk of my operating activity, with procedures every week at CHIREC Delta. Dual specialisation: corneal laser surgery (Femto-LASIK, PRK) and intraocular surgery (ICL, PRELEX, cataract). Consultations in French, Dutch, English, Turkish, Kurdish, Persian and Italian.
