Cataract Surgery

The changes in the eye’s lens associated with cataracts are primarily age-related. Intense light, UV radiation, and smoking promote the development of cataracts. Early onset can also occur after injuries and other eye surgeries, as well as after cortisone treatment and radiotherapy.

If you notice a gradual loss of visual acuity in one or both eyes, colors becoming paler, contrasts weaker, and you are increasingly sensitive to glare (e.g., from the headlights of oncoming cars or the low-lying sun), then this could be due to cataracts. Sometimes, the thickening and hardening of the eye lens can change your visual acuity, making you nearsighted, or reducing farsightedness, allowing you to read without glasses again. As soon as you notice these signs – or even better, regularly once a year – you should visit your ophthalmologist for an examination.

During the cataract examination at our practice, your vision is assessed and your visual acuity determined, and, if necessary, your contrast vision and twilight vision as well. Using biomicroscopy at the slit lamp, clouding of the eye’s lens is identified. Other possible additional causes of deteriorating vision—especially retinal and macular changes and glaucoma—must be ruled out. In discussion with you and based on previous findings, we determine how quickly the cataract is progressing, whether surgery is already necessary, and when the best time for it is.

To date, surgery is the only option for treating cataract. In most cases, however, surgery does not have to be performed immediately. Visual requirements vary from person to person. And cataract is not “dangerous” — surgery fully restores vision. If the clouding of the lens and the reduction in visual performance do not cause any impairment in everyday life, it may be sensible to wait and monitor its progression. However, there are clear studies showing that as cataract progresses, the risk of falls increases, accidents and bone fractures become more frequent, and this also leads more often to permanent impairments and lasting disability. If the cataract is already very advanced, the surgery also becomes more difficult and riskier. For this reason, there are also well-established international guidelines on when cataract should be operated on. In all cases, however, the decision remains an individual one.

Cataract surgery can completely remove the cataract. Ideally, vision is fully restored as a result. However, sometimes there are other eye conditions in addition to the cataract. If there is also macular degeneration, for example, the visual field will brighten after the operation and orientation will improve again. However, reading ability can only be restored to the extent permitted by the condition of the retina and the macula. The retinometer test is used for an objective functional assessment of the macula and can provide a guideline for predicting the expected improvement in vision.

On the day of your cataract surgery, you will arrive at Eyeside or the Sanatorium Privatklinikum Leech at the scheduled time. You may take all your medications as usual. There is also no need to discontinue any blood-thinning medication. After registration, biometry is performed—if not already done in advance—to determine the appropriate intraocular lens for your eye. We always have all lenses in stock in our inventory. You will then be escorted to the preparation room. The anesthesiologist will speak with you once more, your blood pressure will be measured, and—for safety—an intravenous access (“IV line”) will be established. Drops will be administered to the eye being operated on several times. Then I will come to collect you, and we will wheel you into the operating room on a mobile surgical bed. The cataract surgery itself usually takes only 10–15 minutes.

Cataract surgery is usually performed under topical anesthesia (without an “injection”); only in rare cases is retrobulbar anesthesia, i.e., an injection next to and behind the eye, required. The surgery itself normally takes only 10-15 minutes. First, the area around the eye to be operated on is cleaned and disinfected. Then the face is covered with a drape—only the eye remains exposed. The blood pressure cuff inflates once more and measures your blood pressure. I sit behind or above your head. We can talk to each other throughout the entire procedure. I ensure once again that your eye is pain-free and then adjust the operating microscope. Through small incisions in the cornea of the eye (less than 2 mm), the clouded lens is removed from the eye, and a new, clear lens is inserted. At the end of the surgery, the operated eye is dressed with an antibiotic eye ointment and covered with a protective shield for one night.

After the surgery, you can rest for a few minutes in the “Post-OP” room. A snack and beverages are prepared for you. You will receive eye drops and a card with the details of the implanted lens. After that, you can go home. I recommend that you do not travel alone using public transportation. Please have someone accompany you, or arrange to be picked up (if necessary, by taxi). If desired, you can also stay overnight at the clinic. Please leave the eye bandage and protective shield on your eye until the follow-up examination the next day at the practice. If the bandage comes loose, or if it itches and you “must” remove it, you may use the eye drops you received at the clinic.
At the follow-up examination the next day, I will remove the bandage. Vision will initially be blurred due to the eye ointment, but will improve quickly. Sometimes it takes a few days for vision to improve. You should take it easy for about one week after the surgery, and keep the eye clean and avoid applying makeup for 2 weeks. In particular, please avoid activities involving sand, dust, soil, and unclean water. Light outdoor activity, however, is not a problem. In strong sunlight and wind, you should also wear (sun)glasses.

After the surgery, you will need to use eye drops on the operated eye for several weeks. In most cases, there are 2 different eye drops (one of which you will receive at the clinic; the other you will receive during your follow-up appointment at the practice the next day).

An existing refractive error—whether nearsightedness, farsightedness, or astigmatism—can of course also be corrected during cataract surgery. However, in most cases, glasses—either for reading or for distance vision—are still required. As the diopters may still change slightly in the first few weeks after surgery, fitting new glasses is recommended no earlier than 4–6 weeks after the procedure. If desired, presbyopia can also be corrected with a special multifocal lens, so that you are largely glasses-free after cataract surgery. However, the use of these premium lenses requires a careful preliminary examination and detailed counselling regarding the advantages and disadvantages. In most cases, we advise against a “cataract” operation solely to correct refractive error or presbyopia—i.e., a so-called “Refractive Lens Exchange” or “Clear Lens Exchange”—in an otherwise healthy eye and without a medical indication for surgery.

The costs for cataract surgery at the sanatorium, including lens calculation, the artificial lens, anesthesia services, etc., are covered in full by the BVAEB (Social Insurance for Public Servants, Railways and Mining) as well as the municipal health insurance funds (KFA). Billing is handled directly, so you do not need to apply for cost coverage in advance, pay a deposit, or submit any invoices afterward. The SVS only covers surgery costs for certain patients, and even then, only partially. In this case, it is necessary to obtain written confirmation of cost coverage from the SVS in advance.
Furthermore, practically all supplementary insurance plans cover the costs of cataract surgery in full. In this instance, you do not need to worry about the billing process.

For self-paying patients, the surgery currently costs 2,500 euros per eye.
Special lenses for correcting astigmatism and multifocal lenses for independence from glasses at near and far distances are normally not covered by health insurance providers or supplementary insurance. The current costs range between 350 euros for a toric IOL for astigmatism and 600 euros for a multifocal IOL. The exact costs depend on the specific lens type.