Definition

Pseudophakia, or "false lens," is a condition that occurs after an artificial lens, also known as an Intraocular Lens (IOL), is implanted in the eye to replace the natural lens. These lenses provide better vision. The intraocular lens is placed during cataract surgery and remains there for life. These lenses do not interfere with normal eye function, require no special care, and are not rejected by the body. Intraocular lenses are made of acrylic or silicone, similar to clear plastic, with optical power that can permanently improve vision.

Causes

The most common cause for needing an intraocular lens is cataracts. Cataracts are an abnormality in the lens of the eye, characterized by cloudy lenses, which reduces vision acuity. Cataracts are prevalent and are the leading cause of blindness worldwide. They develop because the lens of the eye, which focuses light to produce clear and sharp images on the retina, becomes less flexible, less transparent, and thicker over time, partly due to aging. Eventually, the cloudiness becomes denser and spreads, blocking light from passing through the lens and preventing a clear image on the retina, resulting in blurry vision.

In the early stages, cataracts may not interfere with daily activities. However, as the disease progresses, it causes cloudy vision, making it difficult to drive, read, and perform daily tasks. This cloudiness prevents light from reaching the retina, leading to vision problems where objects appear blurry. If cataracts are mild and have not caused significant visual impairment, surgery is usually not recommended. The doctor will recommend surgery when symptoms such as impaired night vision, blurred vision, difficulty distinguishing colors, sensitivity to light, nearsightedness, double vision, and halos around light sources appear.

Risk Factor

Risk factors for pseudophakia are related to those that increase the risk of cataracts, such as age. As we age, the lens naturally hardens and becomes cloudy. Additionally, the lens size increases as new lens fibers emerge. Most cataracts develop around the age of 60-70 years, but some inherited genetic disorders causing other health problems can also increase the risk of cataracts.

Cataracts can also be congenital or occur at a young age. Gender and occupational factors related to exposure to ultraviolet rays from sunlight can also increase the risk. Other eye conditions, previous eye surgery, or medical conditions such as diabetes can cause cataracts. Long-term use of steroid drugs is another risk factor.

Symptoms

Common symptoms indicating the need for pseudophakia include cloudy or blurred vision, faded colors, difficulty seeing at night, increased sensitivity to sunlight or lights, and double vision. These symptoms indicate the onset of cataracts, which develop slowly and progressively. Cataract symptoms do not spread from one eye to the other but can occur in both eyes simultaneously.

After installing an intraocular lens, symptoms can include blurred vision, which can be myopia (farsightedness) or hypermetropia (nearsightedness) depending on the lens size implanted, and the presence of incision marks or stitches.

Diagnosis

The diagnosis of pseudophakia can be made through an in-depth medical interview regarding the patient's symptoms and medical history, and physical examination. During the history-taking, the presence of previous cataract surgery can be identified. A physical examination involves shining a flashlight into the eye, where a positive mirror reflex, indicating the reflection of light from the flashlight, confirms the presence of an intraocular lens.

Management

The advantage of installing an intraocular lens is improved vision, as the lens is placed where the original lens was removed. This placement maintains the normal visual field, avoids enlargement of visible objects, and enhances psychological well-being and mobility for activities. However, intraocular lenses are not recommended for eyes that frequently experience inflammation, children under three years of age, patients with severe chronic uveitis, or those with severe glaucoma.

After surgical care for an intraocular lens involves managing increased sensitivity to light and eye discomfort. Patients are advised to use prescribed medication and wear an eye patch on the operated eye for the duration specified by the doctor. This prevents rubbing or pressing the eyes, especially during sleep, and protects the eyes from bumps. Follow-up appointments with an ophthalmologist are essential.

During the recovery period, vision may initially be blurry for several days but should improve within 2 to 4 weeks. Patients should wash their hands before touching their eyes or administering eye drops and follow their doctor's medication recommendations to minimize infection and inflammation risks. Avoid getting water in the eyes until permitted by the doctor and refrain from looking down for 24 hours post-surgery to prevent increased pressure on the eyeball. Light exercises like walking are acceptable, but heavy exercises, aerobics, and headstands should be avoided.

A few weeks after surgery, patients will receive new glasses and be allowed to clean their eyes. Blepharitis (infection of the eyelids) is a common complication due to patients' reluctance to clean their eyes thoroughly during the initial recovery period.

Complications

Possible side effects of pseudophakia include over or under-correction of vision, improper lens placement, lens dislocation causing blurry vision, fluid buildup, and retinal swelling. Complications from pseudophakic surgery for cataracts include infection, bleeding, eye swelling and redness, vision loss, double vision, increased eye pressure leading to glaucoma, and retinal detachment.

Prevention

To reduce the risk associated with intraocular lenses, it is essential to prevent cataracts. Measures include protecting the eyes from UV B rays, having regular eye examinations, especially in older age, quitting smoking, consuming fruits and vegetables rich in antioxidants, and managing diabetes and other medical conditions.

When to See a Doctor?

Consult an ophthalmologist immediately if you notice changes in visual function. Seek urgent medical attention if you experience sudden vision changes, such as double vision or flashes of light, sudden eye pain, or a sudden headache.

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