What is Cataract?

Human eye has a natural clear lens, which is transparent and forms a clear image of the outside world on retina. When this lens develops haziness/opacity, it is called Cataract and results in blurred vision.

What is the lens of the eye?

The lens is a part of the eye that along with cornea helps to focus light onto the retina from where the visual signals are sent to the brain. The lens is located just behind the iris, the coloured (brown, blue or green) part of the eye. In focusing for various distances ,the lens changes shape. It becomes more convex (curved) when you look at nearby objects and flatter for distant objects.

When does cataract develop?

Cataract may develop at any age - right from birth to old age - but is most commonly seen in elderly.

What causes cataract?

Cataract is usually due to aging process, but, may occure at a younger age also. Although researchers are learning more about cataracts, no one knows for sure what causes them in old age. There can be other reasons besides age to cause cataract , e.g. eye diseases like uveitis, general diseases like diabetes, heredity, injury, radiation, infections, trauma and steroid intake.

explain cataract conditions

Eye MicroSurgery

What are the symptoms of cataract ?

The most common symptoms are:

  • Cloudy or blurry vision
  • Problems with light, headlights that seem too bright at night, glare from lamps or the sun, or a halo or haze around lights
  • Colours seem faded
  • Double or multiple visions
  • Frequent changes in eye glasses or contact lenses

In early cataract one may not notice any changes in vision. Most Cataract tends to grow slowly, so vision worsens gradually.

explain cataract conditions

phacoemulsification-removal of Cataract thru 2.2mm incision

What are the different types of cataract?

Age-related cataract: Usually cataracts are related to aging.

Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes.

Secondary cataract: Cataracts are more likely to develop in people with certain other eye diseases like uveitis or health problems, such as diabetes. Consumption of oral steroids or using steroid eye drops for long can also cause cataract.

Traumatic cataract: Cataracts can develop soon after an eye injury, or months later.

explain cataract conditions

Foldable Intraocular Lens Being Injected in Eye

How is a cataract diagnosed?

A comprehensive eye examination usually includes:

Visual acuity test/ Refraction : This test measures how well you can see at various distances and if you can improve with change in glasses prescription.

Pupil dilation: The pupil is widened with eye-drops to allow us to see more of the lens & retina and to look for other eye problems.

Tonometry: This is a standard test to measure eye pressure. Some patients have high eye pressure leading to glaucoma .

Biometry :Ultrasonic or Optical measurement of the eye to calculate the power of intra ocular lens to be implanted.

Other eye and general test may be required to establish complete diagnosis and fitness for cataract surgery.

explain cataract conditions

Toric Intraocular Lens to Correct Astigmatism During Cataract Surgery

Dr. Parul Sharma

Iris Hooks used for nondilating pupil in phacoemulsification

What should one do?

The first thing a person must do on experiencing any of these symptoms is to consult an Eye Surgeon for a thorough eye examination. Answers to the following questions should be sought:

  • Do I have cataract?
  • Do I have any other eye disease?
  • What is the cause of cataract in my eye?
  • What are the treatment modalities available?
  • What treatment would be most suitable for me?
  • What is the expected outcome of the surgery in my case?
    • What are the risks involved and possible complications?
    • How long can I wait before I get operated?
    • What does the surgery involve in terms of time and expenditure?
explain cataract conditions

Femto Lasik & Cataract OT

Dr. Parul Sharma

Dr Parul femto cataract OT

Is there a medical treatment or prevention for cataract ?

None . There is no prevention or medical treatment .The only solution is surgery wherein the opaque lens is removed and replaced with a clear customised intra ocular lens .

explain cataract conditions

Capsulotomy -rhexis planning

What is the treatment of cataract?

Surgery is the only defintive treatment. Whenever the patient feels his vision has decreased to a level where it interferes with his daily activities he can get operated upon (waiting for cataract to mature is an old concept suitable for the surgery of that era). However, in certain cases where there are associated complications or potential risks of complications, an early (even urgent) operation may be required - here the advice of your Consulting Eye Surgeon should be followed. The operations done for cataract are the following (the list includes only established standard procedures):

  • Phacoemulsification with foldable IOL –MicroIncision Cataract Surgery (MICS)
  • Femto Assisted Bladeless Cataract surgery (FLACS) with foldable IOL
  • Small Incision Cataract Surgery (SICS) with IOL

MICS Phacoemulsification:

  • It is a no stitch, no injection and no bandage micro incision cataract surgery. A very small cut/incision (only 2.2 mm) is made into the clear part of the eye (Cornea) and the hard core (nucleus) of the lens is converted into small pieces & soft pulp using high frequency ultra sonic waves (NOT Laser) and sucked out. Then a foldable lens (IOL) is injected through the small incision and positioned into the capsular bag.
  • The main advantages of this operation are early rehabilitation and decreased occurrence of astigmatism (cylindrical power in glasses).
  • All these operations are done under local (injection) or topical (eyedrops) anaesthesia that makes the eye numb and the patient although conscious does not feel any pain. The preferred method of giving anaesthesia is topical or eye drops anaesthesia. This not only helps in avoiding the painful injections and the eye bandage, but also reduces the risk associated with injection anaesthesia (e.g., retro-bulbar haemorrhage, globe perforations, etc.)
  • The general anaesthesia or sedation is used only in children and uncooperative patients.

Intra-ocular Lenses (IOL):

  • Intra-ocular Lenses (IOL) are small lenses made of a soft polymer (like Acrylic) and are implanted inside the eye in place of natural opaque lens. The greatest advantage of IOL is a clear wide field of vision and the fact that the patient does not have to constantly wear thick glasses.
  • Intra-ocular Lenses (IOL) are small lenses made of a soft polymer (like Acrylic) and are implanted inside the eye in place of natural opaque lens. The greatest advantage of IOL is a clear wide field of vision and the fact that the patient does not have to constantly wear thick glasses.
  • Monofocal foldable IOLs correct majority of distance visison and patient has to wear near glasses as n when required
  • Toric foldable IOLs correct astigmatism for distance
  • Multifocal foldable IOLs offer the advantage of distant and near vision correction , hence, reduce the dependence on glasses, but suffer minor disadvantage of slight lower contrast, & lower color saturation.
  • Your eye surgeon will be able to guide you on the choice of IOLdepending on your lifestyle and eye condition.

Femto Laser Assissted Cataract Surgery (FLACS)

  • A Femtosecond is one millionth of a nanosecond and is a measurement used in laser technology. The femtosecond laser in cataract surgery is used to make corneal incisions (instead of microkeratome blade) , opening of capsule of lens (instead of a needle to make capsulorhexis),and pre chopping & fragmentation of cataract. The rest of surgery wherein cataractous lens is emulsified, cortex cleaning & lens insertion remains the same as in MICS Phacoemulsification surgery. Although it is called a BLADELESS surgery it does not mean that there is no cut on cornea. The femto laser advantage is that it can be used with varied specifications, which gives the surgeon more control, PRECISION and increases the SAFETY FACTOR. Femto laser assisted cataract surgery has distinct advantages in hard cataracts, hypermature milky white cataracts , subluxated cataracts , posterior polar cataracts . The femto laser can also correct corneal astigamtism by doing LRI –limbal relaxing incisions. Your eye surgeon will guide you on choice of technique of surgery after examinaing your eye in detail

Small Incision Cataract Surgery (SICS ):

  • This surgery is usually reserved for hard dense advanced cataracts which are difficult to break by phaco machine/ FLACS and may result in complications. SICS becomes a safer option in such eyes.
  • The incision made is larger (7-9 mm) and a non foldable PMMA IOL is used to replace the cataractous lens removed.
  • Monofocal foldable IOLs correct majority of distance visison and patient has to wear near glasses as n when required
  • SICS is relatively low cost and done in centres where there is volume work and phaco machines cannot be afforded.

explain cataract conditions

treatment planning cataract femto

explain cataract conditions

Corneal Incisions ,Rhexis, Prechop done by Femto

explain cataract conditions

Magnified view -Femto CapsuloRhexis prechop

explain cataract conditions

Capsuolrhexis clean capsular bag in which the IOL will be implanted

What is done for the preparation before surgery?

Before surgery, a detailed eye examination is done including Biometry (measurments of eye to decide on the power of intraocular lens) . Other tests - BP, blood sugar, viral marker screening, urine R/M, ECG have to be done.

What happens after surgery?

Most people after a cataract surgery can go home in few hours . It's normal to feel itching, sticky eyelids, and mild discomfort for a while after the surgery and on day one. You will be instructed to put eye drops and most of routine daily activities can be resumed from the very next day. There are no diet restrictions and no lifestyle changes are required. The post op visits are next day in opd, then after a week and then at end of third week wherin we give final spectacles prescription. Some outstation patients may choose to go back early after the first opd visit and follow up locally .

When does the vision become normal?

After the surgery, you can read and watch TV etc from the next day itself, but your vision may be blurry. It takes few days for vision to stabilise. The vision is restored after the final spectacles prescription at 2 or 3 weeks time.

What are the results and complications of cataract surgery ?

Cataract surgery is a relatively safe day care surgery due to advanced technology with gratifying visual results. But like any surgery in body ,there is an inherent small risk of predicted or non predicted complications. Problems after cataract surgery are uncommon, but they may occur sometime despite best technique & aseptic precautions. These can include infection, higher eye pressure ,inflammation, haziness of the cornea, swelling in macular area of retina and rarely retinal detachment of the retina. We also have to keep in mind that the surgeon, surgical technique and the quality of the IOL are not the only factors that decide the result of cataract surgery. It also depends on the pre existing condition of the eye, the cornea, retina status and the presence of systemic diseases like diabetes, hypertension, infections, etc. The quality of the operation theatres, use of disposable instruments, ancillary and backup facilities, training of the support staff, etc. also have a significant influence on the success of the surgery. Ensuring good quality in all these areas leads to an increase in the surgical cost for the patient, but it must be understood that our eyes are worth a lot more.