Cataract

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What is Cataract?

Patients with cataracts often note that their vision is blurry, colors appear dull, and they struggle with driving at night due to the troubling glare and halos around headlights. If this sounds familiar, you may be experiencing cataracts yourself.

A cataract is a clouding of the eye’s naturally clear lens. The lens typically becomes cloudy and has a bit of a yellowish hue to it. When the natural lens experiences this clouding effect, vision quality is diminished. Many people describe this sensation as looking through a foggy car window or a piece of wax paper. Cataracts can be burdensome especially to people who have had clear vision most of their life.

The lens in your eye is responsible for focusing light rays on the retina, which is the part of the eye that senses light and transmits these images to the brain. When the natural lens becomes cloudy, light rays cannot possibly pass through. Vision becomes blurry at this point and as the cataract develops, it becomes increasingly difficult to see. Developing cataracts is part of the normal aging process. It has been stated by many eye doctors that if you live long enough, you will develop cataracts.

CLOUDY BLURRY VISION

TROUBLE SEEING AT NIGHT

LIGHT & GLARE SENSITIVITY

SEEING HALOS AROUND NIGHT

FADING OR YELLOWING OF COLOURS

DOUBLE VISION

Types of Cataract

Nuclear Cataract

Nuclear as the name suggests tiny, so a tiny formation at the centre of the lens. Initially, that cataract may cause an increased clarity in the reading sight but this is a discrepancy and later on it turns out ugly by forming cloudiness of the eyes and vision and the colors cannot be distinguished adequately.

 

Cortical Cataract

Opposite to nuclear cataract this cataracts covers the periphery of the lens. So a cloudiness is formed around the outer edge of the lens cortex and overtime this extends towards the centre of the lens as in nuclear cataract . Patients with diabetes can more likely acquire this.

 

Posterior Subcapsular Cataract

Here the lens is affected in its back and the progresses is fast compared to above mentioned types. Reading is impaired, bright light is sensed with reduced vision reduces your vision and glares the eyes and there are halos is formed around light source at night. Patients with diabetes, Uveitis and on steroid for extended period of time have higher risk of acquiring this type of cataract.

 

Congenital Cataracts

Cataract by birth is congenital cataract, often both eyes are affected. This cataract is most of the time genetic disorder, but can also occur due to infection, trauma, inflammation, metabolic problems or drug reactions. These cataracts may be extremely small and don’t always affect vision. However, moderate to severe cataracts that affect vision may need to be treated with cataract removal surgery at the earliest to avoid lazy eye (Ambylopia).

 

Traumatic Cataract

An injury to the eye can also form a cataract, the injury can occur on different events like driving, playing, or any other form of accidental incidents where a blunt force is involved to the eye can also cause cataracts as there is a damage to the lens within the eye.

 

Radiation Cataract

A radiation therapy for any ontological conditions can cause cataract formation after the treatment as the lens cells are affected and damaged due to the radiation treatment.

 

Diagnosis

To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:

  • Visual acuity test. A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.
  • Slit-lamp examination. A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities.
  • Retinal exam. To prepare for a retinal exam, your eye doctor puts drops in your eyes to open your pupils wide (dilate). This makes it easier to examine the back of your eyes (retina). Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract.
  • Applanation tonometry. This test measures fluid pressure in your eye. There are multiple different devices available to do this.

What’s the Treatment?

Overview of Treatment

Clumping of the lens proteins is the only reason for the cause of cataract. This clumping is irreversible with medication, and thus, surgery is the only method used to treat cataract. During this surgery, the doctor removes the affected lens and an artificial lens called the Intra-Ocular Lens (IOL) is implanted in the eye. Thus, allowing the passing of the light through it and sending proper image signal to the brain.

Cataract surgery

There are several kinds of operations for cataracts, but they all have one thing in common: Your surgeon takes out the cloudy lens and replaces it with an artificial one.

You might feel a little uncomfortable with the idea of an operation on a sensitive spot like your eye. But it’s a very common procedure. You’ll get medicine called local anaesthesia to numb your eye. You’ll be awake but sedated, and you won’t feel anything.

It usually takes about 15 to 20 minutes, and you don’t need to stay overnight in a hospital. If you have cataracts in both eyes, your doctor will wait until your first eye heals before they perform surgery on the second. More than 95% of people who have this done say they can see better afterward.

Specialists can undertake different types of surgeries. With the advancement of science and technology, different surgical methods for treatment of cataract have come up. These different surgical techniques include:

  • Micro-incision Cataract Surgery: The surgeon makes a small incision on the cornea to remove the affected lens. The size of the incision in this method is 2.2 mm, thus the name, micro-incision. The process of emulsification helps in emulsifying the affected lens which is then removed. The doctor then inserts a foldable IOL which replaces the original lens. This is a quick procedure which is painless and stitch-less. It also leads in quick healing and recovery. The smaller size of the incision leads to markedly reduced astigmatism after surgery.
  • Phacoemulsification: The techniques uses phacoemulsification process for emulsifying the cataract. It needs an incision of 2.8 mm. An ultrasonic phacoemulsification probe helps to emulsify and remove the cataract. This process is also stitch-less. On removal of the cataract, a foldable IOL is implanted.
  • Small Incision Suture-less Cataract Surgery: In this type of surgery, the incision is not made on the cornea, but a larger (6mm) scleral tunnel incision made. This procedure is useful when phacoemulsification is not possible as in very advanced or hyper-mature cataract which pose a risk and are not suitable for phacoemulsification procedure. This does not cause damage to the cornea. The removal of cataract takes place is done manually followed by implantation of IOL.
  • Femtosecond laser surgery. In this operation, your surgeon uses a laser to break up the lens. As with the other types, they’ll then put in the new lens. Your doctor may suggest this if you also have an astigmatism, a curve of your cornea that makes your vision blurry. Your surgeon can treat that problem during the cataract surgery by using the laser to reshape your cornea.
 

Intra-Ocular Lenses (IOLs) for Cataract Surgery to replace natural lens

There are different IOLs based on the power and function like Monofocal IOLs, Toric IOLs, Multifocal IOLs, Trifocal IOLs & EDOF IOLs

Monofocal IOLs: Correct only distance vision and near vision glasses are still required after surgery.

Toric IOLs: When the pre-operative astigmatism is significantly high, a toric IOL is chosen.

Multifocal/ Bi-vision IOLs: These IOLs reduce the dependence on glasses to a very large extent and patient can enjoy clear vision for both distance and near without spectacles after surgery. But, should be avoided incase if your drive during night as these IOLs area associated with glares, halos and streaks of light are common side affects of multifocal/Bi-vision IOLs. They occur more frequently at night or in dim lighting

Trifocal IOLs – Provide near to distance. Reduces dependency on glasses. Should be avoided incase if your drive during night as these IOLs area associated with Halos & Glares due to presence of rings or Zones in IOLs which makes night driving riskier. Also, associated with contrast issues.

EDOF (Extended Depth of Focus) IOLs (EDOF/EDOF Toric) – These are the new generation IOLs which provides –

  1. Near, Intermediate & Distance vision
  2. Distance to Intermediate vision

Vision outcome post surgery depends on the type of EDOF IOL patient choose. Thereby, reducing dependency on glasses. EDOF IOLs provides comfort of Night driving & don’t have any contrast sensitivity issues.

NOTE – However, with best of Surgeon’s skills, Medical equipments & IOL’s – Outcome of the surgery also depends patients medical history & conditions like Diabetic retinopathy, Glaucoma, Age related macula degeneration, Myopic degeneration, Amblyopia, Retina condition, Corneal opacity and Corneal curvature depending on which your surgeon will decide which the best IOL suited for your eyes.

Tell everything about your medical history & medications currently/past taken by you to your Doctor before proceeding for cataract operation.

Tips for post-cataract surgery recovery

Majority people can resume everyday activities 24 hours after cataract surgery, there are a few instructions that you will be asked to follow. They include:

  • Don’t do any strenuous activities for a few weeks. Avoid rigorous exercise and heavy lifting.
  • Don’t drive. The length of time after cataract surgery before you can drive depends on a number of factors – your doctor will tell you when it is safe to resume driving.
  • Follow your doctor’s orders regarding any antibiotic and anti-inflammatory eye drops. These are important to prevent infection and inflammation and ensure proper healing. If you have difficulty in administering them, get a friend or family member to help you out.
  • Stay away from dirt & dusty areas. It’s a great idea to have your house vacuumed and cleaned before surgery, as your eyes will be sensitive to airborne allergens such as dust.
  • Don’t rub your eye. Eye rubbing is a quick way to develop a nasty infection. It’s never a good idea, even when you aren’t recovering from cataract surgery.
  • Don’t swim. It’s best to avoid swimming or hot tubs for a week after surgery.
  • Don’t wear make-up. Ask your doctor when you can resume doing so.

Cataract surgery in the majority of cases successfully restores vision. Aftercare post-surgery during the recovery period is essential to avoid a nasty infection. Follow your doctor’s instruction to avoid any complications and for fast healing of the eye.