Cataract

Cataract is the leading cause of bilateral blindness in India. It has been reported that cataract is responsible for 50-80% of the bilaterally blind in the country. Cataract formation is a natural part of the eye’s aging process. In cataract there is a buildup of protein in the lens that makes it cloudy. This prevents light from passing clearly through the lens, thereby causing loss of vision.

However advancing age is a primary reason for cataract. With age, protein of the lens turns opaque. Other causes of cataract are metabolic disorders such as diabetes, excessive exposure to sunlight, lifestyle disorders like heavy alcohol consumption and smoking. Injury to the eye can also lead to clouding of the lens of the eye.

For perfect vision the lens should be clear so that light can pass through it and reach the retina. When the lens becomes cloudy or opaque, light cannot pass through it and the vision become dim or blurred. A cloudy lens is called a cataract. A cataract is not a growth or a film over the eye — it is a cloudiness of the natural lens inside your eye.

Causes of Cataract:

The most common cause of cataract is the deterioration of the normal structure within the lens of the eye with age. There may be other causes like diabetes, kidney disease, glaucoma, eye injuries, infection, and inflammation inside the eye. Prolonged use of certain medications can also lead to cataract formation.

In the early stages, you can improve your vision by changing your glasses. But once the cataract progresses, changing glasses will not help. You will notice some deterioration in your ability to see things clearly from a distance. You may have difficulty with glare while driving or while performing activities like reading that require clear vision. Other symptoms may be coloured haloes or double or multiple images in the eye when the other eye is occluded.

A cataract may develop slowly over several years or rapidly within months. Often the other eye will also be affected but it may not happen at the same time. There are no medications, eye drops or dietary restrictions that can cure or prevent cataract formation. If the cataract interferes with your regular activities, the only solution is surgery.

In cataract surgery your natural clouded lens is replaced by an artificial intraocular lens (IOL) which helps incoming light rays to be focused properly. Your new lens should restore vision to nearly what it was earlier, though you may need to wear glasses for reading or driving.

Surgical techniques:

Several techniques are used for removing cataracts:

Phaco-emulsification: In this method a tiny instrument is inserted through a very small incision. The instrument uses ultrasound vibrations to break the cataract into fine pieces, which are gently suctioned out. The new lens is then inserted into the eye. Usually no stitches are required to close the incision. This minimal surgery allows faster and safer healing, hastening your return to normal activity.

Small Incision Cataract Surgery (SICS): This is a new technique where the cataract is removed manually through a small incision. The small incision heals fast, enabling you to recover quickly.

Extra Capsular Cataract Extraction (ECCE): Here the lens is removed in a single piece through a relatively larger incision. It is replaced with an artificial lens and the incision is closed with fine stitches. The surgeon may opt for this technique in cases where the cataract is very advanced. The recovery period is longer here.

The doctor will select the method of surgery that is most suitable for the patient.

Planning for surgery:

It is not necessary for the cataract to mature fully or for the vision to become totally cloudy before scheduling surgery. You and your ophthalmologist should jointly decide on the time for surgery. Be sure to inform your doctor about any medications or herbal remedies that you may be using.

At the Institute our counselors will help you to understand the pre-operative procedures and obtain an estimate of the expenditure involved. Prior to your surgery, you will need to undergo some routine medical and blood tests. If you wear glasses or contact lenses bring them so that your prescription can be checked. An A-scan will help the doctor to determine the power of the new lens to be implanted in your eye.

It is good to wash your face thoroughly with soap and water before coming for surgery. You will be advised to use some eye drops. Please follow the instructions carefully as these drops help dilate your eye. If your eye is not properly dilated, surgery may be delayed. You may also be advised not to eat or drink anything for a few hours prior to surgery. You can bring only one attendant; children below 15 years are not allowed unless they are patients.

Though the success rate for cataract surgery is almost 98%, sometimes there may be complications. Most of these complications are minor and can be rectified. Your doctor will advise you about any specific issues related to your case.

The Surgery:

In the operating room, the area around your eye will be cleaned thoroughly. Sterile drapes will be placed around your head and face, with only the eye exposed. Usually a local anesthetic in the form of an injection is administered next to the eye. Sometimes doctors may have to perform the surgery under general anesthesia. An oxygen tube will be placed near your nose so that you do not feel suffocated.

The actual surgery lasts about 30 minutes. You will be relaxed and awake but feel no pain. The nerves in your eye will be completely numbed so you will not be able to see or move your eye. Generally, there is very little bleeding.

Care after surgery:

After surgery a bandage or shield will be placed over your eye. You will be advised to rest till you are ready to leave.

You should wear protective glasses or an eye shield in the day and an eye patch at night to avoid accidental injury. The doctor will advise you when you can discontinue them. You can bathe carefully from below your neck but do not wet the operated eye for 15 days. You may gently clean the eyelids with a piece of cotton boiled in water or a sterilized tissue.

Some important tips:

• Do not rub the operated eye.
• Do not use any eye cosmetics until the doctor allows it.
• Do not wash your hair until the doctor says you can.
• Shave carefully, soap or water should not enter the eye.
• Avoid any vigorous activity.
• Do not lift heavy things.
• Do not bend so that your head is lower than your waist.
• Avoid driving till your vision improves.
• Avoid sleeping on the operated side.
• No sexual intercourse until permitted by the doctor.
• Avoid alcoholic beverages.
• Watch television for short periods only.
• Please follow the advice of the patient counselor about medication and follow-up visits.

Be Alert for Problems:

If you have any of these symptoms that last more than 24 hours, inform the Institute or an ophthalmologist immediately:

• Any sudden change in vision or blurring of vision.
• Increase in sensitivity to light or seeing flashes of pain.
• Increase in redness.
• Swelling of the eyelid or bleeding.
• Nausea or vomiting.
• White or cloudy cornea or pupil.
• Persistent discomfort or pain — if the pain is severe, do not delay, contact us immediately..

Secondary cataract:

Blurred vision, months or years after cataract surgery, leads to the mistaken assumption that the cataract has grown again. This is not a cataract but the clouding of the thin capsular bag membrane that helps keep the lens implant in place.

To restore clear vision surgeons use a laser to open a visual path through the cloudy membrane. This is a simple procedure and is done on an outpatient basis. No stitches or surgery are needed. Your vision should improve soon after the laser treatment.

If you have any concerns or questions, ask the doctor when you come for an examination. If you feel you cannot wait, call or email us, or send a fax.

If there is an emergency at night, during a weekend, or on a holiday, come for emergency care to the Institute.

Always mention the patient’s MR number, name and the doctor’s name in all your communications.