Article on Cataract 2

8/3/2019 Article on Cataract 2

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Modern Cataract & IOL implantation surgery A cataract is an opacity in the natural lens in the eye reducing the vision. Aging is the commonestcause. Cataract is not contagious, and is not a layer that grows on the eye as many peopleconsider. Also, it cannot be treated by peeling off this layer. Cataract cannot be treated withdrops, injections or even a Laser. It needs a surgery which is extremely sophisticated. Thenatural lens in the eye is much more sophisticated than a camera lens, and focuses an image onthe retina. The retina converts light into electricity, which is conducted to the brain through theoptic nerve and it is actually the brain which µsees¶ what ever the eye captures & relays!

Apart from senile cataract, there are other types. Secondary cataract is due to an eye surgery,diabetes, use of steroids etc. Traumatic cataract follows an eye injury, sometimes many yearslater . Congenital cataract occurs often in both the eyes and may be due to metabolic diseases,consanguinity, viral infections etc. Radiation cataract is due to exposure to irradiation. Smoking,alcohol, malnourishment, prolonged exposure to sunlight, a family history of early cataract etc. areknown to predispose development of cataract.

Wearing sunglasses and a hat are known block the ultraviolet sunlight and delay onset of cataract, especially in those who work outdoors for long hours and where UV light is abundant likein seashores, beaches, mountain tops etc. Good nutrition rich in protein, anti-oxidants andvitamin C can help reduce the risk or delay age-related cataract. After the age of 40 , you shouldhave comprehensive eye examinations at least once every two to three years. In addition tocataract, you need to look out for age-related macular degenerations, glaucoma, diabetic andhypertensive retinopathy and other vision disorders. Early treatment at the right time could savesight.

The most common symptoms of a cataract are painless, progressive blurring of vision. Colorsmay appear faded. Headlights & lamps may appear too bright or glaring. A halo may appear around lights.Night vision may be poor. Vision may be defective in bright lights Double vision or multiple images may appear. Frequent changes in eyeglasses may be needed. Sometimesreading vision may improve and you will be able to read without glasses! This so called ³secondvision´ is a temporary phenomenon and is due to cataract. Cataract does not cause headache,watering or redness. If the cataract is there in only one eye, you may be totally unaware of it!Visual acuity test, slit lamp examination, pupillary reactions, dilated retinal assessment,



Tonometry, status of the lacrimal sac etc are some of the tests done when you reach an eyehospital.

Treatment

The symptoms of early cataract may be improved with a new pair of glasses, bright lighting, anti-glare sunglasses etc. If they don¶t help, surgery is the only effective treatment. Surgery involvessurgical removal of the lens and replacing it with an artificial lens. When the vision loss interfereswith day to day activities, such as cooking at home, office work, hobbies, driving, reading, or watching TV etc. it is time to get surgery done. You can time the surgery to suit your convenience, as delaying cataract surgery will not cause damage to the eye or make the surgerymore difficult, unless you have a mature cataract with total blindness. You do not have to rushinto surgery but plan it to suit your convenience. Sometimes a cataract might have to be removed

at an early stage, like when it prevents assessment or treatment of another eye problem, like inage-related macular degeneration or diabetic retinopathy.

If you have cataracts in both the eyes, the surgery will be performed on each eye at separatetimes, and the gap between the two surgeries can be as early as 1 day, in case you are hardpressed for time. Pre operative investigations, control of other diseases, post operativemedications and follow ups will be easy if both the eyes are operated in a short interval. In severalcenters, simultaneous cataract IOL surgeries on both eyes are being performed, especially onchildren where they have to be taken under general anesthesia. You will also have better 3 Dvision, better depth perception and better multi-focality by this way. There are many differenttechniques of cataract surgeries, and it is best to leave the selection to the surgeon, as he canchose the technique that best matches your type of cataract.

1. Phacoemulsification. Three very small incisions are made on the side of the cornea.Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften or breaks up the cataract so that it is removed by suction. MICS or Microincision cataract surgeryaims at performing the same with even smaller incisions, but does not suit all types of cataracts. As any energy used in excess inside the eye is harmful, in recent days, more andmore mechanical and hydro forces are used, and the use of ultrasound is minimized.



2. Small incision cataract surgery Here a tiny incision is made and the cataract is brokeninto smaller pieces mechanically, and removed from the eye. This technique is the preferredmethod for majority of surgeons, and is particularly useful in difficult cases of cataract surgery.

3. Phacosection is a modification, wherein the nucleus & epinucleus of the cataract arebroken into two pieces, and removed through a single tiny incision. Ultrasound device is notnecessary for this technique, & the procedure extremely safe for all types of cataracts.

Phacoemulsification and Phacosection do not significantly alter the corneal curvatures, andhence toric and multifocal IOLs can be implanted.

4. Extracapsular surgery & intracapsular surgery are older techniques, which need larger incisions and suturing. They are generally not employed these days.

What are the risks of cataract surgery?

As with any surgery, cataract surgery has risks, such as infection, bleeding, inflammation,glaucoma etc. Before cataract surgery, please give the list of all your illnesses, and the treatmentyou are taking. Your doctor may have to temporarily stop certain medications that increase therisk of bleeding during surgery. Inform about Diabetes, high BP, previous surgeries, enlargedprostrate & the medicines you are taking for them, cough, infections, heart diseases, allergies,

past history of the eye, esp. any sudden loss of vision etc. to the surgical counselor. After surgery,you must keep your eye clean, wash your hands before touching your eye, and use theprescribed medications properly. With today¶s modern surgery, you could return to your work andall household tasks the very next day. As the surgery is safe & painless, there is no need for ananesthetic injections, no need for stitches to close the tiny incision, and no bandage! High myopiaand those with weak retina need regular follow ups. In them, retinal detachment can occur suddenly with symptoms of flashes or floaters. Floaters are little "cobwebs" or specks that float inyour vision. If you notice them see your eye doctor immediately, as retinal detachment is anemergency. Those who have diabetic or any other progressive retinopathy need periodicassessments.



. After the natural lens is removed, an artificial lens called an intraocular lens (IOL) is inserted. AnIOL is a clear synthetic lens that requires no care and becomes a permanent part of the eye.Today, most IOLs can be injected through a tiny incision using a cartridge. They are made of acrylic material, and can by hydrophilic or hydrophobic. Both are very popular.Light is focused bythe IOL onto the retina, improving your vision. You will not feel or see the new lens, and it servesyou for life time. It never needs a replacement! Newer lenses have aspherical surfaces like thelens of an young adult, and this increases the quality of vision. Few IOLs have a slight yellow tint,to match the natural lens There are many kinds of IOLs, some are monofocals, and few aremultifocals. With monofocals, you would need glasses for some of your work tasks. Themonofocals can be focused for near, distance or for intermediate distances. Discuss about your

needs with the doctor or surgical counselor. You could chose monofocal for distance in your dominant eye and for near in the other eye. If you have astigmatism, it can be corrected by ToricIOLs. Multifocal IOLs make you see both distance and near without glasses, and gives maximumvisual independence. They do cause some haloes around lights. Multifocal Toric IOLs wereintroduced recently. Keratometry & Biometry are used to measure the curve of the cornea and thesize of your eye, and appropriate IOL power is calculated. If you have been wearing high poweredglasses before, the new IOL will drastically reduce the spectacle power after surgery. Two birdswith one stone!! Lasers are not used for cataract surgery, although some patients call it as Laser surgery! While all other Lasers tried in the past have been abandoned, research is going on for



the development of Femtosecond Laser based equipment to perform some steps of cataractsurgery like making incisions, capsulotomy and nucleus softening. Few equipment models havebeen released into the market recently. But surgery to remove the cataract from the eye and toimplant the IOL cannot be avoided. Research towards prevention or reversal of cataract is in stillgoing on, without any headon results.

How is the cataract surgery done?

Cataract removal is one of the most common operations performed on the human body. It also isone of the safest and most effective type & technologically the most evolved form of surgery.Surgeon¶s skills are equally important. Don¶t take it lightly although the technology has made itappear too simple a surgery! In over 95 percent of cases, people who have cataract surgery havemuch better vision.

Several tests are done before surgery and these minimize the risk factors. When you arrive at thehospital for the surgery, few eye drops are put into your eye to dilate the pupil, to disinfect and tonumb the eye. The area around your eye will be washed and cleansed. The operation usuallylasts less than fifteen minutes and is painless. You will be awake during surgery and can talk to

the surgeon if needed. You could cough or sneeze or move during this modern surgery, but doinform the surgeon before doing it!

After the operation, instruction will be given about the care and medications. You can returnhome in about half an hour, once you are feeling quite well. You can eat normally, both beforeand after the surgery. Mild discomfort, watering and glare are normal after cataract surgery. Somefluid discharge is also common. Your eye may be sensitive to light and touch. If you have morediscomfort or pain, call your doctor for advice. After one or two days, moderate discomfort shoulddisappear.

You need to use some eye drops for about a month after surgery. You will be taught as to how to

use your eye drops, how often to use them, and for how long. You will need to wear an eye shieldat night & eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye. Don¶t keepon wiping your eye with kerchiefs or tissues. Don¶t touch the eye with dirty hands. You can washyour face with soap and water right from the next day after surgery. Avoid splashing the eye withwater with the eyes open. You could use all cosmetics, but avoid Khajal and eye make up. Athome, you can bend to pick up objects on the floor, lift moderate weights, can walk, climb stairs,and do household chores.



Can problems develop after surgery?Problems after surgery are rare, but they can occur. These problems can include infection,bleeding, inflammation (pain, redness, and swelling), decreased vision, double vision, and high or low eye pressure. These may be the new ones or pre existing. With prompt medical attention,many of these problems can usually be treated successfully. Many people who need cataractsurgery also have other eye conditions, such as age-related macular degeneration, diabeticretinopathy or glaucoma. Then the vision recovery may not be complete, and this may beexpected before itself or may come as a surprise.

After several years of good vision, the capsule of the lens that encloses the IOL may becomehazy & blur your vision. This condition is called Posterior capsular opacity or PCO. This can betreated with a Nd YAG Laser capuslotomy, a painless outpatient procedure.

Todays cataract surgery with IOL implantation is a very safe procedure, and if you are advised togo through it, there should be no reason to hesitate. Most of the insurance and TPA companiesreimburse the cataract IOL surgery completely, and the cashless facilities will give you a verygood package. If you cannot afford surgery at a good private hospital, there are many charityinstitutions supported by government and philanthropists who perform cataract IOL surgery free of cost. As most hospitals do offer subsidized services for poor, discuss about monetary issues withthe counselor. If you can afford some payment, avoid mass eye surgery camps, where the risks



are little higher. Due to logistics of performing many surgeries, there may be compromise in thehygiene or surgical protocols.

Enjoy vision, enjoy nature and enjoy life with the modern cataract IOL surgery. This is vastlydifferent from how Sushrutha practiced cataract surgery centuries ago.

Cataract surgery was pioneered in the 8th

century BC by Shushruta, who discovered that the sight could be

restored by pushing the cataract out of the pupillary zone.He did this by poking a needle into the eye!

³The patient sat opposite on the ground so that the doctor was at a comfortable height for doing the

operation on the patient's eye. After having taken bath and food, that patient had been tied so that he could

not move during the operation.

The doctor warmed the patient's eye with the breath of his mouth. He rubbed the closed eye of the patient

with his thumb and then asked the patient to look at his knees. The patient's head was held firmly. The

doctor held the lancet between his fore-finger, middle-finger and thumb and introduced it into the patient's

eye towards the pupil, half a finger's breadth from the black of the eye and a quarter of a finger's breadth

from the outer corner of the eye. He moved the lancet gracefully back and forth and upward. There was a

small sound and a drop of water came out.

The doctor spoke a few words to comfort the patient and moistened the eye with milk. He scratched the

pupil with the tip or the lancet, without hurting, and then drove the 'slime' towards the nose. The patient got

rid of the 'slime' by drawing it into his nose. It was a matter of joy for the patient that he could see objects

through his operated eye and the doctor drew the lancet out slowly. He then laid cotton soaked in fat on the

wound and the patient lay still with the operated eye bandaged.´

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Article on Cataract 2