OPHTHALMOLOGIST

What is a Cataract?

The lens of the eye is made up of water and proteins which gives it a clear appearance. When the proteins are damaged due to trauma or other factors, their structural changes cause the lens to become cloudy. Depending on the extent of the damage & placement, it can lead to decrease or loss of vision.

They develop slowly & may affect one or both eyes.

Cataracts are the cause of 50% of blindness and 33% of visual impairment globally.

What are the Symptoms?

• Faded Colours
• Blurry, hazy or Double Vision
• Increased sensitivity to light & glare
• Halos seen around lights
• Difficulty seeing at night
• Changes in eyeglass prescription or number
• Trouble with driving, reading or even recognizing faces.

What are the Causes of Cataract?

Most cataracts develop due to age-related changes in the lens, in people over 50, but sometimes can occur at younger age due to risk factors such as:

• Diabetes
• Smoking
• Prolonged exposure to UV light (Sunlight)
• Alcohol
• Nutritional deficiency
• Injury/trauma to the eye

How is Cataract Treated?

If cataract causes vision impairment that affects daily life, then surgery is the best option. Over 98% of cataract surgeries are completed without any complications & 95% patients report improved vision post-surgery.

There are generally 2 types of surgery that may be performed :

1. Phaco/Phacoemulsification

   A smaller incision of 2-3mm is made & the affected area of the lens is emulsified by ultrasound energy from a hand-held probe. The emulsification is then sucked out & an artificial intraocular lens replaces the old lens in the same manner.

2. Femtosecond Laser Assisted Cataract Surgery

   A laser is used to make the incision & fragment the cataract, which can then be removed & artificial intraocular lens fitted by the surgeon.

   Additionally, the laser can also correct pre-existing astigmatism (poor vision not caused by cataract).

   Laser assisted surgery is an automated & more precise process, and is a safer option for complex cataracts.

Types of Intraocular Lenses

1. Monofocal:- Single zone clear focus lenses – usually for distance vision, and reading glasses are required for near tasks.
2. Toric:- Reduce the residual refractive cylinder thereby reducing the effect of pre-existing astigmatism, and consequently improving vision further.
3. BIfocal:- Both distance & near powered correction. Multifocal IOLs minimize/eliminate the need for eyeglasses or contact lenses after surgery.
4. Trifocal:- Distance ,near and intermediate vision is corrected. Patient is 99% spectacle free.

Potential Complications

While cataract surgery is one of the safest surgical procedures to be carried out, rarely, complications may occur:

• Swelling of Cornea/Retina
• Increased pressure in the eye
• Droopy eyelid
• Infection, bleeding or retinal detachment may cause loss of vision – extremely rare.
• Sometimes vision may not improve fully due to other diseases such as diabetic retinopathy or glaucoma. However, your doctor will already have checked for these conditions before recommending surgery, therefore chances are minimal of complications.

What to expect after cataract surgery?

You may experience some mild symptoms post-surgery:

• Itching & Mild discomfort
• Fluid discharge (1st day)
• Increased sensitivity to light, colour& touch.

What is an After-Cataract?

The lens capsule, which is left to support the artificial lens, may sometimes become cloudy years after cataract surgery, creating an After-Cataract.

It can be easily treated with a laser in a simple & painless Outpatient Procedure, using a laser beam to make a tiny hole in the lens, allowing light to penetrate.

Pre-operative Care

• Wash your hair with shampoo the night before surgery, do not wash it on the morning f surgery.
• Wash your face properly with soap the night before & the morning of surgery.
• Remove all traces of make-up from face & eyes.
• Do not eat any food after midnight the night before surgery.
• Drink plenty of fluids on the day of surgery, but stop 3 hours before.
• Take blood pressure medicine on the morning of surgery.
• DO NOT take diabetes medication or insulin on the morning of surgery.

Post-operative Care

The recovery period is short (usually 4 weeks), but it is advisable to avoid heavy lifting & strenuous activities for about 4 weeks post-surgery.

• No water should go near the eyes for up to 4 days after surgery.
• Wear an eye-shield or eyeglasses to protect from dust & infection.
• Do not rub/press your eyes.
• Don’t lift heavy objects.
• Try not to bend from the waist for a few days.
• You can do light household chores, walking & climbing stairs.
• Use the eyedrops as prescribed (usually upto 3 months) to prevent infection & assist healing.

FAQ

Is surgery the only option to treat a cataract?

Just because you have a cataract does not mean that you have to have it removed. Cataract surgery only becomes necessary if you are not happy with your vision and want to see better and are not able to achieve adequate improvement with a change in glasses. Talk to your doctor if you have any questions or concerns about your vision.

Does cataract surgery hurt?

Thanks to numbing drops and medications to help you relax, this procedure involves minimal discomfort.

Will I be asleep during cataract surgery?

Since this procedure does not take very long, it is unnecessary to put you completely asleep with general anesthesia. Instead, your surgeon will use a local/topical anesthetic to numb your eye and you will remain awake during the surgery.

I have cataracts in both eyes. Will the doctor treat both at the same time?

Typically, doctors will perform surgery in the second eye one to four weeks after the first eye. All patients are different, so talk to your doctor about what is right for you.

How long will I be in the hospital or surgery center?

Patients commonly spend only a few hours at the hospital or surgery center, and are allowed to go home the very same day.

How long before I can see after surgery?

Every patient and every eye is different, but patients commonly see well shortly after surgery. Ask your doctor how quickly he or she expects you to recover.

How long until I can return to normal activities?

Most patients can resume normal basic activities like reading and watching TV by the next day, and return to work within one to seven days. However, results vary for different patients, so you should ask your doctor what is best for you.

After surgery, will I be able to drive at night?

Your ability to drive at night should be much enhanced once your cataract is removed. Patients with a Multifocal IOL may notice a ring of light around headlights and other point-light sources. These are typically mild, rarely bothersome, and tend to diminish with time.

Will I need glasses after cataract surgery?

It depends on what type of intraocular lens you elect to have implanted. Most patients do not need glasses or contacts for distance tasks following cataract surgery with a standard distance vision lens, but still rely on glasses for reading, sewing, computer work and other close up activities.

Can my cataract come back?

No, once a cataract has been removed it cannot return. However, over time, patients may complain that their vision has once again become cloudy. This sometimes-common condition, which may occur with any type of lens, is caused by scar tissue behind the implant and can be easily treated by a painless laser procedure performed in the office.

Who do I call if I have a problem?

Consult your doctor immediately if you have any problems, especially if you experience decreased vision or pain.

What is Glaucoma?

One of the most common causes for irreversible visual loss is glaucoma. Glaucoma is damage to the nerve fiber layer of the retina that is typically caused by an elevation in the intraocular pressure. It can go undetected until extreme visual loss has taken place. That's why it is crucial for an individual to undergo an annual eye examination, especially if there is a risk factor for such a blinding disease.

Who are at risk for glaucoma?

• Family history
• Diabetes
• Migraine
• Myopic patients
• Eye injuries
• Blood pressure
• Steroid users

What are the symptoms?

Symptoms are:

1. Frequent change of glasses (none of which is satisfactory)
2. Difficulty in dark adaptation.
3. Bumping into things at unfamiliar places.
4. Blurred or foggy vision.
5. Coloured halos (rainbow coloured rings) around lights.

What kind of treatment do we offer?

The Humphrey Compurerized Field analyzer

An instrument which evaluates what you can see with your “fields” of from the periphery of your eye while keeping the eye fixated in the middle. It evaluates the extent of loss. In gluacoma the fileds progressively decrease till only a central island is left, which if untreted, extinguishes leading to blindness. The Humphrey Analyzer is the Gold standard all over the world. Fields are normally done twice a year.

Intraocular pressure evaluation

Non Contact Pneumotonometer: Acts as an analyzing tool and excellent as a survey instrument. Reasonably accurate when kept properly gradted.

These are some examples of the progression of glaucoma

This is an example of normal vision. This is also an example of how someone sees during the beginning stages of open-angle glaucoma. Because there are no symptoms initially, regular eye examinations are very important.

Early symptoms may include a gradual and often imperceptable failing of peripheral (side) vision.

As the disease progresses, the center of vision may still be clear, however peripheral vision begins to fail.

During the advanced stages of glaucoma, only a small central area of vision remains. If the entire optic nerve is destroyed, then total blindness will result.

TREATMENT OPTIONS

Treatment

The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:

• Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you have open-angle glaucoma. It's done in your doctor's office. Your doctor uses a small laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.
• Filtering surgery. With a surgical procedure called a trabeculectomy , your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.