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  • Cataract
    Cataract

Cataract

A cataract is a clouding of the lens of the eye.

cataract eye diagram

Causes, incidence, and risk factors

What the eye sees may appear blurry. This condition is known as a cataract. It is an age related change similar to graying of the hair.

Factors that may speed up cataract formation are:

  • Diabetes
  • Eye inflammation
  • Eye injury
  • Congenital as due to some genetic defect
  • Steroid (taken by mouth)Abuse as in Asthmatics
  • Surgery for another eye problem
  • Too much exposure to ultraviolet light (sunlight)

In many cases, the cause of cataract is unknown.

Symptoms

Adult cataracts develop slowly and painlessly. Vision in the affected eye or eyes slowly gets worse.

Visual problems may include the following changes:

  • Cloudy, fuzzy, foggy, or filmy vision
  • Double vision or multiple images
  • Loss of color intensity
  • Seeing halos around lights
  • Frequent changes in eyeglass prescription.

Signs and tests

A standard eye exam including slit-lamp examination is used to diagnose cataracts. Other diagnostic tests may be needed to rule out other possible causes of poor vision.

How can cataracts affect my vision?

Age-related cataracts can affect your vision in two ways:
  • The lens consists mostly of water and protein. When the protein clumps up, it reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time the cataract may increase in size.
  • The clear lens slowly changes to a yellowish/brownish color. Over time, increased tinting may make it more difficult to read and perform other routine activities.

Treatment

The success of therapy in Glaucoma depends upon your success in using medications regularly and periodic check-ups .
  • The following may help people who have an early cataract:
    • Better eyeglasses
    • Better lighting
    • Magnifying lenses
    • Sunglasses
  • The only treatment for a cataract is surgery to remove it. Surgery is done if vision is not satisfactory even with glasses.

However, some people may have additional eye problems, such as diabetic retinopathy, that cannot be treated without first having cataract surgery.

Expectations (prognosis)

Retinal evaluation is done to prognosticate the results but may not be always possible.

Complications

Early diagnosis and treatment are important to preventing permanent vision problems.


Although rare, a cataract that progresses to an advanced stage can begin to leak into other parts of the eye. This may cause a painful form of glaucoma and inflammation inside the eye (called a lens induced Glaucoma).

Prevention

  • Wearing sunglasses which filter UV light can delay cataract formation.
  • Quit cigarette smoking to delay the onset of cataract.
  • It is recommended to eat green leafy vegetables, fruit, and other foods with antioxidants.
  • If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years.
Normal vision

Normal vision

cataract vision

The same scene as viewed by a person with cataract

Treatment

How is a cataract treated?

Surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.


You and your eye care professional can together decide when to operate on your cataract. Once you understand the benefits and risks of surgery, you can make an informed decision.


Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy


If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at a separate time.


Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have any doubts about these comorbid conditions or risks, benefits, alternatives, and expected results of cataract surgery talk to us and get them clarified.

What are the different types of cataract surgery?

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

  • Phacoemulsification or Phaco: This uses ultrasound energy to break your lens into smaller pieces which are sucked through a probe. No stitches are needed and the recovery is faster. In colloquial terms it is called ‘Laser based surgery’.
  • Extra capsular surgery or Small Incision surgery: Here the lens is removed in total leaving the posterior capsule and hence a longer opening is required. Sutures may be needed.

After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL) in both the procedures. An IOL is a clear and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.

Some people cannot have an IOL. They may have another eye disease or problems during surgery. An IOL can be implanted in their eyes in a second sitting.

What are the risks of cataract surgery?

As with any surgery, cataract surgery poses risks, such as infection in extremely rare cases. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can affect vision.


Cataract removal is one of the most common operations performed. It also is one of the safest and most effective types of surgery. Risk benefit ratio weighs more towards benefits than risks.

What happens before surgery?

A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL.

What happens during surgery?

At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed.


The operation lasts less than one hour and is almost painless. Many people choose to stay awake during surgery and only the eye and surrounding area is made numb. Others may need to be put to sleep for a short time.


After the operation, a patch may be placed over your eye. You will rest for a while. Most people who have cataract surgery can go home the same day.You will need someone to drive you home.

What happens after surgery?

Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light. After one or two days, moderate discomfort should disappear.


For a few days after surgery, your doctor may ask you to use eye drops to help healing and decrease the risk of infection. Ask your doctor about how to use your eye drops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.


When you are at home do not lift any heavy objects. You can walk, climb stairs, and do light household chores.

In most cases, healing will be complete within six weeks. Your doctor will schedule exams to check on your progress.

Can problems develop after surgery?

In 95 % it is uneventful. Rest of the 5 % can include infection, inflammation (pain, redness, and swelling), double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully. You may meet with an accident while crossing the road but to get across you must cross; isn’t it?


Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.


An after-cataract is treated with a laser. It is a painless OPD procedure and rarely results in other eye problems.

When will my vision be normal again?

You can return quickly to many everyday activities. With an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. With time you will become used to improved color vision. Also, when your eye heals, you may need new glasses or contact lenses.

What are the different types of intraocular lenses implanted after cataract surgery?

The implant is placed in or near the original position of the removed natural lens. There are a variety of intraocular lens styles available for implantation.

  • Monofocal lens: These lenses are the most commonly implanted lenses today. They provide high-quality vision at a single focal point (usually at distance).
  • Toric lens: They correct astigmatism; they remove the distortion in your image.
  • Multifocal lens: Multifocal intraocular lenses have a variety of regions with different power within the lens that allows individuals to see at a variety of distances, including distance, intermediate, and near. One should remember that multifocal lenses are not for everyone.
  • Toric Multifocal: They have the advantage of both- multifocal as well as toric lenses.

What should one expect prior to and on the day of surgery?

Be cool.Do not dwell on the problems faced by others. Your co operation makes it simpler. Place trust in your doctor !

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