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Cataract

Understanding cataract

Cataract is clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lens is a bit like looking through a frosty or fogged-up window.

Clouded vision caused by cataracts can make it more difficult to read, drive a car (especially at night) or see the expression on a friend’s face.

Most cataracts develop slowly and don’t disturb your eyesight early on. Eventually, with time, cataracts interfere with your vision.

At first, brighter lighting and eyeglasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe, effective procedure.

Types of cataract

Mature senile/Immature senile cataracts:

These cataracts occur due to the normal aging process which affects the lens which results in opacification. They generally occur in people after 40 years of age.

Complicated cataracts:

These cataracts can occur at any age due to some other medical condition in the body like diabetes, kidney disease etc. They can also occur as a side effect of some medications being administered for some other medical condition, the most common being prolonged intake of corticosteroids in the form of eye-drops or oral medication

Congenital cataracts:

Some children may have signs of cataract when they are born. If these cataracts are progressive then they have to be treated. There are some cataracts which occur at birth and remain the same or change very slowly. These cataracts do not need to be removed surgically if they are not hindering the vision.

Symptoms of cataract

Symptoms of cataracts include:

  • Clouded, blurred or foggy vision
  • Glare, especially at night
  • Increased sensitivity to light
  • Seeing “halos” around lights
  • Frequent changes in corrective glasses or contact lens prescription
  • Fading or yellowing of colors
  • Double vision in one eye

At first, the cloudiness in your vision caused by a cataract may affect only a small part of the lens in your eye and you may be unaware of any vision loss. As the cataract progresses, it clouds more of your lens and distorts the light passing through the lens. It is at this point that you are more likely to notice the symptoms.

Causes of cataract

Most cataracts develop when aging or injury changes the tissue inside lens in your eye.

Some cataracts are related to genetic disorders that cause other health problems and increase your risk of cataracts. Cataracts can also be caused by other eye conditions, medical conditions such as diabetes, trauma or past eye surgery. Long-term use of steroid medications too can cause cataracts to develop.

How do cataracts form?

The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens focuses light that passes into your eye, producing clear, sharp images on the retina - the light-sensitive membrane on the back inside wall of your eyeball that functions like the film of a camera.

A cataract scatters the light as it passes through the lens, preventing the formation of a sharply defined image on the retina. As a result, your vision becomes blurred.

As you age, the lenses in your eyes become less flexible, less transparent and thicker. Age-related changes cause tissues within the lens to break down and clump together, clouding small areas within the lens. As the cataract continues to develop, the clouding becomes denser and involves a greater part of the lens.

Cataracts may develop in only one eye, but they usually develop in both. However, the cataracts usually aren’t totally symmetrical and it may be more advanced in one eye than the other.

Risk factors of cataract

Factors that increase your risk of cataracts include

  • Increasing age Family history of cataracts
  • Diabetes Obesity
  • Excessive exposure to sunlight
  • Exposure to ionizing radiation, Previous eye injury orsuch as that used in X-rays and inflammation/Previous eyecancer radiation therapy surgery
  • Prolonged use of corticosteroid medications

Test and diagnosis for cataract

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

Asking you to read an eye chart (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.

Using a light and magnification to examine your eye (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 optical slices, which makes it easier to detect any tiny abnormalities.

Dilating your eyes (retinal examination)

To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina). Using a slit lamp, your eye doctor can examine your lens for signs of a cataract.

Treatments and drugs for cataract

The only effective treatment for cataract is surgery.

When to consider cataract surgery

Talk with your ophthalmologist about whether surgery is right for you. Most of the doctors suggest considering cataract surgery when your cataract begins to affect your quality of life or interferes with your ability to perform normal daily activities, such as reading or driving at night.

It’s up to you and your doctor to decide when cataract surgery is right for you. For most people, there is no rush to remove cataracts because they usually don’t harm the eye.

Delaying the procedure in early stages is unlikely to affect your recovery even if you decide to have cataract surgery a little later. Take time to consider the benefits and risks of cataract surgery with your doctor.

If you choose not to undergo cataract surgery immediately, your eye doctor may change your glasses and recommend periodic follow-up exams to see if your cataract is progressing. How often you will see your eye doctor depends on your condition.

What are the surgical options available for treating cataract?

There are 2 most common types of surgeries that are used to treat cataracts

Traditional Phacoemulsification:

This involves the surgeon using a blade (knife) to make entry wounds, then manually tear the capsular bag before breaking and removing the cataract using ultrasound or phaco (also wrongly known as the ‘laser’). After removal an artificial lens is implanted to restore the vision.

Femtosecond laser or the No-Blade cataract surgery

A femtosecond laser is used to replace many of the steps performed manually by a surgeon, such as making incisions (wounds), creating the capsular bag opening and breaking apart the cataract. Aided by advanced guidance and real-time imaging technology, the No-Blade cataract surgery automates some of the most challenging steps in a cataract surgery resulting in a greater level of precision, safety and results.

What surgical option should one go with?

Traditional blade cataract surgery

Laser cataract surgery

Blade corneal incisions

- Surgical incision with a blade

Laser corneal incisions

- Laser used, no metal blade

Astigmatism correction

- No astigmatism correction

Astigmatism correction

- Toric lens (Astigmatism correcting lens implant) or Monofocal lens with laser guided astigmatism correction

Manual capsule opening

- Manually creates circular opening in the lens capsule

Laser capsule opening

- Opening created with laser, ensuring precision and accuracy

- Allows for more accurate lens placement

Manual lens division

- Lens is manually divided by a surgeon

Laser lens division

- Divides lens with laser into multiple fragments

- Less energy is used to remove the cataract, causing less postoperative inflammation and faster recovery

Single focus lens insertion

- Good distance vision, depending on amount of uncorrected astigmatism

Customized lens insertion

- Good distance vision

- Good close up vision

- Good intermediate vision

- Traditional method

- Glasses still needed

- Blade incisions

- Longer recovery time

- Increased precision

- Less recovery time

- Blade free incisions

- Astigmatism correction

- Customized lens options

- May not need glasses or contacts

Which lens should one go for?

The type of lens you choose to implant determines the quality of vision you get. Our division offers variety of intraocular lenses that fits patient’s lifestyle, to restore the vision what they once had, for many more years to come.

Various standard & high tech intraocular lenses complete the advanced line up for the optimal visual outcomes after cataract surgery. These include:

Monofocal IOL -

Single Focus traditional IOL

Aspheric IOL -

Provide sharper vision

Toric IOL -

Correct Astigmatism

Multifocal IOL -

Youthful Vision

Multifocal Toric IOL -

Youthful Vision + Correct Astigmatism

How to prepare for the surgery?

Once you have decided to have your cataract removed and have chosen the type of surgery and the lens to be implanted, you will have to undergo further testing. The artificial intraocular lens you are given will be partially decided by your existing number, the length of your eye and the shape of your cornea. Tests will be done to determine these variables.

When you have had these tests, and decide on a date for the surgery, you will be given a set of preoperative instructions. These instructions will inform you on how to go about the surgery and what medications you will be required to take before you come to the operation theatre.

What happens during the surgery?

Both the types of surgeries take approximately 15 minutes but there will be a preparation time of another 30 minutes or so.

Phaco Phacoemulsification:

Two small incisions are made in the eye where the clear front covering (cornea) meets the white of the eye (sclera). A circular opening is created manually on the lens surface (capsule). A small surgical instrument (phaco probe) is inserted into the eye. Sound waves (ultrasound) are used to break the cataract into small pieces. The cataract and lens pieces are removed from the eye using suction. An intraocular lens implant (IOL) may then be placed inside the lens capsule. Usually, the incisions seal themselves without stitches.

Femtosecond laser or the No-Blade cataract surgery

In Femtosecond laser surgery, you are first treated with the lenSx laser that delivers ultrafast laser for making precise tiny corneal cuts, opening in the lens capsule and breaks down the lens into multiple small fragments. Your eyelids will be kept wide apart using an instrument to keep your eyes open during the surgery. After the laser treatment is done, you are shifted to another table in the operating room where a thin phaco probe is used to liquefy and suck the already fragmented lens matter. After thorough removal of all the cloudy lens material, a customized artificial lens is placed inside the eye.

Preventing Cataract

No studies have proved how to prevent cataracts or slow the progression of cataracts. However, doctors think several strategies may be helpful, including:

Haveing regular eye examinations:

Eye examinations can help detect cataracts and other eye problems at their earliest stages. Ask your doctor how often you should have an eye examination.

Wearing sunglasses:

Ultraviolet light from the sun may contribute to the development of cataracts. Wear sunglasses that block ultraviolet B (UVB) rays when you’re outdoors.

Managing other health problems:

Follow your treatment plan if you have diabetes or other medical conditions that can increase your risk of cataracts.

Maintaining a healthy diet:

If you currently have a healthy weight, work to maintain it by exercising most days of the week. If you’re overweight or obese, work to lose weight slowly by reducing your calorie intake and increasing the amount of exercise you get each day. Excess usage of nutritional supplements can also cause cataracts so do not self medicate.

Choose a healthy diet that includes plenty of fruits and vegetables:

Adding a variety of colorful fruits and vegetables to your diet ensures that you’re getting many vitamins and nutrients. Fruits and vegetables have many antioxidants, which help maintain the health of your eyes.

Why Medanta - The Medicity

Medanta’s new Ophthalmology division aims to constantly upgrade patient’s experience. All the equipments and software are advanced to the modern in technology and safety standards to seek for improvement and higher precision in our treatments. The division is the first centre in Delhi, NCR to have the No-Blade Laser Cataract Surgery Suite that offers this technology for much improved safety and outcomes.

Each of the elements of this suite is designed to advance cataract surgery, from the planning process through laser based surgery on the latest generation cataract removal system to the final image guided positioning of the IOL.

Also, our division offers the widest range of lenses to help you achieve the visual results and the freedom from glasses that you have always wanted. Our doctors will carefully select and recommend the lens most suitable for you from the best lens manufacturers