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2. What Are the Symptoms of a Cataract?

3. Risk Factors & prevention

4. Diagnosis & Treatment of cataract & Timing of surgery

5. Methods of surgery including phacoemulsification

6. Advantages of phaco operation

7. How successful is cataract surgery?

8. Benefits and Risks of Cataract Surgery

9. Instructions after a cataract operation

10. Second Eye Surgery

A cataract is formed when the natural lens of the eye, responsible for focusing light and producing sharp images, becomes cloudy and hardens, resulting in a loss of visual function. The lens of the eye is clear at birth, but is one of the first parts of the body to show the effects of aging.

A cataract is painless and usually develops gradually over several months or years. Normally, the onset of a cataract in one or both eyes may cause decreased night vision, impaired depth perception, and increases color distortion.

What Are the Symptoms of a Cataract?

Most people with cataracts have a cataract in both eyes. However, one eye may be worse than the other because each cataract develops at a different rate.

Some people with cataract don't even know it. Their cataract may be small, or the changes in their vision may not bother them very much. Other people who have cataracts cannot see well enough to do the things they need or want to do.

Here are some symptoms of a cataract:

	Cloudy, fuzzy, foggy, or filmy vision.
	Changes in the way you see colors.
	Problems driving at night because headlights seem too bright and surrounded by halloes..
	Problems with glare from lamps or the sun.
	Frequent change of spectacle power, which usually leads to increase in minus number for distance & decrease in plus number for near. So many a times patient discards near glass & reads the book, threads a needle with out glass. Some patients may be happy with unaided near vision & may not complain of decrease in clarity for distance.
	Double vision.
	Decrease in vision in bright sunlight in central cataract. Opposite in peripheral cataract.
	Difficulty in reading, early in posterior polar type of cataract.
	If one does not get still operated, he will not be able to count the finger even at distance of 10 feet. However, one should not wait till this stage.

These symptoms also can be signs of other eye problems.

Risk Factors

The single largest risk factor for cataract development is age. Everyone older than age 55 naturally has some degree of lens clouding. That clouding may or may not lead to significant impairment of your vision.

Any of the following may speed up the aging process and put you at higher risk for developing cataracts:

	Diabetes
	Excessive sunlight exposure
	Long-term use of certain medications such as corticosteroids
	A family history of cataracts, which can mean you have a genetic predisposition to clouding in your eyes
	Previous eye injury
	Excessive consumption of alcohol
	Exposure to heavy doses of radiation, such as may occur in cancer therapy
	Smoking

Prevention

These steps may help you prevent the development of cataracts:

	Don't smoke . Smoking produces free radicals, molecules that damage other cells as they seek to replace their missing electron.
	Protect yourself from the sun. Ultraviolet (UV) light also produces free radicals and may play a role in cataract development. When outside, wear a wide-brimmed hat and sunglasses to help block UV rays from damaging your eyes. Look for sunglasses that offer UVA and UVB light protection. Close-fitting, wraparound sunglasses offer the greatest protection. The cost and darkness of lenses don't necessarily indicate greater eye protection.
	Adequate control of diabetes.
	Avoid unsupervised steroid treatment

Some evidence shows that antioxidant vitamin supplements, including vitamin C, vitamin E and beta carotene, can neutralize free radicals. Antioxidants neutralize free radicals by donating the electrons the free radicals need. Researchers continue to study the effectiveness of antioxidant vitamin supplements, but their role in reducing the risk of cataracts is unclear.

How is a Cataract Diagnosed?

A regular eye exam is all that is needed to find a cataract. Your eye doctor will ask you to read a letter chart to see how sharp your sight is. You probably will get eye drops to enlarge your pupils (the round black centers of your eyes). This helps the doctor to see the inside of your eyes. The doctor will use a bright light to see whether your lenses are clear and to check for other problems in the back of your eyes.

How is a Cataract Treated?

The treatment of cataract is surgery. No medicine, eye drop can cure it. In very early stages when cataract has not firmed up, change of glass may help some patients who have low visual demand.

Advanced surgical instrument like operating microscope & phaco-machine, newer surgical methods help your surgeon to remove your cataract at any stage of cataract with same success (98 %). However very mature cataract may create problem during surgery.

So, timing of operation does not depend on stage of cataract. But when the visual need of patient { like reading, going outdoors esp. at night, night driving, recognizing people } is compromised; one can go for surgery. Your doctor cannot make your decision for you, but talking with your doctor can help you decide. Tell your doctor how your cataract affects your vision and your life. The findings of the physical examination should corroborate that the cataract is the major contributing cause of the functional impairment, and that there is a reasonable expectation that managing the cataract will positively impact the patient's functional activity

Earlier the operation, earlier the benefit of better vision, with same 2-3% surgical risk. So, make decision for early operation.

Most people do not need to stay overnight in a hospital to have cataract surgery. You may go to an outpatient center or hospital, have your cataract removed, and leave when the doctor says you are fit to leave. However, you will need a friend or family member to take you home.

Methods to remove the Lens

There are two types of surgery to remove lenses that have a cataract:

Extracapsular surgery

Through an incision about 10-12 millimeters long[ approximately cataract size] ,the eye surgeon removes the lens, leaving behind the back half of the capsule (the outer covering of the lens). The capsule helps support the clear artificial lens that the surgeon inserts to replace the cloudy lens. This type & size of direct cut has to be sutured.

Phaco-emulsification (Laser), stichless surgery

Phaco-emulsification is the latest method in which we have to put an incision of size of only 2.5 m.m., which allows the entry of phaco needle inside the eye. The needle vibrates at an ultrasonic speed & liquefies the cataract. The liquefied cataract is sucked out through same needle. In this size of incision, we can construct the incision in such a way that an intrinsic valve is created, which will close firmly rather then gape when pressure is applied over eyeball. This eye can withstand pressure up to 500 m.m. of Hg. So it is left unsutured. Routine incision of even this small size will gape on slightest pressure.

Advantages of phaco operation

The type & size of construction of incision

Does not distort the eyeball.

So distortion induced cylindrical number in routine surgery is not here.

Give stability to incision.

So it is almost immune to injury and pressure related complication.

Number is stabilized fast.

So we can prescribe power of glass with in 10-15 days.

Does not require suture mostly.

So suture related complications like irritation, suture infection are avoided.

Does not permit direct entry of organism from outside postoperatively.

So diabetic patient have less chance of infection.

Maintains dome shape of cornea during surgery.

So corneal edema is prevented or minimized.

Completely eliminates blinding complication of expulsive hemorrhage.

Internal clearing of liquid is fast.

Induces very less inflammation

With the safety mechanism of higher Phaco machine, occasional phaco complications like, catching

of capsule and subsequent dropping of cataract piece inside eye due to high liquid pressure are very

much minimized compared to routine phaco machine. However only retinal surgeon can deal with

this complication.

A 1994 survey of American Society of Cataract and Refractive Surgery members reported that 86% of respondents preferred phacoemulsification to ECCE, and 88% were very satisfied with it. The observed benefits to patient care include more rapid visual rehabilitation and less induced astigmatism, allowing the patients to return to work earlier or to have improved function and independence in daily activities sooner. Other observed benefits include lessened incidence of traumatic wound rupture in the elderly, lessened postoperative inflammation and the ability to perform other ocular procedures sooner, such as repair of a retinal detachment.

Replacing the Lens

A person who has cataract surgery usually gets an artificial lens at the same time. A plastic disc, called an intraocular lens, is placed in the lens capsule inside the eye that has been corrected to meet your eye's specific needs.

How successful is cataract surgery?

Cataract surgery has an overall success rate of 98 percent. Continuous innovations in cataract surgery allow cataract surgeons to treat greater numbers of patients while keeping costs down with no sacrifice in quality or patient care.

Initially, your eye may have mild inflammation and irritation and may feel a little scratchy for a couple of days. You may need to wear an eye patch for the first 24 hours. Improvement in vision usually begins within 1 or 2 days of surgery. Because your eye takes time to heal from the surgery, the greatest improvement in vision won't occur until about 4 weeks after surgery. Most people still need to wear glasses after cataract removal

Occasionally, otherwise successful cataract surgery may not improve the vision up to the mark because of the presence of other diseases of the eye, such as glaucoma or macular degeneration.

Benefits and Risks of Cataract Surgery

Improvements in Activities

	Everyday activities
	Driving
	Reading
	Working
	Moving around
	Social activities
	Hobbies
	Safety
	Self-confidence
	Independence

Possible Complications

	High pressure in the eye
	Blood collection inside the eye
	Infection inside the eye
	Artificial lens damage or dislocation
	Drooping eyelid
	Retinal detachment
	Severe bleeding inside the eye
	Swelling or clouding of the cornea
	Blindness
	Loss of the eye

Instructions after a cataract operation

In general avoid dust, water, pressure, injury to operated eye.

For stitch less phaco operation, precautions are to be taken for 1 week

& for operation with stitch, precautions are to be observed for 3 weeks.

	Don’t bathe over the head. You can take bath below the neck.
	Don’t sleep over side of operated eye. You can sleep on other side/flat.
	Wear the dark goggles according to your convenience.
	Cooking, necessary travel, full Namaz, reading (if your glass permits) is allowed after one week.

You can do following things from the first day

	Eat everything except sweet things for diabetes & salts for high B.P patient.
	View T.V, shave, oil the hair, take pillow, switch on fan-light,have morning walk
	Clean the sticky discharge over lower eye-lid with, boiled squeezed surgical cotton with proper hygiene& care so as to avoid pressure on the eyeball.
	Sponge the face with wet napkin.

Medication

Tablets for 3-4 days/ Eye drops for 2-3 months/ Consult your doctor for detail.

You can take any other medicine, you require for other disease.

Follow-up visits

On 2^ndday, on 5^th day, at one month (in stitchless-phaco surgery)

On 2^ndday, on 5^th day, at two month (in operation with stitch)

Final power of glass is usually at last visit.

Danger signal for immediate consultation

Unable to gain reasonable vision with in 3 – 4 days of operation

OR Marked & fast drop in vision you have gained after operation esp. associated with increased watering, pain, redness.

Unsatisfactory result

Occasionally, successful surgery may not give desired vision because of optic nerve problem, retinal problem, delayed settling of number after operation. Unsatisfactory result can’t always be predicted before operation.

Second Eye Surgery

Patients with uniocular cataract had symptomatically poor vision which improved by having the second eye surgery, with alleviation of glare, difficulty reading and blurred vision. There appears to be a benefit in restoring binocularity to patients, with an improvement in vision and quality of life following second eye surgery. If necessary, it can be performed after one week of first eye operation.

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Cataract Back to home page

1. What is a cataract?