What is a cataract?
It is the cloudiness of the original lens in the eye.
What are the reasons for a cataract?
The commonest reason is aging. In a few cases, there are other reasons like steroid eye drops or tablets or injury or a cataract can be present from birth.
What complaints does a patient have?
The commonest complaint is hazy vision for reading or for far, especially in dim light. Second is a glare or a halo against bright lights like car headlights. Third, there can be repeated change in the spectacle numbers. Fourth could be a change in your colour judgement.
Can a patient not know that she has a cataract?
Yes. When there is a cataract in one eye, the patient may be seeing from the other eye and not realise the cataract.
A cataract is not painful nor does it cause any redness.
How is a cataract diagnosed?
A complete examination by the doctor after putting eye drops gives the accurate diagnosis.
Can a cataract be treated by medicines?
No. There is no treatment by eye drops or tablets. The only treatment is by surgery.
Does everybody get a cataract?
Cataract is due to aging. So, as we age all of us will get a cataract. However, each one gets a cataract at a different age. One patient can get it at the age of 40, while another could get it at 90.
Is it possible that a person will never get a cataract?
If the person does not survive long, she may pass away before getting a cataract.
Can we prevent a cataract?
We cannot prevent aging. So the normal damage to the eye lens cannot be prevented. However, improper use of steroid drops should be avoided to prevent early onset of cataract.
CATARACT SURGERY
When should the surgery be done?
Once the cataract is sufficiently advanced, one should start planning for the surgery. There is no formula to decide the date. Someone in Mumbai would definitely be able to get the surgery early than someone else in a village with poor access to an eye doctor. The earlier a significant cataract is operated, the lesser the risk of complications.
How urgent is the surgery?
In most cases, the surgery is not an emergency. It is not like a heart attack. Most cases have a very smooth recovery if done in time. If the delay makes the cataract hard, the surgery can be difficult and the results may not be very good.
Can you operate both eyes on the same day?
Technically it is possible to do so. However most eye doctors would prefer to see the result of the first eye before they operate on the second eye. The doctor can fine tune his technique or the lens power in the second eye depending on the result of the first eye.
What type of surgery is necessary?
The advanced type of stitchless surgery by phacoemulsification followed by a lens implant is the best technique for cataract removal. The cataract is broken up into small pieces and converted into a liquid and then sucked out by a small probe. The lens is implanted safely into a transparent bag of the original cataract. In most cases, no stitch is required.
What is femtosecond laser cataract surgery?
Femto laser assisted cataract surgery (FLACS) is another technique where some of the steps are performed by laser. However, there is no definite advantage to the patient and results are not better than the ultrasound assisted surgery. The cost and the time taken for the procedure, however, increases.
Is the cataract surgery painful?
No. The surgery is not painful at all.
How long does the surgery take?
A normal cataract surgery takes around 15 minutes. However, if the cataract is hard because of delayed surgery, it can take up to an hour or more.
Does the patient need to stay in hospital?
No. The patient is in hospital for a few hours, after which she goes back home.
What type of anesthesia is given during surgery?
Normally the surgery is done with local anesthesia. In very few cases where the patient is a child or is unable to cooperate, sedation or general anaesthesia is necessary.
Will I need an injection before my operation?
There are some patients who are confident enough to keep their eyes stable during surgery without moving them. Other patients, however, are anxious and cannot focus at a particular point; so a small injection below the eye may be given to make the operation safer.
Can the cataract happen again after removal?
No. the cataract once removed cannot come back.
What is an after cataract?
The bag in which the lens is implanted can become opaque over time. This can reduce the clarity of vision and is called “chhaari” or after cataract or a posterior capsular opacity.
Does the after cataract need another operation?
No, it is removed using a painless laser. The procedure is done after putting eye drops, and takes less than 5 minutes.
Does the after cataract develop by eating ghee or any oily food?
No, this is a common misconception. There is no relationship between diet and an after cataract.
LENSES
Is it necessary to implant a lens during surgery?
Yes. It is necessary to replace the damaged lens with a new clear lens to restore normal vision.
What types of lenses are used in surgery?
The older types of lenses are hard and require a larger cut in the eye. Newer advanced types of soft lenses can be folded and implanted into the eye through very small cuts, so that the eye remains stronger.
What is the life of the lenses?
The lenses that are implanted are lifelong and do not need to be replaced.
Can the lenses fall out of the eye if the eyes are rubbed?
No. The lenses become part of your body. They do not move at all. They are not like contact lenses that may fall out when the eyes are touched.
Will the colour of the eyes change because of the lenses?
No. The eyes will look just the same. Some lenses have a light golden colour to protect the retina layer of the eye. But that does not change the eye colour at all.
Will there be an eye number after the lenses are implanted?
Yes. There will be a small number after surgery. As of now, medical science has not been able to make lenses that can change their shape or position. Most of the number gets taken care of, but fine tasks like reading small print or watching objects at a long distance, will require a small spectacle number.
But I have heard that multifocal lenses remove the whole number. Is that true?
Multifocal lenses are still getting better every year. The rate of satisfaction with multifocal lenses today is not very high at present because of complaints like glare and haloes, and more research is necessary to improve them. New designs come every few months claiming to be better.
What are cylindrical or toric lenses?
These are advanced lenses that improve the quality of vision by taking care of the cylinder power of the eye. The better quality comes at a higher cost for those who can afford them.
Is most of the cost of surgery because of the lens that is implanted?
No, the lens cost is just a part of the total cost. The machines that are used during surgery are far more expensive. The cost is divided among many surgeries. The higher packages also subsidise the lower package patients who are unable to afford to pay for the advanced technology.
