Cataract

What are cataracts?

A cataract is a cloudy formation in the lens of an eye. A cataract occurs when the proteins in the eye break down and forms clumps. It disrupts the normal vision of the eye.

How do cataracts develop?

The natural lens is located behind the iris. The iris is a pigmented, circular membrane located between the lens and the cornea. It controls the amount of light that enters the eye by contracting and expanding the pupil.

The lens refracts the light and sends clear images to the retina. The retina contains nerve tissues. It converts the light rays and sends signals to the brain through the optic nerves.

A cataract clouds the normal lens and it can no longer focus properly. The impaired vision depends on the size and location of the cataract. A person can have cataracts in one eye or both eyes.

Cataracts mostly occur in older people above the age of 55. Infants, children, and middle-aged adults can also grow cataracts due to some trauma in the eyes or medication side effects.

Who can develop cataracts?

Many people start developing cataracts when they reach the age of 40. The symptoms are hardly visible until they are 60 years old. It is more common in older people above the age of 80.

People who can develop cataracts:

• Old age.
• Middle-aged adults.
• Newborn babies due to birth defects.
• Children and young people due to side effects from medicine.
• Smokers.
• Heavy alcohol drinkers.
• Family history of the disease.

Symptoms of cataracts

A person suffering from cataracts may experience these symptoms:

• Blurred vision
• Cloudiness in the eye(s)
• Double visions
• Difficulty in night vision
• Seeing halos around lights
• The colors seem faded
• Frequent change of prescription eyeglasses
• Sensitive to glares during the daytime
• Old people may complain of nearsightedness

Types of cataracts

Cataracts are of different types:

Nuclear cataracts

They are also known as nuclear sclerotic cataracts. They generally develop in old age. The cataract occurs in the center of the nucleus of the lens. As the symptoms progress, the reading vision may improve. This is called the “second sight” but it may not last long. As the cataract worsens, the lens hardens and becomes yellowish or brown. Patients have difficulty differentiating small details, see halos around the lights, and the colors appear faded.

Cortical cataracts

They appear on the edges of the lens called the cortex. They look like white wedges and point towards the center of the eye. As the symptoms worsen, they reflect glares or scatter lights and it becomes incredibly difficult to drive at night. Cortical cataracts make the vision hazy or foggy. Patients have difficulty differentiating between colors and seeing near and distant objects.

Posterior subcapsular cataracts

They appear at the back of the lens capsule. The symptoms appear faster than the other forms of cataracts and may worsen within a few months. They affect near vision and patients have difficulty seeing things in bright light.

Anterior subcapsular cataracts

It appears on the front of the lens capsule. They is due to some trauma or swelling in the eye. Atopic dermatitis can also cause anterior subcapsular cataracts.

Congenital cataracts

They are due to congenital birth defects. A baby is born with congenital cataracts. It is generally gene-related or due to some disease that the mother contracted during pregnancy like rubella. If a baby is born with congenital cataracts, it will block the vision. Doctors need to remove it immediately after birth so that the eye can learn to see.

Traumatic cataracts

Trauma or injury to the eye(s) can lead to cataracts. A hit on the eye, a burn, or exposure to certain chemicals can cause cataracts. The symptoms may take years to appear.

Secondary cataracts

Cataracts caused due to a medication or a disease are secondary cataracts. Diabetes, glaucoma, and steroids such as prednisone are some of the reasons for secondary cataracts.

Radiation cataracts

Too much exposure to the sun causes cataracts. Fishermen, farmers, salesmen, and people who spend long hours outdoors have high risks of developing the disease. Patients who have undergone cancer radiation therapy can develop cataracts.

Lamella/zonular cataracts

They appear in small children and can affect both the eyes. They are gene-related and are usually passed from the parents. Cataracts develop as white dots on the center of the lens and gradually take the form of a “Y”.  After some time, it may spread to the whole lens and turn white.

Posterior polar cataracts

These types of cataracts that appear on the back and center of the lens are gene-related. They are mostly asymptomatic.

Anterior polar cataracts

Unlike posterior polar cataracts, they form in the front and center of the lens. They look like white dots and do not obstruct the vision.

Post-vitrectomy cataracts

Vitrectomy surgery is an eye operation that treats the vitreous (fluid inside the eye) and the retina. Persons who have undergone vitrectomy surgery may develop cataracts post-surgery.

Christmas tree (polychromatic) cataracts

They appear as shiny, needle-like crystals in the lens. People with myotonic dystrophy are more likely to develop polychromatic cataracts.

Brunescent cataracts

Nuclear cataracts if not treated on time may turn hard and brown. They are brunescent cataracts. Patients have difficulty differentiating colors. Brunescent cataracts are difficult to remove.

Diabetic snowflake cataracts

A diabetic cataract occurs in patients with long-term diabetes. The cataracts are grayish and appear as snowflakes.

Treatment options

Surgery is the only treatment for cataracts. If the problem is diagnosed early, doctors may prescribe prescription eyeglasses and stronger contact lenses. Patients having trouble reading, can try a magnifying glass or a bright lamp. Anti-glare glasses help in driving or travelling during the night. If the symptoms worsen and the vision troubles disrupt the normal daily activities, cataract surgery is the only option.

Preparation for a cataract surgery

Before having cataract surgery, the ophthalmologist will have a detailed examination of the patient. Diagnosis of the eyes include:

• Evaluating the family history of the patient.
• Checking the health of the patient.
• A visual acuity test to determine the extent of the cataract.
• Refraction test to see if any adjustments are needed in the contact lens or eyeglasses.
• Retinal exam to examine the retina.
• A slit-lamp exam to check the iris, cornea, and lens.
• Evaluation of the lens to see the location and size of cataracts.
• Measuring pressure in the eye.
• Tests for assessing light sensitivity and color vision.
• Check the eyes to see if the patient suffers from any other eye diseases.

Procedures

Once the diagnosis is complete, the doctor will decide on a date for surgery. The patient must come on that day early and ask a family member or friend to accompany him/her.

The surgery involves replacing the damaged or cloudy lens with an artificial lens. The doctor uses local anesthesia to numb the area on the eye. It is an outpatient surgery and the patient can go home after taking some rest.

The surgery takes about fifteen to twenty minutes. If the patient has cataracts on both eyes, the doctor will perform the surgery on one eye first. After that eye heals, the doctor will do the surgery on the other eye.

There are three types of cataract surgeries:

Phacoemulsification

It is the most common procedure for cataract surgeries. The surgeon makes a small corneal incision. An ultrasonic probe is passed through the incision. The probe vibrates to break the cloudy lens into small particles. The capsule attached to the tip of the probe sucks out the broken pieces and an intraocular or IOL lens is inserted to take its place. The incision heals naturally and no stitches are required. Recovery is also very fast.

Femtosecond laser-assisted cataract surgery (FLACS)

It is laser surgery and is a high-precision operation. It minimalizes the use of scalpels and blades. Doctors use a femtosecond laser to make a clean incision on the cornea and the lens. The laser softens the cloudy cataract and removes it smoothly. It can also heal mild astigmatism by making corrections or reshaping the cornea.

Conventional extracapsular extraction (ECCE)

It is generally done if the cataract is large. The surgeon makes an incision on the side of the cornea and carefully opens the lens capsule. The soft lens is removed and an IOL is implanted. The cornea is placed back and the incision site is stitched with sutures. Since the clouded lens is removed in one piece, the incision site has to be bigger. Healing may take six or more weeks. Sutures are removed once the healing is done.

Traditional versus laser-assisted cataract surgery

Traditional cataract surgeries like phacoemulsification and ECCE use handheld surgical devices like a scalpel or a blade to make an incision. In phacoemulsification, stitches are not needed. The incision heals on its own. In ECCE, the incision is slightly bigger as the cataract-affected lens is removed in one piece. Sutures are required to stitch the incision.

Femtosecond laser-assisted cataract surgery (FLACS) uses no manual instruments. It uses a femtosecond laser and 3D imaging to remove the cataract. The laser makes small incisions to remove the cataract lens. The surgery is automated and hence more precise. It reduces the risk of manual surgeries or man-made mistakes.

FLACS uses fewer instruments and the incisions are exact. The laser energy is also low and the surrounding tissues are not affected. Sometimes, surgeons use Femto laser surgery to correct other deformities like mild astigmatism. Recovery in laser surgery is faster than traditional surgeries.

When should you go for cataract surgery?

Common causes for cataracts are:

• Old age is the main reason for cataracts. The lens becomes cloudy and opaque.
• It can cause the cloudiness of the eyes.
• Studies show that increased alcohol intake causes cataracts.
• Patients suffering from diabetes mellitus can develop cataracts.
• Drug reactions. Certain medications like corticosteroids cause cataracts.
• Ultraviolet rays. People who are exposed to the sun for a long time can get the disease especially if they do not wear sunglasses.
• Cataracts can run in the genes. Parents having cataracts are likely to pass on the disease to their children.
• Trauma or injury to the eye, eye surgeries, or radiation therapy to the upper part of the body can cause the disease.
• Insufficient nutrition. The scarcity of antioxidants in the body can lead to cataracts.

In rare cases, newborn babies can develop cataracts after birth. This may be due to genetics or the mother had developed some infections diseases like rubella during pregnancy.

Surgery options

Cataract surgery does not require hospitalization. It is a simple procedure and patients are released the same day. The surgery is done in an eye care center or a hospital. Typically, the surgeon recommends the place for the surgery. Patients can also choose a bigger hospital if they do not prefer the small setup at the doctor’s clinic.

Small clinics

Pros

• Personalized attention from caregivers.
• Cheaper rates of surgery.
• Faster service.

Cons

• A small setup may be insufficient to handle complications.
• Some clinics lack the infrastructure and facilities.

Hospitals

Pros

• Access to top eye doctors and surgeons.
• Well-equipped to handle risky procedures.
• High success rates.

Cons

• Expensive surgeries.
• One-to-one patient care is not possible.

Cost of cataract surgery

The average cost of the surgery can be anywhere between INR 15,000 to 1 lakh.

Factors affecting the cost of cataract surgery:

• The hospital or clinic.
• Experience and reputation of the hospital and the surgeon.
• Type of intraocular (IOL) lens used.
• Medications and aftercare costs.
• Some patients may need hospital stay post-surgery due to complications.
• Diagnostic tests.
• Equipment used in the surgery.

Post-op care and things to keep in mind

Following a cataract operation, your doctor will give you dark eyeglasses. If surgery was performed under local anesthesia, the eye will be covered with an eye patch and a plastic shield. The surgeon will remove them after two hours and once the patient is ready to go home.

Before the patient leaves, the surgeon will explain to him the post-op care regimen. Eye drops and other medications are prescribed to reduce inflammation, infections, and to regulate eye pressure.

Aftercare tips to remember:

• After a few hours, patients can watch television but only for a limited time.
• Always wear protective glasses.
• Wear the eye pad and the protective shield while sleeping at night.
• The eye drops may cause mild stinging or blurriness which is normal.
• Avoid bending for at least one day after surgery.
• Do simple exercises.
• Avoid head-bath or water running into the eyes.
• Do not cook or go near the stove for one week after surgery.

Risks

Like any other surgery, a cataract operation has certain risks:

Infections

Infections can cause redness, pain, and difficulty in vision. Doctors may suggest an antibiotic shot in the eye. In some cases, doctors remove the vitreous (the liquid gel in the eye) fluid to prevent the infection from spreading.

Swelling

Inflammation and redness are common after surgery. If the symptoms are worse, eye drops are recommended.

Retinal detachment

In rare cases, the retina may be pulled back during the surgery. This condition is called retinal detachment. Patients may experience:

• Light flashes
• Spots in the vision
• Feel something has fallen into the eye

Fragments of the lens

During the surgery, there are chances that some fragments of the lens  are left behind in the eye. The surgeon may remove the vitreous gel to prevent swelling and infection.

Fluid buildups

There may be some leakage in the blood vessels. This causes fluid buildups and blurs the vision. Doctors recommend eye drops but it generally takes a few months to recover fully. If the symptoms are serious, steroid shots are needed.

Dislocation of intraocular lens (IOL)

The artificial lens may slip out from the position causing blurred vision. It can also lead to inflammation and bleeding. Corrective surgery is done to reposition the IOL lens.

Cornea swelling

Temporary inflammation in the cornea may cause blurry vision. Eye drops are prescribed to treat the condition.

Secondary cataract

In cataract surgery, patients may develop a secondary cataract at the back of the lens capsule. Surgeons perform a YAG laser capsulotomy to make a hole in the lens capsule to allow the light to enter. This is a simple and painless procedure and takes only a few minutes.

Bleeding

After surgery, the blood vessels may leak and blood may accumulate in the eye. Eye drops may help. If the symptoms worsen, surgery is recommended.

Light flashes

In the case of vitreous detachment, patients can see light flashes or the vision is clouded. This generally resolves within a few months.

Ocular hypertension

Post-surgery, some patients may develop increased eye pressure. Leftover lens fragments, bleeding, or inflammation can increase the pressure in the eyes. Eye drops, injections, or medication help relieve the symptoms.

Sensitivity to light

Light sensitivity is normal after surgery. Wearing eyeglasses can help. Inflammation can cause light sensitivity. If the symptoms persist, doctors recommend eye drops.

Ptosis

Ptosis or droopy eyelids is a common side effect. If the condition lasts for more than six months, eye surgery is recommended.

Dysphotopsia

Patients can see optical images after the surgery. Negative dysphotopsia is more common and patients see dark curved shadows. Positive dysphotopsia appears like light streaks, halos, or flashes of lights. Patients can try thick-rimmed eyeglasses or eye drops for a few months. In severe cases of dysphotopsia, the doctor may recommend surgery.

Best option

Cataract eye surgery is a minimally-invasive procedure. Many patients prefer laser cataract surgery because of fewer complications, easy recovery, and high success rates. Goficure is an elective surgery provider in Bangalore. They provide a complete package of treatment and medical care. Goficure has a team of Medi-Pals who will handle your appointments, hospital stay, post-surgery care, insurance coverage, and even transport facilities.

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