Cataract and Cataract surgery with Intraocular Lens Implants

What is a cataract ?

A cataract is a clouding or loss of transparency of the lens of the eye. The normal lens is crystal clear. As one ages, chemical changes occur in the lens that make it less transparent.Cataracts are of varying severity. In early cases, the loss of transparency may be very mild, so vision is hardly affected. In severe cases where there is a total loss of transparency, the cataract may appear white and opaque, and vision is severely impaired. In the later stages of cataract, glasses or contact lenses cannot sharpen your vision.
What causes cataract ?The most common cause of cataract is aging. Other causes include trauma, medications such as steroids, illnesses such as diabetes and less commonly prolonged and excessive exposure to ultraviolet light and smoking. Occasionally, babies are born with a cataract. Young adults and children can also have cataract.
Symptoms of CataractYour eye functions like a camera. Light rays focus passing through the eye are focussed by the lens on the retina, a layer of light sensitive cells at the back of the eye. Similar to the camera film, the retina allows the image to be “seen” by the brain. When a cataract is present, the passage of light through the eye is blocked or scattered, and the light rays do not fall precisely on the retina, causing blurring of vision.

Visual blurring in cataract is slow, progressive, and painless. Other changes include glare, particularly at night or in dim lighting, a need for frequent eyeglass prescription change, a change in colour perception and less commonly doubling of the image in the affected eye.

Cataract Surgery: What you need to know Once visually significant, the only way to improve vision is to have the cataract surgically removed. Outpatient surgical procedures can remove the cataract through either a small incision (phacoemulsification) or a large incision (extracapsular extraction), or with the help of a femtosecond laser. These days, with modern techniques, it is unnecessary to wait for the cataract to be severe before surgery is undertaken. The decision making process will involve you, the patient (your lifestyle, expectations and visual needs) and your ISEC doctor.

Cataract surgery is a very successful operation. Millions of people around the world have enjoyed the benefits of cataract surgery. The success rate is at least 95%. As with any surgical procedure, complications can occur during or after the surgery. Fortunately, serious side effects or complications that cause loss of vision are rare, and most patients end up with their vision restored after the surgery and their quality of life enhanced.

There are 3 types of Cataract Surgery1. Phacoemulsification or “phaco”. This modern method is commonly but mistakenly known as the “laser” method. A small incision is made in the eye. A special device utilizing high frequency ultrasound energy is used to soften and breakdown the cataract so that it can be removed.

2. Femtosecond Laser cataract surgery. In traditional “phaco” surgery, the surgeon uses a blade to enter the eye through a small wound and ultrasound to breakdown thecataractous lens. In the femtosecond laser method, no blade is used. Instead the surgeon uses a femtosecond laser beam to create the wound and facilitate the removal of the cataract withminimal use of ultrasound energy. This technology is available at ISEC.

3. Extracapsular cataract surgery. This is an older method whereby a larger incision (wound) is made in the eye. The cataract is then removed in one piece through the wound. In view of the larger wound, suturing is required (usually 7-6 stitches are used) and therefore the recovery time is longer. In ISEC we do not routinely offer this from of cataract surgery, but some very dense and complicated cataracts may have to be removed by this technique. Your ISEC doctor will make the important decision for you.

All about Phacoemulsification (PHACO)

Phacoemulsification is a surgical method that uses ultrasonic waves to remove a cataract. It remains the gold-standard of modern cataract surgery .

In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye through a small incision between 1.8 to 2.75mm. The probe ‘emulsifies” or breaks up the lens nucleus, which is the centre of the lens. The emulsified pieces are simultaneously removed from the eye by an aspiration system which absorbs the pieces. Most of the outer covering of the lens (the capsule) is left behind. In this capsule, an intraocular lens implant, or IOL, is placed. An experienced surgeon using state of the art phacoemulsification technology can successfully perform the surgery within 10-15 minutes. The procedure is painless, without injection and does not require stitches or sutures most of the time. Vision returns quickly and one can resume normal activities within a short period of time. New technologies in phacoemulsification have significantly reduced the risks of cataract surgery making cataract surgery one of the safest surgical procedures. At ISEC, phacoemulsification is the standard techniquefor cataract surgery.

More about Intraocular Lenses (IOLs)

An intraocular lens (IOL) is a tiny, lightweight, clear disc placed in the eye during cataract surgery. An IOL mimics the focusing power of the eye’s natural lens.Following removal of the cataract, if no IOL is placed in the eye, you will not be able to see, as the focusing power of the eye is lost.

Unlike contact lenses, which must be removed, cleaned, and reinserted, the IOL remains permanently in the eye after surgery.

An IOL may be placed either in front of or behind the iris. Behind the iris (posterior chamber) is the most frequent placement site. They can be hard plastic, soft plastic or soft silicone. These lenses are soft and foldable, and thus can be inserted through a small incision, which shortens recovery time following surgery.Rapid evolution of IOL designs, materials, and implant techniques have made them a safe and practical way to restore normal vision after cataract surgery.Monofocal IOLs give excellent distance vision, but glasses will be required for reading and close near work. Currently, multifocal intraocular lens which include bifocal, trifocal and extended range IOLs are also available to correct presbyopia, and reduce the dependence on reading glasses.The best IOL that suits your lifestyle and visual needs with be chosen by your ISEC doctor.