What is cataract?

The clear lens behind the cornea of our eye focuses light rays on retina (like a camera) and gives us clear vision. When this natural lens  becomes cloudy (translucent or opaque) for some reasons, the vision becomes blurred or hazy. This is cataract. The spread of opacity  of the lens varies from    person to person. If the centre of the lens is not  affected, then the patient is not even aware of the problem. Cataract can be compared to foggy glass.
Some misconceptions about cataract are:
  • It is some kind of a layer on the eye
  • It occurs due to excessive use of the eye
  • It is infectious 
What are the symptoms of cataract?
  • Blurring of vision
  • Frequent changes in correction in specs
  • Glare - intolerance to light
  • Difficulty in vision at night
  • Multiple images
  • Need for more light for reading
  • Dull or yellowish image of colours 
What are the reasons of cataract?
  • Aging process
  • Hereditary
  • Injury to the eye
  • Diseases like Diabetes
  • Side effect of steroids
  • Previous surgery of the eye 
How fast does cataract develop?

The degree varies among and between the two eyes of an individual. Most senile cataracts develop      gradually. The development can be rapid among youngsters and diabetics. However, the progress of the disease in an individual case can not be  predicted with certainty.

How is cataract diagnosed? 

An ophthalmologist diagnoses cataract after detailed examination of the eye. During examination all parts of the eyes are checked to ascertain whether the  blurring is actually due to cataract. The cataract      surgery may fail to result in any  improvement in vision if there is problem with  cornea, retina or optic nerve.

How is cataract treated?

There is no medicine or exercise to stop or reverse cataract. The only treatment is its surgical removal. If the vision is blurred slightly then change in refraction may help. But if one has difficulty in activities like   driving, reading, watching TV or seeing faces of    people cataract surgery is the only solution.

When should one undergo cataract surgery?
As long as one is able to go about doing routine work with fair comfort there is no need to hurry. It is also not necessary to wait until the cataract matures          completely. When one finds it difficult to go about the routine work then one can think about surgery with the ophthalmologist’s advice. One can go through the  operation in any season. Surgery in summer gives the same result as in winter. Those having cataract in both eyes may go through operation in one eye and wait for the operation in other eye until everything is normal with the first.

What will happen if one does not undergo   surgery?

Postponing surgery will keep your vision blurred.  However, postponing it for too long may possibly make the cataract hard or over mature. An over mature cataract may induce glaucoma and this may make  surgery  difficult both for the  patient as  well as the surgeon and fail to yield expected result.
 
What is the Phacoemulsification (Phaco, in short) technique of cataract surgery?

This is the modern technique of cataract surgery which uses a machine. The cataract is broken to pieces, liquefied and extracted through a hollow pipe-like ‘probe’ that is inserted into the eye through approx. 3 mm incision. An artificial lens is implanted in the same place. This ascertains that the lens will not move and no other problem arises.

What are the benefits of Phaco? 
  • The patient does not have to spend more than two hours in the hospital (Walk-in, Walk-out Procedure).
  • There is no need for a patch and recovery is rapid.
  • Minimal post operative care needed because of rapid healing.
  • Resumption of routine life in a day or two.
  • Less chances of postoperative astigmatism. Refractions, if required, can be determined early.
  • Safe and convenient for patients with diabetes, high BP and asthma.
What is latest in phaco treatment?

Micro-coaxial Phaco: 
As modern equipment is available it is possible to operate through micro-incision. This technique requires an incision of about 2 m.m. The healing is much faster than normal phaco.

Painless Phaco
The jelly like drops are used as anaesthesia instead of painful injection. This also reduces the need for a patch (bandage). As the eye remains open the improvement in vision is experienced by the patient immediately after the surgery.

 What are the types of intraocular lenses (IOLs) used currently?
The quality and dependability of the material is important. The extra cost paid for it is always   beneficial. As the incision in phaco is very small, foldable lenses that can be implanted through them are popular. Various types of foldable lenses made of high grade acrylic that last till the patient lives are available.

Monofocal Lens:  This type of lens has a   single ‘power’. It has capability to focus rays   coming from either distant or near objects on the retina. Normally, the doctor implants a lens that can focus clearly on distant objects. This requires the patient to use specs for focussing on near objects.

Till recent times ‘Spherical monofocal’ lenses were implanted during cataract surgery. Scientific innovation has now led to availability of ‘Aspheric  monofocal’ lenses that are custom made to suit the structure of the eye.

Such lenses provide better contrast sensitivity in low lighted conditions. This gives much better   ability to the patient to identify and differentiate between objects.

Newer generation lenses:

Multifocal Lens: Monofocal lens normally facilitates clear distant vision due to its single  power. But in routine life about half of daily        activities (like sewing, stitching, picking grain,  reading) requires use of specs. Multifocal lens has multiple focal power that enables it to focus on  objects at various distances. It gives clear distant and near vision to a person. This does away with the requirement for specs. A study indicates that 80% people implanted with Multifocal lens can read and write without using specs whereas only 10% people with monofocal lens are able to do so. Hence, specs are hardly required after implantation of Multifocal lens.

However, contrast sensitivity is reduced especially in dim light. Due to the design of the lens a patient may notice circles around a light source or even feel that the light spreads away. Mulitfocal lens is not suitable to everyone. One may need to consult the doctor to find out whether it will be appropriate with one’s lifestyle.

Toric Lens: This kind of lens is implanted in people having cataract with Astigmatism (cylindrical number). 35% of the patients undergoing cataract surgery have eye with Astigmatism. Normal     spherical/aspheric monofocal lens will not take care of cylindrical number. Such patients require cylindrical number in specs for clear distant vision. Toric lens is available for such patients. It has     cylindrical power in addition to the spherical power of monofocal lens which enables clear distant vision without specs. However, for near vision specs may be needed like a normal monofocal lens. The doctor’s judgement is essential for such facilities.


Cataract Surgery

Our centre has acquired special proficiency in cataract surgery. Once the patient is diagnosed as having cataract, he/she is given information about cataract and its treatment through a powerpoint presentation that includes animations and videos. This helps the patient to understand it better. Though there are different techniques of cataract surgery and options of Intraocular Lenses (IOLs), the technique and lenses used at our centre are as follows:

1) Technique - Micro-coaxial Phacoemulsification
All cataract surgeries at BECC are done using the latest technique of painless Micro-coaxial Phacoemulsification (Micro-Phaco) where the cataract is emulsified by a machine and removed through a micro-incision of about 2 mm. The natural cataractous lens is then replaced with the artificial intraocular lens. The surgery is done under topical anaesthesia by applying anaesthetic jelly or eye drops. This avoids the requirement of conventional painful injection. Also, no patching of the eye is needed postoperatively.
 
2) Options for Intraocular Lenses (IOLs)
As the incision in our technique (micro-phaco) is very small, we prefer to implant foldable IOLs that can be inserted without enlarging the incision. At BECC we implant foldable IOLs manufactured by American companies. We offer options of Standard Monofocal IOLs as well as Newer-generation (Premium) IOLs like Toric and Multifocal.

A)    Monofocal IOL – This lens has only one spherical power for patients to clearly see long-distance objects. One will need reading glasses postoperatively.
B) Toric IOL - This lens has cylindrical power in addition to the spherical power. It is recommended for patients having cataract with pre-existing astigmatism (cylindrical numbers). 
C) Multifocal IOL - This lens has a combination of spherical powers required for distant and near vision. It significantly reduces dependence on reading glasses post-operatively.
We have acquired skill and experience in implanting premium IOLs as we started using them since they were introduced for clinical practice.

3) Costing of the Surgery

BECC offers different packages for cataract surgery. 
Each package includes the cost of the following:
    • Fitness Test by a Physician (M.D).
    • Cost of medicines - preoperative, intraoperative and postoperative.
    • Cost of Intraocular Lens.
    • Operation charge. 
    • Operation theatre charge that includes cost of disposables and consumables.
    • Anaesthetist’s (Standby) fees
The total cost in each package would vary depending on the type of intraocular lens, cost of medicines and other consumables.