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Everything you need to know about cataract

Category : |
Author : Dr Deepak Garg

Cataracts are age-related changes in the lens that are present inside your eye. Most commonly, these are results of ageing and can often cause blurry vision. At this point, the only treatment for cataracts is eye surgery or phacoemulsification.

What is a Cataract?

A cataract develops when the lens in your eye becomes foggy. The word cataract is derived from a Latin word called cataracts which means waterfall.

Usually, our eyes have a transparent lens inside them. This lens focuses light rays onto the retina, the eye's light-sensitive layer. This information passes from the retina to the brain to know what we are seeing.

The lens resides behind the iris (coloured part of your eye). It is made up of protein, and this protein changes with age. As it ages, it may become cloudy, allowing less light to go through the lens. As the amount of light entering the eye reduces, the viewing power diminishes too.

Usually, cataracts develop and progress slowly. In the initial stages of a cataract, the person may not complain of vision difficulties. If they face problems, these are usually corrected by changing glasses or increasing light. However, as the cataract advances, people may struggle to read under dim light. They may also face glare while driving at night and may not see clearly.

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How does Cataract affect vision?

Typically, the rays of light pass through the eye's various layers to form an image on the retina. This information then goes to the brain. If the rays cannot reach the retina for some reason, vision will become blurry.

The lens inside the eye is one such layer, and when it becomes foggy or white, it can block the rays of light from passing through. Early cataracts do not cause significant vision loss. Bright lights may still pass through these early cataracts. However, as cataracts become denser, even bright light cannot pass through, which leads to blurred vision.

Symptoms of Cataracts

Following are the common cataract symptoms.

  • Clouded, blurred or dim vision
  • Increasing difficulty while viewing at night
  • Sensitivity to light and glare
  • Need for brighter light for reading and other activities
  • Seeing halos around lights
  • Frequent changes in eyeglass or contact lens prescription
  • Fading or yellowing of colours
  • Double vision in a single eye or monocular diplopia

In the initial stages, cataracts do not cause significant vision difficulties. These difficulties are corrected by changing glasses or increasing the room lights. As the cataract advances, vision difficulties begin to increase gradually,

Causes of Cataracts

The lens inside our eyes is made up of protein. Tissues in our body change with age, and so do these proteins. Most cataracts develop when ageing changes the tissue that makes up the eye's lens. Proteins and fibres in the lens begin to break down, causing vision to become hazy or cloudy.

Some inherited genetic disorders that cause other health problems can increase your risk of cataracts.

If cataracts occur for reasons other than ageing, they are secondary cataracts.

Here are the causes of cataracts,

  • Ageing
  • Eye Injury or traumatic cataracts
  • Eye Surgery
  • Uveitis
  • Congenital - Some metabolic disturbances in the child can cause congenital cataracts. Some infections that the mother or the child acquire can also cause congenital cataracts.

Some health problems and treatments can also make cataracts more likely, including: 

  • Diabetes 
  • Smoking 
  • Drinking too much alcohol 
  • Spending too much time in the sun without sunglasses 
  • Taking steroids — medicines used to treat a variety of health problems, like arthritis or allergies — for a long time 
  • Getting radiation treatment for cancer or other diseases

Types of Cataracts

Depending on the location of the white opacity within the lens, there can be a few types of cataracts. The treatment for each of these remains the same.

  • Cataracts affect the centre of the lens (nuclear cataracts). Central cataracts are most commonly seen in age-related cataracts. A nuclear cataract may cause a phenomenon called 'second sight'. This occurs because this cataract causes more nearsightedness or a temporary improvement in your reading vision. Individuals may feel that with age, their eye health is improving. But with time, the lens gradually turns more densely yellow and further clouds your vision. As the cataract slowly progresses, the lens may even turn brown. Advanced yellowing or browning of the lens can lead to difficulty distinguishing between shades of colour.
  • Cataracts that affect the edges of the lens (cortical cataracts). These are more white than cortical cataracts. A cortical cataract begins as wedge-shaped opacities or streaks on the outer edge of the lens cortex. As it progresses, the lines extend to the center and interfere with light passing through the center of the lens. These cataracts reduce the quality of vision and are seen more in people with diabetes.
  • Cataracts that affect the back of the lens (posterior subcapsular cataracts). A posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of the lens. This opacity is generally present right in the path of light. It thus interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night. This can be particularly difficult while driving at night. Sometimes these are associated with another type called the posterior polar cataract. Posterior polar involves a part of the capsule of the lens. A capsule is like a bag that holds the lens in place. Usually, the capsule remains clear while the cataract develops. If the capsule is involved, there is a slight modification in the surgical procedure.
  • Cataracts you're born with (congenital cataracts). Some people are born with cataracts or develop them during childhood. These cataracts may be genetic or associated with an intrauterine infection or trauma. Congenital cataracts are treated as soon as possible to reduce the risk of developing amblyopia or lazy eye.

    These cataracts may occur due to certain conditions, such as myotonic dystrophy, galactosemia, neurofibromatosis type 2, or rubella.

When to see a doctor for Cataracts?

In the olden days, a patient who could not see clearly would visit an eye doctor. The eye doctor would say that vision's blurry because of a cataract, but the cataract is not ripe yet, and the patient will have to wait. Your doctor said this was due to the unavailability of technology to remove the cataract before it became mature or hard.

Your doctor can remove the lens inside the eye these days, even before a cataract. Thus the question. When should I get my cataract removed?

In the initial stages, vision may not be much affected. As cataracts advance - vision becomes blurry. Whenever an individual feels that daily activities, such as watching tv, reading newspapers, or driving, are becoming challenging, it might be time to visit an eye doctor. While your cataract may still be early, it may be a good idea to undergo a surgical procedure to get rid of your cataract and maintain your ocular health.

Also, in most cases, the delay does not particularly harm your eyes. However, it keeps you from having clear vision.

Pro Tip: There is no right or wrong decision here. You may choose to get cataract surgery as soon as you have the slightest problem with the quality of your vision, or you may decide to wait. Either way is acceptable. You must remember that the quality of vision will only improve once you get your cataract surgery.

Diagnosis of Cataracts

Patients visit their eye doctors when they have vision difficulty. Your eye doctor would perform the following.

  • Refraction and visual acuity test - First, we check your vision using Snellen's Visual acuity chart. We also check your eye power and try and improve your vision by changing the eye power.
  • Slit Lamp Examination - Slit Lamp is an instrument that helps look at the front part of the eye. Here we can see the lens and stage, and type of cataract.
  • IOP Checkup - Before performing cataract surgery, it is essential to check the entire eye and make sure everything is normal. We thus also check the eye pressures. Increased eye pressures lead to a condition known as glaucoma.
  • A retinal examination - It's essential that the retina is normal before cataract surgery. If the retina has certain conditions, then those may have to be treated before cataract surgery.

Treatment of Cataracts

Cataracts are treated by a surgical procedure. Here the opaque lens in the eye is removed and replaced by an artificial lens known as the Intraocular lens or IOL. Over the years, there have been significant improvements in the technology available to perform cataract-removal surgery.

Managing mild Cataracts without surgery 

In the initial stages of cataract, vision is not significantly impaired. One can do the following:

  • Make sure your eyeglasses or contact lenses are the most accurate prescription possible. This will enable you to see clearly despite the mild cataract.
  • Use a magnifying glass to read if you need additional help reading
  • Improve the lighting in your home with more or brighter lamps. Usually, brighter lights overcome the difficulties caused by early cataracts.
  • When you go outside during the day, wear sunglasses or a broad-brimmed hat to reduce glare.
  • Limit your night driving. One may see halos around the oncoming headlights. This can be blinding and make driving at night difficult and sometimes even dangerous.

What is Cataract surgery?

Modern cataract surgery is far superior. Here a 2 mm incision is made in the eye, and through this incision, the cataract is removed, and the IOL is placed in the eye. The surgery is a daycare procedure without any injections or sutures. 

Cataract surgery is the most common eye surgery performed worldwide. Most of the cataract surgeries are performed for age-related cataracts. Many years ago, the surgery performed was known as extracapsular cataract surgery. Here a large incision, up to 5mm, was made, and then after removing the cataract, was sutured.

Book an appointment for a Cataract Operation in Mumbai with Eye Solutions.

Types of Cataract surgeries

There are mainly two types of cataract surgeries.

  1. Phacoemulsification
  2. Femtosecond assisted phacoemulsification

Phacoemulsification is the more popular type of cataract surgery. More than 90% of cataract surgeries today are done by this method. Here a small 2mm incision is made in the peripheral cornea, and the cataract is extracted by a combination of suction and ultrasound energy. The surgery takes less than 15 min, and while patients may feel that something is going on, they rarely complain of pain.

Femtosecond laser-assisted cataract surgery or laser cataract surgery is the newer method of performing cataract surgery. However, because there is no significant benefit to the patient, this technique has not gained popularity. There is also a considerable cost involved for the doctor and the patient. Here, instead of a blade, a laser is used to make the 2 mm incision. The cracking of the cataract also is done by the laser. Post the laser procedure, the patient is then shifted to the operation theatre, and standard phacoemulsification is done.

Know about What Happens in a Cataract Consultation?

Cataract Surgery Recovery Time

With today's treatment options, patients recover from cataract surgery very quickly. Gone are when patients were asked not to leave home for a month and wear dark glasses for a few weeks to protect the eyes from sunlight.

Most of the time, patients start seeing clearly the same evening of surgery or the next day. The minimum prick or poking they feel also reduces a day or two after surgery. By the 3rd or 4th day, patients forget that they have just undergone surgery.  

The drops that patients should use continue for a month after surgery.  

What to Expect after Cataract Surgery? 

The eye is patched after surgery and removed ten minutes later. Sometimes, there is no need for even this patch. The patient is given protective glasses and explained the drops to be used.

The patient may experience blurry vision for most of that day or part of the next day. There may be a slight foreign body sensation in the eye for a day or two.

Usually, by the same evening, patients notice a significant improvement in vision. They typically tell us that everything is very bright, and the colours are very different from what they were used to. They also start seeing the subtitles of their favourite shows on TV. There is no restriction on watching TV or using the phone and computer.

As the days go by, the vision continues to improve. Irritation, watering, and redness, if at all, disappear.  

We instruct patients not to let water enter the eye for seven days after surgery. So no head bath allowed. This is to prevent eye infections from occurring. These are known as endophthalmitis.

Cataract surgery aftercare

There are certain dos and don'ts to follow after cataract surgery. This can help prevent eye infections known as endophthalmitis. Endophthalmitis can be blinding if not treated in time. Here are some of the instructions to keep in mind after cataract surgery:

  • Don’t skip follow-up appointments 
  • Keep eyes covered with protective glasses during the day. At night it's crucial to use a cup and tape to prevent accidental touching of the eyes while sleeping.
  • Keep eyes away from water - which means no head bath or washing the face for seven days.
  • Use eye drops as prescribed.
  • Report to your doctor in case of redness, watering, pain, and blurry vision
  • Avoid rubbing your eyes
  • Stay away from dusty regions
  • Avoid wearing makeup 
  • Follow all the instructions precisely 

Get information regarding What are eye drops after cataract surgery?

Factors that increase the risk of cataract

  • High blood pressure
  • Excessive alcohol intake 
  • Smoking
  • Age
  • Eye injuries and surgeries
  • Obesity
  • Excessive exposure to UV rays

How to prevent cataracts?

Cataracts occur because of ageing, which is something one cannot control. But we have seen certain factors which hasten or delay the formation of cataracts:

  • Ensure proper nutrition - Healthier people develop visually significant cataracts later than others. Nutrition plays an essential part in your health. Fruits and vegetables have vitamins, minerals, and antioxidants which are suitable for overall health too.
  • Get regular checkups - Regular eye checkups ensure your eyes are in good health. Your eye doctor would be able to detect cataracts or other eye problems that may be causing blurry vision.
  • Reduce alcohol consumption - Excessive alcohol can increase the risk of cataracts.
  • Use sunglasses when stepping out - Exposure to increased sunlight increases cataract formation.
  • Quit smoking - Smoking is known to increase the risk of developing cataracts.
  • Exercise regularly to reduce obesity - Healthier people develop visually significant cataracts later than others. Exercise is essential otherwise, too. In the later years of your life, your quality of life would depend on how much you exercise today.
  • Don't indiscriminately use steroids - Steroids cause two issues in the eyes. The first is glaucoma which raises eye pressures, and the second is cataract. 

Types of Cataract Lens

All cataract surgeries involve implanting a lens inside your eye. There are multiple options that one can choose from. Let's divide them into the following three categories:

Monofocal Lens

As the name suggests, these lenses focus on one distance. This distance could be far or near. Usually, the far distance is chosen. This means that after using this lens, one will be able to see the TV clearly without glasses. For reading or computer work, patients will have to wear glasses. If the patient has astigmatism, then these lenses won't render you glass-free. For these patients, Toric lenses are used.

Everything you need to know about Monofocal Cataract lenses.

Toric Lenses

These lenses are used for those who have astigmatism or a cylindrical number. Toric monofocal lenses, when used, will render the patient glass-free vision for far. They will need glasses for reading.

Everything you need to know about Toric Astigmatism lenses.

Presbyopia correcting lenses - Symfony IOL – EDOF Lenses

Presbyopia means the need to wear reading glasses. Lenses are available that will make you glass-free for up to 90% of all your daily activities. These lenses could be multifocal or trifocals, or EDOF lenses. Multifocal lenses give you clear vision for far and near meaning, like reading a book. Trifocals give you clear vision for far, reading, and intermediate vision. Intermediate vision is needed to work on a computer. EDOF lenses, known as extended depth of focus lenses, give you clear vision for far and intermediate vision. One would have to wear glasses for reading activities. Some who desire to be glass-free have astigmatism. For them, we use toric lenses, which are available in these presbyopia-correcting lenses.

Everything you need to know about EDOF lenses.

Cost of cataract surgery

To give you a clear idea, the cost of cataract surgery starts from Rs 15000 to Rs 140000 per eye. The amount you pay for your cataract surgery can vary greatly. It depends on multiple factors, the most important of which is the lens that you choose. The presbyopia-correcting lenses are more expensive than the monofocal lenses. The cost would also depend on the location of the hospital and the quality of the equipment that is being used. You can read more about it here.

To know in detail about Cataract Surgery & Cataract lenses cost in Mumbai, click here.

Conclusion

We are focussing more on quality of life these days. It would help if you kept in mind that even though you may have an early cataract, it can still be treated. If your daily activities are hampered, then it may be a wise decision to consider undergoing cataract surgery, a very safe and quick procedure, so that you live independent lives, spend quality time with your grandchildren, and enjoy your travels.

Are you looking for a Cataract Surgeon in India or especially in Mumbai?

Eye Solutions have one of the top Cataract Specialists in Mumbai. He has 15+ years of diverse experience as an Ophthalmologist/ Eye Surgeon. Dr Deepak Garg and Dr Svetlana Toshniwal are two Cataract Specialists at Eye Solutions. Contact us now to book an appointment for cataract surgery in Mumbai.

 

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