Cataracts are one of the most common causes of vision loss, especially with aging. The good news is that cataract surgery is a safe, effective, and permanent solution that can restore clear vision. This article explains everything you need to know about cataract surgery—from symptoms and procedure to recovery, cost, and lens choices.

How do the eyes work?

Before understanding cataract, it is important to know how a normal eye works.The eye is like a camera. The lens in a camera allows light to pass through and focusses that light on the film at the back of the camera for a clear picture. The eye works in a similar way. The lens of the eye is normally clear and allows light to pass through. The light is focussed on a thin film-like retina, which is situated at the back of the eye. This is how we see. 

What is a Cataract?

Cataract is a cloudiness of the normal clear lens in the eyes. It prevents the lens from focussing light onto the retina and hence causes unclear vision. As the cataract advances, the cloudiness of vision increases over a period of time until the vision is completely impaired.

Why does a cataract develop?

Cataract development is part of the normal ageing process. Almost all people above the age of 60 years have cataracts of a variable degree, although it can occur at an earlier age also. In some people cataract development is aggravated by an eye injury, presence of diabetes, use of medications or other eye diseases. Rarely cataract may be present in the newborn as a congenital defect. 

What are the symptoms of a developing cataract?

Because cataracts form in different ways, the symptoms of cataracts are variable. Most people notice  that their vision gradually deteriorates – objects may begin to look yellow hazy, blurred or distorted. Some people report double vision , or polyopia (objects appearing multiple). Many people also find that they need more light to see clearly or that they experience glare or haloes from lights at night. In advanced cases, the cataract may be visible as a whitish-looking pupil. 

Can cataract be prevented or treated with Medicines?

Cataracts that occur due to the aging process cannot be prevented as the aging process itself cannot be prevented. Using the eyes for reading and similar activities has nothing to do with cataract formation. Avoiding the use of eyes will not prevent cataract. Till date as per all authentic medical research no medication exists to prevent or cure a cataract. The only known treatment for cataract is surgery. 

When can one go for cataract surgery?

Cataract surgery can be performed as soon as the patient feels handicapped in performing routine activities at work and leisure. It is not advisable to wait for the cataract to mature as unnecessary delay can make surgery difficult and prone to complications. Modern cataract surgery can be performed successfully in any season including summers and the rainy season. 

What does the cataract surgery entail?

Modern cataract surgery is one of the safest and most successful forms of surgery. It requires a very short hospital stay and is generally performed under local or topical anesthesia. The patient is awake during the surgery but does not feel any discomfort or pain. Patients can move around immediately after surgery and are discharged on the same day.  

Benefits of Cataract Surgery

There are numerous benefits of cataract surgery , many of which cannot be measured statistically. These include: 

• Improved clear vision: Colours are brighter and more vivid
• Greater clarity of vision – vision is crisper and sharper 
• Improved quality of life – studies have repeatedly shown that people enjoy an improved quality of life after successful cataract surgery. Many people can resume driving, reading, writing, watching television, sewing, household work and using a computer immediately after. 

Even when retinal diseases or other problems prevent a total restoration of vision, the remaining vision is usually improved by cataract surgery. 

Is clear vision guaranteed after surgery?

No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery. In certain cases, eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful. However, it might not be possible to evacuate the condition of the retina, optic nerve, in advanced cataracts. 

Can cataracts be treated with lasers?

What is Femtosecond Bladeless Cataract Surgery?

Until a few years ago cataract could not be removed with lasers. Surgery done by phacoemulsification was commonly termed “Laser Surgery” by lay people. Today, some of the most critical steps of cataract surgery can be performed by Femtosecond Laser. This has significantly improved the precision of the same steps that were traditionally performed manually. 

The femtosecond laser is a special laser which allows the surgeon to create highly precise incisions. Femtosecond laser technology has already been in use in recent years for creating precise flaps in bladeness. LASIK with more predictable outcomes and increased safety.

Similarly, in cataract surgery, the Femtosecond Laser automates some of the most complicated steps. That means rather than performing these steps manually, your surgeon would use the Femtosecond Laser to replace or assist several aspects of the conventional phacoemulsification surgery. One of the most advanced lasers available today for bladeness laser assisted cataract surgery is the LenSx Femtosecond Laser System from Alcon. 

How is Femtosecond Bladeless Cataract Surgery different from Conventional Phacoemulsification Surgery?

In cataract surgery the initial step is to make corneal incisions to gain access to the cataract. In conventional phacoemulsification surgery, the surgeon makes the corneal incisions with a metallic blade. These incisions are not as consistent with respect to size and architecture as those achieved by a laser. As the entire laser process is carried out under computer-guided imaging, there is greater control and reliability of the incisions with regard to size, shape and location. 

In the next step, an opening has to be created in the front layer of the lens also called the anterior capsule. In manual surgery this opening is not as perfectly circular as compared to that achieved by the femtosecond laser. Also, the laser created opening is extremely well centered. 

Another crucial step in cataract surgery  is the removal of the lens matter or nucleus. In conventional surgery, this is done entirely by ultrasound energy using a phacoemulsification probe. In laser assisted cataract surgery, the nucleus is initially broken down to small pieces by the femtosecond laser. Thereafter, the lens fragments are removed by the surgeon using the ultrasonic probe. This greatly reduces the amount of ultrasound energy used to remove the cataract. Lesser the ultrasound energy used in the eye, the lesser is the risk of damage to the delicate structures of the eye, which in turn helps in early visual recovery. 

In the final step of cataract surgery, the intraocular (IOL) lens is placed inside the eye to replace the natural lens that was removed. Here the perfect laser created opening in the lens capsule helps greatly in the final position of the IOL. The lens is better centered than in the manually performed surgery. 

This is of utmost importance in premium intraocular lenses such as aspheric design IOLs, Toric IOLs, Multifocal IOLs and Accomodative IOLs where the slightest error can compromise the quality of vision. 

Is clear vision guaranteed after surgery?

No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery. In certain cases, eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful. However, it might not be possible to evaluate the condition of the retina, optic nerve, in advanced cataracts. 

What is Posterior Capsular Opacification (PCO) or After Cataract?

In a certain number of patients undergoing cataract surgery, the back part of the lens capsule may thicken over a period of time causing blurred vision. This is known as Posterio Capsular Opacification (PCO), secondary cataract or After Cataract. This is not a complication. The condition is treated with YAG Laser Capsulotomy  with full restoration of vision.

What are the types of lenses for cataract surgery?

1. Monofocal IOLs – These lenses provide good distance vision and most patients are dependent on their distance glasses for daily activities. However, patients implanted with monofocal IOLs typically require reading glasses after cataract surgery. 
2. Aspheric Monofocal IOLs – In recent years, monofocal lenses have been designed with aspheric surfaces. These state-of-the-art FDA approved aspheric or aberration-free IOLs greatly improve image quality by enhancing contrast, eliminating glare and haloes, and improving night vision.
3. Toric IOLs – These special lenses are useful in patients having cataracts with significant corneal astigmatism (cylindrical power). By correcting the cylindrical power, they reduce the patient’s dependence on distance glasses. 
4. Multifocal IOLs – These lenses are designed to provide good unaided distance and near vision with less dependence on glasses. In a small number of cases patients may experience glare and halos. A few cases may require reading glasses for reading fine print. 
5. Newer Multifocal IOLs – With more accurate methods to calculate the power of the IOL and improvement in IOL technology the drawbacks associated with these IOLs have largely been addressed. 

• Extended depth of Focus IOL – The Symfony Extended depth of the focus IOL from AMO is a recently introduced lens that creates an elongated zone that increases depth of focus ensuring good distance and intermediate vision. The Symphony scores over other multifocal lenses in terms of decrease in glare, haloes and dysphotopsias commonly encountered with other multifocal IOLs. It helps maintain quality of vision by decreasing chromatic aberration. 
• Trifocal Lenses – These lenses provide good vision for distance and near as well as relatively good vision for computer usage at intermediate distance. 

6. Multifocal Toric IOLs – These are special Multifocal lenses which can correct cylindrical power as well.

Multifocal lenses are not suitable for:

1. Pilots/Naval officers/ Seamen
2. People who drive a lot a night
3. Patients with corneal or retinal problems 
4. Patients with dry eye

Depending on the patient’s personal visual needs, the surgeon will decide the most appropriate lens to implant in the eye. 

How is the IOL power calculated prior to the cataract surgery?

IOL power calculations are done by trained personnel and every endeavor is made so as to get very minimal post-operative power in the distance glasses. This is done using new devices like IOLMaster and the Tomey OA-2000 that are capable of extremely accurate measurement of the eye and IOL power calculation even in very dense and mature cataracts. 

Immersion ultrasound biometry is used to reconfirm measurements taken with the IOLMaster to ensure optimal outcomes.

In order to ensure a better outcome before the surgery certain tests are performed:

1. Specular Microscopy – To determine the health of the cells in the cornea. Based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If the endothelial cell count is low we use BSS Plus and Viscoat, to coat the endothelium, to minimize loss of the already depleted endothelial cell counts during surgery. 
2. Optical Coherence Tomography – This device helps the surgeon  to image different layers of the retina. It is used to rule out retinal problems that may not be evident on examination and may potentially cause poor vision even after a successful surgery. This test is very important before Multifocal IOL Implantation.
3. Schirmers Test and Tear Film Breakup Time – These tests are done to analyze whether you are suffering from dry eye. This needs to be treated before cataract surgery. 
4. Pentacam – This test needs to be performed in patients who have undergone prior refractive surgery such as LASIK, PRK or RK as well as before Toric and Multifocal IOL Implantation to determine the IOL power accurately. It also allows your doctor to study the shape of the cornea in cases of irregular astigmatism and corneal scarring.
5. iTRACE – Prior to Toric and Multifocal IOL implantation this device allows us to study subtle micron level Corneal and Lenticular changes called Aberrations and tells us if your eye is suitable for a Toric or Multifocal Intraocular Lens Implantation.
6. Verion – It is an image guidance system which helps your surgeon to plan a procedure tailored specifically to your eyes with computer accuracy so as to give you the best possible vision after surgery. This test is specifically applicable to those cases undergoing Toric IOL Implantation and Bladeless Femtosecond Laser Assisted Cataract Surgery.
7. B Scan – It is done for advanced cataract where the view of the retina is not possible.

What is the life of Cataract Lenses or Intraocular Lens?

These lenses are permanent and remain in place for decades without undergoing any degradation.

Are there any problems with Cataract Surgery Lens?

Fortunately, the technological advances in IOL manufacture and surgery have made it quite safe. Complications are rare and similar ones can occur with conventional surgery without an IOL implantation. All patients irrespective of other general illnesses like diabetes, hypertension etc. can have IOL surgery. If there is any reason why you should not have an IOL your ophthalmologist will explain.

Cataract Surgery at Shroff Eye Centre

Shroff Eye Centre stands out as one of India’s premier facilities for eye care. Patients from around the globe, not just India, seek treatment for various eye conditions here.Cataract surgery at Shroff Eye Centre is performed using three advanced techniques: Zepto Cataract Surgery, Femto Laser-Assisted Cataract Surgery, and Micro Incision Cataract Surgery (phacoemulsification). The choice of technique is tailored to each patient’s unique visual requirements, ensuring the best possible outcomes.The award-winning team of surgeons is dedicated to adopting cutting-edge techniques, such as blade-free Femto Laser cataract surgery. The hospital maintains rigorous sterilization protocols and holds regular Continuing Medical Education (CME) programs to stay at the forefront of advancements in eye care. At Shroff Eye Centre, patient well-being is always their top priority, solidifying their reputation as leaders in eye surgery and comprehensive eye care.

Disclaimer: The information provided is sourced from Shroff Eye Centre. For comprehensive details or to schedule an appointment, please visit their official website.

Shroff Eye Centre is renowned for its expert eye care services. Their team is dedicated to addressing a wide range of vision-related issues, ensuring each patient receives personalized attention.

To explore the various treatments offered, including routine eye exams and advanced surgical options, visit their website. There, you can also find informative resources that delve into eye health and preventive care.

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Stay informed and take charge of your vision health by checking out Shroff Eye Centre’s offerings today. Your eyes deserve the best care possible.