At Ajwani eye hospital Cataract surgery is being performed by the latest technique of Phacoemulsification (Microincision cataract surgery MICS with 1.8 mm incision using Stellaris MICS platform which allows the smallest possible incision
Ajwani Eye Hospital has 35 years’ experience in Cataract Surgery with over 1,10,000 satisfied patients.Detailed preoperative assessment, Advanced diagnostic equipment, State-of-the-Art operation theatre complex, renowned surgeons, and meticulous postoperative care makes AEH the best choice for Cataract Surgery
The lens inside your eye that has become cloudy is removed using high frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction and replaced with an artificial lens to restore clear vision.
An Intraocular Lens (IOL) is an optical lens implant (artificial lens) made from synthetic materials such as silicone, acrylic, or plastic. An IOL is used to replace the natural lens in your eye during cataract surgery. As with contact lenses, IOLs are available in different powers. The power of the IOL is chosen specifically for each eye based on measurements taken by your doctor before the surgery.
Your cataract surgeon can help you decide which intraocular lens is best for you, based on your daily activities and which type of vision, near or distance focus, is required to complete those activities. Other factors to consider include pre-existing conditions such as astigmatism, glaucoma, macular degeneration, corneal disease, or other conditions which will need a specific type of lens.
After the cataract surgery is done, you will need to rest in the recovery area until the effects of the sedation or anaesthesia wear off. This generally takes about 30 minutes to an hour. You can go home after you receive post-operative instructions from the surgery counsellor on how to care for your eyes at home.
Contact lenses alter the shape of the corneal surface and may affect the preoperative measurements of the cornea that is required to determine the type of lens to be used during the cataract surgery. Depending on the type of contact lenses you wear (soft, hard or RGP), you will need to stop wearing them one to four weeks prior to your cataract surgery. The corneal surface will not return to normal if you wear your contact lens until the day of cataract surgery, which can result in inaccurate corneal measurements and a disappointing postoperative vision outcome.
Yes, cataract surgery can be performed after LASIK or other refractive surgery which reshape the cornea to correct vision. However, the significant surgical alteration in the corneal shape would require additional calculations to determine the correct lens power for the lens implant used during the cataract surgery. Prior records of vision from exams immediately before and after the refractive surgery can help the cataract surgeon determine the best intraocular lens (IOL) power for optimal visual outcome after the cataract surgery.
Cataracts cannot be reversed without surgery. A part of the natural aging process, cataracts are caused by the gradual build-up of protein in the eye’s lens. Presently, no medications or eye drops exist that can dissolve or remove a cataract and surgery is the only viable treatment option, during which the cataract is removed and an artificial lens that completely restores the vision is implanted.
Fact – Currently, surgery is the only effective treatment for cataract.
Cataract is a clouding of the eye’s natural crystalline lens and is the most common cause of vision loss in older adults. Normally, light passes through the clear lens and is focused onto the retina at the back of the eye. With age, the lens gradually becomes more and more opaque and obstructs the passage of light, leading to a decrease in vision which affects day-to-day living and quality of life. Most patients notice symptoms of cataract after the age of 60, in one or both eyes. Some people, however, develop cataract in their 50s and even their 40s. Most cataracts develop slowly and your eyesight may not get affected in the initial stages. However, with time, the clouding of your lens will eventually interfere with your vision. When the cataract is the size of a pin head, the cloudiness affects only a small part of the lens. You may notice a slight change in your vision. As it grows larger, the cataract clouds more of your lens. This scatters and blocks the light as it passes through the lens, preventing a sharply defined image from reaching your retina. This may lead to more noticeable symptoms. While cataracts commonly develop in both eyes, one eye may be affected before the other. In other words, the cataract in one eye may be more advanced than the other, causing a difference in vision between eyes.
Other than aging, factors that increase your risk of cataracts include a previous eye injury or inflammation, a previous eye surgery, excessive exposure to sunlight (ultraviolet-B rays), medical conditions such as diabetes and high blood pressure, genetic abnormalities, skin diseases, smoking, ionizing radiation (treatment for cancer) and prolonged use of corticosteroid medications.
Symptoms of cataract include cloudy
or blurred vision, distorted or double vision, sensitivity to light and glare,
difficulty seeing in poor lighting conditions, difficulty in distinguishing changes in contrast,
and fading of colours.
People with cataract may feel as if they are living in a perpetual fog or looking through dirty
eyeglasses. Everyday
tasks such as driving, reading and recognizing faces is affected. If allowed to progress,
cataract can also lead to loss
of vision.
If you notice any unexpected changes in your vision, such as hazy, blurred or double vision,
experience minor loss of
night vision, faded colours, or sudden sensitivity to light and glare, see your doctor right
away. If you are above the
age of 60 and require brighter light for reading and other activities, see halos around lights,
or need frequent changes
in glasses or contact lenses, then you most probably have cataract. Even if you do not have any
visible changes in
vision, it is a good idea to have your eyes checked for cataract regularly if you are over the
age of 50.
It is not always possible to predict exactly how fast a cataract will develop as the rate of growth varies from person to person and may also vary between both eyes in a particular individual. There are many kinds of cataracts, and they can either develop very slowly or progress rapidly. Cataracts that are caused by the aging process most often progress gradually over a period of years. Cataracts that affect diabetics and young people, or cataracts that are caused due to certain injuries or use of certain medications may progress rapidly over a few months.
An adult cataract can be immature, mature, or hyper-mature.
Presently, there are no preventative treatments for cataract, as it is a part of the natural aging process, caused by the gradual denaturation of protein in the eye’s lens. 80% of normal people after the age of 50 develop cataract. Eye drops that could be an alternative treatment to cataract surgery in the near future are being developed by scientist. However, extensive trials are still required to establish whether they can be used safely and effectively.
Treatment is a simple surgery where the natural cataractous (opaque) lens is removed and replaced with a clear artificial intraocular lens (IOL). Since cataract usually, occurs due to age-related changes in the lens of the eye, it is necessary for everyone over the age of 50 to have their eyes checked for cataract regularly. If you choose to put off your cataract surgery, it would soon impact your everyday vision and overall quality of life. As it becomes severe, you could probably only distinguish between light and dark.
SICS-Small Incision cataract surgery – This is a cataract surgery wherein a 6-7 mm cut is made by the surgeon and the cataract is removed as a whole, preserving the capsule of the lens. The new rigid artificial intraocular lens is then inserted into the lens capsule through the same wound to replace the old lens. The wound is sealed and stitches are usually not required.
Phaco/Phacoemulsification – Phacoemulsification refers to modern cataract surgery via a small 2-3 mm cut, in which a handheld probe is used to break up and emulsify the lens into liquid using ultrasound energy. The resulting ‘emulsion’ is sucked out. After these steps, the artificial foldable intraocular lens is inserted inside the eye.
RIGID – PMMA
FOLDABLE – ACRYLIC/SILICONE
1. Monofocal Intraocular Lens – or standard IOLsare implantable lenses made of acrylic or silicone material and is a single lens used to restore vision for one area of focus, usually distance vision. You will still need to use reading glasses or bifocals for near tasks such as writing, reading, sewing, seeing mobile after surgery. Alternatively, the IOL can be set for intermediate or reading vision, but you will need to use glasses for distance vision.
2. Multifocal Intraocular Lens –provides enhanced vision for near and far – The center of the lens provides distance focus and the periphery provides near focus. This lens is helpful if you are constantly switching distances during the day and greatly reduces the need for wearing glasses or contact lenses after surgery doesn’t give good intermediate vision.
3. Trifocal IOL–Provides distance vision for watching TV and other far activities. Provides intermediate vision for working on computers/laptops. Provides near vision for reading, writing, seeing mobile.
Toric Intraocular Lens – are premium IOLs that can treat the cataract and also help correct or reduce the effect of pre-existing corneal astigmatism in astigmatic cataract patients. This lens is an excellent option for people with corneal astigmatism who wish to see clearly without the help of glasses. Your cataract surgeon can help you determine whether your type of astigmatism can be helped by a toric IOL.
Toric IOL can be monofocal , multifocal or trifocal.
1. Monofocal IOLs are implantable lenses made of acrylic or silicone materials and placed permanently in the eye after removal of the eye’s natural lens. Monofocal lenses have a single zone of clear focus, usually set for excellent distance vision, but require the use of reading glasses for near tasks, like reading
2. Toric IOLs are intraocular lenses that reduce the effect of pre-existing corneal astigmatism by reducing the residual refractive cylinder and improve the quality of uncorrected distance vision.
3. Multifocal IOLsincorporate both distance and near powered segments in one lens. The base power bends light coming from distant objects to a single focal point on the retina. The higher power segments bend light from near objects to the same focal point on the retina. Multifocal IOLs greatly reduce the likelihood of wearing glasses or contact lenses after surgery.
4. Trifocal IOLS(Panoptix lenses)These are a new form of IOL, which allow three ranges of clear vision & is designed to provide improved intermediate & near vision along with better distance vision. These lenses as they provide clear vision at three distances, reduce the dependance on glasses post cataract surgery.
5. EDOF (Extended depth of focus) IOLS Also the extended Range of vision lenses, is a new technology, that has recently emerged in the treatment of presbyopia - correcting IOLS. In contrast to multifocal intraocular lenses (IOLS) used in treatment of presbyopia, EDOF lenses work by creating a single elongated focal point to enhance "range of vision" or "depth of focus" & have shown to increase level of spectacle independance.
6. Scleral Fixated IOLs (SFIOL)Ideally, the lens is placed in the capsular cover (bag) of the lens using the support structure of the natural lens. However, there will always be instances where “in the bag” implantation isn’t possible, requiring that the IOL be sutured to the sclera with special permanent sutures. Trans-scleral suturing of Posterior Chamber IOL or Scleral Fixated Intraocular lens (SFIOL) is wellestablished and is a good option in patients with insufficient capsular support or zonular support, either as a primary or secondary implantation. The other options in these cases are Anterior Chamber IOLs and Iris Fixated IOLs. Each has its merits and demerits.
You cataract surgeon can help you decide which intraocular lens (IOL) is best for you based on your daily activities and which type of vision, near or distance focus, is required to complete those activities. Other factors to consider include pre-existing conditions such as astigmatism, glaucoma, macular degeneration, corneal disease, or other conditions which will need a specific type of lens.
Intraocular lens implants (IOLs) are made from materials such as acrylic or silicone, which are very durable and will last for the rest of your life. Unlike the eye’s natural lens, IOLs can neither grow cataract nor cloud up. In some cases, an IOL can dislocate (shift out of position inside the eye) as a result of trauma and result in blurred vision. In such an instance, you should contact the doctor immediately.
Depending on the type of contact lenses you wear, you will need to stop wearing them for two to four weeks prior to your cataract surgery. Since contact lenses alter the shape of the corneal surface, it may affect the preoperative measurements of the cornea that is required to determine the type of lens to be used during the cataract surgery. If you use soft lens, stop wearing them for at least one week before surgery. If you use rigid gas permeable (RGP) or hard contact lens, stop wearing them for at least 3 weeks before surgery. Failure to do so will not allow the corneal surface to return to normal. This could lead to inaccurate corneal measurements that could result in a disappointing postoperative vision outcome.
A week or two before your cataract surgery, you will undergo a pre-operative exam to ensure that you are physically healthy enough to have the surgery. Your surgeon will do tests to measure the size and shape of your eye in order to determine the type of artificial lens (intraocular lens) that will give you good visual outcome. If you have other conditions such as astigmatism or presbyopia which affects your vision, your surgeon may suggest a replacement lens that could treat both the cataract and your pre-existing condition.
1. You will be informed about your pre-operative laboratory examinations and cardiopulmonary clearance schedule. The pre-operative investigation includes some blood tests and examination by the physician to determine your fitness for surgery. It also includes specialized eye tests to find out the IOL which is most suitable for your eye. It takes between 1-3 hours for the entire testing.
2. If you wish to have the examination performed elsewhere, kindly bring all the reports with you on the day of your cardiopulmonary clearance with the physician.
3. If you are diabetic, please discuss with the physician about the medication you should take before surgery.
4. Please make arrangements for a responsible adult to be with you in the hospital on the day of the surgery.
It is important for you to follow all the pre-operative instructions given to you by your doctor. Your surgeon may advise you not to eat or drink anything (especially alcohol) for 12 hours before the surgery if planned for surgery under general anaesthesia. If you are on other medications, your doctor may ask you to stop taking them or alter the timing of the medications prior to the surgery. You may be instructed to use medication or eye drops before surgery to prevent infection. A good night’s rest is important before the day of the procedure.
On the day of the cataract surgery, dress for your appointment in loose, comfortable clothing. Do not wear any make-up as the area around the eye needs to be as clean as possible. Avoid wearing jewellery. Try to be on time or a little early for your appointment to prevent unnecessary stress prior to the surgery. This way, you can clear any last minute questions or doubts.
While the cataract surgery itself takes about 15-30 minutes depending on the type of cataract. You can expect to be at the hospital for approximately two to four hours, taking into account the preparation and post-operative observation (recovery period), as well as postoperative instructions.
Before the cataract surgery, you will be given eye drops to dilate your pupils and a mild sedative to help you relax. The surgery takes under an hour and you will be awake during the procedure. Anaesthetic (numbing) eye drops will be applied to your eye by your doctor so that you don’t feel any pain or discomfort.
1. The surgeon makes small cuts in the cornea (the transparent dome-shaped tissue that covers the front part of the eye) with a surgical blade or a laser to allow insertion of instruments into the eye.
2. A circular hole is then made in the lens capsule that encloses the eye’s natural lens.
3. A balanced salt solution is used to separate the cataractous (opaque) lens from the lens capsule.
4. The lens is then broken into smaller pieces with a laser or special ultrasound device and gently suctioned out.
5. A clear artificial intraocular lens (IOL) is then inserted into the lens capsule to restore vision.
6. Finally, normal pressure is restored in the eye and the incisionsare sealed. In most cases, stitches are not required to close the incisions as the eye heals quickly after surgery.
You will need to rest in a recovery area immediately after the surgery, until the effects of the sedation or anesthesia wear off. This usually takes about 30 minutes to an hour.After you receive instructions on how to care for your eyes at home, you can go home. Few hours after surgery, feeling will start to return to the eye. Your vision may be cloudy, blurry or distorted after the eye shield. It can take a couple of weeks for your vision to settle as the eye needs time to adjust to the removal of the cataract and adapt to the new intraocular lens implant (IOL) used to replace the eye’s natural lens. Since each person heals differently, recovery time can vary from 24 hours, to a few days, a couple of weeks or as long as a month to experience clear vision. It’s normal to experience dry eye or grittiness, watering, blurred or double vision and red or bloodshot eye after the cataract surgery. These symptoms usually subside as the eye heals, but it can take 4 to 6 weeks to recover fully.
While any kind of surgery entails a certain amount of risk, cataract surgery is highly successful and generally considered as one of the safest surgeries you can have. Most complications are minor, such as swelling of the cornea or retina, increased pressure in the eye, and droopy eyelid. In general, the risk of severe visual loss is very rare, but may occur as a result of infection or bleeding inside the eye, or even retinal detachment, which may occur months or years after a perfectly successful cataract surgery. Underlying eye damage from other eye diseases such as glaucoma, diabetic retinopathy, or macular degeneration or pre existing co morbid conditions of the eye can increase your risk of complications and reduce the chance of improved vision after surgery.
1. You may have to wear a protective pad or protective glasses provided at hospital over your eye when you leave the hospital to protect your eye from bright light and glare.
2. It is not safe for you to drive, so make arrangements to have someone else drive you home.
3. You can resume light activities such as reading and watching television one day after the surgery
4. Avoid washing your face and hair for 1 week after the surgery. A wet tissue or towel can be used.
5. There is no diet restriction after cataract surgery.
6. Medication for other conditions like Diabetes, Hypertension etc. if any, can be continued
Your follow up visits will be scheduled for 12 hours after the cataract surgery, one week after the surgery and one month after the surgery.