A cataract is a natural process of aging in the lens of the eye. After cataract surgery, one can potentially see a lot better. The normal lens is a transparent structure inside the eye, which permits light to enter unobstructed, thus providing clear vision.
Just like natural hair goes grey and then eventually white, your natural lens is transparent, and with increasing age develops clumps of proteins and water within it. This causes gradual painless translucent clumps (Immature cataracts) causing hazy vision, which eventually become opaque clumps in the lens (Mature cataracts) causing extremely poor vision.
Importance of Cataract Surgery
Your eyes are one of your most important sense organs, and so it goes without saying that you need to take utmost care of them. Cataract produces blurred vision, which interferes with your daily activities like driving/ reading etc. Once the visual symptoms have begun bothering you, it is an appropriate time to get the surgery done.
Cataract surgery in the present day is highly advanced, with high-precision lasers and lenses giving excellent results in a short and simplified daycare procedure.
Dr Kareeshma Wadia is a fellowship-trained Cataract, Cornea, and Refractive Surgeon. She specializes in techniques to help remove your dependency on glasses after cataract surgery. She does advanced lasers as a part of Cataract surgery, to enable delivering high precision outcomes.
PHOTO OF DR KAREESHMA DOING SURGERY
What are Cataracts?
Cataract is the natural aging process of the lens, where the initially clear and transparent lens of the eye, becomes translucent and eventually opaque. This structure then becomes a mechanical obstruction in the eye, causing fluctuating spectacle numbers and then progressively blurred vision, which ultimately worsens if left untreated.
Just like greying of the hair is a natural and slow process that can begin in different people at different ages. Similarly, cataracts can develop at any age, but most commonly occur above 45-50 years. However, they affect each individual differently too. Some people may be affected very early if the lens changes are more in the center of the lens, versus some people where changes progress in the periphery of the lens and so their vision is spared till much later.
Causes and risk factors of cataract
There are many causes of cataracts.
- The most common type is called Senile Cataract- which is age-related and seen due to the natural aging process in the lens. As you age, your lens fibers also age, and just like the wrinkles on your face gradually increase, so also the lens changes (cataracts) will gradually increase. There is nothing to fear in this. It is a natural process with effective treatment available.
- Diabetic Cataract- is commonly seen in Diabetic patients, where the metabolic function of the lens is affected earlier in life because of Diabetes, causing water accumulation in the lens, which ultimately causes blurred vision.
- Traumatic Cataract- commonly seen in blunt trauma or injury to the eye.
- Congenital Cataract- when the child is born with a cataract- may be due to the transfer of maternal infections or some metabolic conditions in the child.
- Infantile Cataract- when the child is born with normal eyes but develops a cataract in infancy.
Risk factors for cataracts include age, excessive sunlight exposure, chronic smoking, diabetes, and chronic steroid use in certain conditions eg uncontrolled asthma.
Symptoms and Effects of Cataracts on Vision
A cataract is usually a gradual, painless loss of vision. Initially, symptoms may be as subtle as finding lights too bright/ difficulty in night driving. This may go on to produce difficulty in reading/ lack of clarity in fonts and may progress to inability to recognize faces at a distance.
Each individual may have different symptoms. Very often, elderly people who are home-bound never realize they have cataracts, because it may have affected distance vision but they are only used to near work/ mobile use in the comfort of their houses. Just like conditions such as Diabetes/ Blood pressure can be diagnosed only when you go for a check-up, similarly, you may have good vision and yet be developing a cataract inside the eye. This is why it is important that you get your eyes checked regularly by an Eye Specialist. In India, it is a very common practice to go get numbers checked up from the Optical Stores. Here only a glasses number can be checked and given, but any underlying eye problem may be missed since the internal eye has not been checked at all.
Benefits of Cataract surgery
- Quick (approximately 20-30mins total in-to-out time)
- No Injection in most cases
- Easy recovery
How does laser cataract surgery work?
Have you ever seen a road under construction? The concrete driller drills holes and breaks it into multiple smaller pieces.
In the eye, the cataract, which is hardened lens material, is broken into smaller pieces with a similar mechanism, except it is HIGHLY PRECISION BASED. The PHACOEMULSIFICATION is actually an ULTRASOUND machine commonly referred to as laser cataract removal. This machine allows ultrasound energy to break the lens with an instrument tip as fine as a ball pen point, from which the energy breaks the cataract into smaller pieces, and has a simultaneous vacuum-cleaner-like mechanism, allowing the broken fragments to be emulsified and sucked out from the eye, while being simultaneously flushed with fluids to maintain the internal structure of the eye.
Once this is done, a new artificial lens of the power of that particular individual’s eye is placed into it. If a lens is not placed, then the vision of the person will remain extremely hazy. The lens is placed into its appropriate position and that concludes the surgery. Since most surgeries do not even involve any sutures/stitches, the recovery is smooth and quick.
Dr. Kareeshma performing Phacoemulsification Cataract Surgery
Now, in traditional phacoemulsification, the entry into the eye and opening of the covering of the lens is done manually by the surgeon. When even these steps are laser-assisted, it is also referred to as “All- laser “ Cataract surgery. Here, only the initial few steps are assisted with a femtosecond laser (cuts and openings). The ultimate breakdown/emulsification of the lens is done by the same procedure as explained previously.
Safety and efficacy of laser cataract surgery
Since all the equipment and technology used in cataract surgery are highly precise, the outcomes also are very accurate. The incisions (cuts/openings) are as small as 2.2-2.8mm. These small incisions are self-sealing and do not usually require any stitches either. This is why the recovery is so smooth and quick.
Preparing for Laser Cataract Surgery
- Initial consultation with Dr Kareeshma Wadia- she discusses your visual complaints and other issues you have in the eye.
- Comprehensive Eye examination- involves checking vision with spectacles, and eye pressure, followed by a dilated evaluation of the lens and retina- basically checking all structures from outside to inside of the eye.
- Scanning and Measurements- this is the most important part of the evaluation- where scans are done to see if the front (cornea) and back of the eye (retina) are in perfect health, and then actually measure the eye, to calculate the power of the lens that needs to be placed into the eye after the cataract is removed.
- Discussion of surgical options and lens choices
Remember- there is no “one-size-fits-all”. There are certain conditions where laser cataract surgery should be avoided and alternative procedures like Small Incision Cataract Surgery (SICS) may be preferred. Eg very hard/ Mature cataracts, or conditions where the cornea is weakly called Fuchs’ Dystrophy.
Let your surgeon examine and decide what’s best for your body.
The biggest dilemma for patients is what lens to choose to put in their eyes.
At Jehan Eye Clinic, once your scans and evaluation are complete, Dr Kareeshma will be able to help you narrow down to a few choices based on your eye health and your visual needs. Once you have a clear idea of the pros and cons of each lens, then you can make an informed decision with her help.
Not everyone can choose whatever lens they want, the eye needs to be suitable for that lens. And we can find that out only with the help of your scanning tests.
Pre-operative instructions for patients.
Based on your systemic conditions eg Blood pressure, thyroid, Diabetes, etc, Dr. Kareeshma will be able to decide what medications you need to start/withhold before your surgery.
You need to inform your surgeon regarding any/ all other medications you are on, any allergies to medications, etc