What is cataract?

The term cataract comes from the Greek word catarrhaktes (running down; waterfall) because a cataract was previously thought to be a coagulated fluid from the brain that had flowed in front of the lens.

Our eye is like a camera. The lens focuses light rays that pass through the pupil onto the retina, or the back of the eye. The different parts of the retina collect this light and send a massage to our brain so that we can see.

For perfect vision, the lens must be transparent, so that light can pass through it and reach the retina. When the lens becomes cloudy or opaque, light cannot pass through it and vision becomes dark or blurry. A cloudy lens is called waterfall.

Symptoms:

• Sensitive to sunlight (photophobia).
• Cloudy, fuzzy, hazy, or blurry vision.
• Difficulty seeing at night or in low light.
• Monocular diplopia.
• Trouble seeing shapes against a background or the difference between shades of colors.
• See rainbow halos around the lights.

Causes and risk factor of Cataract:

• With age.
• Diabetes.
• Glaucoma.
• Inflammation of the eyes (Uveitis).
• Family history of cataract.
• eye injury
• Infection.
• Congenital or by birth.
• Exposure to ultraviolet light (sunlight).
• Long-term use of corticosteroids (taken orally for skin or any other systemic illness).
• Exposure to radiation (X-ray technicians, airline pilots have a higher risk of developing cataracts than non-pilots and that the cause may be exposure to cosmic radiation).
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• Surgery for another eye problem.
• Long-term use of antiglaucoma eye drops such as pilocarpine.

Classification of cataracts according to the moment of appearance:

(A) Congenital and developmental cataracts (less than 1% of all cataracts):

These occur due to some disturbance in the normal growth of the lens. When the alteration occurs before birth, the child is born with a congenital cataract. Developmental cataract can occur from infancy to adolescence. There are many congenital cataracts. They are hereditary or acquired through the placenta.

1. Hereditary Congenital Cataracts: Familial forms of congenital cataracts can be autosomal dominant, autosomal recessive, sporadic, or X-linked.

2. Cataract due to transplacental infection in the first trimester of pregnancy:

The incidence of congenital cataract is due to viral infection contracted by the mother during the first trimester of pregnancy.

• Rubella.
• Mumps.
• hepatitis.
• Toxoplasmosis.

The most common cause of congenital cataract is a rubella infection contracted by the mother, which also produces other developmental abnormalities such as hearing loss. This infection occurred during the fifth to eighth week of pregnancy, the phase in which the lens develops. Because the protective lens capsule has not yet formed at this time, viruses can invade and cloud the lens tissue.

(B) Acquired Cataract (greater than 99% of all cataracts):

1. Senile cataract (over 90% of all cataracts)-This type of cataract occurs with age.
2. Traumatic cataract.
3. Cataract with systemic disease such as diabetes or any other systemic disease.
4. Secondary and complicated cataracts due to night blindness (Retinitis Pigmentosa), inflammation in the eye (Uveitis).
5. Toxic Cataracts: Corticosteroids (taken orally for skin or any other systemic disease).
6. Postoperative cataracts due to any intraocular surgery such as vitrectomy and retinal surgery.

Treatment: In the early stage of the cataract, following things can help temporarily.

• Better glasses (frequent changes show power).
• Better lighting.
• Magnifiers.
• Sunglasses.

If vision worsens with glasses, cataract surgery may be necessary.

Is there any medication to remove cataracts?

There is no medication to remove the cataract, the only option is cataract surgery to achieve a good visual result.

If I do not have cataract surgery, what complications can occur?

A cataract that progresses to an advanced stage (called a hypermature cataract) may begin to leak into other parts of the eye. This can cause severe pain called Secondary Glaucoma. If these kinds of things happen, vision may also not improve after cataract surgery.

When should I have cataract surgery?

When you are diagnosed with a cataract, consider how your vision affects your quality of life and your ability to do the things you normally do. Unless a cataract interferes with working, driving, computer work, reading, or daily work, there is no urgent need to remove it. There’s nothing wrong with waiting if you keep regular appointments with your ophthalmologist to assess how your cataract is progressing.

Will the operation be successful?

Cataract surgery is now performed as a microsurgical technique under an operating microscope. Modern techniques, microsurgical instruments, and specially trained surgeons have made it possible to successfully perform cataract surgery without serious complications in 98% of all patients.

Therefore, it is important that the patient undergo a complete preoperative ophthalmologic examination to exclude any ocular disorder, in addition to the cataract, that may worsen visual acuity and compromise the success of the cataract operation. Such disorders include uncontrolled glaucoma, uveitis, macular degeneration, retinal detachment, optic nerve atrophy, and amblyopia (lazy eye).

How long does it take to perform a cataract operation?

The procedure only takes 15-20 minutes.

Length of hospitalization:

Now it is not necessary to stay in the hospital for a day, after surgery you can go home immediately. Even the medical insurance company also recommended this as a day care procedure.

Is it a painful surgery?

You will not feel any pain because cataract surgery is performed under anesthesia. There are two types of anesthesia, one is local anesthesia and the second is general anesthesia. Today, most cataract surgery is performed under local anesthesia.

Local anesthesia: (Retrobulbar Injection, Peribulbar Injection or Topical Anesthesia): Here a small injection is given in the lower part of the eye which is called retrobulbar or peribulbar.

Now daily topical anesthesia is very popular, because the cataract surgery procedure takes only 15-20 minutes. Therefore, long-term anesthesia is not required for that. Here, before surgery, only one drop needs to be instilled into the eye, which is sufficient for cataract surgery. This type of anesthesia is recommended for patients who are highly intelligent and not nervous.

General anesthesia: This is recommended for extremely nervous, deaf or mentally retarded patients or children. It is also indicated for patients with Parkinson’s disease or rheumatism, who cannot sit still without pain.

Surgical techniques to remove cataracts:

Various techniques are used to remove cataracts. The last technique is phacoemulsification. In this method, a tiny instrument is inserted through a very small incision. The instrument uses ultrasonic vibration to break the cataract into fine pieces, which are gently suctioned out. An intraocular lens (IOL) is then inserted into the eye. Stitches are not required to close the incision.

Is it necessary to implant IOL during surgery?

In 95-98% of all cataract extractions, an intraocular lens (IOL) is implanted instead of the natural lens (posterior chamber lens). An eye with an artificial lens is called pseudophakia. If the surgery is performed without an intraocular lens, you must wear +10D glasses to see clearly. Without a show you can’t do day-to-day activities and the second thing is the great weight of the show, which is very disgusting. So during IOL surgery it is necessary.

Types of intraocular lenses:

Monofocal IOLs: This type of lens can be implanted both far and near. Here the patient can select whether she wants clear distance vision or clear near vision without glasses. If someone has a lot of close-up work and wants to do close-up work without a spectacle then it is possible in this type of lens. But most people want clear distance vision without glasses, the surgeon also wants the same.

Multifocal IOLs: These allow you to see far and near clearly. So Show is not required. But one disadvantage of this type of lens is the problem of glare. Many perfectionist people should not opt ​​for this type of lens. This type of lens is ideal for housewives who have less visual demand.

Can I get 20/20 or 6/6 vision without glasses after cataract surgery?

Preoperative control can give an idea of ​​20/20 or 6/6. It depends on various conditions such as:

• Corneal curvature of the eye (horizontal and vertical), if both meridians differ by more than 0.75 D in keratometry, then after surgery glasses are required (Today Alcon toric IOL is available for this solution, but it is very expensive).
• If the length of the eyeball (axial length) is very high or very short, then glasses are needed after surgery. The length of the eyeball is measured with an A-Scan machine. The normal length of the eyeball is 23-24 mm.
• Shape of the image on the retina. For a good visual result, the retina must be healthy and free of diseases such as diabetic retinopathy, age-related macular degeneration or any other retinal disease.
• If the previous cataract vision was good, after surgery it is also possible to obtain the same vision.
• The 90% visual outcome depends on proper calculation of IOL power. Calculation of IOL power should be performed by an expert technician, optometrist, or physician.
• The last important thing is that the surgeon must be skilled and qualified.

After cataract surgery, can I develop cataracts again?

No, there is no chance of developing cataracts once the surgery is done. But the posterior lens capsule where the implanted lens thickens over time is called posterior capsular opacification (PCO) or secondary cataract. Once PCO develops, you should opt for the YAG (yttrium-aluminum-garnet) laser. This is a maximum two minute opd procedure. With a laser beam, the thickened capsule is cut. Therefore, it is a painless procedure.

Prevention:

• The best prevention is to control diseases that increase the risk of cataract.
• Wearing sunglasses when outdoors during the day can reduce the amount of ultraviolet (UV) light your eyes are exposed to. Some sunglasses don’t filter out harmful UV rays. An optician should be able to tell you which sunglasses filter out the most UV rays.
• For patients who smoke cigarettes, quitting will decrease the risk of cataracts.
• Eat green leafy vegetables.
• Some studies suggest that people with diabetes are at risk of developing cataracts. So check your blood sugar.
• You should not take oral steroids for a long time for any systemic disease.
• Some eye care professionals believe that eating too much salt can increase the risk of cataracts.