All About Cataract - Symptoms, Causes, Diagnosis, Treatment, Surgery, Intra-Ocular Lenses (IOLs)
What is Cataract?
Our eyes have a natural lens which lies behind the Iris and the Pupil. Cataract is the clouding of this natural lens of our eye which causes poor vision. Most cataracts develop slowly and have little effect on vision in the initial stages but over time as cataract builds up it can lead to severe degradation of vision. Cataract can affect one or both eyes and may develop more in one eye compared to the other.
What are the symptoms of Cataract?
The most common symptoms of a cataract are:
Cloudy or blurry vision
Colors seem faded
Experiencing Glare - headlights, lamps, or sunlight may appear too bright
Seeing a halo around lights
Poor night vision
Double vision or multiple images in one eye
Frequent prescription changes in your eyeglasses or contact lenses
How is Cataract diagnosed?
Visual Acuity Test - Your vision is tested using an AutoRefractometer and Vision Chart. Poor vision which does not correct with glasses is often an indicator of cataract.
Slit Lamp Exam - Your eye doctor would examine your eyes on a slit lamp (kind of a microscope for eyes which allows ophthalmologists to look into the eye under magnification) to see if your natural lens shows signs of cataract.
Retinal exam - Your eye specialist may choose to dilate your eyes to examine your Retina also to ensure that Retina is healthy. This is important because If the Retina has some problem then even after cataract surgery the vision may not improve to the fullest.
What causes Cataract?
Most cataracts are age related and affect people over 40. Natural lens in our eye is mostly made of water and protein. As we age, protein in the lens can clump together clouding the lens which reduces the light that passes through and reaches the retina thus causing poor vision. Cataracts can develop for reasons other than age as well and can affect younger people also. Besides natural ageing, risk factors for cataract include
Hypertension / High Blood Pressure
Excessive exposure to ultraviolet radiation from Sun
Excessive alcohol consumption
Eye surgery for other eye problems
Eye injury - Cataracts due to eye injury can sometimes develop years later
Prolonged use of corticosteroid medications
Exposure to radiation from other sources such as X-rays and cancer treatments
Cataract may be present at the time of birth as well (called Congenital cataract). Not all congenital cataracts are visually significant, however, visually significant congenital cataracts must be removed urgently.
Are there different types of Cataract?
Cataracts are classified in several categories and sub-categories primarily based on the part of the lens where opacities develop. Some of the most common types of cataracts are
Nuclear sclerotic cataracts occur in the lens nucleus (central portion of the lens). Nuclear cataracts are usually age related and develop slowly over years.
Cortical cataracts occur in the lens cortex, which is the part of the lens that surrounds the nucleus. In cortical cataracts wedge shaped opacities start in the cortex and grow towards the nucleus resulting in spoke-like opacity from center to periphery.
Posterior sub-capsular cataracts occur at the back of the lens. Typically, these types of cataracts tend to progress faster than other types do.
How is Cataract treated?
In the early stages of cataract, vision may be improved by a change in glasses prescription. However, as the cataract increases, surgery to remove cataract is the only effective treatment. Generally, there is no urgency to remove a cataract. One should consider removal of cataract if the cataract changes vision so much that it interferes with one’s daily life such as driving, reading, watching TV etc. You should take your time to decide whether to undergo cataract surgery or not and when to undergo cataract surgery – talk to your doctor and weigh the pros and cons.
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What is Cataract Surgery and how will it affect my vision?
Cataract surgery is a procedure in which the cloudy natural lens is replaced with an artificial one, known as an intraocular lens (IOL). The new lens not only restores clear vision, it also corrects any pre-existing short sight or long sight, thereby minimizing dependency on spectacles after surgery, however, most people still need to wear glasses or contact lens after cataract surgery for either near and/or distance vision and astigmatism. Cataract surgery does not correct other causes of decreased vision, such as glaucoma, diabetes, or age-related macular degeneration.
Cataract surgery has come a long way and most cataract surgeries these days are what are called MICS (Micro Incision Cataract Surgery) using the Phacoemulsification technology wherein a very small incision is made, ultrasound is used to soften the cloudy lens for removal and a foldable intraocular lens (IOL) is inserted. Benefits of MICS is that unlike in a large incision conventional surgery, the micro incision is self-sealing and hence generally no stitches are needed (which is why these surgeries are also referred to as ‘stitch-less’).
Cataract surgery is a day-care procedure, meaning you don’t need to stay at the hospital or eye centre after the surgery. Cataract surgery is generally performed under local or topical anaesthesia so you are awake during the procedure.
What are the steps in a Cataract Surgery?
Step 1 - Incisions in the eye
Cataract surgeon creates two micro incisions on the eye of approx. 2.2mm and a circular opening on the anterior capsule of the natural lens.
Step 2 - Removal of cloudy natural lens
The cataractous natural lens is removed through a special ultrasonic technique called Phacoemulsification. A special advanced equipment is required for this.
Step 3 -Implantation of Intra-Ocular Lens (IOL)
The new Intra-Ocular Lens (IOL) is inserted into the eye. The type of IOL inserted determines the quality of vision after the surgery
What is FLACS (Femto-Laser-Assisted Cataract Surgery)?
FLACS (Femto-Laser-Assisted Cataract Surgery) is a new advancement in cataract surgery. In FLACS, first step of MICS is accomplished by a femto laser. For this reason these surgeries are also referred to as ‘blade-less’.
What types of Intraocular Lenses (IOLs) are available?
Multiple types of intraocular lenses (IOLs) are available and each has their pros and cons. Discuss with your doctor which IOL is best suited for you.
Monofocal IOLs are the most commonly used IOLs and provide distance vision.
EDOF (Extended Depth of Focus) IOLs are a new type of lenses which offer some benefits over monofocal IOLs in that they improve intermediate range vision
Multifocal IOLs (historically called so but are actually bifocal IOLs) provide for distance and near vision but not intermediate range vision.
Trifocal IOLs are the most advanced IOLs that provide for full range of vision (distance, intermediate, and near)
Toric IOLs correct astigmatism
Accommodative IOLs move or change shape inside your eye, allowing focusing at different distances. These are not preferred much.
What are the major risks of Cataract Surgery?
As with any surgical procedure, cataract surgery has its risks. With modern technology, this procedure is generally safe and produces good results, however, there is a possibility of unsuccessful results and complications, from both known and unknown causes.
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Have more questions about Cataract Surgery? Schedule a consultation with Dr Aditi Agarwal - one of the best Cataract Surgeon in Gurgaon
Additional resources on Cataract
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