Everything You Need To Know About Cataract

What is Cataract Surgery?

Cataract surgery, also known as lens replacement surgery, is a method of removing the clouded natural lens of the eye and replacing it with an artificial lens (also known as an intraocular lens). It is performed when the natural eye lens becomes opaque and causes vision loss.

During the procedure, the ophthalmologist will remove the cataract by emulsification or by cutting the lens out. It is generally performed in local or topical anesthesia and causes little to no discomfort in the eye. Cataract surgery is performed on an outpatient basis and doesn’t require hospitalization.

Thanks to technological advancements, nowadays, cataract surgery can be done in a minimally invasive manner with more than a 90% success rate. If you are suffering from a cataract, make sure that you visit an experienced cataract surgeon and get proper treatment on time to prevent permanent vision loss.

How do cataracts form?

A cataract forms over the eye lens, which is responsible for focusing the light that enters the eye. The lens is present behind the colored part of the eye, i.e., the iris. It produces a clear and sharp image on the retina. Due to reasons like aging, trauma, radiation exposure, etc., the mechanism of the lens may get disturbed. It will lead to the accumulation of clumps of protein that is present in the lens. As the protein starts depositing, it forms a cloudy layer over the lens, which halts the transmission of light to the retina.

The cloudiness of the lens is called a cataract which continues to develop over time, making the lens denser, thicker, and less transparent. As a result, the vision declines and becomes blurry over the years.

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Types of Cataracts

• Nuclear Cataract
• Cortical Cataract
• Posterior Sub capsular  Cataract

Cataract Causes & Symptoms

Causes

Aging
Eye trauma or injury
Radiation exposure
Genetics
Smoking and alcohol abuse
Vitamin C deficiency
Medical problems like diabetes
Birth defects
Excessive use of certain medications, such as corticosteroids

Symptoms

Blurred, clouded, or dim vision
Inability to see at night
Sensitivity to light and glare
Difficulty in reading
Halos around lights
Frequent changes in eye power
Fading colors or yellowish vision
Double vision

Cataract Diagnosis

Tests

• Visual Acuity & Refraction Test

Both these tests are done to examine the sharpness or clarity of your vision. One eye is tested at a time to look for signs of impairment.

• Slit-lamp Examination 

In this exam, a microscope is used to emit an intense line of light (slit) that illuminates the cornea, iris, lens, and the space in between. It allows the eye doctor to see the structures of the eye under magnification and detect abnormalities, including early-stage cataracts.

• Retinal Examination 

To perform a retinal exam, the eye doctor will firstly dilate your pupils and examine the back of the retina. This helps the doctor to identify whether the light rays are able to reach the retina or not. Generally, an ophthalmoscope is used to detect eye problems like cataracts at the early stage.

Self Diagnosis

To diagnose a cataract yourself, you can try using various self-tests available on the web. These tests take only a few minutes and you’ll be able to confirm whether you have a cataract eye or not.

Besides that, you can also experience your eye lens becoming opaque and the vision declining over time. If you are aware of the symptoms of cataracts, this will also help to recognize that cataracts may be developing in one or both eyes.

Diagnosis by Doctor

If you suspect that you have a cataract, you should see an ophthalmologist. He/she will perform a comprehensive eye exam and suggest some tests.

At first, the doctor will perform a physical exam by dilating your pupil to see the internal components of the eye. If cataracts have advanced to the chronic stage, the doctor will be able to see them clearly during the physical exam. If not, then diagnostic tests will be recommended that includes:

Visual acuity and refraction test
Retinal Examination
Slit-lamp examination
Applanation tonometry, if needed

Cataract Severity

Cataracts usually progress gradually and take years to mature. Over time, the cataract will cover more area of your natural lens as it becomes severe. The severity of cataracts are:

• Early Cataracts- It is the beginning stage of cataracts at which the lens is almost clear but the ability of the lens to change focus is compromised. Due to this, symptoms like blurry vision, glare from lights, and increasing eye strain will start to appear.
• Immature Cataracts- At this stage, the protein starts to accumulate on the lens, making it cloudy and slightly opaque. Along with vision problems, other symptoms like light sensitivity will also appear. You may need eyeglasses or anti-glare lenses to see nearby.
• Mature Cataracts- In this stage, the cataract starts to mature, and the opacity of the lens further decreases. The lens will appear milky white or amber in color and the vision will also be considerably affected.
• Hypermature Cataracts- It is the most serious stage of cataracts at which the damage to the lens is significant. If not removed at the right time, a hyper mature cataract may cause inflammation in the eye or increase the eye pressure that can cause glaucoma.

Cataract Risks & Complications

During the Surgery

Though risks and complications are rare during cataract surgery, the cataract surgeon still looks out for risks like:

Inflammation can occur in the eyes as the cornea or sclera is cut to perform the surgery
Infection
Bleeding
Drooping eyelid
Dislocation of the artificial lens
Glaucoma
Secondary cataract
Loss of vision

If Left Untreated

The effects of cataracts are determined by how fast it is advancing. In the beginning, cataracts will negatively impact your daily life as you won’t be able to read, work, drive, or follow any of your hobbies due to reduced vision.

Eventually, if cataracts are left untreated, they will cause total blindness that will be irreversible.

After the Surgery

Normally, once the eye lens is replaced, there are usually no complications. Still, in rare cases, cataract surgery may fail to improve your vision. It usually happens when other underlying conditions are present, such as glaucoma or macular degeneration and they are the primary cause for eye damage.

Cataract Prevention

Various studies have been done to find out if it is possible to prevent cataracts from developing or even slow their progression. Through these studies, the following things are found to be helpful in preventing cataracts to some extent:

• Have regular eye examinations as they will allow you to detect cataracts as well as other eye problems at the earliest stage possible.
• Quit smoking as soon as possible. Take medications, counseling, or use other strategies while you are trying to quit.
• Manage other health conditions you have that can increase your risk of developing cataracts, especially diabetes.
• Eat a healthy diet that consists of plenty of fruits and vegetables with antioxidants and is rich in fiber, vitamins, and minerals.
• Wear sunglasses and avoid ultraviolet light exposure as much as possible as it can increase the risk of cataracts.
• Avoid drinking alcohol as it can also increase the risk of cataracts.

Recovery Tips after Surgery

For a safe, quick, and smoother recovery after cataract surgery, you can follow the tips below:

• Avoid driving for the first few days until cleared by the eye doctor.
• Try to avoid situations where you might have to sneeze, cough, or vomit.
• Avoid swimming, using a hot tub, or taking a shower bath for the first week.
• Don’t go out in direct sunlight or expose them to dust, grime, or wind for at least a week.
• Do not use makeup, creams, lotions, perfumes, shampoo, conditioner, or any other cosmetic product as they can irritate the eye.
• Though you are allowed to watch digital screens, try to keep it minimal as your eyes will strain after spending long hours on the screen.

Cataract Treatment Options & Cost

When to consider cataract surgery?

There are no medical or non-surgical treatments available for cataracts. The only effective treatment method is undergoing cataract surgery which involves removal of the natural lens and implanting an artificial lens in the eye.

Thus, you should consider undergoing cataract surgery as soon as possible. Normally, it is up to you to decide when to have the surgery. In most cases, there is no hurry to remove cataracts until they start affecting your daily life. However, if you have conditions like diabetes, high blood pressure, or obesity, there are chances that your cataract will progress faster.

You should know that even if you delay cataract treatment, it won’t affect how your vision improves after the surgery. Therefore, you can take time to consider the benefits and risks of the procedure and get diagnosed frequently to see how the cataract is progressing. Then the doctor will recommend when you should undergo surgery.

Types of Surgery

Cataract surgery can be performed through various techniques, such as:

Phacoemulsification
An ultrasound probe will be used to break up the lens for removal. This removal of the lens is done through phacoemulsification which involves making tiny incisions in front of the cornea.

Then the probe is inserted into the lens where the cataract has formed. The probe emits ultrasound waves to emulsify the cataract and suction out the fragments without harming other components. The backside of the lens is preserved to place the artificial lens there. After that, stitches may be used to close the cornea.

Microincision Cataract Surgery (MICS)
It is an advanced technique that involves the removal of the entire lens. In this technique, a self-sealing scleral tunnel wound is created to carry out the procedure. The size of the incision made in this type of cataract surgery is very small and the surgery is carried out with higher precision.

Extracapsular Cataract Extraction (ECCE)
It is a conventional type of cataract surgery that involves the removal of most parts of the lens except for the elastic lens capsule, also known as a posterior capsule. It is left in place so that the artificial lens can be implanted there. An incision of 10-12 mm is made in the cornea or sclera through which the procedure is carried out.

Intracapsular Cataract Extraction (ICCE)
In ICCE, the lens and lens capsule is removed completely by making a large incision. After lens removal, the artificial plastic lens is placed either in the anterior chamber or sutured in the sulcus. This type of surgery has many risks due to the large size of the incision. That is why it is rarely performed in countries where microscopes and other technologies are readily available.

Femtosecond Laser-assisted Cataract Surgery (FLACS)
It is another modern technique to perform cataract surgery where the laser is used to make an incision as well as to remove the clouded lens. It is one of the safest and most effective techniques to treat cataracts.

Types of IOLs (Intraocular Lens)

One of the biggest decisions that a cataract patient has to make is choosing the right intraocular lens (IOLs). There are two primary types of lenses, i.e., anterior chamber lenses and posterior chamber lenses. The anterior chamber lenses (ACIOL) are placed on top of the iris whereas posterior chamber lenses (PCIOL) are placed over the residual posterior capsule which is the original position of the lens. As compared to the ACIOLs, PCIOLs are a preferable choice as long as the posterior capsule is intact.

The various types of PCIOLs that are available in the market are:

Monofocal lenses are the type of lens that allows the patient to see clearly at a certain distance, either near or far.
Multifocal lenses are the ones that can correct both nearby and farby vision at the same time.
Trifocal lenses, also known as EDOF (Extended Depth of focus) are the type of lenses that provide clear vision at all nearby, farby, and all the intermediate distances in between.
Toric lenses are a special type of lens that corrects the spherical as well as cylindrical power of the eye at all distances.
The surgeon will discuss the specifications of these lenses and help you choose the right type of IOL for the surgery. You should also know that the cost of IOLs is not covered under health insurance policies. And the price of all these lenses varies significantly which will further increase the overall cost of cataract treatment.

Surgery Preparation

The preparation for cataract surgery starts with your first consultation with the doctor. During the appointment, the eye doctor will perform the necessary tests and determine which lens implant will be the best to use during the surgery.

• The complete plan will be laid out for the day of surgery and the doctor will suggest that you ask someone to drive you home after the surgery.
• On the night before surgery, you will have to take some eye drops or medications. You should also abstain from drinking alcohol the night before the surgery. If you have a habit of smoking, the doctor will also ask you to quit at least one month before to ensure that smoking doesn’t increase the risks during and after the surgery.
• Besides all this, you should also avoid eating and drinking past midnight (unless advised by your doctor). Also, try to get proper rest and do not worry about the procedure.

What to expect during the surgery?

On the day of surgery, wear comfortable clothes and do not wear makeup, cosmetics, perfume, etc. Make sure that you arrive 30 minutes early at the hospital or clinic. Ask any questions or doubts that you have before the surgery while the surgeon prepares everything. If necessary, the surgeon will also give you a sedative to help you relax while you will stay awake during the procedure.

The surgeon will take you to the OT (operation theater) and the surgery will begin. You can expect the following things during the surgery:

An incision is made in the eye through which the damaged or clouded lens is removed.
Once the natural lens is extracted, the surgeon will place the artificial intraocular lens inside the eye.
If necessary, incisions may be used to close the cornea.
The same procedure can be done using different techniques. This technique is decided after a thorough diagnosis of the eye and the test results.

After the Surgery

Immediately after the cataract surgery, you won’t have any sensation for a couple of hours in the eye. The surgeon will place an eye patch over the treated eye for protection against dust, dirt, wind, sunlight, and other particles that can irritate the eye.
When you remove the protective shield, your vision may be blurry at first. The eye will take some time to heal and adjust with the lens. The colors may seem brighter after the surgery as you will be looking through a new, clear artificial lens.
For the first few days, you may also experience itching or mild discomfort in the eye. As long as these after-effects of surgery are present, avoid rubbing or pushing your eye at all costs.
The doctor will ask you to come back for follow-up after one or two of the surgery, the following week, and then after a month to ensure that the lens has adjusted well and your eye has healed completely.
The doctor will also prescribe some eye drops and other medications to prevent eye infection, control eye pressure, or reduce inflammation. The complete healing usually takes around 8 weeks during which you have to be very careful with your eyes.
*In case you experience symptoms like vision loss, persistent pain, increased redness, eyelid swelling, or light flashes in the eye, contact the eye specialist right away.

Before & after surgery comparison

Before undergoing cataract surgery, your vision will be blurry, hazy, and clouded. But after the cataract is removed and the new artificial lens is implanted in the eye, your vision will clear up. You will notice significant changes in your vision.

Types of Cataracts

The different types of cataracts that commonly develop in the eyes include:

Nuclear Cataracts
It is a type of cataract that starts developing at the center of the lens, i.e., the nucleus. It progresses slowly and causes yellowing or browning of the lens. If you have a nuclear cataract in one or both eyes, you will at first have nearsightedness, i.e., your nearby vision will improve temporarily.

Cortical Cataracts
A cortical cataract starts as a whitish streak that appears on the outer edge of the cortex lens. It also progresses slowly and extends to the center over time, interfering with the light that passes through the center of the lens.

Posterior Subcapsular Cataracts
A posterior subcapsular cataract appears at the back of the lens as a small opaque area in the direct path of the light. It affects the reading vision, reduces the vision in bright light, and causes glares. It progresses quicker than other types of cataracts.

Congenital Cataracts
It is a type of cataract that people are born with or develop during childhood due to trauma, genetics, or intrauterine infection. They usually don’t affect vision. However, if vision gets affected, you must get them removed as soon as possible.

There are other less common types of cataracts as well that include:

Secondary cataracts are caused by medications or some other diseases, such as glaucoma or diabetes.
Traumatic cataracts that develop after an injury may take years to develop.
Radiation cataracts form when a person undergoes radiation treatment for cancer.

Cataracts Insurance coverage

Yes. You will be glad to know that cataract eye surgery in India is covered under health insurance policies. As cataracts can lead to permanent blindness, which is a physical disability, its treatment is regarded as medically necessary. Thus, all insurance providers offer a specified amount of coverage for cataract treatment which may vary depending on the policy you have.

Normally, the cost of cataract surgery ranges from Rs. 35,000 to Rs. 1,00,000 approximately. This expense includes the cost of tests, doctor’s fee, OT charges, medications needed, hospital stay, etc.

If you have a health insurance policy, you can use it to cover all these expenses to the maximum. Generally, there is a waiting period of 2 years to claim the insurance against cataract treatment. Fortunately, the disease advances at a slow rate, which means you can delay getting treatment until you become eligible to get a claim for cataract surgery.

Make sure that you talk to your insurance provider and check all the terms and conditions properly to get maximum benefits.

Cataracts Recovery Rate

The rate at which patients recover after having cataract surgery varies significantly. Some people are able to see clearly on the very same day whereas others may need a few days or weeks to get the results. In most cases, the complete recovery takes around a month.

First Week after Surgery
During the first week, the eye is kept covered using an eyeglass or eyeshield to ensure that you accidentally don’t rub or poke the eye. Even the slightest amount of external pressure can reopen the incision which can lead to complications. Thus, the patient is advised to refrain from-

Bending over, i.e. taking the head below the waist
Lifting weights heavier than 10 pounds
Straining during activities, even on the toilet
If you follow these tips and use the medicines prescribed by the doctor, your recovery will be much faster and smoother.

Few Weeks after Surgery
After a few weeks, when the vision has stabilized, the doctor will again examine your eye to see if you need eyeglasses or not. Depending on the patient’s physiology and healing abilities, full recovery may take around four to six, given the condition that you follow all the post-surgery care instructions and follow-up with the doctor at the suggested time.

Results
The purpose of cataract surgery is to remove the clouded lens and allow the person to see clearly afterward. However, most people need glasses to see clearly (at certain distances) after cataract surgery. This is so because many people choose a monofocal lens for replacement which can only correct the vision at a single distance, either near or far.

People who’ve had cataract surgery may develop a secondary cataract, also known as posterior capsule opacification (PCO). It happens when the cataract is not removed completely and a small part of the clouded lens was left behind. As a result, the new lens implant also becomes cloudy.

The good news is that PCO can be treated with a technique YAG (yttrium-aluminum-garnet) is a 5-minute procedure that can clear the cloudiness on the capsule with precision. Thus, you don’t have to overstress about compromising the results of cataract surgery.