STRUCTURE OF THE EYE :
The construction of the human eye is just like that of a camera.
Light rays are focused through the cornea and the lens, on to the retina (The retina is a layer of light sensitive cells at the back of the eye like the photosensitive film of the camera).
The retina then transmits the focused images to the brain via the optic nerve. This is seen as a bright clear image.

WHAT IS CATARACT ?
The normal crystalline lens of the eye is clear and transparent.
Whenever the lens develops cloudiness or opacity, it is called a ‘cataract’.
This opacification obstructs light from being transmitted to the retina causing blurring of vision. This may be compared to a window that is frosted or fogged with steam.

WHAT CAUSES A CATARACT ?
Most cataracts occur as a result of :
• increasing age. The normal process of aging may cause the lens to harden and turn cloudy.
Other less common causes of development of cataract are:
• Injuries to the eye,
• Infections or inflammations within the eye,
• Certain medications like steroids,
• Radiation,
• Diabetes - can accelerate the process of cataract formation,
• Rarely some children are born with cataracts - as a congenital abnormality
• Family history - cataract can occur at a much earlier age than otherwise expected, even as early as 20 years.

SYMPTOMS :
• Blurred vision.
• Double vision and distortion of images may occur.
• Sensitivity to light glare, making night driving difficult.
• There may be a need to change glasses frequently.

WHEN SHOULD ONE BE OPERATED FOR CATARACT ?
Since there is no scientifically proven medicine for reducing or dissolving cataracts, surgical removal is the only treatment of cataract at an appropriate time.
• When a cataract causes enough loss of sight to interfere with the patient’s routine life style, it is time to remove it.
• Depending on individual needs, the patient and the ophthalmologist decide together when the cataract should be operated.
• At this point it may be important to mention that the concept of ‘mature’ or ‘ripe’ cataract for its removal is not necessary.
In short, whenever a patient is visually handicapped to carry on his / her daily activities, it is time to consider cataract surgery.

WHAT WOULD HAPPEN IF CATARACT IS NOT REMOVED ?
If not operated, a cataractous lens advances to maturity (becomes more cloudy), that leads to rapid deterioration of vision, erratic changes in glasses numbers and eventually blindness.
If still not operated upon,
• the lens material may cause a rise in pressure in the eye (glaucoma),
• intraocular inflammation
• in some cases the support of the lens becomes weak and the cataractous lens may move from its normal position.
These complications may cause permanent damage and affect the final visual recovery even after surgery, and also make the surgery technically more difficult.

ABOUT CATARACT SURGERY :
There are several surgical techniques for cataract removal. The operating surgeon is the best person to decide which technique is likely to yield the best result.
1 Intracapsular cataract surgery: (redundant & obsolete ) The entire cataractous lens is removed.
2. Extracapsular cataract surgery: The posterior capsule of the lens is not removed and is left behind to act as a support for intraocular lens implantation.
Both these procedures require a large incision and stitches, which are removed at variable intervals.
3. Phacoemulsification: This technique removes the cataract through a small 2 mm incision in the eye.
The cataractous lens is broken into fragments and each of these is then liquefied (emulsified) using ultrasound energy.
This technique usually takes 5-7 minutes, depending upon the density of the Cataract.
Special foldable **intra ocular lenses are inserted through these small Incisions.
Note (matter in red from intra ocular lenses should be clickable and to open as separate link content given below in **)
At BCEIRC the above procedure is done with high end phacoemulsifiers called Infinity with OZIL technology - the topmost technology with advanced safety features from Alcon, USA.

ADVANTAGES OF PHACOEMULSIFICATION :
• NO STICH
• NO PATCH
• NO INJECTION
Faster recovery and return to most of the normal activities within a day.
Return home within ½ an hour of the procedure only with black goggles.
Low Number - better vision.

**INTRAOCULAR LENS (IOL) :
The intraocular lens is designed to replace the human lens and is fitted inside the eye permanently.
This lens may be foldable or non-foldable.
The IOL is implanted during the surgery after removal of the cataractous lens.
The measurement of the power of the IOL to be implanted is determined before the surgery.
At BCEIRC this is done using IOL Master (Zeiss) and A scan Biometry (Alcon, USA)
Unlike contact lenses which require periodic change, intraocular lenses once implanted stay throughout life.

By and large they do not need to be changed.
The other advantages of an IOL are:

• It causes no magnification,
• No distortion of objects,
• Normal side/peripheral vision,

Non foldable IOL:
This IOL generally requires a large incision and may require a stitch.

Foldable intraocular IOL :
These lenses are inserted through incisions as small as 2.2mm.
Foldable lenses are made of ¬¬¬¬silicone or soft acrylic.
All IOL’s used today offer protection from harmful ultra violet rays, newer ‘yellow lenses’ offer additional protection from potentially harmful blue light in visible spectrum.
As their production involves advanced technology, their cost is higher.

DIFFERENT TYPES OF IOL’s

• Monofocal : Routinely used for most cases, generally corrects the distance vision, a small number is left for near vision( Reading, Computer etc)

• Multifocal IOL : This reduces the dependency on glasses for both distance and near vision.
(However, not all patients are suited for this type of lens and you need to discuss with the doctor about it.)

• Toric IOL : These lenses are designed to reduce the high cylindrical number.
( You need to discuss with the doctor whether you need these lens or not.)

• Multifocal Toric IOL : This is recent available technology which corrects the cylindrical power and reduces the dependency on glasses for both distance and near vision.
( You need to discuss with the doctor whether you need these lens or not.)

HOW MUCH VISUAL RECOVERY TO EXPECT ?
Cataract surgery has a very high success rate, over 99% cases are technically successful.
It is however important to realize that factors such as the condition of the retina, optic nerve, pre-existing disease, amblyopia (lazy eye), etc play a very important role in the visual recovery after cataract surgery. Sometimes it may be difficult to diagnose the abnormality before the surgery because of the dense cataract.

AFTER CATARACT : Posterior Capsular Opacification (P.C.O.) - also known as ‘Chari’:
In Modern cataract surgery (including phacoemulsification) the posterior part of the lens (the posterior capsule) is left behind.

It is usually clear and forms a support for implantation of the intraocular lens. Since it is a part of the lens it may undergo opacification and may hamper vision even after cataract surgery.

It is also known as ‘After Cataract’, Or Chari.

It may develop within a few months to few years from surgery, though its incidence is significantly reduced with foldable lenses.

Chari is treated as an OPD procedure by a laser which takes about 1-2 minutes only.
With the state of art technology available the “ AFTER CATARACT “ is less common.

FREQUENTLY ASKED QUESTIONS

1. When can reading be resumed ?
Depending on type of IOL, reading can be resumed from even next day in case of multifocal IOL or after you get a small reading number (which will be after 1 week) in case of monofocal IOL. However if other eye is good reading can be resumed from next day in any case.

2. When can work be resumed ?
Work restricted to the office can be resumed after about 3 to 4 days. Dusty environment, however must be avoided . Also work involving physical strain must be avoided for upto 1 week.

3. Can the patient watch T.V. ?
The patient can watch T.V. from the day of surgery.

4. When can exercise be resumed ?
Exercise restricted to walking can be resumed from the next day. Any heavier exercises like playing tennis, badminton, gym-workouts, etc., should be avoided for 2 weeks. Swimming should be avoided for about 4 to 6 weeks

5. When can travel be undertaken ?
With the doctor’s permission, depending on the recovery; but usually after 4 to 5 days.

6. When can sex be resumed ?
Usually in a week’s time.

7. When can smoking / drinking be resumed ?
Usually within a week’s time.

8. When is hair coloring or dye permitted ?
After 15 days.