Cataract & IOL Service :
Cataract and its treatment
Details about Cataract surgeries
The mere presence of a cataract does not need surgery. A cataract needs to be removed only when vision loss interferes with your everyday activities such as driving, reading, or watching TV. The decision to have cataract surgery is usually made by both the patient and the doctor together.
We routinely perform a minimally invasive cataract surgery called Phacoemulsification.
Some of the features of the procedure are
· No injections
· No stitches
· No patch
· No dark glasses
· Faster visual recovery
The patient is given anaesthesia to numb the eye in the form of eye drops. A tiny incision (2.8 mm or less) is fashioned on the eye to facilitate insertion of a small ultrasonic probe. This probe crushes, or emulsifies the cloudy lens into tiny pieces and gently sucks the debris out of the eye in a matter of a few minutes. An intraocular lens (IOL) is then inserted in its place.
Acrysof Monofocal Intraocular lenses (IOL)
Traditionally lenses were rigid, necessitating bigger incisions and stitches, thus resulting in longer recovery period. Also the sutures would cause irritation, redness, watering etc. besides inducing a spectacle number which would be unpredictable.
The size of the cataract is roughly the size of a regular sized button (collar button)
This means that the IOL implanted would also be the same size, thus necessitating a similar sized incision.
Today with advent of foldable lenses, the lens is actually rolled onto itself, thus greatly reducing incision size. The wound is practically self-sealing without for any stiches.
SELECTION OF IOL..
HUMAN EYES IS ALL READY A WORK OF ART CHOOSE THE SCIENCE TO PERFECT IT
what is IOL it is an artificial lens which is placed inside eye after removal of cataractous natural lens. Your whole life is depend of the lens you choose. There are two types of IOLS
Details about Cataract surgeries
The mere presence of a cataract does not need surgery. A cataract needs to be removed only when vision loss interferes with your everyday activities such as driving, reading, or watching TV. The decision to have cataract surgery is usually made by both the patient and the doctor together.
We routinely perform a minimally invasive cataract surgery called Phacoemulsification.
Some of the features of the procedure are
· No injections
· No stitches
· No patch
· No dark glasses
· Faster visual recovery
The patient is given anaesthesia to numb the eye in the form of eye drops. A tiny incision (2.8 mm or less) is fashioned on the eye to facilitate insertion of a small ultrasonic probe. This probe crushes, or emulsifies the cloudy lens into tiny pieces and gently sucks the debris out of the eye in a matter of a few minutes. An intraocular lens (IOL) is then inserted in its place.
Acrysof Monofocal Intraocular lenses (IOL)
Traditionally lenses were rigid, necessitating bigger incisions and stitches, thus resulting in longer recovery period. Also the sutures would cause irritation, redness, watering etc. besides inducing a spectacle number which would be unpredictable.
The size of the cataract is roughly the size of a regular sized button (collar button)
This means that the IOL implanted would also be the same size, thus necessitating a similar sized incision.
Today with advent of foldable lenses, the lens is actually rolled onto itself, thus greatly reducing incision size. The wound is practically self-sealing without for any stiches.
SELECTION OF IOL..
HUMAN EYES IS ALL READY A WORK OF ART CHOOSE THE SCIENCE TO PERFECT IT
what is IOL it is an artificial lens which is placed inside eye after removal of cataractous natural lens. Your whole life is depend of the lens you choose. There are two types of IOLS
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1. MONOFOCAL allows you to see clearly for distance but you have to use near glasses for near work like reading
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2. MULTIFOCAL IOLS this is a really a safe alternate to correct your vision for all distance say far,
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High Risk Cataract Surgery :
Which includes Phaco donesis cataracts mostly seen after trauma and also in some Eye diseases related to Systemic syndromes like Marfans disease etc., Uveitic cataract, Cataract after retina surgery with silicone oil insitu.
PLANNING FOR SURGERY It is not necessary for the cataract to mature fully or for the vision to become totally cloudy before scheduling surgery. You and your ophthalmologist should jointly decide on the time for surgery. Be sure to inform your doctor about any medications or herbal remedies that you may be using.
At the hospital our counselors will help you understand the pre-operative procedures and obtain an estimate of the expenditure involved. Prior to your surgery, you will need to undergo some routine medical and blood tests. If you wear glasses or contact lenses, bring them so that your prescription can be checked. An A-scan will help the doctor determine the power of the new lens to be implanted in your eye.
It is good to wash your face thoroughly with soap and water before coming for surgery. You will be advised to use some eye drops. Please follow the instructions carefully as these drops help dilate your eye. If your eye is not properly dilated surgery may be delayed. You may also be advised not to eat or drink anything for a few hours prior to surgery. You can bring only one attendant; children below 15 years are not allowed unless they are patients.
Though the success rate for cataract surgery is almost 98%, sometimes there may be complications. Most of these complications are minor and can be rectified. Your doctor will advise you about any specific issues related to your case.
THE SURGERY In the operating room, the area around your eye will be cleaned thoroughly. Sterile drapes will be placed around your head and face with only the eye exposed. Usually a local anesthetic in the form of topical drops or an injection is administered next to the eye. Sometimes doctors may have to perform the surgery under general anesthesia. An oxygen tube will be placed near you nose so that you do not feel suffocated.
The actual surgery lasts about 30 minutes. You will be relaxed and awake but feel no pain. The nerves in your eye will be completely numbed so you will not be able to see or move your eye.
CARE AFTER SURGERY After surgery a bandage or shield will be placed over your eye. You will be advised to rest till you are ready to leave.
You should wear protective glasses or an eye shield in the day and an eye patch at night to avoid accidental injury. The doctor will advise you when you can discontinue using them. You can bathe carefully from below your neck but do not wet the operated eye for 10 days. You may gently clean the eyelids with a piece of cotton boiled in water or a sterilized tissue.
Some Important Tips:
· Do not rub the operated eye.
· Do not use any eye cosmetics until the doctor allows it.
· Do not wash your hair until the doctor says you can.
· Shave carefully as soap or water should not enter the eye.
· Avoid any vigorous activity.
· Do not lift heavy things.
· Do not bend or bring your head lower than your waist.
· Avoid driving till your vision improves.
· Avoid sleeping on the operated side.
· No sexual intercourse until permitted by the doctor.
· Avoid alcoholic beverages.
· Watch television for short periods only.
Please follow the advice of the doctor about medication and follow-up visits.
Be Alert About Problems:
If you have any of these symptoms that last more than 24 hours, inform the Institute or an ophthalmologist immediately:
· Any sudden change in vision or blurring of vision
· Increase in sensitivity to light
· Increase in redness
· Swelling of the eyelid or bleeding
· Nausea or vomiting
· White or cloudy cornea or pupil
· Persistent discomfort or pain.
SECONDARY CATARACT Blurred vision, months or years after cataract surgery leads to the mistaken assumption that the cataract has grown again. This is not a cataract but the clouding of the thin capsular bag membrane that helps keep the lens implant in place. To restore clear vision surgeons use a laser to open a visual path through the cloudy membrane. This is a simple procedure and is done on an outpatient basis. No stitches or surgery are needed. Your vision should improve soon after the laser treatment. If you have any concerns or questions ask the doctor when you come for an examination. If you feel you cannot wait, call or email us.
At the hospital our counselors will help you understand the pre-operative procedures and obtain an estimate of the expenditure involved. Prior to your surgery, you will need to undergo some routine medical and blood tests. If you wear glasses or contact lenses, bring them so that your prescription can be checked. An A-scan will help the doctor determine the power of the new lens to be implanted in your eye.
It is good to wash your face thoroughly with soap and water before coming for surgery. You will be advised to use some eye drops. Please follow the instructions carefully as these drops help dilate your eye. If your eye is not properly dilated surgery may be delayed. You may also be advised not to eat or drink anything for a few hours prior to surgery. You can bring only one attendant; children below 15 years are not allowed unless they are patients.
Though the success rate for cataract surgery is almost 98%, sometimes there may be complications. Most of these complications are minor and can be rectified. Your doctor will advise you about any specific issues related to your case.
THE SURGERY In the operating room, the area around your eye will be cleaned thoroughly. Sterile drapes will be placed around your head and face with only the eye exposed. Usually a local anesthetic in the form of topical drops or an injection is administered next to the eye. Sometimes doctors may have to perform the surgery under general anesthesia. An oxygen tube will be placed near you nose so that you do not feel suffocated.
The actual surgery lasts about 30 minutes. You will be relaxed and awake but feel no pain. The nerves in your eye will be completely numbed so you will not be able to see or move your eye.
CARE AFTER SURGERY After surgery a bandage or shield will be placed over your eye. You will be advised to rest till you are ready to leave.
You should wear protective glasses or an eye shield in the day and an eye patch at night to avoid accidental injury. The doctor will advise you when you can discontinue using them. You can bathe carefully from below your neck but do not wet the operated eye for 10 days. You may gently clean the eyelids with a piece of cotton boiled in water or a sterilized tissue.
Some Important Tips:
· Do not rub the operated eye.
· Do not use any eye cosmetics until the doctor allows it.
· Do not wash your hair until the doctor says you can.
· Shave carefully as soap or water should not enter the eye.
· Avoid any vigorous activity.
· Do not lift heavy things.
· Do not bend or bring your head lower than your waist.
· Avoid driving till your vision improves.
· Avoid sleeping on the operated side.
· No sexual intercourse until permitted by the doctor.
· Avoid alcoholic beverages.
· Watch television for short periods only.
Please follow the advice of the doctor about medication and follow-up visits.
Be Alert About Problems:
If you have any of these symptoms that last more than 24 hours, inform the Institute or an ophthalmologist immediately:
· Any sudden change in vision or blurring of vision
· Increase in sensitivity to light
· Increase in redness
· Swelling of the eyelid or bleeding
· Nausea or vomiting
· White or cloudy cornea or pupil
· Persistent discomfort or pain.
SECONDARY CATARACT Blurred vision, months or years after cataract surgery leads to the mistaken assumption that the cataract has grown again. This is not a cataract but the clouding of the thin capsular bag membrane that helps keep the lens implant in place. To restore clear vision surgeons use a laser to open a visual path through the cloudy membrane. This is a simple procedure and is done on an outpatient basis. No stitches or surgery are needed. Your vision should improve soon after the laser treatment. If you have any concerns or questions ask the doctor when you come for an examination. If you feel you cannot wait, call or email us.
Microincision Sutureless Cataract Surgery - Modern Microsurgery To Restore And Enhance Vision
Sight is our most precious sense enabling us to enjoy the beauty of the world in which we live. Blindness has been recognized as an important public health problem in India, a country that is now home to a billion inhabitants. A nationwide survey, undertaken in 1999-2001, revealed the prevalence of blindness to be 8.5%. Over 60% of blindness has been attributed to cataract alone.
For centuries, developing cataract doomed a person to blindness. Today modern microsurgical techniques utilizing state-of-the-art equipment, lenses and surgical material, allow people to enjoy good, clear vision after their cataracts have been removed. We at Jyoti Eye Hospital believe that giving up favourite activities and suffering through years of poor vision due to cataract is no longer an inevitable part of the ageing process. Our centre cataract surgeons is dedicated to provide the best possible care to patients suffering from cataract.
Learn about cataract and its treatment.
How the eye works
Before understanding cataract, it is important to know how a normal eye works. The eye is like a camera. The lens in a camera allows light to pass through and focuses that light on the film at the back of the camera for a clear picture.
The eye works in a similar way. The lens of the eye is normally clear and allows light to pass through. The light is focused on a thin film-like retina, which is situated at the back part of the eye. This is how we see.
What is a cataract?
It is a cloudiness of the normally clear lens in the eye. It prevents the lens from focusing light onto the retina and hence causes unclear vision. As the cataract advances, this cloudiness of vision increases over a period of time until the vision is completely impaired.
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For centuries, developing cataract doomed a person to blindness. Today modern microsurgical techniques utilizing state-of-the-art equipment, lenses and surgical material, allow people to enjoy good, clear vision after their cataracts have been removed. We at Jyoti Eye Hospital believe that giving up favourite activities and suffering through years of poor vision due to cataract is no longer an inevitable part of the ageing process. Our centre cataract surgeons is dedicated to provide the best possible care to patients suffering from cataract.
Learn about cataract and its treatment.
How the eye works
Before understanding cataract, it is important to know how a normal eye works. The eye is like a camera. The lens in a camera allows light to pass through and focuses that light on the film at the back of the camera for a clear picture.
The eye works in a similar way. The lens of the eye is normally clear and allows light to pass through. The light is focused on a thin film-like retina, which is situated at the back part of the eye. This is how we see.
What is a cataract?
It is a cloudiness of the normally clear lens in the eye. It prevents the lens from focusing light onto the retina and hence causes unclear vision. As the cataract advances, this cloudiness of vision increases over a period of time until the vision is completely impaired.
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Why does a cataract develop?
Cataract development is part of the normal ageing process. Almost all people above the age of 60 years have cataract of a variable degree, although it can occur at an earlier age also. In some people cataract development is aggravated by an eye injury, presence of diabetes, use of medications or other eye diseases. Rarely cataract may be present in the newborn as a developmental defect.
What are the symptoms of a developing cataract?
Because cataracts form in different ways, the symptoms of cataracts are variable. Most people notice that their vision gradually deteriorates - objects may begin to look yellow, hazy, blurred or distorted. Many people also find that they need more light to see clearly, or that they experience glare or haloes from lights at night. A common problem encountered is increasing nearsightedness. In advanced cases, the cataract may be visible as a whitish-looking pupil.
Can cataract be prevented or treated with medication?
Cataracts that occur due to the ageing process cannot be prevented as the ageing process itself cannot be prevented. Using the eyes for reading and similar activities has nothing to do with cataract formation. Avoiding the use of eyes will not prevent cataract.
Till date as per all authentic medical research no medication exists to prevent or cure a cataract. The only known treatment for cataract is surgery.
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When can one undergo Cataract Surgery?
Cataract surgery can be performed as soon as the patient feels handicapped in performing routine activities at work and leisure. With modern microsurgical techniques of stitch-less cataract surgery (phacoemulsification) it is not necessary to wait for the cataract to mature.
What does cataract surgery entail?
It is one of the oldest, safest and most successful forms of surgery. It requires a very short hospital stay and is generally performed under local or topical anesthesia. The patient is awake during surgery but does not feel any discomfort or pain. Patients are ambulatory immediately after surgery and are discharged on the same day.
The eye operation is performed with the help of a sophisticated operating microscope. A small incision of 2.0-2.5 mm is first made in the eyeball (Step 1).
A smooth round opening is then made in the front part of the lens capsule, which is a thin membrane enclosing the entire lens (Step 2).
All cloudy lens material within the lens capsule is then removed through the same incision by the procedure of phacoemulsification using a thin titanium probe that emits high-speed ultrasound waves, vibrating at 40,000 times per second. This breaks the cataract into tiny pieces, which are then suctioned out of the eye through the same probe (Step 3).
In the final step, a Foldable Intraocular Lens (IOL) is introduced through the small incision, and placed within the capsule of the lens where it unfolds and stays in place securely (Step 4).
One of the most recent advancements has been the ability to perform cataract surgery through even smaller incisions (as small as 1.8 mm). Small and micro incisions such as those used in phacoemulsification seal themselves immediately after surgery and heal very quickly. Compared to non-phaco cataract surgery, the postoperative rehabilitation for stitch-less phacoemulsification is faster and one can return to normal work and activities within a few days. This is currently the most effective method for removing cataracts.
Great strides have been made in phacoemulsification technology. All top-of-of-the-line phacoemulsification machines currently available have the capability to deliver "Cold Phaco" which has the advantage of significantly reducing the ultrasonic energy to break up the cataract resulting in safer surgery and less damage to the eye. A further development in this field has been the introduction of "Torsional Phaco" (OZil Technology) available in the latest state-of-the-art Alcon Infiniti Vision System. This revolutionary technology leads to even further reduction of ultrasonic energy delivered in the eye, resulting in crystal clear corneas after surgery and faster visual recovery even in hard cataracts.
The WhiteStar Signature with Ellips "Transversal Phaco" is another such phacoemulsification device, which has made cataract removal a safe procedure. Both these technologies are available at Jyoti Eye Hospital for the benefit of cataract patients.
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Are there any problems with an Intraocular Lens (IOL)?
Fortunately, the technological advances in IOL manufacture and surgery have made it quite safe. Complications are rare and similar ones can occur with conventional surgery without an IOL implantation. All patients irrespective of other general illnesses like diabetes, hypertension etc. can have IOL surgery. If there is any reason why you should not have an IOL your ophthalmologist will explain.
Does one need glasses after IOL surgery?
The improvement in quality of life after cataract surgery is extraordinary, and most patients are not dependent on their distance glasses for daily activities. Some patients however, may need glasses of small plus or minus power to obtain the best possible distance vision.
IOL power calculations are done by trained personnel using a computerized ultrasound biometer for measuring the eye before the operation, and every endeavor is made so as to get very minimal post-operative power in the distance glasses. A new device called the IOLMaster is now available which is capable of very accurate measurement of the eye and calculation of the IOL power. However, since these calculations are based on certain theoretical formulae, it will vary on a person-to-person basis, and some people may have a slightly larger postoperative refraction than others. Unlike the natural human lens, which can change its shape to focus for various distances, the IOL, since it is made of plastic, cannot do so. Hence, majority of patients undergoing routine phacoemulsification with IOL implantation, typically require reading glasses after cataract surgery.
What are the latest advances in Intraocular Lens (IOL) technology?
Advances in IOL technology have made available various state-of-the-art IOLs. These new lens designs include 1) Blue-light blocking IOLs that filter out harmful ultraviolet radiation as well as blue light, 2) Aberration-free IOLs which greatly improves image quality by enhancing contrast, eliminating glare and haloes, and improving night vision, and 3) the newer Multifocal IOLs which provides good unaided distance and near vision with less dependence on glasses. 4) Toric IOLs are also available for the correction of high cylindrical spectacle numbers. Depending on the patients' personal visual needs, the surgeon decides the most appropriate lens to implant in the eye.
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Does one need glasses after IOL surgery?
The improvement in quality of life after cataract surgery is extraordinary, and most patients are not dependent on their distance glasses for daily activities. Some patients however, may need glasses of small plus or minus power to obtain the best possible distance vision.
IOL power calculations are done by trained personnel using a computerized ultrasound biometer for measuring the eye before the operation, and every endeavor is made so as to get very minimal post-operative power in the distance glasses. A new device called the IOLMaster is now available which is capable of very accurate measurement of the eye and calculation of the IOL power. However, since these calculations are based on certain theoretical formulae, it will vary on a person-to-person basis, and some people may have a slightly larger postoperative refraction than others. Unlike the natural human lens, which can change its shape to focus for various distances, the IOL, since it is made of plastic, cannot do so. Hence, majority of patients undergoing routine phacoemulsification with IOL implantation, typically require reading glasses after cataract surgery.
What are the latest advances in Intraocular Lens (IOL) technology?
Advances in IOL technology have made available various state-of-the-art IOLs. These new lens designs include 1) Blue-light blocking IOLs that filter out harmful ultraviolet radiation as well as blue light, 2) Aberration-free IOLs which greatly improves image quality by enhancing contrast, eliminating glare and haloes, and improving night vision, and 3) the newer Multifocal IOLs which provides good unaided distance and near vision with less dependence on glasses. 4) Toric IOLs are also available for the correction of high cylindrical spectacle numbers. Depending on the patients' personal visual needs, the surgeon decides the most appropriate lens to implant in the eye.
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Can all patients having a cataract undergo Phaco surgery?
Your eye surgeon will be the best judge to decide whether you can undergo phaco-surgery.
Each patient undergoing cataract surgery is examined in detail to assess the endothelial count of the cornea using the Automated Specular Microscope. The endothelium is the inner most layer of the cornea which is responsible for its transparency. Preoperative assessment of the endothelial count enables the surgeon to identify patients in whom this layer is weaker (low cell counts), who are not fit for the phacoemulsification procedure, and in whom surgery by the conventional technique would be safer. Again based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If necessary, special protective substances such as Chondroitin Sulphate, are used to minimize loss of the already depleted endothelial cell counts during surgery.
Is clear vision guaranteed after surgery?
No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery.
The calibre of vision obtained after a successful cataract surgery with IOL depends upon the health of the retina behind. Eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful.
However, it might not be possible to evaluate the condition of the retina, optic nerve, in advanced cataracts.
Cataract and IOL surgery is not a magical procedure and need not necessarily restore normal vision immediately. Blurred vision may be present immediately after surgery. As the eye heals over a period of time, vision improves gradually.
What are the possible complications that can occur with Cataract & IOL surgery?
Modern microsurgical techniques for cataract removal are highly successful procedures. The few complications that exist are becoming even more remote, with newer developments in surgical techniques and anesthesia.
Some minor complications that can occur include a slight drooping of the eyelid, swelling around the eye, corneal haze, reflections or slight distortion from the lens implant, which are usually temporary. The chances for serious complications are negligible. Possible serious complications include infection, severe inflammation, and hemorrhage.
In a majority of cases these complications can be treated successfully or may resolve on their own with a good final restoration of vision. The above list is however not exhaustive.
Can Cataract be treated with Lasers?
Contrary to a popular myth cataract cannot be removed with lasers. Surgery done by phacoemulsification is commonly termed "Laser Surgery" by many people.
However, in a certain number of patients undergoing cataract surgery, the back part of the lens capsule may thickens over a period of time causing blurred vision.
This is known as a secondary cataract. This is not a complication. The condition is treated with a "YAG Laser Capsulotomy" with full restoration of vision.
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Benefits of cataract surgery:
There are numerous benefits of cataract surgery, many of which cannot be measured statistically. These include: -
Each patient undergoing cataract surgery is examined in detail to assess the endothelial count of the cornea using the Automated Specular Microscope. The endothelium is the inner most layer of the cornea which is responsible for its transparency. Preoperative assessment of the endothelial count enables the surgeon to identify patients in whom this layer is weaker (low cell counts), who are not fit for the phacoemulsification procedure, and in whom surgery by the conventional technique would be safer. Again based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If necessary, special protective substances such as Chondroitin Sulphate, are used to minimize loss of the already depleted endothelial cell counts during surgery.
Is clear vision guaranteed after surgery?
No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery.
The calibre of vision obtained after a successful cataract surgery with IOL depends upon the health of the retina behind. Eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful.
However, it might not be possible to evaluate the condition of the retina, optic nerve, in advanced cataracts.
Cataract and IOL surgery is not a magical procedure and need not necessarily restore normal vision immediately. Blurred vision may be present immediately after surgery. As the eye heals over a period of time, vision improves gradually.
What are the possible complications that can occur with Cataract & IOL surgery?
Modern microsurgical techniques for cataract removal are highly successful procedures. The few complications that exist are becoming even more remote, with newer developments in surgical techniques and anesthesia.
Some minor complications that can occur include a slight drooping of the eyelid, swelling around the eye, corneal haze, reflections or slight distortion from the lens implant, which are usually temporary. The chances for serious complications are negligible. Possible serious complications include infection, severe inflammation, and hemorrhage.
In a majority of cases these complications can be treated successfully or may resolve on their own with a good final restoration of vision. The above list is however not exhaustive.
Can Cataract be treated with Lasers?
Contrary to a popular myth cataract cannot be removed with lasers. Surgery done by phacoemulsification is commonly termed "Laser Surgery" by many people.
However, in a certain number of patients undergoing cataract surgery, the back part of the lens capsule may thickens over a period of time causing blurred vision.
This is known as a secondary cataract. This is not a complication. The condition is treated with a "YAG Laser Capsulotomy" with full restoration of vision.
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Benefits of cataract surgery:
There are numerous benefits of cataract surgery, many of which cannot be measured statistically. These include: -
- Improved colour vision - colours are brighter and more vivid after cataract surgery.
- Greater clarity of vision - vision is crisper and sharper after cataract surgery.
- Improved quality of life - studies have repeatedly shown that people enjoy an improved quality of life after successful cataract surgery. Many people can resume driving, reading, writing, watching television, sewing, household work and using a computer immediately after.
Even when retinal diseases or other problems prevent a total restoration of vision, the remaining vision is usually improved by cataract surgery.