Is Cataract Surgery Serious?

Cataracts are inevitable with aging and not completely preventable. Recent advancements in Cataract surgery have increased its safety, efficacy and success in many folds. This is the only effective treatment to remove cataracts and is vital for sight.

In a cataract surgery the cloudy cataract affected natural lens are replaced by artificial IOL depending on the suitability.

With present advancement in ophthalmology it is possible to detect cataract at an early stage and treat with best technology.

What happens if cataract surgery is not done in time?

  • Blindness: Initially cataracts may not be severe and may not affect vision. If left untreated cataract may progress and cause difficulties in vision and in rare cases it can lead to blindness.
  • Cause for other eye disorders: Cataracts can also lead to other eye disorders like glaucoma etc if untreated.
  • Complications: The surgery could get more complicated and risky in case of delay as the cataract tends to get dense and hard.

Advantages of a timely cataract surgery:

  • Spectacle Freedom: Cataract surgery the correction for Astigmatism and myopia can be made along with the cataract surgery and you could get spectacle independent in case you are a suitable candidate for the procedure. Cataract surgery previously had only a mono – focal lens implant option now with Multi – focal IOL technology can decrease dependence on glasses after surgery.
  • Helps to increase the quality life: Depending on your eye condition, nature of your job and your visual needs the right kind of surgery would be suggested to you so that you could enjoy best visual outcome. If delayed, there would be chances that make treatment more challenging with onset of other unforeseen diseases if any, e.g. heart or diabetes etc. In any case if surgery is unavoidable then procrastination could cause more harmful and affect your quality life.
  • Reduces the risk factor: A cataract surgery in time reduces the risk factor both for your eyes as well as overall health. Falling and accidents causing health hazards could be minimized as cataract blurs the vision.
  • Optimum visual results: Optimum visual results are possible with smaller incisions with new technology thereby faster recovery and better visual outcome. You need not be confined to the long rest time and have a painless, stitch less surgical experience. You could get back to your routine work faster depending on the type of surgery undergone.
  • Astigmatism correction: Corrections to resolve astigmatism could be conducted during the cataract surgery enabling you to have good distance vision without spectacles.
  • Insight for other eye illnesses undiagnosed: When you diagnosis for the cataracts we also look into the possibilities of other eye illnesses like AMD, if any through a comprehensive eye check up. Some conditions reducing visual potential like retinal scarring from macular degeneration, Floaters and other eye disease unrelated to cataract too be eventually treated and corrected.
  • Reduction in intraocular pressure: Emerging data suggests that cataract surgery may provide a significant reduction in IOP.

Cataract could be severe and may not actually cause any visual impediments or they could be minor and yet cause severe visual difficulties.

Hence cataract surgery at the right time could enhance your vision and thereby could avoid getting it serious.

 

What are the Risk Factors for Cataract?

Cataract clouds the natural lens of the eye causing loss of vision. Let’s note the factors that increase your risk of cataracts.

Risk factors

  • Aging- Aging is major cause of age related cataract most commonly known.
  • Genetics- Some having a family history of cataracts may inherit from parents genetically.
  • Congenital cataract- Some children are born with cataract.
  • Ethnicity-Evidence suggests that our ethnic ancestry influences the likelihood of developing cataracts.
  • Female gender-Studies have reported that women are more likely to develop cataracts than men.
  • Medical conditions
    • Diabetes- Diabetes type 1 or 2 has a high risk factor for cataract at a younger age. The accumulation of certain sugars in the blood leads to formation of sugar alcohols in the lens which causes swelling and rupturing of the lens cells causing cataract due to diabetes. Managing blood glucose at normal or near normal levels is hence important.
    • Hypertension- High blood pressure is seen as a risk factor.
    • Obesity- Studies shows the effect of diet high in saturated fat and occurrence of cataract. Obesity boosts blood sugar levels which in turn increase risk of cataracts.
    • Eye Trauma- Blunt trauma, penetrating trauma, chemical injuries and electrical injuries. It is advisable to wear protective eye gear as per requirement.
    • Previous eye surgery- Eye surgeries such as surgery for a retinal detachment can increase the risk of developing a cataract.
    • Prolonged use of corticosteroid medications (commonly called steroids) pose a particularly high risk.g. Steroids are used to treat autoimmune diseases such as asthma and Crohn’s disease, rheumatoid arthritis, and lupusetc resulting in cataract as a side effect.
    • Statin medicines used to reduce cholesterol- Studies suggest that the risk for cataract is high among Statin users as compared with nonusers.
  • Life style risk factors
    • Drinking excessive alcohol– Chronic drinkers under high risk for cataract. Avoid excessive use of alcohol.
    • Smoking– Smoking can increase your risk of developing cataract Avoid smoking.
  • Environmental risk factors
    • Excessive exposure to sunlight – Over exposure to ultraviolet (UV)radiation is risk factor for nuclear cataract. It is advisable for people whose jobs are exposed them to sunlight for prolonged periods to use sunglasses with 100% UV protection.
    • Exposure to ionizing radiation- Exposure used in X-rays and cancer radiation therapy may cause cataract.
    • Poor nutrition-Vision researchers believe that a diet high in saturated fat and refined carbohydrates may be linked to the development of cataracts. Healthy diet rich in antioxidants helps in risk reduction of cataract.

Regular eye exams can detect early occurrence of cataracts. Further research is in progress to develop interventions that will have an impact on their prevalence. Sometimes in some persons one or more risk factors never develop the disease, while in some persons it develops having no known risk factors. Nevertheless the understanding of the risk factors aids in the management of cataract.

Let’s discuss… We guide you to a better vision.

How to choose a Cataract Surgeon

A cataract surgery would mean entrusting your most precious sense organ of your body for surgery. A successful cataract surgery results in satisfying experience and best visual outcome.

In order to streamline your search on choosing a right cataract surgeon the aspects in the selection has been chalked out as below:

Aspects in selection of a Cataract surgeon

  • Yourself
  • Your surgeon
  • Your hospital
  1. Yourself: The decision of choosing a right cataract surgeon for your eyes lies within you. In case you are unable to decide yourself, you need to consult your family members, friends, relatives, those specialized in the ophthalmic field etc. for opinion. It is also suggested to ask for reference from friends or relatives whom you trust.

Factors to be considered

  • Cost -The payment options need to work out for you. In some surgeries insurance is not applicable.
  • Research- Flashy advertisements may not expose the reality in terms of experience and skill. Before scheduling the consultation, the credentials need to be researched.
  1. Your surgeon:

Factors to be considered

  • Experience- Cataract surgery is a microsurgery wherein a single wrong move could create a serious outcome. Successful outcomes are the fruits of vast time tested experience. Check on how experienced the surgeon is in his field of specialty.
  • Use of latest technology – Important aspect of consistent success is how the surgeon is able to adapt to the latest technology. Surgeon’s credentials including Training- Educational qualification, professional affiliations, state licensing, board certification etc. Check if the surgeon is a state licensed practitioner.
  • Total procedure performed- The total surgeries performed fine tune the expertise in the specialty. Check on the number of cataract surgeries done.
  • Skills – A skilled surgeon can handle any complex complications and emergencies.
  • Safety– Once the surgery is scheduled; your trust in the safety boosts your confidence. A good surgeon would conduct the surgery only if you are prepared and if you are the right candidate for the surgery. In case otherwise, for your safety the surgery could be postponed or cancelled. Your safety factor matters.
  1. Your Hospital:
  • Surgical Team- Cataract surgery is a team work. Team knowledge also counts and capability of team also is important. An ideal hospital would have an excellent surgical team.
  • Facilities – Advancement in the usage right from the basic equipment is important as it aids in the refraction diagnosis, calculations and facilitates the better surgical outcome.
  • Hospital staff – Pleasant Behavior, positive attitude of the staff creates cordial and patient friendly environment.
  • Facilities to handle emergencies.
  • Post operative follow ups are conducted or not need to be checked. Good hospital simultaneously gives pre and post operative instructions for follow up.
  • Transparency in Information- Openness and transparency instills goodwill and confidence. E.g. Opportunity for your caretakers or family to see the surgery live on screen.
  • Professional environment.
  • Location advantage– Travelling for regular, follow ups and post operative check up are less tedious if centrally located by rail, road and air.
  • Hospital Reputation- It the goodwill created over years of commitment. Certifications of the hospital aids in distinguishing them from the other hospitals.
  • Choice of various surgical and IOL options should be available.
  • Media Reports- Media network and social network communications could also act as indicator in deciding the efficacy of the hospital.

Tips for choosing the right surgeon for cataract surgery

  • Find the complication rate & Infection Rate- Infection Rate also needs to be noted. Ideal hospital for cataract surgery would have the lowest rate.
  • Visit the surgeon or hospital website for more details.
  • Meet the surgeon face to face and discuss with past medical history.
  • Seek 2nd opinion if required.
  • Check online Testimonials for others experience.

A holistic evaluation before making your final decision in choosing the right cataract surgeon would benefit you; after all you have just a pair of eyes. The parameters to check on the criteria of selection in choosing the best cataract surgeon could vary from person to person.

Over decades, Shroff Eye Care is a pioneer in eye care built on trust and commitment to quality ophthalmic care for a lifetime.

We look forward hearing from you.

Cataract Surgery For Children

Cataracts occur in children at birth or after. Unlike adults, cataracts in children are likely to get unnoticed, more difficult to determine and are not as common. Exact cause is still unknown. A newborn’s eye test should not be avoided, particularly if the child is premature and if there is a history of congenital cataract in the family. Cataract surgery in case of pediatric cataracts is most effective in the first month after the birth. In elder children any difficulties in reading, writing that impairs vision and should not be ignored.

Risk factors for Pediatric cataracts.

  • Congenital cataract: Cataract or lens opacity at birth in children. These could be due to hereditary/genetic, metabolicg. galactosaemia or in-utero infection related conditions.
  • Developmental cataracts: They are due to genetic or metabolic e.g. galactokinase deficiency conditions.
  • Acquired cataracts: They are due to metabolicg. diabetes mellitus, traumatic or post radiotherapy conditions.

Most common symptoms of cataracts in children:

  • Unable to see clearly / blurring
  • Visible white spot in pupil.
  • Improper eye alignment.
  • Unusual rapid eye movements.
  • No reaction to colorful stimuli or larger objects.

How eye condition in cataract surgery in children is different from adults

  • Potential for amblyopia
  • Unlike adults longer life span after cataract removal
  • Change in axial length and corneal curvature with time
  • Increased tissue reactivity and decreased scleral rigidity
  • Smaller size (compared to the adult eye)
  • Lenses are softer.
  • Capsule is comparatively more elastic

 Surgical Treatment: Cataract surgery in children is a daycare procedure. The approach changes according to the age, nature of the eye, type of cataract, onset and diagnosis etc. Sometimes surgeries are conducted under anesthetic drops or in some cases children are anesthetized with general anesthesia. In kids, eyeball growth is rapid and higher risk for possible rejection so initially contact lens are used and when the child is suitable by age and prevailing conditions are conducive only then contact lenses are replaced by IOLs.

Precautions for pediatric cataract surgery:

  • After surgery
    • Ensure that medication, follow up is adhered to.
    • Ensure that the child takes good rest.
    • Bending to pick objects is restricted.
    • Due protection and care is taken for the operated eye as instructed like avoid rubbing, strain, etc.

Complications: Normally complications are more in children compared to adults. Few common ones are:

  • Amblyopia
  • Posterior capsular opacification
  • Glaucoma
  • Retinal detachment

Post operative follow up: Regular post operative test and follow ups are important for the overall visual outcome. We closely monitor your child for the visual development to detect any post operative complications. Further as the eye matures the glasses or contact lens need to be changed and the eye ware consultation details would be informed.

At Shroff Eye Care, your child would experience unmatchable highly refined surgical techniques with the vast expertise of surgeons handling pediatric surgeries of children from all age’s right from birth.

Do get in touch with us for appointment and more details.

Can Cataracts be Prevented?

Cataract is world’s leading cause of blindness currently affecting nearly 20 million people. We do understand that age is the most common risk factor for cataract. Aging cannot be prevented and so is cataract. The alternate prevention mode that we focus attention on is how the risk of developing cataract can be minimized by slowing down its development.

The lens in the human eye consists of unique cells known as lens fibers that contain water and proteins called crystallins. These let light pass through the lens. Aging causes abnormal development in the lens causing cataract.

Eye drops and eye exercise do not prevent cataract formation and there is no sufficient evidence supporting that it may slow down progress either.

Let’s learn how to prevent cataract to some extent or to slow down its development.                  

  • Nutrition and Diet strategies:

Information supports that having a rich nutritional diet with dark coloured fruits, vegetables (rich in lutein and zeaxanthin), fish with in omega 3 helps in decreasing the progression of cataracts.

  • Wellness management strategies:

Regular check on the potentially interrelated personal factors such as:

  • Regular check up and control on blood pressure is important. Stress being a risk factor need to be kept in control.
  • Diabetes: Maintenance of healthy blood glucose levelscould prevent the onset of cataract.
  • Obesity: Maintenance of healthy weight through exercise etc.
    • Other external conditions :
  • Radiation exposure like X rays and gamma irradiation to be minimized.
  • Protection of eyes from eye injury to avoid Traumatic cataracts.
  • Sunlight: Moderate sunlight exposure at the right time is required for Vitamin D in the body and helps in controlling Myopia but exposure to intense sunlight without sufficient protective measures like sunglasses with UV protection can be a risk factor for cataracts.
  • Medicines / Drug strategies:
  • Use of steroid medicines– It has been observed that higher doses of steroid (prednisone and cortisone) along with longer usage could be a risk factor for posterior subcapsular cataracts.
  • Uses of statin– Certain studies have associated the link between long term statin usage and cataracts.
  • Homeopathy eye drops (Cineraria Maritima) is used by some to delay progress
  • Lifestyle management strategies
  • Smoking- Avoid smoking to prevent the risk cataract.
  • Alcohol – Excessive amount of alcohol could increase the incidence of cataracts.
  • Eye care strategies:
  • Eye examination and test: Have frequent eye test to keep cataracts in check. Congenital cataract occur at birth can be detected if checked early.
  • Neglecting presbyopic conditions could lead to cataracts.

Atomic-scale views of an eye protein aquaporin zero (AQP0) has been recently discovered. This protein maintains transparency of the lens in the eye, which could potentially lead to new methods in cataract treatment and prevention.

Vision researches research progressively on the known and unknown prevention measures. With multiple factors responsible occurrence of cataracts can be minimized by a following a healthier lifestyle.

Do get in touch with us an appointment and more details.

You can prevent cataract occurrence from developing to a great extent nevertheless cataracts cannot be fully prevented but we can treat them effectively.

What you need to know about Femtocataract Surgery?

At the moment surgery is the only effective treatment for cataract. Now you need to get the cataract affected natural lens replaced by a new IOL (intra ocular lenses) by surgery.

Read on for an insight to Femtocataract surgery.

What is Femtocataract surgery?     

Gone are the days where you had to wait in dark glasses in pain for days for clear vision after a cataract surgery. With the advances in ophthalmology procedures like Femtosecond laser-assisted cataract surgery (FLACS) a novel revolution in Cataract Refractive surgery has paved its way. As the name suggests the major difference here is the use of a Femtosecond laser controlled by the surgeon.

The edge over the conventional phacoemulsification lies in major surgical steps as noted below.

The first few steps in a cataract surgery involve the creation of corneal / corneo-scleral incisions (ports of entry) and capsulorhexis – creation of an incision in the front surface of the lens capsule, to enable removal of the cataract affected lens. Both these steps today are under the manual skill of a cataract surgeon. The phacoemulsification steps begin with the ‘chopping’ of the lens, breaking it down into smaller fragments to aid removal through a small incision, thus avoiding the need for stitches.

All above steps can be substituted with a good Femtosecond laser. However, it cannot substitute phacoemulsification in cataract surgery. The aspiration of the lens completely will still require the phacoemulsification equipment.

Thus it serves as a good aid to reduce complications, improve accuracy, safety and precision in cataract surgery.

Clear Corneal Incisions-

It is faster and safer to have incisions (surgical cuts) being computer-controlled with imized precision that can be customizable according to your eyes. Incisions made by the laser have a clear cut edges which results in quick sealing and healing, letting you have a satisfied refractive post operative outcome on day 1 of surgery itself.

Capsulotomy (Capsulorhexis) – Creation of the Opening made on the lens covering is done by dissecting with unmatchable precision which aids in perfectly positioning the implanted IOL.

Lens Fragmentation –Initial fragmenting (breaking up) of the lens to minute parts is done by the Laser thereby reducing the Phaco energy and time making it safer and less traumatic for the eye.

What are the steps in Femtocataract surgery procedure?

After pupillary dilatation and topical anesthesia the applanation (flattening of the cornea) with disposable patient interface cone is done.

  • Real time OCT (Optical coherence tomography) along with high resolution video microscope captures images of the anterior segment of your eye which are further analysed.
  • Every step is planned and customized according to your eye requirement to enhance vision. After mapping and marking of the size, shape and location of the incisions and surgery is completed with the removal of the capsulorhexis flap, the lens fragmentation and cortical clean up.
  • Finally the IOL is implanted.

WHY Femtocataract surgery?

  • Less complications- In comparison with phacoemulsification certain risks of injury to the capsule, iris, and cornea.
  • Laser Precision and Accuracy
  • Decreased Phaco energy
  • Better refractive outcome– you can now experience functional visual improvement and spectacle independence
  • Safer surgery- The laser wavelength is not absorbed by the corneal tissue.
  • Moreover least risk of infections.
  • Perfect capsulotomy- Accurate capsulotomies improves the precision of intraocular lenses (IOL)
  • Helps to treat astigmatism, complex cataract cases, dense lenses etc.

The challenges

  • May not be suitable to every patient.
  • Cost and Infrastructure- The challenge of a huge financial investment both in initial cost and maintenance costs for the surgeon and procedure cost for the patient.
  • Medical insurance – not covered by insurance.

Laser Systems used in Femtosecond cataract surgery

          • VisuMax from Zeiss
          • LenSx from Alcon
          • Catalys from Optimedica
          • LensAR fom LensAR
          • Technolas

Other systems (Femto LDV Z6 –FDA cleared, Centurion newly released)

Femtocataract surgery is being adopted worldwide successfully nevertheless the technology is relatively new compared with conventional phacoemulsification cataract surgery. It has been used in complicated cataract cases too. The outcome on a large scale human trials and studies would need more time to justify.

Your eye is precious.

No doubt the best treatment suggested for you will be the one which you are best suited and which will optimise the best overall outcome.

The Cataract Incision

The Cataract Incision may seem to be a small word in the gamut of ophthalmic terminologies; nevertheless it has a major impact on the wound construction and visual acuity outcome.

After the eye is prepared for surgery, an incision (cut) is carefully made on the edge of the clear cornea. According to the type of surgery conducted the size of the incision varies. Today smaller incisions are possible without any stitches thereby enabling you to quick recovery, fast healing and less likely to get infected.

What are the major considerations in a cataract incision?

  • Location- One of the major factors affecting the degree of astigmatism is the distance of the incision from the center of the cornea, the size of the incision and its shape.
  • Size- Size refers to the area of the wound in terms of its length and width. Smaller the incision lesser the astigmatic effect.
  • Shape- Incisions are made in different shapes according to the favorable factors   e.g. curved, straight, frown, keyhole or chevron.
  • Architecture– Architecture is denoted by the number of incision planes. If the incision construction is not perfect it could lead to endophthalmitis. OCT (Optical coherence tomography) is an instrument used to examine the incision construction and architecture. Incisions in multiple planes ease self sealing thereby reducing the risk of infection.

Incision configuration and manipulation.

Corneal relaxing incisions (Limbal relaxing incisions): These are tiny incisions made on the cornea at precise location to reduce astigmatism.

Features for an ideal incision irrespective of the type of surgery.

  • Postoperative astigmatism – An ideal incision aims in achieving astigmatic ally neutral results.
  • Well balanced – The size and form of the incision gives the fluidic balance during the surgery.
  • Watertight – Watertight incisions avoid leakages and infections and aids faster healing.
  • Stability- The incision should be stable without causing any openings.

Surgeries versus incision size:

  • Standard extracapsular surgery incision size – usually 10-12 mm. has higher risk of infection and takes more healing time.
  • Manual small incision surgery incision size –Usually 5.5 mm to 7.0 mm. clear corneal incisions is one of techniques implemented.
  • Instrumental phacoemulsification incision size– Usually around 2.2 mm. Phase needle and probe is used for the incision.
  • Micro cataract surgery incision size– Usually 1.8mm
  • Femtosecond assisted Laser cataract surgery incision size– Usually 1 mm. In this surgery the flap is made by the laser and multiplanar incisions are repeatable.

The control over Fluidic balance, infection resistance and astigmatism are of paramount importance in any cataract incisions done.

The type of surgery opted and procedure details would be made clear to you prior to your cataract surgery. After a cataract surgery you would be advised to avoid rubbing, forceful blinking or any kind of pressure on the eyes to avoid any damage to the newly made incisions.

With advances in intraocular lens implant and progressive changes in the cataract incisions, you can now experience a painless surgery and obtain faster recovery after a cataract surgery.

How to Diagnose Cataract?

If you have symptoms that suggest a possibility of cataract, get it diagnosed immediately. Identifying the type of cataract helps doctors determine the most appropriate course of treatment. Details on eye movement, pupillary responses, eye pressure and pupils on dilation are recorded.

Your eye is not just a window to the world, but also a window to understand other health conditions. The main purpose of the diagnosis is to determine if vision deterioration is particularly due to cataract and not other eye diseases which have similar conditions. The right diagnosis helps in deciding if the eye is suitable for cataract surgery.

Steps in diagnosing cataracts

Comprehensive Eye Examination is conducted by both Optometrist and Ophthalmologist to determine the type, location and size of the cataract.

Examination by Optometrist

Detailed history and physical examination of the eyes – Review of your medical history helps in determining cataract. Do discuss the existing illness and medications. Ensure that you carry your existing spectacles and stop the use of your contact lens before the appointment.

  • Visual Acuity Test– The impairment in the vision can be easily detected by asking you to read an eye chart known as the Snellen eye chart. This is a chart with variation in the size of letters and is read from various distances usually 20 feet. Each eye is tested individually. The normal visual acuity is taken at 20/20.
  • Refraction Test– If there is a reduction in visual acuity, a pinhole card is used to exclude short-sightedness as the cause of the vision loss. This determines the need for changes in your eyeglass or contact lens prescription.
  • Tonometry test for Glaucoma screening– This is a standard test to measure fluid pressure (Intra Ocular Pressure) inside the eye. This is commonly known as the ‘Puff Test’ as the new method does not need to ‘touch’ your eyes, but uses air to take measurements.
  • Pupil Dilation: This is a retinal examination where dilating drops are put in the eyes to enlarge the pupils. It is advisable to wear sunglasses after pupil dilation due to light sensitivity and blurred vision. Due to the dilated eyes, one is not allowed to self-drive after this check for your own safety.

Examination with Ophthalmologist

  • Slit Lamp examination for cornea: The structure in front of the eye is magnified using a microscope called the slit lamp. The front parts of your eye – the cornea, iris, lens and the spaces in between are illuminated using a slit lamp to investigate minute abnormalities.
  • Fundus Examination for retina: In the fundus examination the pupil is dilated which increases the size of your pupil. The observation on the vitreous, optic nerve, blood vessels, macula and retina is recorded. Here the retina is checked using an ophthalmoscope.

Treatment Plan

The above series of tests help in the management of the cataract progression. Tests like color perception, contrast sensitivity, and reaction to glare are conducted on case to case basis .The only effective treatment for cataracts is to have them surgically removed. In the treatment plan the further course of action is discussed like medications, pre – operative tests, blood tests, an ECG and chest X-ray. Diabetes, hypertension and heart conditions are also checked prior cataract surgery. The only cataract-specific test is the A-Scan. This determines the power of the artificial intra ocular lens which will need to be inserted in your eyes once the cataract affected natural lens is removed during surgery.

Cataract if left untreated, can cause blindness.

Ensure you get the right diagnosis at the right time.

What are the Signs and Symptoms of a Cataract?

Having an eye for the types of cataract and its various symptoms helps you to identify cataract early and save your vision.

Why identification of symptoms is important?

Symptoms could be unnoticeable in the initial stage. It could also be the cause for other eye diseases. In the initial stages cataract may affect only a small portion of the eye lens. The signs and symptoms get noticeable to a patient after the cataract has grown to some extent. With advances in technology in ophthalmology it is possible to detect and treat at a very early stage.

Let’s delve into the common types of cataract.

Age related cataract is most commonly found type of cataract caused mainly due to aging. Symptoms vary according to the location of the cataract in the eye.

The types of age-related cataract:

  • Nuclear sclerosis: Cataract forming at the center of the lens. This cataract is formed by new layers of fiber (added with aging) compressing the nucleus of the lens. Reduction of vision is a symptom noticed in this type of cataract.
  • Cortical: Cataract forming at the edges of the lens. New fibers are added to the outside of the lens which age and produce cortical spokes. These may not produce symptoms unless on the visual axis or the entire cortex is affected when mature.
  • Posterior subcapsular: Cataract forming back of the lens. Opacities in the central posterior cortex. This may occur in younger patients. Glare is a symptom noticed in this type of cataract.

Secondary cataract– It formed after surgery for other eye problems e.g. glaucoma.

Cataracts also can develop in people who have other health problems such as diabetes. Cataracts are sometimes linked to steroid use.

Traumatic cataract– Developed after an eye injury, sometimes years later.

Congenital cataract– Some babies are born with cataracts or develop them in childhood in both eyes.

Radiation cataract– a cataract caused by excessive or prolonged exposure to ultraviolet rays, x-rays, radium, gamma rays, heat, or radioactive isotopes.

Depending on the type and extent of the cataract, patients may experience the following symptoms.

  • Visible cloudiness in the pupil in the eye.
  • Painless gradual loss of vision.
  • Cloudy or blurred vision.
  • Double vision (diplopic) in one eye – Seeing two images instead of one image.
  • Halos – Circle of light around bright lights, automobile headlights etc.
  • Frequent prescription changes for glasses or contact lens.
  • Fading or yellowing of colour
  • Second sight – a phenomenon where one’s reading vision improves as a result of the increased nearsightedness from swelling of the cataract.
  • Unable to differentiate between certain colors e.g. Blue and purple.
  • Poor Night Vision.

A regular eye check up aids in early detection – a critical aspect in preserving your sight.

In case you experience any of these signs and symptoms, No need wait and resign yourself to increasingly poor vision.

Visit an ophthalmologist for a complete eye examination, diagnosis and treatment.

Your vision is precious. We care.

Dislocated Intraocular Lenses

During a cataract surgery an intra ocular [artificial lens] is placed in the capsule of the natural lens of the eye, after the cataract affected lens is removed. The capsule supports or holds the artificial lens and prevents dislocation. However, sometimes the lens gets dislocated from its original position to another position. This is known as dislocation of the IOL [intra ocular lens].

This is one of the major, but uncommon intra operative or post operative complication after a cataract surgery or an Nd YAG posterior capsulotomy. Dislocation of the intraocular lenses may occur due to trauma during surgery or with systemic diseases where the capsular support weakens.

IOL dislocations are categorised as ‘in-the- bag’ and ‘out- of- the- bag’. The most common in-the-bag etiologies are pseudoexfoliation [deposition of whitish-grey protein material on the lens surface] and prior vitreoretinal surgery. IOL dislocation could either be early if it’s within three months of cataract surgery or late if it’s beyond three months of cataract surgery. Dislocation of IOL has estimated occurrence in 0.2% to 3% of cases.

Signs and Symptoms

This depends on the degree of malfunction. The patient may notice the edge of the lens implant or even have double vision. If the lens implant dislocates entirely out of the visual axis, the patient may have a very substantial drop in visual acuity, usually to the “counting fingers” level.

Dislocated intraocular lenses

 

Degree of malfunction:

  • Mild (where the optic covers more than half of the pupillary space)
  • Moderate (where the optic covers less than half of the pupillary space)
  • Subluxated
  • Luxated (completely dislocated)

Symptoms:

  • Streaks of light.
  • Sudden blurry vision.
  • Decrease in vision.
  • Edge glare.
  • Diplopic (double vision).
  • Induced astigmatism.

Causes:

  • Pseudo exfoliation
  • Prior vitreoretinal surgery
  • Trauma – Rubbing the eyes hard after cataract surgery can cause dislocation
  • Increased Axial length
  • Associated with syndromes such as Marfan’s syndrome

Diagnosis:  A dilated slit-lamp examination is conducted along with other tests. One of the challenges which surgeons face is the movement of the bag – IOL as the location may changes according to your resting or sitting position during the examination.

Treatment: Usually treatment is surgical.

Dislocated IOL is treated by moving the lens into the correct position, or replacing the lens. In most cases the gel in the back of the eye, or vitreous, must be removed in part through the surgical process called “vitrectomy”. Once the lens is free of the vitreous gel it can be moved more safely and repositioned or replaced. In some cases a new lens can also be sewn into the back of the eye.

Hence, the treatment differs on a case to case basis.

Vitrectomy: This surgical procedure is conducted to remove the vitreous gel from the central cavity of the eye. The various approaches are Anterior vitrectomy (anterior approach to fixate the implant when the lens is   subluxated but still stable within the anterior segment). In some cases the IOL is unstable or dislocated posterior into the vitreous cavity then IOL is retrieved through the posterior segment or a Pars plana Vitrectomy.

  • IOL Removal – IOL is removed based on certain factors like damaged  haptics, small optics, highly flexible haptics which does not support sutures, eyes with a poor visual prognosis, associated complicated retinal pathology such as retinal detachment, or damaged IOLs.
  • IOL Repositioning – IOL is surgically rotated and repositioned and fixed in the right place..
  • IOL exchange – Wrong IOL power and malposition is the main indication for the IOL exchange.

Depending on your type of IOL and specific anatomic considerations, you would be suggested on the type of treatment most suitable. The existing symptoms, visual needs, and expectations are considered before finalizing the treatment. We endeavour to give you the best treatment with minimal risk and long term visual outcome.