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Human eye has a natural lens which is normally transparent and forms a clear image of the outside world in the eye. When this lens develops haziness /opacity,  the sight is decreased or may be completely lost - this is called cataract.

When the lens is partially opaque, it is called an immature cataract and some light can pass through it to help perform some routine functions. However, when the opacity increases to engulf the entire lens, vision is totally cut off and the cataract is mature.

Cataract (safed motia bind )may develop at any age - right from birth to old age - but is most commonly seen in the old after the age of 60 years. By the age of 90 years almost 98 % of people have had some degree of cataract motia bind problem.

Cataract seen in the old age may be caused by normal aging process but seen at younger age is caused by many disease processes e.g. some eye diseases like uveitis , general diseases like diabetes, heredity, injury, radiation, infections and many more.

The most important symptom of cataract (motia bind) is a decrease in vision for distance & /or near objects. Other features are decreased vision in bright or low light, decreased contrast, altered color appreciation, seeing many images of one object (typical history of seeing more than one moons at night), rapid changes in the number / power of glasses, or sometimes pain, redness and watering. In advanced cases there is complete loss of vision and pupil becomes pearly white in color. However, none of these symptoms are seen exclusively in cataract.

The first thing a person must do on experiencing any of these symptoms is to consult an Cataract Eye Surgeon (Ophthalmologist) for a thorough eye examination. Dr. Pooja Mehta is one of the best cataract Surgeon in Delhi

Answers to the following questions should be sought:

  • Do I have cataract (motia bind) ?
  • Do I have any other eye disease?
  • What is the cause of cataract in my eye?
  • What are the treatment modalities available?
  • What treatment would be most suitable for me?
  • What is the expected outcome of the surgery in my case?
  • What are the risks involved and possible complications?
  • How long can I wait before I get operated?
  • What does the surgery involve in terms of time and expenditure?
  • What are the different techniques available & their merits?

What are the different types of lenses available & the merits of each?
Once it is decided that the patient has cataract the treatment is essentially surgical and the only question that arises is when? The decision is patient's - whenever the patient feels his vision has decreased to a level where it interferes with his routine daily activities he can get operated (no longer is it required for the cataract to become mature). However, in certain cases where there are associated complications or potential risks of complications an early (even urgent) operation may be required - here the advice of consulting eye surgeon should be followed.


Cataract Surgery

The cataract operations done as per the following (the list includes only established standard procedures):

Phacoemulsification / MICS with Foldable Lens (Intraocular Lens - IOL)

Small Incision Cataract Surgery (SICS) with Foldable Intraocular Lens (IOL) Implantation.

Conventional surgery is virtually obsolete (but has to done in select cases)



In Phacoemulsification a very small incision (3 mm or less) is made into the clear part of the eye (Cornea) and the hard core (nucleus) of the lens is converted in to a soft pulp using high frequency sound waves (NOT Laser) and sucked out. Then a foldable lens (IOL) is injected through the small incision and positioned into capsular bag. The main advantages of this operation are early rehabilitation and decreased occurrence of astigmatism (cylindrical power in glasses) & other complications. Non-foldable IOLs are not recommended as they necessitate enlarging the incision and thereby sacrificing the advantages of the small incision.

All these operations can be done under topical anesthesia (or eye drop anesthesia) which makes the eye numb/senseless, and the patient although conscious does not feel any pain. This removes the phobia of undereye injection (but rarely one does need to use injection anesthesia). The general anesthesia, which has its own risks, is used only in children and uncooperative patients. Topical or eye drops anesthesia is the preferred method as not only the painful injections and the eye bandage are avoided but it also reduces the risk associated with injection anesthesia (e.g., retro-bulbar hemorrhage, globe perforations, etc.)


Microincision Cataract Surgery/Operation (MICS)

MICS (Microincision Cataract Surgery) is just a variation of Phacoemulsification. Here using thinner phacoemulsification tips, the surgery is performed through narrower incision (about 2 mm). It offers only minimal advantage over standard phacoemulsification by causing slightly lesser surgical induced astigmatism. However, the IOLs implanted through such small incisions are still very new and the experience with them is very limited.

Lasers are not used to remove cataract (although some patients mistakenly use the term Laser for Phacoemulsification).

Is this technique more expensive than conventional stitch technique?
Hi-tech expensive equipment and special foldable lens are required to execute a good surgery, making it a little more expensive than the conventional technique.
Can an immature cataract be operated by Phaco surgery?
It is easier and safer to operate on an immature cataract by Phaco surgery. As the cataract matures, it tends to become harder requiring more Phaco energy to do the same job. Beyond a certain limit, excess energy may cause harm to the eye.
If one eye has had a conventional cataract surgery with IOL, can Phaco be done in the other eye?


Small Incision Cataract Surgery (SICS)

SICS (Small Incision Cataract Surgery) has virtually replaced the conventional cataract surgery for difficult situations. Here although the incision made is larger (5-6 mm) and the nucleus is removed using fluid pressure, yet no stitches are required and the recovery is much faster and more comfortable than the conventional surgery.


Intraocular Lenses (IOLs)

Intra-ocular Lenses (IOL) are small, made of a soft polymer (Acrylic) and are implanted inside the eye in place of natural lens.

Foldable IOLS: Made of either Silicon or Soft Acrylic. On folding, its diameter is reduced to 2.75 mm and it can be introduced into the eye through a 3 mm incision, where it unfolds automatically to take its position. The main advantage of this lens is that there is fast visual recovery in the patient.

Non-foldable Lens: This lens has a diameter of 5.5 mm. A 3 mm incision has to be enlarged to 5.5 mm to introduce this lens. However, the incision still remains self-sealing and requires no sutures in most of the cases.

Aberration Free Foldable Lens: This lens is like a foldable lens in all ways, except that it’s an aspheric lens. It reduces glare in the patient and is very useful for the patients who would like to drive at night.

Multifocal Lens: This is also a type of foldable lens which has distance as well as the near power in it. After its implantation, patients will become much less dependent on glasses for near as well as distance. However, if you have cylindrical power in your glasses, you may need corrective lenses for fine work.

The greatest advantage of IOL is a clear wide field of vision and the fact that the patient does not have to constantly wear thick glasses. Since the IOL stays in the eye lifelong therefore there should not be any compromise on the quality of the IOL. Multifocal IOLs offer the advantage clear distant and near vision and, thus, lesser dependence on glasses but suffer the disadvantage of lower contrast, lower color saturation and a subjective compromise in image quality. But both eyes have to be operated within short interval of 2-6 weeks and it takes about 4-8 weeks for complete adaptation to new visual status.

To conclude, the surgeon, the surgical technique and the quality of the IOL are not the only factors that decide the result of cataract surgery; but also the condition of the eye otherwise, the cornea, the retina and the presence of systemic diseases like diabetes, hypertension, asthma, infections, etc. Moreover, the quality of the operation theatres, the ancillary and the backup facilities, the training of the support staff, etc. also have a significant influence on the success of the surgery. Ensuring good quality in all these areas leads to increase in the surgical cost for the patient, but it must be understood that our eyes are worth a lot more...



What is the lens of the eye?
The lens is the part of the eye that along with cornea helps focus light onto the retina. The retina is the light-sensitive layer of the eye that sends visual signals to the brain. The lens is located just behind the iris (the colored part of the eye). In focusing (accommodation), the lens changes shape. It becomes more convex (curved) when you look at nearby objects and flatter for distant objects.
What is a cataract (motia bind / safed motia)?
The lens is made mostly of water and protein. The protein is such arranged to let light pass through and focus on the retina. Sometimes some of the protein clumps together and starts to cloud a small area of the lens. This is a cataract (motia bind / safed motia). Over time, the cataract may grow larger and cloud more of the lens, making it hard to see.

Aging and exposure to ultra-violet light have definite role in the formation of cataract.
What are the symptoms?
The most common symptoms of a cataract are:

Cloudy or blurred vision.
Problems with light, such as headlights that seem too bright at night, glare from lamps or the sun, or a halo or haze around lights.

Colors seem faded
Double or multiple vision(typical history of seeing more than one moons at night).
This symptom goes away as the cataract advances.

Frequent changes in power of spectacles or contact lenses.
These symptoms can also be a sign of other eye problems. In the event of any of these symptoms please consult an eye surgeon.

In early cataract one may not notice any changes in vision. Cataracts tend to grow slowly, so vision gradually worsens. Some people with a cataract find that their near vision suddenly improves (phenomenon of second-sight), but this is temporary. Vision is likely to get worse again as the cataract grows.
What are the different types of cataract?
Age-related cataract: Most cataracts are related to aging.

Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.

Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.

Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.
How is a cataract diagnosed?
A comprehensive eye examination usually includes:

Visual acuity test: This eye chart test measures how well you see at various distances.
Pupil dilation: The pupil is widened with eye-drops to allow us to see more of the retina and look for other eye problems.

Tonometry: This is a standard test to measure eye pressure. Increased pressure may cause glaucoma.

Ultrasound (Biometry) of the eye to calculate the power of the lens to be implanted.
Other eye and general test may be required to establish complete diagnosis and fitness for cataract surgery.

Cataract removal is one of the most common operations performed in India today. It is also one of the safest and most effective. More than 90 percent of people who have cataract surgery have better vision afterward.
What is the preparation before surgery?
Before surgery, some tests are performed including tests to measure the curvature and the length of the eye ball by a special Ultrasound machine. This helps in calculating the power of the IOL to be implanted - A Scan/Biometry.

Some other tests e.g., blood, urine, ECG, etc may have to be performed to establish general fitness of the patient.
What happens after surgery?
Most people who have cataract surgery come to the hospital in the morning and can go home the same day. It's normal to feel itching, sticky eyelids, and mild discomfort for a while after cataract surgery. Some fluid discharge is also common. In most cases, reasonable amount of healing will take in about 4 weeks.

Mild pain, irritation, redness and watering are of common occurrence after cataract surgery but subside in a few days. Problems after surgery are uncommon, but they can occur. These can include infection (in severe cases endophthalmitis), bleeding, higher pressure inside the eye (glaucoma), inflammation (pain, redness and swelling), haziness of the cornea and detachment of the retina. Any problem occurring should be immediately reported to the eye surgeon especially in the event of unusual pain, loss of vision, or flashing lights(but these complications are very uncommon in experienced hands).
When does the vision become normal?
After the surgery, you can read and watch TV almost right away, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. This healing period may take up to 4-6 weeks.

Though the best vision may not be obtained until several weeks following surgery, but individual results vary considerably, depending on many variables. Activities such as reading, watching television, and light work will not hurt the operated eye.

 With an IOL, for example, you may notice that colors have a blue tinge, and that after you've been in bright sunlight, everything is reddish for a few hours. It doesn't take long to adjust to these changes.  

Most surgeons arbitrarily recommend waiting 4 to 6 weeks before new glasses are prescribed. This allows the eye to achieve considerable stability from a refractive standpoint and, therefore, the glasses prescription should be accurate and relatively stable.

Many patients are surprised at how clear their vision is after cataract surgery. Some patients may have better vision than they ever did before cataract surgery. Furthermore, depending on the degree of refractive error (need for glasses) prior to surgery, many patients will be much less dependent on glasses for far vision than they were before surgery. Patients will often notice that colors are brighter and more brilliant.
What is an "after-cataract"?
Sometimes people after cataract surgery develop an opacification of the lens capsule called after-cataract. This can easily be treated by a Laser called YAG Laser which makes a small opening in the capsule - YAG Capsulotomy.
What are the preventive measures for cataract?
Regular eye examinations after the age of 50 years are mandatory to detect eye diseases early and to institute timely treatment. Exposure to UV rays in sun light especially in tropical countries predisposes to early development of cataract, therefore, prevention of exposure to UV rays by regular use of UV protective sun glasses may confer certain degree of protection. However, this conjecture is not supported by any research or studies.

There are no medicines to treat cataract. The answer lies only in surgery where the cataract is removed and replaced by an intra-ocular lens.
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Dr. Pooja Mehta