Cataract Surgery

Cataract is clouding of normal clear crystalline lens of the eye. It leads to decrease
or loss of functional vision . It can be compared to a window that is frosted. The
amount and pattern of cloudiness can vary within the lens.
Cataract formation is not associated with "signals" such as pain, redness or tearing.
The common symptoms are:
Blurring or dimness of vision
Feeling of a film over the eyes
Sensitivity to light and glare
Change in colour of pupil
Double vision & dulling of colour sense
How is Phacoemulsification surgery done?
Cataract surgery is performed on an outpatient basis, and usually requires just a few
hours of your time from start to finish. Your eye will be treated with anesthetic prior to
the procedure so you'll feel little, if any, discomfort. First, a tiny incision will be made
in the eye allowing your surgeon to use a small instrument (about the size of a pen
tip) to break up or wash away the cloudy cataract. Once the cataract is removed, and
the IOL will be inserted through the same tiny incision and set into its permanent
position.
Phacoemulsification with intraocular lens implantation is the latest technique
available for cataract surgery. almost all the cases are done by this method at our
center.
The ophthalmic surgeon decides whether the patient can undergo phaco or not.
Advantages of Phaco
Early surgery can be done, so that patient need not wait for the cataract to mature
Small Incision
No sutures and no need of suture removal.
No irritation, no watering
Early return to work
No need to continue drops for a long time
No need for hospital stay, Even if the patient stays, it is only for a short time
Stable refraction after one month
Why at our center?
We have one of the latest phaco machines SOVEREIGN COMPACTCOLD
PHACO. Normally heat is generated during phaco surgery due to ultrasonic waves
which causes microscopic damage to the surrounding structures of the eyeball.This
is prevented by cold phaco method.

No injection
No stitch
State of art equipments
Carl zeiss microscope
Keratometer

No pain
No admission
Sovereign Compact cold phaco
Quentel medical (axis ll)A scan
Nd Yag laser

To give you a crystal clear vision we use following IOL'S

PMMA
FOLDABLE
Acrylic (Hydrophilic, Hydrophobic)
Aspheric : Can Correct only Far Vision, but you will have to wear glasses for near
work
Blue Filter
Toric
Is phacoemulsification safe?
In the hands of a good surgeon phacoemulsifiaction is extremely safe due to these
advantages:
Small self sealing incision (3mm): Sutures are not needed due to the very small
incision. This reduces the risk of astigmatism and foreign body sensation after
surgery.
Topical Anesthesia: Anesthetic eyedrops is all what is required. No need for
injections or general anesthesia.
Immediate recovery: No admissions to the clinic or bandages are needed. The
patient may restart daily activities immediate
Just as any other surgical procedure, phacoemulsification has risks. One out of a
hundred persons operated on with this technique has some sort of complication. In
almost every case there is a solution to the problem. Severe complications are
extremely rare.
FAQ'S
Who will benefit from phacoemulsification?
Most people suffering from cataracts will benefit from this procedure. Best results are
obtained in persons with early cataracts. It is preferable not to wait until the cataract
is ripe and vision is excessively low since the cataract will be too hard for the
phacoemulsifier. Surgery is indicated as soon as vision is not adequate for daily
activities.
Do I have to undergo any investigations before surgery?
Your ophthalmologist will make sure there are no associated pathologies, which can
interfere with the prognosis, by making an extensive examination of your eyes
including pupil dilatation. A measurement of your eye's length and corneal curvature
is crucial for calculating the power of the intraocular lens to be implanted.Systemic
examination includes tests like blood sugar ,blood pressure examination, ECG etc.
What should I do during surgery?
During surgery you will be lying on the operating bed. The operating microscope will
be in front of you and you will always see the microscope's bright light. Your face will
be covered with sterile drapes. You should never touch these drapes. A small device
will hold your lids open. During the procedure you should keep your eye as still as
possible. Usually looking at the operating microscope's light is a good reference

point. You will feel the hands of the surgeon on your forehead and the sound of the
phacoemulsifier, similar to that of a hair trimmer. You will occasionally feel cold water
over your eye that may even go down your cheek. This is the solution needed to
keep your eye properly hydrated.
Is phacoemulsification painful? How long does it take?
Phacoemulsification is performed under topical anesthesia (anesthetic eyedrops). No
injections or general anesthesia are required. The patient is awake during the
procedure feeling no pain at all. Phacoemulsification takes about 15 minutes per
eye. Once finished, you will go home without need for hospitalization.
What care should i take after surgery?p
Do not rub the operated eye
Do not sleep on the operated side for3 to 4 days
Use dark glasses for first 15 days
Wash your hands thoroughly before application of drops
Avoid washing eyes with water for 10 days
Avoid head bath for 10 days
Avoid playing with small children
Avoid exposure to smoke, heat &dust
What results can I expect?
Over 90% of people achieve a vision better than 20/30 after phaco. If there is some
kind of a retinal pathology this could not be the case. Reading glasses are the rule
after cataract surgery.
Can a second procedure be necessary?
In some cases the capsule may opacify some time after surgery, compromising
vision. In these cases a central perforation in the capsule is required to restore
vision. This is called a capsulotomy and is achieved with a YAG laser. The
capsulotomy is performed as an outpatient procedure and produces no pain. No
anesthetic is necessary and rehabilitation is immediate.
Facts About Cataract
This information was developed by the National Eye Institute to help patients and
their families search for general information about cataracts. An eye care
professional who has examined the patient's eyes and is familiar with his or her
medical history is the best person to answer specific questions.
Cataract Defined
What is a cataract?
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are
related to aging. Cataracts are very common in older people. By age 80, more than
half of all Americans either have a cataract or have had cataract surgery.
A cataract can occur in either or both eyes. It cannot spread from one eye to the
other.

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina.
The retina is the light-sensitive tissue at the back of the eye.
In a normal eye, light passes through the transparent lens to the retina. Once it
reaches the retina, light is changed into nerve signals that are sent to the brain.
The lens must be clear for the retina to receive a sharp image. If the lens is cloudy
from a cataract, the image you see will be blurred.
Are there other types of cataract?
Yes. Although most cataracts are related to aging, there are other types of cataract:
Secondary cataract. Cataracts can form after surgery for other eye problems, such
as glaucoma. Cataracts also can develop in people who have other health problems,
such as diabetes. Cataracts are sometimes linked to steroid use.
Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
Congenital cataract. Some babies are born with cataracts or develop them in
childhood, often in both eyes. These cataracts may be so small that they do not
affect vision. If they do, the lenses may need to be removed.
Radiation cataract. Cataracts can develop after exposure to some types of radiation.
Causes and Risk Factors
What causes cataracts?
The lens lies behind the iris and the pupil. It works much like a camera lens. It
focuses light onto the retina at the back of the eye, where an image is recorded. The
lens also adjusts the eye's focus, letting us see things clearly both up close and far
away. The lens is made of mostly water and protein. The protein is arranged in a
precise way that keeps the lens clear and lets light pass through it.
But as we age, some of the protein may clump together and start to cloud a small
area of the lens. This is a cataract. Over time, the cataract may grow larger and
cloud more of the lens, making it harder to see.
Researchers suspect that there are several causes of cataract, such as smoking and
diabetes. Or, it may be that the protein in the lens just changes from the wear and
tear it takes over the years.
How can cataracts affect my vision?
Age-related cataracts can affect your vision in two ways:
Clumps of protein reduce the sharpness of the image reaching the retina.
The lens consists mostly of water and protein. When the protein clumps up, it clouds
the lens and reduces the light that reaches the retina. The clouding may become
severe enough to cause blurred vision. Most age-related cataracts develop from
protein clumpings.
When a cataract is small, the cloudiness affects only a small part of the lens. You
may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision
gets worse gradually. Over time, the cloudy area in the lens may get larger, and the

cataract may increase in size. Seeing may become more difficult. Your vision may
get duller or blurrier.
The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint
to vision.
As the clear lens slowly colors with age, your vision gradually may acquire a
brownish shade. At first, the amount of tinting may be small and may not cause a
vision problem. Over time, increased tinting may make it more difficult to read and
perform other routine activities. This gradual change in the amount of tinting does not
affect the sharpness of the image transmitted to the retina.
If you have advanced lens discoloration, you may not be able to identify blues and
purples. You may be wearing what you believe to be a pair of black socks, only to
find out from friends that you are wearing purple socks.
When are you most likely to have a cataract?
The term "age-related" is a little misleading. You don't have to be a senior citizen to
get this type of cataract. In fact, people can have an age-related cataract in their 40s
and 50s. But during middle age, most cataracts are small and do not affect vision. It
is after age 60 that most cataracts steal vision.
Who is at risk for cataract?
The risk of cataract increases as you get older. Other risk factors for cataract include:
Certain diseases such as diabetes.
Personal behavior such as smoking and alcohol use.
The environment such as prolonged exposure to sunlight.
What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to
delay cataract. If you smoke, stop. Researchers also believe good nutrition can help
reduce the risk of age-related cataract. They recommend eating green leafy
vegetables, fruit, and other foods with antioxidants.
If you are age 60 or older, you should have a comprehensive dilated eye exam at
least once every two years. In addition to cataract, your eye care professional can
check for signs of age-related macular degeneration, glaucoma, and other vision
disorders. Early treatment for many eye diseases may save your sight.
Symptoms and Detection
What are the symptoms of a cataract?
The most common symptoms of a cataract are:
Cloudy or blurry vision.
Colors seem faded.
Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear
around lights.
Poor night vision.
Double vision or multiple images in one eye. (This symptom may clear as the
cataract gets larger.)
Frequent prescription changes in your eyeglasses or contact lenses.
These symptoms also can be a sign of other eye problems. If you have any of these
symptoms, check with your eye care professional.

How is a cataract detected?

Cataract is detected through a comprehensive eye exam that includes:
Visual acuity test. This eye chart test measures how well you see at various
distances.
Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your
eye care professional uses a special magnifying lens to examine your retina and
optic nerve for signs of damage and other eye problems. After the exam, your closeup vision may remain blurred for several hours.
Tonometry. An instrument measures the pressure inside the eye. Numbing drops
may be applied to your eye for this test.
Your eye care professional also may do other tests to learn more about the structure
and health of your eye.
Treatment
How is a cataract treated?
The symptoms of early cataract may be improved with new eyeglasses, brighter
lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help,
surgery is the only effective treatment. Surgery involves removing the cloudy lens
and replacing it with an artificial lens.
A cataract needs to be removed only when vision loss interferes with your everyday
activities, such as driving, reading, or watching TV. You and your eye care
professional can make this decision together. Once you understand the benefits and
risks of surgery, you can make an informed decision about whether cataract surgery
is right for you. In most cases, delaying cataract surgery will not cause long-term
damage to your eye or make the surgery more difficult. You do not have to rush into
surgery.
Sometimes a cataract should be removed even if it does not cause problems with
your vision. For example, a cataract should be removed if it prevents examination or
treatment of another eye problem, such as age-related macular degeneration or
diabetic retinopathy. If your eye care professional finds a cataract, you may not need
cataract surgery for several years. In fact, you might never need cataract surgery. By
having your vision tested regularly, you and your eye care professional can discuss if
and when you might need treatment.
If you choose surgery, your eye care professional may refer you to a specialist to
remove the cataract.
If you have cataracts in both eyes that require surgery, the surgery will be performed
on each eye at separate times, usually four to eight weeks apart.
Many people who need cataract surgery also have other eye conditions, such as
age-related macular degeneration or glaucoma. If you have other eye conditions in
addition to cataract, talk with your doctor. Learn about the risks, benefits,
alternatives, and expected results of cataract surgery.
What are the different types of cataract surgery?

There are two types of cataract surgery. Your doctor can explain the differences and
help determine which is better for you:
Phacoemulsification, or phaco. A small incision is made on the side of the cornea,
the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a
tiny probe into the eye. This device emits ultrasound waves that soften and break up
the lens so that it can be removed by suction. Most cataract surgery today is done by
phacoemulsification, also called "small incision cataract surgery."
Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea
and removes the cloudy core of the lens in one piece. The rest of the lens is
removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens,
called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care
and becomes a permanent part of your eye. Light is focused clearly by the IOL onto
the retina, improving your vision. You will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye disease or have
problems during surgery. For these patients, a soft contact lens, or glasses that
provide high magnification, may be suggested.
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as infection and bleeding.
Before cataract surgery, your doctor may ask you to temporarily stop taking certain
medications that increase the risk of bleeding during surgery. After surgery, you must
keep your eye clean, wash your hands before touching your eye, and use the
prescribed medications to help minimize the risk of infection. Serious infection can
result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye
disorders, such as high myopia (nearsightedness), can further increase your risk of
retinal detachment after cataract surgery. One sign of a retinal detachment is a
sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that
seem to float about in your field of vision. If you notice a sudden increase in floaters
or flashes, see an eye care professional immediately. A retinal detachment is a
medical emergency. If necessary, go to an emergency service or hospital. Your eye
must be examined by an eye surgeon as soon as possible. A retinal detachment
causes no pain. Early treatment for retinal detachment often can prevent permanent
loss of vision. The sooner you get treatment, the more likely you will regain good
vision. Even if you are treated promptly, some vision may be lost.
Talk to your eye care professional about these risks. Make sure cataract surgery is
right for you.
Is cataract surgery effective?
Cataract removal is one of the most common operations performed in the United
States. It also is one of the safest and most effective types of surgery. In about 90
percent of cases, people who have cataract surgery have better vision afterward.

What happens before surgery?

A week or two before surgery, your doctor will do some tests. These tests may
include measuring the curve of the cornea and the size and shape of your eye. This
information helps your doctor choose the right type of IOL.
You may be asked not to eat or drink anything 12 hours before your surgery.
What happens during surgery?
At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The
area around your eye will be washed and cleansed.
The operation usually lasts less than one hour and is almost painless. Many people
choose to stay awake during surgery. Others may need to be put to sleep for a short
time.
If you are awake, you will have an anesthetic to numb the nerves in and around your
eye.
After the operation, a patch may be placed over your eye. You will rest for a while.
Your medical team will watch for any problems, such as bleeding. Most people who
have cataract surgery can go home the same day. You will need someone to drive
you home.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is
also common. Your eye may be sensitive to light and touch. If you have discomfort,
your doctor can suggest treatment. After one or two days, moderate discomfort
should disappear.
For a few days after surgery, your doctor may ask you to use eyedrops to help
healing and decrease the risk of infection. Ask your doctor about how to use your
eyedrops, how often to use them, and what effects they can have. You will need to
wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing
on your eye.
When you are home, try not to bend from the waist to pick up objects on the floor. Do
not lift any heavy objects. You can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule
exams to check on your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can occur. These problems can include
infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double
vision, and high or low eye pressure. With prompt medical attention, these problems
can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your
vision. This condition is called an after-cataract. An after-cataract can develop
months or years after cataract surgery.

An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole
in the eye tissue behind the lens to let light pass through. This outpatient procedure
is called a YAG laser capsulotomy. It is painless and rarely results in increased eye
pressure or other eye problems. As a precaution, your doctor may give you eyedrops
to lower your eye pressure before or after the procedure.
When will my vision be normal again?
You can return quickly to many everyday activities, 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. Ask your doctor when you can resume
driving.
If you received an IOL, you may notice that colors are very bright. The IOL is clear,
unlike your natural lens that may have had a yellowish/brownish tint. Within a few
months after receiving an IOL, you will become used to improved color vision. Also,
when your eye heals, you may need new glasses or contact lenses.
What can I do if I already have lost some vision from cataract?
If you have lost some sight from cataract or cataract surgery, ask your eye care
professional about low vision services and devices that may help you make the most
of your remaining vision. Ask for a referral to a specialist in low vision. Many
community organizations and agencies offer information about low vision counseling,
training, and other special services for people with visual impairments. A nearby
school of medicine or optometry may provide low vision services.