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Aging, injury or diabetes, changes the tissue that makes up the eye’s lens. Proteins and fibers in the lens begin to break down, causing our eye-sight to become hazy or cloudy.
Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens which remains a permanent part of your eyes. Cataract might interfere with diagnosis and treatment of other eye disorders.
Diagnosis
To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:
Visual acuity test. A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. The decrease in visual acquity is the commonest complaint a cataract patient will present with.
Slit-lamp examination A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. This helps doctor to identify the type of cataract and associated abnormalities of lens apparatus and plan your surgery accordingly.
Retinal exam To prepare for a retinal exam, your eye doctor puts drops in your eyes to open your pupils wide (dilate). This makes it easier to examine the back of your eyes (retina). Using a slit lamp and 90D lens or a special device called an ophthalmoscope, your eye doctor can examine your retina to assess the expected visual outcome after cataract surgery.
Applanation tonometry / NCT This test measures fluid pressure in your eye. There are multiple different devices available to do this. High pressure might indicate at times to postpone one’s cataract surgery
Procedure
Cataract surgery is generally done on an outpatient basis, which means you won’t need to stay in a hospital after the surgery. During cataract surgery, your eye doctor uses a local anesthetic to numb the area around your eye, but you usually stay awake during the procedure and can communicate freely with the doctor during surgery.
These days all cataract procedures are done by phacoemulsification (MICS) only unless indicated otherwise. A small keyhole incision of 2.2 mm is given through which your cataractous lens can be dissolved by ultrasonic vibrations and foldable IOL of your choice can be implanted through same incision.
Cataract surgery is generally safe, but like any other procedure in body it carries a small risk of infection. It may also increase the risk of retinal detachment in some patients.
After the procedure you might feel some discomfort/foreign body sensation or redness, which is quite normal for few days. After surgery and you will have a clear eye-sight from next day of surgery
If both eyes have cataract, the second eye must be planned for surgery after 3 days of first ,unless contraindicated.
Choose the right Intraocular lenses
These days with advent of newer lenses and machines the treatment is tailored to one’s specific needs and eye details. It’s not one shoe fits all type, that used to be the norm earlier. IOL Master machine calculates certain parameters of your eye and helps doctor to decide which type of lens would be most suitable to your eyes taking into account your specific requirements.
Monofocal IOLs
With monofocal lens implant, the distant eye-sight is clear having said that the patient shall need glasses for their near eye-sight.
Multi-focal IOLs
Will give you good vision for near and far but intermediate vision may not be as clear as expected.
Tri-focal IOLs
This is a preferred IOL chosen by patients as they are able to see clearly at all distances. You may feel light glare during night driving. Minimal usage of glasses.
Toric IOLs
Patients with high astigmatism may require these IOLs to minimize dependence on glasses. To be used under doctor’s supervision.
EDOF IOLs
These IOLs are very popular these days as they give good intermediate and distance vision with decent near vision and no/minimum glare during night driving!
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Preparing for Cataract Appointment
What you can do?
- List any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of all medications, vitamins or supplements that you’re taking.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- List questions to ask your doctor.
Questions you should not miss are as follows:
- Are cataracts causing my vision problems?
- What kinds of tests do I need?
- Will cataract surgery correct my vision problems?
- What are the potential risks of cataract surgery? Are there risks in delaying surgery?
- What will cataract surgery cost, and will my insurance cover it?
- How much time will I need to recover from cataract surgery?
- Will any usual activities be restricted after cataract surgery? For how long?
- After cataract surgery, how long should I wait before getting new glasses?
- If I don’t want surgery right now, what else can I do to cope with my vision changes?
- How will I know if my cataracts are getting worse?
- I have these other health conditions. How can I best manage these conditions together?
- In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions at any time that you don’t understand something.
What to expect from the doctor?
Your doctor would be interested in almost all activities that you do. Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- When did you begin experiencing symptoms?
- Do you have your symptoms all the time or do they come and go?
- Do you experience vision problems in bright light?
- Have your symptoms gotten worse?
- Do your vision problems make it difficult for you to drive?
- Do your vision problems make it difficult to read?
- Do your vision problems make it difficult to do your job? Including Previous refractive procedures such as Rk or Lasik !
- Have you ever had an eye injury or eye surgery?
- Have you ever been diagnosed with an eye problem, such as inflammation of your iris (iritis)?
- Have you ever received radiation therapy to your head or neck?
- Any significant systemic disease such as diabetes/arthritis/htn/any history of cardiac episode, heart attack/brain stroke etc
This is just a partial list, doctors generally have a lot of follow-up questions. Please be ready!
Hiding information from the doctor may lead to unexpected consequences. Feel free to share any and everything with the doctor. The information provided is utilized for your benefit.