Cataract

What is cataract?

When this natural lens becomes opaque (ie loses transparency) it is known as cataract

When does one need to have cataract surgery?

Cataract surgery is advised when

  • There is loss of vision.
  • There is disturbing glare (difficulty in seeing in bright light) or haloes (seeing coloured rings around a light source).
  • The cataract has become too hard, although vision is normal, which is a common situation
  • Difficulty in treating other eye diseases, unless the cataract is removed.

 

What are the steps of cataract surgery?

Cataract surgery consists of two stages –

  • Cataract removal – Consists of removing the cataract.
  • Intraocular lens (IOL) implantation– Consists of placing the IOL inside the eye

What pre-operative investigations are required before surgery?

At Susrut, the following pre-operative investigations are advised

  • Biometry – To determine the power of intraocular lens (IOL).
  • Specular microscopy – To determine the health of the cornea.
  • Syringing – To check the patency of the passage between the eye and nose.
  • Corneal topography – To detect corneal aberrations if you are considering toric or multifocal IOLs.
  • OCT (optical coherence tomography) – To detect retina abnormalities in patients with suspected retinal problems.
  • USG – To detect structural (not functional) condition of retina in patients with very advanced cataracts.
  • RAM – to predict the vision after surgery (not possible for very advanced cataracts).
  • Blood pressure.
  • ECG.
  • Blood glucose (both fasting and post-prandial for diabetic patients).
  • Physician clearance – For patients with other health issues (heart disease, breathing trouble, etc).

 

Keratometry
 

 

Specular microscopy
 

 

Ultrasound biometry
 

 

OCT
 

 

Optical biometry
 

 

USG
 

 

RAM
 

What options do I have for cataract removal?

  • 1. Phacoemulsification – Here, the cataract is removed, with the help of ultrasound energy. Before liquefying and sucking the cataract, the steps done manually are (i) entering inside the eye, (ii) opening the anterior capsule (the front layer of the covering of the natural lens), and (iii) breaking the cataract.
  • 2. Femto-second laser assisted cataract surgery (FLACS) – Here, a laser (femtosecond laser) is used (i) to enter inside the eye, (ii) open the anterior capsule and (iii) divide the cataract (instead of doing these steps manually). Then the ultrasound machine, same as in phacoemulsification, is used to liquefy and suck out the cataract. FLACS adds to the accuracy and precision of the procedure.

 

Phacoemulsification in progress
 

 

FLACS (Femtosecond laser assisted cataract surgery)
 

What options do I have for IOL implantation??

There are multiple options for IOL –

  • 1. Monofocal IOL – This corrects distance vision (for those without cylindrical errors). Spectacles are needed for near (i.e reading) vision after surgery.
  • 2. Toric IOL – For patients with cylindrical errors, toric IOLs are required to correct distance vision. (Else, i.e with monofocal IOLs, cylindrical spectacles will be needed for distance correction after surgery). Even with toric IOLs, spectacles will be needed for near (reading) vision.
  • 3. Multifocal IOL – In addition to distance vision, this provides near (reading) and/or intermediate (computer/ mobile phone) vision. The types of mutifocal IOL, depending on the distance from the eye it provides vision, are –
  • (i) Bifocal – Corrects distance and near vision.
  • (ii) Trifocal – Corrects distance, intermediate and near vision.
  • (iii) Extended depth of focus – Corrects distance and intermediate vision
  • 4. Multifocal + Toric IOL– For patients with cylindrical errors and desiring distance, as well as near and/or intermediate vision, IOLs with both toric and multifocal properties are required.

Cataract specialists in Susrut

Cataract Services at Susrut

  • Seven state-of the art operation theatres, each with laminar airflow and hepa filters.
  • High end phacoemulsification machines -Centurion (Alcon), Infinity (Alcon), Stellaris (Bausch and Lomb) and Whitestar Signature Pro (Johnson and Johnson)
  • Femtosecond laser machine – LenSx (Alcon).
  • High end microscopes from Leica and Zeiss.
  • Video recording facility for each patient (available on prior demand by patient)
  • Capability to handle all difficult and complicated situations.
  • Efficient cornea and vitreoretinal services to handle all intraoperative and postoperative situations