MICRO-INCISIONAL CATARACT SURGERY (Phacoemulsification)

How the eye works

Before understanding cataract, it is important to know how the normal eye works. The eye works like a camera. The lens of the eye is normally clear and allows light to pass through. This light focuses on a thin film-like retina, which is situated at the back of the eye. The images are then transmitted to the brain through the optic nerve.

What is cataract?

It is the cloudiness of the normally clear lens in the eye. It prevents the lens from focusing light onto the retina and hence causes blurring of vision and leads to vision impairment. As the cataract advances, this haziness of vision increases over a period of time.

Why does a cataract develop?

Cataract development is part of the normal ageing process. Almost all people above the age of 60 years have cataract of a variable degree, although it can occur at an earlier age also. In some people cataract development is aggravated by an eye injury, presence of diabetes, use of medications or other eye diseases. Very rarely cataract can also be present in a newborn as a developmental defect.

What are the symptoms of a developing cataract?

The symptoms of cataract are variable, as it can develop in different ways,. Most people notice a gradual deterioration in their vision. Objects may begin to look yellow, hazy, blurred or distorted. Greater light may be required to see clearly or glare/or haloes from light may be experienced at night. A common problem encountered is increasing nearsightedness or frequent change in their glass power.

Can cataract be prevented or treated with medication?

Cataract that occurs due to the aging process cannot be prevented as the aging process itself cannot be prevented. Reading & similar activities have no role to play in cataract formation. Till date, as per all authentic medical research, there is no medication available which can prevent or cure a cataract.The only known treatment for cataract is surgery.

When can you undergo Cataract Surgery?

Cataract surgery can be performed as soon as the patient feels handicapped in performing routine activities at work and leisure. With modern microsurgical techniques of stitch-less cataract surgery (phacoemulsuification) it is not necessary to wait for the cataract to mature.

What is cataract surgery?

It is one of the oldest, safest and most successful forms of surgery. It requires a very short hospital stay and is generally performed under local or topical anesthesia. The patient is awake during surgery but does not feel any discomfort or pain. Patients are ambulatory immediately after surgery and are normally discharged a within few hours. However, if required the patients can be admitted for a day.

The eye operation is performed with the help of a sophisticated operating microscope. A small incision of 2-2.8 mm is made. A circular opening is fashioned in the front portion of the lens capsule. The cloudy lens material within the lens capsule is then removed through the same incision by the procedure of phacoemulsification using a thin titanium probe, which emits high-speed ultrasound waves. This liquefies the cataract, which is then sucked out of the eye through the same probe.

Finally, a foldable intraocular lens (IOL) is introduced through the small incision, and placed within the capsule of the lens where it unfolds and stays in place securely.

Small & micro incisions such as those used in phacoemulsification seal themselves immediately after surgery and heal very quickly. Compared to non-phaco cataract surgery, the post-operative rehabilitation for stitch-less phacoemulsification is faster and one can return to normal work and activities within a few days. This is currently the most effective method for removing cataracts.

Torsional & Cold Phaco

With an ICARE’s commitment to quality, we are the only institution in Noida & eastern Uttar Pradesh to acquire the state-of–the-art Alcon Infiniti Vision System with Ozil Technology. This revolutionary technology is based on the new concept of “Torsional Phaco” which further reduces ultrasonic energy delivered in the eye, thereby resulting in crystal clear corneas after surgery and faster visual recovery even in cases of hard cataract removal.

ICARE also possess the AMO Signature phacoemulsificatin system with WhiteStar ICE & Ellips/Fx technology. All of these machines deliver “Cold Phaco” which also has the advantage of significantly reducing the ultrasonic energy to break up the cataract resulting in safer surgery and less damage to the eye.

Will you need glasses after IOL surgery?

The improvement in quality of life after cataract surgery is extraordinary, and most patients are not dependent on their distance glasses for daily activities. Some patients, however, may need glasses of small plus or minus power to obtain the best possible distance vision.

IOL power calculations at ICARE Eye Hospital are done by trained personnel using a computerized ultrasound biometer for measuring the eye power before the operation. Every endeavor is made so as to get minimal post-operative power in the distance glasses. A new device called the immersion technique biometer is now available which is capable of very accurate measurements of the eye & calculation of the IOL power. However, since these calculations are based on certain theoretical formulae, it will vary from person-to-person, and some persons may have a slightly larger postoperative refraction than others.

Unlike the natural human lens, which can change its shape to focus according to the distance involved, the implanted IOL is unable to do the same. Hence, majority of patients undergoing routine phacoemulsification with IOL implantations, typically require reading glasses after cataract surgery.

What are the latest advances in Intraocular Lens (IOL) technology?

ICARE keeps pace with advanced technology available worldwide and, therefore, works with various state-of-the-art IOLs. These new lens designs include Aberration-free IOLs which greatly improves image quality by enhancing contrast, eliminating glare and haloes, and improving night vision. Toric IOLs provides good unaided distance vision in patients with a cylindrical number.

Depending on your own personal visual needs and your clinical examination, you can help your surgeon to decide which lens is best suited for you.

Can all patients with cataract undergo phaco surgery?

Your eye surgeon will be the best judge to decide whether you can undergo phaco-surgery. Each patient undergoing cataract surgery at ICARE is examined in detail to assess the endothelial count of the cornea using the Automated Specular Microscope. This facility, a marvel of technology, is one of the very few available in the NCR.

The endothelium is the inner most layer of the cornea which is responsible for its transparency. Preoperative assessment of the endothelial count enables identification of patients in whom this layer is weaker (low cell counts) and who are not fit for the phacoemulsification procedure, for whom surgery by the conventional technique would be safer.

Again based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If necessary special medications like Healon/Healon GV and Viscoat, may be used to minimize loss of the already depleted endothelial cell counts during surgery. At ICARE Eye Hospital we believe that quality and safety cannot be compromised.

Is clear vision guaranteed after surgery?

No surgeon in the world can perform a surgery with guaranteed results. However, almost all patients regain good vision following cataract surgery.

The caliber of vision obtained after a successful cataract surgery with IOL depends upon the health of the retina behind. Eye disease or problems in the cornea, retina or optic nerve may reduce the potential for clear vision even when the cataract surgery itself has been successful.
However, it might not be possible to evaluate the condition of the retina, optic nerve, in cases of advanced cataract.

Cataract and IOL surgery is not a magical procedure and need not necessarily restore normal vision immediately. Blurred vision may be present immediately after surgery. As the eye heals over a period of time, vision improves gradually.

What are the possible complications that can occur with Cataract & IOL surgery?

Cataract surgeries at ICARE Eye Hospital are highly successful procedures. Our results correspond with international statistics. The few complications that exist are becoming even more remote, with newer developments in surgical techniques and anesthesia.

Some minor complications that can occur include:

  1. a slight drooping of the eyelid
  2. swelling around the eye
  3. corneal haze
  4. reflections/slight distortions from the lens implant (This is usually temporary)

The chances for serious complications are negligible. Possible complications include:

  1. infection
  2. severe inflammation
  3. hemorrhage

In a majority of cases these complications can be treated successfully or may resolve on their own with a good final restoration of vision. The above list is however not exhaustive.

Benefits of cataract surgery

There are numerous benefits of cataract surgery, many of which cannot be measured statistically. These include:-

  1. Improved colour vision – colours are brighter and more vivid after cataract surgery
  2. Greater clarity of vision – vision is crisper & sharper after cataract surgery
  3. Improved quality of life – studies have repeatedly shown that people enjoy an improved quality of life after successful cataract surgery. Many people can resume driving, reading, writing, watching television, sewing, household work and using a computer immediately after.

Cataract

Cataract is the opacification of the crystalline lens of the eye. The lens is a transparent structure whose transparency may be disturbed due to degenerative process. This may lead to opacification of the lens fibres and this development of opacity in the lens is known as cataract.

The opacity of the lens scatters the light and prevents it from focusing light on the retina and hence causes blurring of vision.

Cataract