Planning to undergo cataract surgery? It’s all in here..
Here’s what you would experience if you have a cataract.
Reduced overall brightness.
Intolerable glare due to bright lights.
Significant blurring of vision with advanced cataract.
Intolerable glare caused by oncoming headlights.
You may have a cataract if you have any of the following
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Your vision starts to blur, this starts slowly and generally progresses gradually. This could be for distance and/or near and often appears like a cloud in front of the eyes which doesn’t change throughout the day.
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There is often an overall reduction in the brightness in the evening time.
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You may find bright headlights very disturbing because of light distortion and glare caused by the cataract.
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Your vision may not improve despite wearing the correct glasses.
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You may find that your near vision actually gets clear without glasses.
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If your cataract is advanced you may find a whitish opacity in your pupillary area.
Going ahead with cataract surgery? Here’s what you must know!
Discuss with your treating physician the merits and demerits of all the lenses available.
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If you have been diagnosed with a cataract, you must know that it’s almost never an emergency condition. The timing of surgery is largely decided by the patient, depending on how severely the cataract is affecting the quality of vision and quality of life. You can schedule your surgery based on your personal commitments.
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Cataract can be surgically removed in two ways - either with a manual removal of the entire lens(MSICS) or with the use of ultrasound energy that breaks up the nucleus (phacoemulsification).
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Phacoemulsification, popularly known as ‘laser’ cataract surgery actually uses ultrasonic power. No laser is used to remove the cataract.
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Femtosecond laser assisted cataract surgery, a fairly recent technique, involves cutting edge technology wherein a laser is actually used during the phacoemulsification procedure. It is reported to be even more precise in achieving excellent post operative outcomes.
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Any other medical condition such as diabetes, blood pressure, thyroid dysfunction etc. that you may be suffering from should be well controlled before the cataract surgery.
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If you are on any other medications that you’re taking regularly, they should not be discontinued.
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However, if you are on Aspirin or any blood thinners, it is possible that you will need to discontinue these 3-4 days before surgery after consultation with your cardiologist. After the surgery, as per your treating consultants advise you’re required to restart these.
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If you find you have cold, cough, fever, burning urination or any new symptoms, notify your ophthalmologist and reschedule the surgery.
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Allergies, if any, should be notified to your doctor.
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All preoperative eye drops should be bought well in advance.
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Go through the consent form thoroughly with your relatives prior to signing it.
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A thorough face wash and hair wash prior to the surgery is mandatory.
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For Phacoemulsification the eye is anesthetized in two ways either an injection given around the eye (peribulbar) or by merely instilling drops in the eye (drop anesthesia/topical anesthesia).
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The surgery should be complete well within 30 mins.
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The surgery will take place in the operating theatre which is rather cold. Through the entire procedure there will be a sheet covering your face in order to maintain sterility. However, you’ll be able to communicate with your surgeon throughout the surgery. It is likely that you’ll hear certain sounds (machines) as well as observe certain visual phenomenon during the surgery.
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If you’re given the injection anesthesia your eyes will be patched for the first 4-6 hours. If it is done under ‘drop anesthesia’, the patient goes home with protective glasses and the drops are started immediately.
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Undergoing cataract surgery with drop anesthesia has certain advantages – patient starts seeing immediately and there is no periocular pain.
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The surgery irrespective of the technique will involve removal of the cataract and the insertion of a foldable intraocular lens within the eye.
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An intraocular lens once inserted into your eye is permanent for your entire lifetime.
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Cataract cannot be treated with eye drops surgery is the only option. In our opinion, there are no known drops can reverse or reduce the progression of cataract. The only definitive cure is surgery.
There are various considerations while choosing the intra ocular lens(IOL/ Lenses) to be implanted in your eye during cataract surgery.
The choice depends on the following factors
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Patients need for minimising the dependence on glasses after surgery
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Patients comfort/ keenness for wearing glasses after surgery
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Patients intense dislike for glasses
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Patients who need to drive at night
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Patients work/ hobbies/ lifestyle/ ambient lighting
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Patient’s spectacle prescription
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Patient’s personality type
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Ability to pay for premium IOLs
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Indian vs Imported lenses: We have today some very good options of indian lenses in all categories, these are more reasonably priced and they help patients achieve good post-operative vision
Choosing the ideal Intraocular Lens when planning cataract surgery.
Clear vision for near work is achieved with reading glasses with Monofocal IOLs.
One would always require reading glasses when implanted with a Monofocal IOL.
Reduced contrast with Multifocal IOLs necessitates bright light for near work.
Reduced contrast with Multifocal IOLs necessitates bright light for near work.
Avoid Multifocal IOLs for those who frequently drive at night
Near work(reading, writing, cooking, knitting) needs to be corrected with glasses or a Multifocal IOL.
One may need to optimize the smartphone(increase brightness) with Multifocal IOLs.
EDOF (Extended depth of focus) IOLs
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These lenses despite not being multifocal IOLs provide good distance, intermediate vision and fairly improved near vision.
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They do not have rings and therefore do not produce any visual symptoms such as glare and haloes around light therefore can safely be used for night drivers.
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They could be considered the better choice for some retinal condition.
Multifocal TORIC/ trifocal TORIC
If you have a cylindrical number and still wish for a multifocal IOL, the best choice then would be Multifocal TORIC/ trifocal TORIC.
Trifocal IOLs
- Provide clear for distance,near as well as for intermediate vision(60-80 cm).
- Superior to multifocal IOLs as they provide useful intermediate vision.
- Today we require Intermediate vision for various activities- cooking , eating, signing cheques, counting money, opening door locks and using iPad/Laptops.
- You may still require glasses for few activities both for distance and/or near.
- Glare and Haloes around light may be seen upto 6 months following surgery.
- Night driving may not be comfortable using these lenses.
- There may be a small drop in overall brightness (contrast) more noticeable in the evening.
Multifocal IOLs
These lenses provide clear vision both for distance as well as for near work
Multifocal IOL (Bifocal IOL) correct vision for distance and at a fixed point for near.
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You may still require glasses for few activities both for distance and/or near.
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Glare and Haloes around light may be seen upto 6 months following surgery.
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Night driving may not be comfortable using these lenses.
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There may be a small drop in overall brightness (contrast) more noticeable in the evening.
If you have a cylindrical number in your spectacle prescription, it is likely to cause distorted vision if not corrected.
If you wish to correct the cylindrical number during cataract surgery you should consider a TORIC IOL.
A TORIC IOL which corrects for distance vision only is called monofocal TORIC.
A TORIC IOL that corrects for both distance and near vision is called multifocal TORIC IOL.
Let’s understand the different types of IOLs (Lenses)
Some lenses correct distance vision only (Monofocal IOLs)
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These are the most commonly implanted lenses
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Patients implanted with these IOLs, will almost always require reading glasses
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The best vision at all distances is achieved by a pair of progressive/ bifocal glasses Post surgery
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There are no visual symptoms like glare, halos or reduced contrast with these lenses
How to look after your eyes after cataract surgery. The DOs and DON’Ts.
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DO put your drops and take your medications regularly.
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The drops following cataract surgery are continued for approximately 4-6 weeks after surgery. Lubricating eye drops however may continue for upto 3 months after surgery.
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Always keep a gap of approximately 5 minutes between two different drops.
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Ensure strict hygiene while instilling and storing the drops.
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Do not discontinue the drops when the bottle finishes, buy a new bottle and continue until the prescribed date.
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If the drops change color, it must be discarded as it is possibly contaminated. Ensure the drops are replaced every 40 days.
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Some drops cause precipitation which is normal. Please consult your treating ophthalmologist regarding the same.
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Clean your eyes with a sterile cotton ball (boiled and cooled overnight) two to three times a day.
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Any excess tearing, should be wiped away from below the eyes using clean tissues which are immediately discarded.
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DON’T rub your eyes.
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It is important to use an eye shield taped down at night for the week following surgery to prevent accidental injury whilst sleeping.
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DO wear your protective glasses for the first week.
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DON’T splash tap water in your eyes
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DON’T let dirt or smoke go into your eyes
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DON’T let tap water enter your eyes while bathing, for a few days its preferable to have a bath just below the neck and the face can be cleaned with a clean wet towel ensuring you don’t go close to the operated eye.
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DO continue your daily activities like watching TV, working on your computer
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DO continue having your regular diet
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DON’T lift heavy weights for the first week. For those into sports, avoid contact sports for few months.
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You will have some amount of itching, irritation, redness or watering in your eye after the surgery this is totally normal. Over a period of time these symptoms will gradually go away
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It takes almost one month for the post operative visual acuity to stabilize after the surgery.
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Should you find any odd symptoms after your surgery, please pick up your phone and call your ophthalmologist.
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Generally, follow ups are done on day 1, day 5 and day 21.
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Your final glass prescription will be given to you within 20 to 30 days postoperatively which will further improve the quality of vision.