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Dr Shamsher Singh Eye Hospital
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Cataract

What is a Cataract ?
Cataract is a clouding of the eye’s lens. When we look at something, light rays travel into our eye through the pupil and are focused through the lens onto the retina, a layer of light-sensitive cells at the back of the eye. The lens must be clear in order to focus light properly onto the retina. If the lens has become cloudy, this is called a cataract.

Cataract symptom progression
Gradually, as cataracts progress, you may have symptoms such as:

  • Painless cloudy, blurry or dim vision
  • More difficulty seeing at night or in low light
  • Sensitivity to light and glare
  • Seeing halos around lights
  • Faded or yellowed colors
  • The need for brighter light for reading and other activities
  • Frequent changes in eyeglass or contact lens prescription
  • Double vision within one eye

Who is at risk of Cataracts?
Cataracts develop as part of the aging process, so everyone is at risk eventually. By age 75, about 70 percent of people will have cataracts. With age, our eye’s lens slowly becomes less flexible, less transparent and thicker. Then areas of the lens become cloudy as protein in the lens begins to clump together.

Cataract Causes
The lens is made mostly of water and protein. As we age, the lens continues to grow layers on its surface and hardens. Protein in the lens may clump together and become cloudy in some areas, preventing light from passing clearly through the eye. This cloudiness of the lens is what we call a cataract.

If the clouding is mild or only involves a small part of the lens, your vision may be only slightly affected. If there is more clouding and it affects the entire lens, your vision will become severely limited and cataract surgery becomes necessary.

Less common types of cataracts, not related to normal aging, include the following.

Congenital or Developmental Cataract
This type of cataract can occur in infants or children. They may be hereditary or they can be associated with some birth defects. Some occur without any obvious cause.

Non-age related cataracts from other disease or medication
These cataracts are caused by other eye diseases or previous eye surgery. Chronic disease can make you more likely to develop cataracts; for example, diabetes has been proven to increase risk of cataracts. Excessive use of steroid medications can spur development of this type of cataract as well.

Traumatic Cataract
These cataracts are related directly to an eye injury. Traumatic cataracts may appear immediately following injury, or they can develop several months or even years later.

Cataract Diagnosis
During a comprehensive, dilated eye exam (where your pupil is widened with eye drops), your Eye M.D. will examine and test your eyes to make a cataract diagnosis.

Slit-Lamp Examination
Your ophthalmologist will closely examine the eye’s cornea (see How the Eye Sees video above), iris, lens and the space between the iris and cornea. With this special microscope, the doctor is able to examine your eye in small, detailed sections, making it easier to spot abnormalities.

Retinal Exam
When your eye is dilated, the pupils are wide open so the doctor can more clearly see the back of the eye. Using the slit lamp and/or an instrument called an ophthalmoscope, the doctor looks for signs of cataract. Your Eye M.D. will also look for signs of glaucoma and other potential problems with the retina and optic nerve.

Refraction and Visual Acuity Test
This test assesses the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.

Cataract Treatment
If your vision is only slightly blurry, a change in your eyeglass prescription may be all you need for a while. However, after changing your eyeglass prescription, if you are still not able to see well enough to do the things you like or need to do, you should consider cataract surgery.

Cataract Surgery
With cataract surgery, your eye’s cloudy natural lens is removed and replaced with a clear artificial lens implant (called an intraocular lens or IOL). Cataract surgery is often performed as an outpatient procedure and does not require an overnight hospital stay.

 Pre-operative tests for cataract surgery
Before surgery, the length of your eye will be measured in what is called an A-scan, and the curve of your cornea will be measured in a technique called keratometry. These measurements help your Eye M.D. select the proper lens implant for your eye. You will also discuss the various lens options available to you.

Medications and cataract surgery
If you are having cataract surgery, be sure to tell your ophthalmologist about all medications and nutritional supplements you are taking. If you currently use or have ever used alpha-blocker drugs for prostate problems, such as Flomax®, Hytrin®, Cadura® or Uroxatral® , tell your Eye M.D. These medications may prevent your pupil from dilating properly during surgery, leading to possible complications. If your surgeon is aware that you have had these drugs, he or she can adjust their surgical technique to adapt as needed, allowing for a successful cataract removal procedure. You should also tell your Eye M.D. about any other sedative medications you are taking.

To reduce the risk of infection from surgery, your ophthalmologist may prescribe antibiotic eyedrops for you to use one or two days before surgery.

The cataract surgery procedure
The most common procedure used for removing cataracts is called phacoemulsification.   A small incision is made in the side of the cornea (the front part of your eye), where your Eye M.D. inserts a tiny instrument that uses high-frequency ultrasound to break up the center of the cloudy lens and carefully suction it out.

After the cloudy lens has been removed, the surgeon will replace it with an intraocular lens (IOL) implant made of plastic, silicone or acrylic. This new, clear lens allows light to pass through and focus properly on the retina. The IOL becomes a permanent part of your eye. In most cases, the IOL is inserted behind the iris, the colored part of your eye, and is called a posterior chamber lens. Sometimes, the IOL must be placed in front of the iris. This is called an anterior chamber lens. When the IOL is in place, the surgeon closes the incision. Stitches may or may not be used. After the surgery, your Eye M.D. usually places a protective shield over your eye.

Cataract surgery recovery
You will spend a short period of time resting in the outpatient recovery area before you are ready to go home. You will need to have someone drive you home.

Following your surgery, it is very important to put in the eye drops exactly as prescribed by your ophthalmologist to promote healing. You will also need to take care to protect your eye by wearing the eye shield whenever you sleep, and by wearing special wraparound sunglasses in bright light. Be sure not to rub your eye.

During the first week of your recovery, you must avoid strenuous activity such as exercise or bending and heavy lifting (including anything over 25 pounds). You will also need to avoid getting any water, dirt or dust in your eye, which can lead to infection.

You may have some blurry vision a few days to weeks after surgery procedure. If you experience any pain or loss of vision, be sure to call your ophthalmologist.

Cataract surgery risks and complications
As with any surgical procedure, there are risks associated with cataract surgery.  Risks and complications can include:

  • Infection
  • Bleeding inside the eye
  • Increased pressure inside the eye (glaucoma)
  • Swelling of the retina
  • Swelling of the cornea
  • Retinal detachment
  • Loss of vision (partially or completely)

In some cases, the part of the lens covering that supports the IOL (called the capsule) can become cloudy several months or years after the first cataract was removed. This is called an “after cataract” or “secondary cataract.” If this occurs and blurs your vision, your Eye M.D. will make an opening in the center of the cloudy capsule with a laser to allow light to pass through the lens properly again. This procedure, called a posterior capsulotomy, takes about five minutes in the doctor’s office and requires no recovery period.

Most people who wear bifocals or reading glasses for near vision may still need to wear glasses after cataract surgery for reading, and, in some cases, even for distance. If you choose to have a multifocal or accommodative IOL, your dependence on glasses may be minimized or, in some cases, eliminated completely.

Cataract surgery costs
Cataract surgery costs are generally covered by Medicare (if you are Medicare eligible) as well as by most private insurance plans.

Your cataract surgery costs will be covered by Medicare as long as your vision tests at a certain level of acuity or clarity. If you have a private insurance plan, they too may have similar vision requirements that you must meet in order to have your surgery covered. Even if Medicare or private insurance covers your cataract surgery, there may be some costs you would still be responsible for, such as having a special enhanced type of intraocular lens (IOL) implanted instead of a standard IOL, or choosing to have cataract surgery before your vision has deteriorated enough to be eligible for Medicare or insurance coverage.

In certain cases, it might be possible to get insurance or Medicare coverage for cataract removal before you meet the age or visual acuity eligibility requirements. Talk with your ophthalmologist if you are considering having early cataract surgery.

If you don’t have Medicare or private insurance coverage, you may still be able to reduce and manage the cost of cataract surgery through other means, such as payment plans through your doctor’s office or with a flexible spending account through your employer. Your Eye M.D. can help you learn more about costs of cataract surgery and discuss your options for affording the procedure

Before intraocular lenses (IOLs) were developed, people had to wear very thick eyeglasses or special contact lenses to be able to see after cataract surgery. Now, with cataract lens replacement, several types of IOL implants are available to help people enjoy improved vision. Discuss these options with your Eye M.D. to determine the IOL that best suits your vision needs and lifestyle.

 

 

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