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CATARACT
Ophthalmic - Cataract Surgery starting at

Cataract Surgery Cost

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FAQs for CATARACT

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. Inside our eyes, we have a natural lens. The lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear. If you have a cataract, your lens has become cloudy. Things look blurry, hazy or less colorful with a cataract. Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. 

Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that happen after the age 40. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets the light pass through it. But as we age, normal proteins in the lens start to break down and some of the protein may clump together and start to cloud a small area of the lens. This keeps light from passing through clearly. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those  in younger people or those in people with diabetes.

Besides aging, other cataract risk factors include:

·         Family history - having parents, brothers, sisters or other family members who have cataracts

·         having certain medical problems, such as diabetes, Hypertension, Obesity

·         having had an eye injury, eye surgery, or radiation treatments on your upper body

·         having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays

·         Smoking

·         Prolonged use of corticosteroid medications

·         Statin medicines used to reduce cholesterol

·         Hormone replacement therapy

·         Significant alcohol consumption

·         High myopia

·         Age-related. These form as you get older.

·         Congenital. This is what doctors call it when babies are born with cataracts. They may be caused by infection, injury, or poor development in the womb. Or, they can form in childhood.

·         Secondary. These happen as a result of other medical conditions, like diabetes. They can also result from being around toxic substances, ultraviolet light, or radiation, or from taking medicines such as corticosteroids or diuretics.

·         Traumatic. These form after an injury to the eye.

·         Other things that can raise your chances of getting cataracts include cigarette smoke, air pollution and heavy drinking.

 

  • A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging. When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called "second sight."
  • A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract. A subcapsular cataract may not produce any symptoms until it's well-developed.
  • A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.

Cataracts usually form slowly. You may not know you have them until they start to block light. Then you might notice:

  • Vision that’s cloudy, blurry, foggy, or filmy
  • Nearsightedness in older people
  • Double vision in the affected eye
  • Changes in the way you see color
  • Problems with glare during the day
  • Problems driving at night (glare from oncoming headlights etc)
  • Trouble with eyeglasses or contact lenses not working well

Doctors don’t know exactly what causes cataracts, so there’s no proven way to prevent them. But since cataracts and other conditions, such as glaucoma, are common in older adults, it’s important to get your eyes checked regularly. This is really important if you have a family history of eye problems or have been exposed to things that could cause trouble with your eyes.

Adults should see an eye doctor at least every 2 years until age 50, and then every year after that.

  • When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, contact lenses, strong bifocals, magnification, appropriate lighting or other visual aids.
  • Protect your eyes from UV light by wearing sunglasses that block at least 99 percent UV and a hat.
  • If you smoke, quit. Smoking is a key risk factor for cataracts.
  • Limit driving at night once night vision, halos or glare become problems.
  • Take care of any other health problems, especially diabetes.
  • Do not use eye drops or other treatments that claim to dissolve or remove cataracts. There is no proven way to dissolve cataracts with eye drops. Surgery is the only way to remove cataracts.
  • Think about surgery when your cataracts have progressed enough to seriously impair your vision making it difficult to complete your regular activities and affect your daily life.
  • Make an informed decision about cataract surgery. Have a discussion with your ophthalmologist about:
    • the surgery
    • preparation for and recovery after surgery
    • benefits and possible complications of cataract surgery
    • cataract surgery costs
    • other questions you have
  • Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.
  • Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery
  • Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40
  • During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).
  • New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients.
  • Presbyopia-correcting IOLs potentially help you see at all distances, not just one.
  • Another new type of IOL blocks both ultraviolet and blue light rays, which may damage the retina.

 

Many people think cataracts only happen to older people, but children can get cataracts too. Both pediatric cataracts and cataracts from aging are a clouding in the lens of the eye that can cause blurry vision or blindness.

In adults, cataracts occur after the eyes and vision are developed and stable. Most adults can have good vision again after the cataracts are removed. Because children's eyes are still developing until they're 8-10 years old, untreated cataracts can have serious long-term effects on their vision. But early detection and prompt treatment can prevent permanent vision loss in children with cataracts.

 

Understanding pediatric cataract:

  • Pediatric cataracts can be congenital (present at birth) or acquired (develop after birth).
  • They can be caused by genetic predisposition, metabolic disorders such as diabetes or trauma to the eye that damages the lens. Sometimes they occur spontaneously.
  • Traumatic cataract caused by injury to a child's eye whereby the injury also damaged the iris.
  • They can occur in one eye (unilateral) or both eyes (bi-lateral).
  • Bi-lateral cataracts can be asymmetric (one cataract is more severe than the other).
  • Cataracts may appear in different parts of the lens and range in size from tiny dots to dense clouds.

Most pediatric cataracts are detected when the child is examined at birth, before they even leave the hospital. Many more are detected by pediatricians at well-baby exams and some are noticed by parents. Acquired cataracts are most often diagnosed at vision screenings by the pediatrician or after an eye injury.

For children, whose eyes and brain are still learning to see, distortion can lead to lazy eye (amblyopia). Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye. Once made, these connections are irreversible.

Treatment for pediatric cataracts can vary depending on the type and severity. But the vast majority of children need surgery to remove the cataracts. Children who receive timely treatment and follow-up have a good prognosis.

Successful outcomes may require years of individualized visual rehabilitation. For most children, surgery is just the first step to rehabilitate the eyes. Ongoing treatment must repair eye-brain connections. This involves teaching the eyes how to focus properly.

Unlike adults with full-sized eyes, children require specialized surgical instrumentation and techniques. When performed by an experienced surgeon, cataract removal is generally safe. The most common risks include glaucoma, retinal detachment, infection and the need for more surgeries.

After surgery, children often need some combination of contact lenses, intraocular lenses implanted in the eye or glasses. If amblyopia has developed, the child may need patching. This treatment involves covering the stronger eye to stimulate vision in the weaker eye.

Before

  • The patient needs to instill some antibiotic eye drops about 4 times a day in both eyes for about 3-5 days before the surgery. Some oral medicines & dosage as pre-medication as decided by the eye surgeon.
  • The treatment for any other systemic diseases is to be continued even on the day of surgery except that anti-coagulant or blood thinning medicines may have to be discontinued a few days prior to operation.

After

  • Avoid head bath for a few days to 1 week
  • Avoid rubbing, pressing, massaging, heat, dust, dirt and bright sun for 1 month (use sunglasses outdoors)
  • Avoid heavy weights and strenuous physical activity for 1 month
  • Avoid swimming and splashing of water on eyes for 1 month
  • Continue other treatments advised by other doctors’ e.g. for Diabetes, High Blood Pressure, Asthma, etc.
  • Patient can resume most of the normal life activities from the next day.

Foldable vs. Non-foldable Lenses -

In conventional cataract surgery & in SICS (Small Incision suture less Cataract Surgery) a large cut or incision is made in the eye to remove the cataract. This is followed by insertion of a rigid non flexible 6.0/6.5 mm lens through the incision into the eye. These lenses are rarely used these days.
In phacoemulsification the entire operation done through a small hole of 3.0 mm or less. It is not possible to implant a rigid lens. The doctors use very flexible lenses which can be folded and loaded in special injectors and inserted through the small hole into the eye. These are currently the preferred lens to be used.

 

There Are Two Methods Of Cataract Surgery :-

  • Conventional Cataract Surgery By Phacoemulsification

In this technique, incisions are made and the cataract is broken into smaller pieces and aspirated, and then the intraocular lens is implanted. The surgery is done under topical anesthesia, only drops are used.

  • Bladeless Laser Cataract Surgery – Lensx Femtosecond Laser

Cataract surgery is done using this femtosecond laser. It makes -bladeless, laser- made incisions, perfect circular opening and also to break the cataract into smaller pieces. It is followed up with lens removal and intraocular lens implantation. It significantly reduces the risk of complications, makes the surgery simpler, more precise, and gives more predictable visual results and faster recovery.

In cataract surgery the natural lens of the eye is removed. This leads a significant decrease in the optical convergence power of the eye or hypermetropia. Intraocular lenses are small lenses made of polymers and implanted into the eye in place of natural lens to help focus the light on to retina. When it comes to intraocular lenses (IOLs) for cataract surgery, there are number of different types of materials that eye surgeons can select from. 

Foldable lenses are made of two types of material – hydrophilic and hydrophobic acrylic – the latter being better in terms of long term results and least possibility of posterior capsule opacity. Both hydrophilic and hydrophobic lenses incorporate UV filters, but hydrophilic IOLs are constructed from aliphatic materials: the UV filter is less efficient when compared with aromatic-based hydrophobic materials.

Lens Material - Silicone, Hydrophilic & Hydrophobic Acrylic :

  • Silicone was used in older lenses & gave good optical results in the immediate post-operative period. But these lenses were somewhat bulky and lead to severe thickening of anterior & posterior capsules (membrane covering of natural lens which is left behind to provide support for artificial intraocular lens). This lead to deterioration of vision and required treatment by YAG Laser Capsulotomy.
  • Hydrophilic Acrylic lenses are soft contacts are made of pliable hydrophilic ("water-loving") plastics called hydrogels. Hydrogels absorb significant amounts of water to keep the lenses soft and supple. These lenses are highly flexible and slim, therefore, can be introduced through extremely small incisions. They have good immediate visual results but suffer from tendency to cause thickening of posterior lens capsule.
  • Hydrophobic Acrylic lenses are slightly less flexible and somewhat thicker than their hydrophilic counterparts. But they are extremely inert and do not lead to lens capsule thickening. Due to these properties they are ideal for use in children, young adults and the eyes predisposed to inflammation. Being hydrophobic in nature it is possible to incorporate a color tint to avoid blue chromatopsia after surgery.
     

The optical design of the intraocular lenses are :

  • Monofocal IOL – Monofocal lenses have a single focal length and unlike the natural lens do not possess the ability to change the focus. The lens is single focal length which is usually aimed to focus at mid or far distance. As a consequence the person needs to wear glasses for reading near print and sometime for far. However, the quality of vision & contrast achieved with this lens is far better. For patients who need sharp vision and better contrast and do not hesitate in wearing reading glasses, monofocal lenses are most suitable.
  • Multifocal IOL – The lens has two focal lengths – one to focus the far objects and one to focus near objects. This is achieved by having multiple optical zones fashioned in the lens in the form of alternating rings for distance and near. This leads to splitting of light into distance and near foci. As a result both the distant and near objects can be focused in the eye at the same time. The need for wearing spectacles is minimized, however, at the cost of loss of some contrast sensitivity, glare and image quality. Moreover, these lenses are expensive and need a period of adjustment after both eyes are implanted with the same type of lens. Those who do not want dependence on reading glasses but are willing to compromise on contrast and sharpness of vision, can opt for multifocal lenses.
  • Spheric IOL - Spheric are the conventional lenses where both surfaces of the lens are uniformly curved or are part of a sphere. These lenses have inherent problem of spherical aberrations caused by excessive bending of light at the edges.  Spheric lenses, though lack the sharpness & contrast to some extent but have better depth of focus leading to slightly better near vision.
  • Aspheric IOL -- Aspheric or advanced optics lenses have their curvatures flattening out towards the periphery or edge, thereby, minimizing spherical aberrations. Aspheric lenses give much sharper vision and better contrast but due to decreases depth of focus, the need for reading glasses becomes more urgent.
  • Toric Lenses - Toric lenses is a modified monofocal lens besides having spherical power, also have cylindrical power which corrects astigmatism present in the eye. Toric lenses are especially useful in patients with high degree of against the rule corneal astigmatism which is not amenable to correction but incision placement.
  • Non-toric - Non-toric lenses do not have any cylindrical power. Eyes with no or negligible astigmatism require non-toric lens and the eyes with significant astigmatism would benefit from toric lenses. 
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