Modern Microsurgery to Restore and Enhance Vision
Cataract is the leading cause of blindness in India. It can be treated by a simple cataract extraction microsurgery, which is performed using advanced technology in a short time. The Himalayan Eye Institute is fully equipped with the most modern technology for performing sutureless cataract surgeries through a 2.8mm (or less) incision with the implantation of foldable intraocular lenses (IOLs).
It is a cloudiness of the normally clear lens in the eye. It prevents the lens from focusing light onto the retina and hence causes unclear vision. As the cataract advances, this cloudiness of vision increases over a period of time until the vision is completely impaired.
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. Rarely cataract may be present in the newborn as a developmental defect.
Because cataracts form in different ways, the symptoms of cataracts are variable. Most people notice that their vision gradually deteriorates – objects may begin to look yellow, hazy, blurred or distorted. Some people report double vision, or polyopia (objects appearing multiple). Many people also find that they need more light to see clearly, or that they experience glare or haloes from lights at night. A common problem encountered is increasing nearsightedness. In advanced cases, the cataract may be visible as a whitish-looking pupil.
Cataracts that occur due to the ageing process cannot be prevented as the ageing process itself cannot be prevented. Using the eyes for reading and similar activities has nothing to do with cataract formation. Avoiding the use of eyes will not prevent cataract.
Till date as per all authentic medical research no medication exists to prevent or cure a cataract. The only known treatment for cataract is surgery.
Cataract surgery can be performed as soon as the patient feels handicapped in performing routine activities at work and leisure. It is not advisable to wait for the cataract to mature as unnecessary delay can make surgery difficult and prone to complications. Modern cataract surgery can be performed successfully in any season including summers and the rainy season.
Modern cataract surgery is one of the 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 discharged on the same day.
Cataract surgery at The Himalayan Eye Center is performed with sophisticated operating microscopes. A micro incision of 1.8 to 2.8 mm is first made in the eyeball (Step 1). A smooth round opening is then made in the front part of the lens capsule, which is a thin membrane enclosing the entire lens (Step 2). All cloudy lens material within the lens capsule is then removed through the same incision by the procedure of phacoemulsification using a thin titanium probe that emits high-speed ultrasound waves, vibrating at 40,000 times per second. This breaks the cataract into tiny pieces, which are then suctioned out of the eye through the same probe (Step 3). In the final step, 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 (Step 4).
Micro incisions such as those used in phacoemulsification seal themselves immediately after surgery and heal very quickly and allow one to return to normal work and activities within a few days. This is currently the most effective method for removing cataracts. The Himalayan Eye Institute has latest state-of-the-art Infiniti Vision System from Alcon, USA for cataract surgery.
Your eye surgeon will be the best judge to decide whether you can undergo micro incision phaco-surgery. Each patient undergoing cataract surgery at our centre is examined in detail to assess the endothelial count of the cornea using the automated Specular Microscope. This facility at The Himalayan Eye Institute is one of the very few available in Eastern India. 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 the endothelial cell count is low we are using BSS Plus and Viscoat, which are imported medicines, to minimize loss of the already depleted endothelial cell counts during surgery.
1) Monofocal IOLs – These lenses provide good distance vision and most patients are not dependent on their distance glasses for daily activities. However, patients implanted with monofocal IOLs typically require reading glasses after cataract surgery.
In the recent years, monofocal lenses have been designed with aspheric surfaces. These state-of-the-art FDA approved aspheric or aberration-free IOLs greatly improve image quality by enhancing contrast, eliminating glare and haloes, and improving night vision.
2) Toric IOLs – These special lenses correct high cylindrical powers reducing the patient’s dependence on distance glasses.
3) Multifocal IOLs and Accommodative IOLs – These lenses are designed to provide good unaided distance and near vision with less dependence on glasses.
IOL power calculations at The Himalayan Eye Institute are done by trained personnel and every endeavor is made so as to get very minimal post-operative power in the distance glasses. This is done using immersion ultrasound biometry for measuring the eye accurately before the operation.
Once the IOL is implanted in the eye, it remains in place for the remainder of one’s lifetime.
Fortunately, the technological advances in IOL manufacture and surgery have made it quite safe. Complications are rare and similar ones can occur with conventional surgery without an IOL implantation. All patients irrespective of other general illnesses like diabetes, hypertension etc. can have IOL surgery. If there is any reason why you should not have an IOL your ophthalmologist will explain.
No surgeon in the world can perform a surgery with guaranteed results. However, almost all the patients regain good vision following cataract surgery. In certain cases, eye disease or problems in the cornea, retina or optic nerve may limit 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 advanced cataracts.
Modern microsurgical techniques for cataract removal are highly successful procedures. 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 a slight drooping of the eyelid, swelling around the eye, corneal haze, reflections or slight distortion from the lens implant, which are usually temporary. The chances for serious complications are negligible. Possible serious complications include infection, severe inflammation, and 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.
However, in a certain number of patients undergoing cataract surgery, the back part of the lens capsule may thicken over a period of time causing blurred vision. This is known as Posterior Capsular Opacification (PCO), secondary cataract or “After Cataract”. This is not a complication. The condition is treated with a “YAG Laser Capsulotomy” with full restoration of vision
There are numerous benefits of cataract surgery, many of which cannot be measured statistically. These include: –
- Improved colour vision – colours are brighter and more vivid
- Greater clarity of vision – vision is crisper and sharper
- 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. Even when retinal diseases or other problems prevent a total restoration of vision, the remaining vision is usually improved by cataract surgery.
- Surgery is a “walk in- walk out” procedure.
- Surgery is mostly done under topical anaesthesia.
Anaesthetic drops numb the surface of the eye and the surgery can be comfortably and painlessly performed. The eye remains open after surgery.
- Some patients may require an anaesthetic injection before the surgery.
- A routine surgery lasts approximately 10 minutes with the preparation time being of similar duration.
- Pre-operatively dilating drops are applied which take between 1 – 1.5 hours to act.
- One could expect to spend half a day at the hospital on the day of surgery
Cataract surgery is pretty much painless and so is the post-operative period. There is mild irritation (or foreign body) sensation for a few days. There may be mild redness & watering of the eyes which again subside in a few days.
There is no need for bed rest after surgery. One can walk, eat normally, watch TV and be normal around home on the day of the surgery. One needs some protective glasses only when outdoors.
- There is a graded schedule for eye drops after surgery.
- No tablets / injections are used.
- One would start with 3 types of eye drops, which would be stopped over a period of 6 weeks.
- One can resume work even the day after surgery.
- One could either work from home or office, but one should remember to apply the drops as advised.
- Normally till the glass correction is given 4-6 weeks after surgery, reading may be difficult, but this is much better after implantation of a multifocal IOL.
- Temporary glasses can be given the day after surgery.
- One could resume routine exercise, yoga & sports like golf 2-3 days after surgery.
- One should avoid water from directly getting into the eyes for 10 days after surgery.
- One could sponge the hair and face properly even the day after surgery.
- Normal bathing (taking precautions for the eye) can be resumed the day after surgery.
- After 10 days one can be completely normal.
- Bending down, chewing food or lifting moderate weights are not at all a problem after surgery.
- One can be pretty much normal after surgery.
- The vision will be bright and pretty much clear the day after surgery.
- Full vision will be restored gradually in a few days time.
- Objects may appear excessively bright & blue in colour for some days. This is because the cataract was not allowing light to reach the retina and most of the blue light was being cut off. The brain gets disused to seeing blue. All these complaints are temporary.
- We use highly specialized equipment (Immersion A-Scan) to predict the IOL power to be implanted.
- Even then, there is a small possibility of a minor error in the IOL power. This leaves a residual spectacle power which would need to be corrected with glasses
- One would not normally need to specifically clean the eye after surgery.
- Mopping the face with a wet towel (with the eyes closed) should suffice.
- If there are deposits of medicines on the eyelids or lashes one could use fresh ear buds, moisten them with an antibiotic eye drops and clean the outside of the eyelids (and lashes) with them.
- One would not normally need to specifically clean the eye after surgery.
- Any amount of travel is absolutely fine provided one remembers to apply the eye drops.
- Timings will be given for the application of the eye drops, but an hour this way or that does not cause any problem.