Cataract Service

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CATARACT TECHNIQUE

The cataract unit is one of the most advanced cataract unit in the world.

Technique

Drishti Eye Centre has always been the torchbearer for established techniques. In early 1980s, Dr.M.C Luthra, the founder, was one of the pioneers of Intra Ocular Lens Implantation in the country.


Phacoemulsification is the technique, which is being used for more than a decade. The cataract procedure and its techniques have evolved dramatically improving vision in up to 99% of cases and saving millions from cataract-induced blindness.

No injection, no stitch & no pad Phacoemulsification Cataract Treatment with Restor Multifocal IOL / IQ Acrysof Intra Ocular Lens {IOL} implantation is the technique, which is being used. This technique is the most advanced technique for cataract management. The institute is certified for Restor Multifocal IOL Implantation.

Drishti Eye Centre is one of the first institute in South Asia to employ 2.2mm incision {using ULTRA SLEEVE} micro coaxial technique with the latest "Torsional Emulsification" with IQ Acrysof Intra Ocular Lens {IOL} / Restor Multifocal IOL implantation.

Cataract Treatment with phacoemulsification is performed on an outpatient basis under topical or regional anesthesia. Paracaine eye drops are used to numb the eye. No injection is given to numb the eye. No patch is required after surgery. The patients can see and move their eyes after surgery. Topical anesthesia has innumerable advantages.

 

  1. There are no risks which are sometimes associated with regional anesthesia.

  2. There is improved vision almost immediately after surgery.

  3. This type of anesthesia is most helpful to cataract patients with sight in only one eye.


A small incision, less than 3mm, incision is made. Special microsurgical instruments are used to break up and suck the lens fragments from the eye (phacoemulsification). The back portion of the lens capsule is left in place and polished for clarity.

A small foldable intraocular lens is inserted through the wound and unfolded in place of the natural lens. The incision is self-sealing so that no stitches are needed. The no stitch incision is used because it can seal itself after Cataract Treatment without stitches, which allows the eye to heal more naturally and with greater symmetry.

The phacoemulsification technique is carried out as an outpatient procedure in stress free environment. The patients are informed about the details of the procedure. This helps in making the patient more comfortable. The patient is encouraged to bring the friends & relatives so that the apprehensions get allayed.

The surgical experience & the recovery becomes a better experience. The attendants of the patients are witness to the details of the procedure as they are able to watch on the LCD monitor. The state-of-the-art surgical methods allow people to return home shortly after the procedure to continue with their regular routines.
The total stay in the Institute is for 2-3 hours.

CATARACT TECHNOLOGY

TorSional Phacoemulsidication with Infiniti Vision System is the most advanced Phacoemulsification technology in the world for cataract surgery. Torsional Emulsification is a much safer & efficient technique as compared with the traditional phacoemulsification technique. This advanced state-of-the–art technology has changed the very perspective of phacoemulsification.

At Drishti eye Centre, the effort is to give the best results. Calculation of the power of intra Ocular lens is another important click in achieving the power of the spectacles which the patient would have to use after the surgery.

No worry for Cataract Patients with history of Refractive Surgery (PRK/Lasik) Drishti Eye Centre offers fool proof methodology for calculating the power of Intra Ocular Lens to be used

Cataract surgery has come of age. Drishti eye centre offers the best customized treatment for each patient. This helps in improving patients’ quality of life they deserve.

The customized cataract surgery involves the following aspects.

Every patient has different visual requirements. These requirements are based on the professional & personal visual goals of the patient.

We at Drishti Eye Centre strive to give to the patient quality and quantity of vision keeping in mind the individual goals. This is possible because of the state-of-the-art capacity of the institute to raise the bar in cataract surgery. We tailor our surgical capability to help the patient achieve any of the following goals:
 

  • Spectacle free eye after cataract surgery.

  • Attaining post operative spectacle power of the eye as per the requirement of the patient.

  • Implanting Intra ocular Lenses having different qualities like:

    • Image Quality

    • Blue light protection to mimic a natural lens of a 20 year old

    • Multifocality provides patients with freedom from glasses

    • Toricity delivers precise astigmatic correction & distance vision spectacle freedo.

    • Protection of the weak Retina by not allowing the posterior capsule to opacify

  • Using different Phacoemulsification techniques according to the type of the cataract.

  • Instant & planned appointment for cataract surgery as per the convenience of the patient.

 

1.What exactly is a cataract?

A cataract is a cloudiness of the eye's natural lens, which lies between the front and back areas of the eye.

2.Are cataracts found only in older people? What are the different causes of cataract ?

Majority of the cataracts are age related. About half of the population has a cataract by age 65 years. But in rare cases, infants can have congenital cataracts. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited. Eye trauma, such as from a puncture wound, may also result in cataracts.

3.My doctor says I have a cataract, when should I get my surgery done?

The modern techniques do not require the cataract to mature & ripen for the decision of surgery. Whenever, the cataract happens to interfere with your lifestyle that would be the time when the surgery should be planned out. By lifestyle is meant when you feel that you are having problem or difficulty in carrying out your personal & professional visual needs to your requirements that should be the time when surgery should be opted for. For example, if you are unable to drive safely because of cataract formation it would be wise to have them removed. Some patients may need cataracts removed for medical reasons; for example, if a patient is diabetic and the cataract is interfering with the ophthalmologist's examination of the retina, then it may be recommended to the patient to have the cataract removed.

4. Is cataract surgery serious?

All surgery involves some risk, so yes, it is serious. However, cataract surgery is the most commonly performed type of surgery in India. Many cataract surgeons have several thousand procedures under their belt. Choosing a surgeon with this much experience will reduce the risk of something going wrong.

5.How is a cataract removed?

A small incision is made into the eye. Dr.Gaurav Luthra uses an ultrasound machine {INFINITI VISION SYSTEM} wherein torsional emulsification is used to break it up, and then remove it. The back membrane of the lens (called the posterior capsule) is left in place. Usually, a replacement lens called an Intra Ocular Lens is used.

6.How is a cataract detected?

If you notice any of the symptoms described previously, go to have an eye exam. By performing it, the Ophthalmologist will know if you have a cataract. Your eye doctor will perform a thorough examination of your eyes. Glare testing and contrast sensitivity tests are sometimes used. There is no single objective test to determine a need for cataract surgery. The final decision for cataract surgery is made by the patient and depends on how much the decreased vision from the cataract is bothersome.

7. What are the symptoms of Cataract?

A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass. Colors may not appear as bright as they once did.

The most common symptoms of a cataract are:
 

  • Cloudy or blurry vision

  • Problems with light, such as headlights that seem too bright, glare from lamps or very bright sunlight.

  • Colors that seem faded.

  • Poor night vision.

  • Double or multiple vision.

  • Frequent changes in glasses or contact lenses.


Paradoxically as the lens gets harder, farsighted or hyperopic people experience improved distance vision and are less dependent on glasses. However, nearsighted or myopic people become more nearsighted or myopic, causing distance vision to be worse. Some types of cataracts affect distance vision more than reading vision. Others affect reading vision more than distance vision.

8.What Causes a Cataract?

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts — and information that may help to prevent them.

Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing UV sunglasses and a wide-brimmed hat to lessen your exposure.

Other studies suggest people with diabetes are at risk for developing a cataract. The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves. Some believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.

Other risk factors may include cigarette smoke, air pollution and heavy alcohol consumption. A small study published in 2002 found lead exposure to be a risk factor; another study in December 2004, of 795 men age 60 and older, came to a similar conclusion. But larger studies are needed to confirm whether lead can definitely put you at risk, and if so, whether the risk is from a one-time dose at a particular time in life or from chronic exposure over years.

9.How can a Cataract be treated?

At first, a change in your eyeglass change of glasses may be all that is needed. This may improve your vision temporarily. There are no medications or eye drops that will cause cataracts to disappear. When you are unable to do the things you like doing, or you are unable to pass your drivers license exam, cataract surgery should be considered.

In other words, think about surgery when your cataracts have progressed enough to affect your lifestyle. Whenever you feel your visual disturbance because of cataract is not allowing you to carry about your professional & personal work to your satisfaction it is at that stage when surgery should be considered.

Cataract surgery is very successful in restoring vision. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40. Cataracts can only be removed with surgery.

10.Are lasers sometimes used in Cataract surgery?

YAG lasers are used in a later procedure to create a clear opening in the lens-containing membrane, if the membrane becomes cloudy in the months following the original cataract removal. Also, some doctors use a laser to break up the cloudy lens before removing it. However, the more efficient method is the Ultrasonic Phacoemulsification.

Dr. Rohit is using Torsional Emulsification which happens to be the latest in Phacoemulsification.

11.How much does cataract surgery cost?

It varies from one doctor to the next; it also depends on the eyewear that is prescribed.

12.How successful is Cataract Surgery?

Cataract surgery has an overall success rate of over 99 percent at Drishti Eye Centre.

13.What are possible side effects of cataract surgery?

As with any surgery, pain, infection, swelling, and bleeding are possible, but very few patients experience serious problems. Your surgeon may prescribe medications for these effects.

Retinal detachment also occurs in a few people. Be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately.

14.What about pre-existing conditions?

Even with successful cataract surgery your eye may not see as well as you would like. Other problems like macular degeneration, glaucoma and diabetes may limit vision after surgery. Even with such problems cataract surgery may be beneficial. If your eyes are healthy, the chances of restoring good vision following cataract surgery are excellent.

15. Can I be too young or old for Cataract Surgery?

Any patient who can undergo a thorough eye examination can undergo surgery if the procedure is performed with topical anesthetic-drops alone.

16. Will I be able to have both eyes treated at the same time?

Surgery can be performed on both eyes on the same day if we conclude you are a good candidate. However, Dr.Gaurav Luthra prefers to do one at a time.

17. Does the cataract have to be “ripe” prior to surgery?

No, the cataract has to be visually significant before cataract surgery. The longer the cataract is in the eye, the harder it is to remove.

18.Do you offer payment options?

Our Accounts Coordinator will be happy to discuss financing information based on your personal needs. Check with your human resources department for any insurance plan so that you can have a cashless procedure done. Credit Cards are also accepted.

19.How is the surgery done?

After drops are used to numb the eye, a small, less than 3mm, incision is made. Special microsurgical instruments are used to break up and suction the lens fragments from the eye (phacoemulsification). The back portion of the lens capsule is left in place and polished for clarity. A small foldable intraocular lens will be inserted through the wound and unfolded in place of the natural lens. The incision is self-sealing so that no stitches are needed.

20.Does Cataract surgery hurt?

Generally cataract surgery does not hurt. Cataract surgery is performed by Dr.Luthra with a local anesthetic therefore you shouldn’t feel anything. Occasionally, you might feel some slight discomfort. If you should experience any discomfort, please make your doctor aware.

21.Are there any restrictions after surgery?

After surgery you may return to your normal activities. You may bend, stoop over, go up and down stairs, watch TV, read or work in the garden as usual. You may take showers and shampoo your hair. However, the most important instruction to remember is DO NOT RUB YOUR EYE for at least one week after surgery, and do not go swimming for two weeks after surgery.

22.What about appointments after surgery?

You will be seen by one of our Doctors the day after surgery. An appointment will then be made for you subsequently.

23. When will I start seeing after surgery?

You will start seeing the moment you get up after the surgery the extent of which may vary in different individuals.

24.How soon can I drive after the surgery?

We will require that you have someone drive you home following your procedure. However, you may drive when you feel comfortable enough to drive safely, possibly the next day.

25. Do I have to avoid all activities post-operatively?

We typically demonstrate to the patients that they can bend over immediately after surgery, pick up 20-30 pounds, and shower, provided they don't get water into their operative eye. We do ask that they wear an eye shield at bedtime for the first few weeks after surgery so they do not inadvertently rub the eye during sleep. Typical follow-up evaluations are scheduled at 1 day, 3 day, 2 week, 5 weeks and as and when required.

26.When will glasses be prescribed?

Temporary glasses can be prescribed on the 4th day. 90% people do not require any change of glasses. However, glasses are traditionally prescribed between the 3rd and 6th week visit.

27. Will I still need glasses or contact lenses?

You may need glasses or other corrective lenses after the procedure on a temporary or permanent basis. Cataract surgery will not prevent, and may unmask, the need for reading glasses.

28.Is cataract surgery performed with a laser?

No, cataracts are removed with rapid frequency sound waves called ultrasound. A laser, however, is used in other areas of treatment for the eye.

29.How long will I be at the Dr. Om Parkash Eye Institute for my cataract surgery?

The surgical procedure itself takes approximately 8to15 minutes, but cataract surgery patients can expect to be at the institute approximately two to four hours for the preparation and recovery period.

30.Will I receive a lens implant?

Yes, an intraocular lens (IOL) implant is used to replace the human lens. This prevents the patient from wearing thick glasses or contact lenses after cataract surgery.

31.My father had cataract surgery a few years ago, and he had to wear thick glasses afterward. Is this still necessary? Nowadays, cataract patients who have intraocular lenses (IOLs) implanted during surgery may need reading glasses for close visiobut that's about it. In fact, with the newer multifocal IOLs, even reading glasses are unnecessary. People who don't receive IOLs wear contact lenses for distance vision, with reading glasses for close up. Or they may wear multifocal contact lenses for all distances. Rarely does anyone have to wear thick eyeglasses now.

 

Described as a natural clouding of the eye lens, cataracts are pretty common, affecting about 20 million people worldwide1.

Cataracts are actually considered an inevitable part of aging and are widespread among people ages 55 years and older. In fact, half of all Americans have them—or have had cataract surgery—by age 80. In other words, if you live long enough, you will likely develop cataracts.

What's worse, if left untreated, cataracts can lead to blindness. Cataracts are already the leading cause of vision loss in adults over age 55 and the most common cause behind blindness worldwide. (For more, see What Are Cataracts?)

The good news, however, is that treatment for cataracts is successful; more than 97 percent of the 3 million-plus cataract surgeries performed each year in the United States are considered successful.

In fact, about 95 percent of patients are able to restore their full pre-cataract distance vision after undergoing the standard intraocular lens (IOL) procedure

Causes of Cataracts

References

1. Brian G, Taylor H. Cataract blindness—challenges for the 21st century. Bulletin of the World Health Organization. 2001;79:249-256. http://www.who.int/bulletin/archives/79(3)249.pdf. Accessed October 20, 2010

Causes of Cataract

Many things can cause a cataract to form, including diabetes, but it is believed that natural aging is the main culprit—at least for 99 percent of cataract sufferers (the other 1 percent are born with congenital cataracts, sometimes due to metabolic disorders or intrauterine infections). For the majority of people with age-related cataracts, age-related cataracts : A clouding of the eye's lens that blocks passage of light to the retina, resulting in impaired vision. Often a result of normal aging, cataracts form when protein clumps cloud areas of the eye's lens. As the cataract progresses, vision worsens and often requires surgical replacement of the damaged lens with an artificial one. or acquired cataracts, these develop very slowly and painlessly over the years and are often initially discovered by an eye doctor during routine exams, but may not be treated until your cataract impedes upon daily activities.

Types of Cataracts

To understand exactly how and why a cataract forms, you first need to know what kind of cataract it is. Following is a breakdown of the 3 most common.

Nuclear cataracts

The most common type, nuclear cataracts are associated with nearsightedness, blurry vision, and faded colors. As a nuclear cataract develops, the eye's lens Lens: The transparent disc behind the pupil that brings light into focus on the retina. becomes more curved and worsens nearsightedness, sometimes temporarily improving farsightedness but not for long

Attributed as a consequence of natural aging, there are several reasons why nuclear cataracts form.

  • Just as skin sheds, so does the eye. But since cells can’t be lost into the air inside the eye, they deposit into the lens, causing it to thicken and yellow.

  • Likewise, with aging, fewer nutrients reach the inner eye, contributing to the formation of an opaque nucleus.

  • Overexposure to ultraviolet light can also contribute, especially as the lens becomes harder, less resilient, and more opaque over time.

  • Several studies have also linked alcohol and exposure to cigarette smoke as cataract contributors.

  • Some systemic disorders, such as hypothyroidism (an underactive thyroid disease), diabetes, and in rare cases, glaucoma, can lead to cataracts as well.


Cortical cataracts

Often associated with farsightedness and natural aging, cortical cataracts are less common and tend to develop in their own unique way.

  • They form when the shell, or cortex, of the lens becomes hard after developing post-birth and grows, usually till around age 60, when nearly 16 percent of the lens has become cortex.

  • Cortical production makes the lens more compact and hard, or sclerotic. Sclerotic: Relating to sclerosis, the hardening of tissue.
    Posterior subcapsular cataracts Posterior subcapsular cataracts are even less common but affect vision more than any other type and tend to affect people under age 40 more often.


Since light converges at the back of the lens, extreme sensitivity to bright lights normally develops and reading can be extremely difficult. Causes include:

 

  • Chronic intraocular inflammation due to overuse of medications such as corticosteroids. Corticosteroids: A class of steroid hormones used to treat a variety of conditions. Chronic use may lead to the formation of posterior subcapsular cataracts.

  • A penetrating injury to the lens, eye surgery, concussion, or the use of irradiation to treat an eye tumor, which can cause any type of cataract but typically result in posterior subcapsular cataracts


Cataract prevention

While many doctors believe that nothing prevents most cataracts from forming, there is some promising research and things you can start doing now for possible cataract prevention (if you don’t have them already) or to slow down the development of a cataract. Such as:

 

  • Wear sunglasses to block out the harmful ultraviolet (UV) rays from sunlight. Too much exposure has been shown to contribute to the development of cataracts. Look for a label from the American National Standards Institute (ANSI) that says that the lenses block both UVA and UVB rays.

  • Eat foods containing high amounts of antioxidants, meaning fruits and vegetables. People who eat large amounts of green, leafy vegetables, such as kale and spinach, which are rich in the nutrients lutein and zeaxanthin, show lower risk for cataracts.

  • Have your cholesterol checked by your doctor. It could be that there is a link between high cholesterol levels and cataracts, as some studies suggest that the use of statins, a class of cholesterol-lowering drugs, may help prevent the formation of nuclear cataracts. Anyway, it doesn’t hurt to get your cholesterol levels tested by a doctor at least every 5 years, or more often if you have had high levels in the past or are a man over age 45 or a women over age 50.1