What is Cataract? 

A cataract is a clouding of the lens of the eye, which is typically clear. For people who have cataracts, seeing through cloudy lenses is like looking through a frosty or fogged-up window. Clouded vision caused by cataracts can make it more difficult to read, drive a car at night or see the expression on a friend’s face.

Most cataracts develop slowly and don’t disturb eyesight early on. But with time, cataracts will eventually affect vision.

At first, eyeglasses and bright lighting can help deal with cataracts. But if impaired vision affects usual activities, cataract surgery might be needed. Fortunately, cataract surgery is generally a safe, effective procedure.

Symptoms

• Clouded, blurred or dull vision.
• Trouble seeing at dim light or at night.
• Sensitivity to light and glare.
• Need for brighter light for reading and other activities.
• Perceiving distortion around light sources.
• Frequent changes in eyeglass or contact lens prescription.
• Fading or yellowing of colours.
• Double vision in one eye.
• At first, the cloudiness in your vision caused by a cataract may affect only a small part of the eye’s lens. You may not notice any vision loss. As the cataract grows larger, it clouds more of your lens. More clouding changes the light passing through the lens. This may lead to symptoms you notice more.

Causes

Most cataracts develop when ageing or injury changes the tissue that makes up the eye’s lens. Proteins and fibres in the lens begin to break down. This causes vision to become hazy or cloudy.

Some disorders passed down from parents that cause other health problems can increase your risk of cataracts. Cataracts also can be caused by other eye conditions, past eye surgery or medical conditions such as diabetes. Long-term use of steroid medicines also may cause cataracts to develop.

How does a cataract form?

A cataract is a cloudy lens. The lens sits behind the coloured part of your eye, called the iris. The lens focuses light that passes into your eye. This produces clear, sharp images on the back part of the eye, called the retina.

As you age, the lenses in your eyes become less flexible, less clear and thicker. Ageing and some medical conditions can cause proteins and fibres within the lenses to break down and clump together. This is what causes the clouding in the lenses.

As the cataract grows, the clouding becomes worse. A cataract scatters and blocks the light as it passes through the lens. This prevents a sharply defined image from reaching your retina. As a result, your vision becomes blurred.

Cataracts usually happen in both eyes, but not always at the same rate. The cataract in one eye may be worse than the other. This causes a difference in vision between eyes.

Types of Cataracts

Cataracts affecting the center of the lens, called nuclear cataracts. A nuclear cataract may at first cause objects far away to be blurry but objects up close to look clear. A nuclear cataract may even improve your reading vision for a short time. But with time, the lens slowly turns more yellow or brown and makes your vision worse. It may become difficult to tell colours apart.

Cataracts that affect the edges of the lens, called cortical cataracts. A cortical cataract begins as white, wedge-shaped spots or streaks on the outer edge of the lens cortex. As the cataract slowly grows, the streaks spread to the center and affect light passing through the lens.

Cataracts that affect the back of the lens, called posterior subcapsular cataracts. A posterior subcapsular cataract starts as a small spot that usually forms near the back of the lens, right in the path of light. A posterior subcapsular cataract often affects your reading vision. It also may reduce your vision in bright light and cause glare or distortion around lights at night. These types of cataracts tend to grow faster than others.

Cataracts you’re born with, called congenital cataracts. Some people are born with cataracts or develop them during childhood. These cataracts may be passed down from parents. They also may be associated with an infection or trauma while in the womb.

These cataracts also may be due to certain conditions. These may include myotonic dystrophy, galactosemia, neurofibromatosis type 2 or rubella. Congenital cataracts don’t always affect vision. If they do, they’re usually removed soon after they’re found.

Risk Factors

• Increasing age.
• Diabetes.
• Getting too much sunlight.
• Smoking.
• Obesity.
• Family history of cataracts.
• Previous eye injury or inflammation.
• Previous eye surgery.
• Prolonged use of corticosteroid medicines.
• Drinking excessive amounts of alcohol.

Prevention

No studies have proved how to prevent or slow the growth of cataracts. But health care professionals think several strategies may be helpful, including:

Regular eye exams: Eye exams can help detect cataracts and other eye problems at their earliest stages. Ask your health care team how often you should have an eye examination.

Do not smoke: Ask a member of your health care team how to stop smoking. Medicines, counselling and other strategies are available to help you.

Manage other health problems: Follow your treatment plan if you have diabetes or other medical conditions that can increase your risk of cataracts.

Choose a healthy diet that includes plenty of fruits and vegetables: Adding fruits and vegetables to your diet ensures that you’re getting many vitamins and nutrients. Fruits and vegetables have antioxidants. Antioxidants help maintain the health of your eyes.

Studies haven’t proved that antioxidants in pill form can prevent cataracts. But a large population study recently showed that a healthy diet rich in vitamins and minerals reduced the risk of developing cataracts. Fruits and vegetables have many proven health benefits. Eating them is a safe way to get enough minerals and vitamins in your diet.

Wear sunglasses: Ultraviolet light from the sun may cause cataracts. Wear sunglasses that block ultraviolet B rays when you’re outdoors.

Reduce alcohol use: Drinking too much alcohol can increase the risk of cataracts.

When to see a doctor?

Make an appointment for an eye exam if you notice any changes in your vision. If you develop sudden vision changes, such as double vision or flashes of light, sudden eye pain, or a sudden headache, see a member of your health care team right away.

Cataract Surgery – Safest Treatment & Highest Success Rate in Nepal

Cataract surgery is a highly important and beneficial procedure for individuals with cataracts. If left untreated, cataracts can lead to several potential complications like vision impairment and a decline in overall quality of life. Book a consultation today with Drishti Eye Care System to undergo safe and effective cataract surgery in Nepal. 

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What Is Cataract Surgery?

Cataract surgery is performed to treat cataracts. When a cataract forms, the lens becomes cloudy, leading to blurry or distorted vision. If a cataract makes it hard for you to carry out your everyday activities, your doctor may recommend cataract surgery.

Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don’t have to stay in the hospital after the surgery. Cataract eye surgery is very common and is typically a safe procedure.

During cataract surgery, the cloudy lens is extracted and replaced with an artificial intraocular lens (IOL). Some of the best lenses used in cataract surgery include monofocal IOL, trifocal IOL, multifocal IOL, Extended Depth of Focus(EDOF) IOL, toric IOL, etc. The surgery usually takes less than 20 mins to complete and has a high success rate.

What Are The Types Of Cataract Surgery?

The technique used in cataract surgery has changed completely over the last couple of decades. There are different types of cataract surgery techniques, each with its mechanism of removing the cloudy lens and placing the intraocular lens. The main 6 types of cataract surgery include the following:

Phacoemulsification (phaco cataract surgery): Phacoemulsification is a cataract surgery method in which the internal lens of the eye, which has formed a cataract, is emulsified using an ultrasonic handpiece and aspirated from the eye. After removing the cataract, an artificial IOL is inserted and positioned in the lens capsule, where the natural lens is located. This procedure minimises the incision size and reduces the recovery time and risk of surgery-induced astigmatism. Phacoemulsification is best suited to soft cataracts, where the ultrasonic energy needed is moderate, and insertion of foldable intraocular prosthetic lenses is possible. This procedures can be performed under topical anaesthesia(No injection to be given, just using eye drops) which reduces the injection related complications.

Extracapsular Cataract Extraction (ECCE): ECCE is an older technique that is less commonly used today but may still be used in some instances. It involves making a larger incision in the cornea or sclera (the white part of the eye) to remove the cloudy lens in one piece rather than breaking it up like in phacoemulsification. The IOL is then implanted through the incision and placed in the lens capsule. ECCE is commonly used when phacoemulsification may not be suitable, such as in cases of very advanced cataracts or when additional procedures, like planting a special lens type, are required. The larger incision used in ECCE often needs stitches to close the wound. Which can be performed under local anaesthesia injection.

Laser-Assisted Cataract Eye Surgery (LACS): Laser-assisted cataract surgery involves using a laser to perform the surgery. The laser is used to make precise incisions in the cornea, to open the lens capsule, and to fragment the cataract. This method can offer increased precision and reduce the need for specific instruments during surgery. 

Femtosecond Laser-Assisted Cataract Surgery (FLACS): Femtosecond laser-assisted cataract surgery is a specific type of laser cataract surgery. It utilises a femtosecond laser to create corneal incisions, open the lens capsule, and break the cataract. This technique aims to improve precision and replaces many steps during cataract surgery requiring a blade. 

Microincision Cataract Surgery (MICS): MICS is a type of cataract-removal surgery that uses a tiny incision, usually less than 1.8 mm. This procedure is minimally invasive and can be completed in 10 minutes or less. It is often used to treat patients with very small or dense cataracts. Many people who require cataract surgery can avoid traditional, open-incision surgery with MICS. This is because the small incision used for this procedure means there is less trauma and scarring, which can lead to a shorter recovery time than traditional cataract removal.

Small Incision Cataract Surgery (SICS): SICS cataract surgery is a modern surgical technique used to remove a cataract. It is an advanced version of the traditional extracapsular cataract extraction (ECCE) procedure, and it is considered a safe and effective method for cataract removal. Which can be performed under local anaesthesia injection.

The choice of cataract surgery technique depends on various factors, including the severity and characteristics of the cataract, the surgeon’s expertise, the patient’s eye health, etc. Your doctor will evaluate your specific case and recommend the most suitable technique for you.

How Is Cataract Diagnosed?

To determine whether you have a cataract, your eye specialist will check your medical history and symptoms and conduct an eye examination. Your doctor may conduct several tests, including:

Visual Acuity Test: In this test, you will be asked to read the letters on a chart to assess the sharpness and clarity of your vision. Your eyes will be tested one at a time to recognize signs of impairment.

Slit-Lamp Examination: A slit-lamp examination, also known as biomicroscopy, involves the use of a specialised microscope called a slit lamp. Your doctor will examine your eyes with this instrument, which delivers a magnified view of the front structures of the eye, including the cornea, iris, lens, and the space between them. This examination allows them to know the presence and severity of cataracts.

Retinal Examination: For the retinal exam, your doctor will use eye drops to dilate (open wide) your pupils. This allows the doctor to view the retina for signs of cataracts better.

Refraction Test: A refraction test may be performed to determine the extent of any refractive error (e.g., nearsightedness, farsightedness, astigmatism) that may coexist with cataracts. 

Visual Field Testing: This test determines how much side (or peripheral) vision you have and how much surrounding area you can see. The most common type of visual field test in a regular eye exam is called a confrontation field test, in which the doctor briefly flashes several fingers in each of the four quadrants of your visual field while seated opposite you. It is commonly performed to detect and monitor conditions such as cataracts, glaucoma, and neurological disorders that may affect vision.

Optical Coherence Tomography (OCT): OCT is a  non-invasive imaging technique that provides cross-sectional images of the eye’s structures, including the cornea, iris, and lens. It utilises light waves to generate high-resolution, precise images of the lens and other parts of the eye. OCT can help determine the thickness and integrity of the lens, assess any associated macular changes or swelling, and evaluate the impact of cataracts on the overall eye health.

Contrast Sensitivity Test: Contrast sensitivity testing evaluates your ability to differentiate objects with low contrast, such as shades of grey or slight differences in light and dark. This test estimates your ability to discern details under various lighting conditions, which can be affected by cataracts.

What Is The Procedure Of Cataract Surgery?

Eye Cataract surgery procedure generally involves the following steps:

Anaesthesia: Cataract surgery is usually performed under local anaesthesia, which involves numbing the eye with eye drops or an injection near the eye. Therefore, your doctor will numb your eyes so you won’t feel anything during the surgery. This will make sure that you are comfortable and pain-free during the procedure. In some possibilities, general anaesthesia may also be used.

Incision: An incision is made in the cornea. This incision can be made manually using a surgical blade in case of extracapsular cataract extraction (ECCE) or created with the assistance of a femtosecond laser in laser-assisted eye cataract surgery.

Capsulotomy: After creating an incision, a circular opening is made in the front portion of the lens capsule. This allows access to the cataract-affected lens.

Phacoemulsification or Lens Fragmentation: In phacoemulsification, an ultrasonic device breaks up the cataract-affected lens into small fragments using high-frequency sound waves. The fragments are then suctioned out through the same device. However, in manual or laser-assisted techniques, the lens may be manually removed or fragmented using a laser.

IOL Implantation: Once the cataract is extracted, an IOL is implanted through the incision and positioned within the lens capsule. The IOL is designed in such a way that it can replace the natural lens and restore clear vision. 

Wound Closure: In most cases, the incision is self-sealing and does not need stitches. It will heal naturally over time. However, in the case of the ECCE technique, your surgeon may use sutures to close the incision.

How To Prepare For Cataract Surgery?

Here are some ways to prepare for cataract surgery:

Medications: Follow your doctor’s instructions regarding the use of eye drops or medications before the surgery. You may be prescribed antibiotics or anti-inflammatory eye drops to use in the days leading up to the procedure to prevent infection and ease swelling.

Remove all makeup before surgery: Do not apply makeup to the eyes or any other part of the face on the day of your surgery. This includes facial lotions, creams, and aftershave. Before surgery, wash your face with soap and water. Bacteria that enter the eye come from the eyelids or eyelashes, so it is essential to keep them (and the surrounding area) as clean as possible. 

Stop wearing contact lenses: Your doctor will probably advise you to stop wearing contact lenses for 1 to 4 weeks before eye cataract surgery. It is essential to follow your doctor’s instructions. Contact lenses change the shape of the cornea’s surface, which is important to measure for proper IOL selection. If you use hard lenses, you may be asked to stop wearing them longer than someone who uses soft lenses. This is because it takes longer for the corneal surface to return to its natural shape after wearing hard lenses. 

Fasting Instructions: Depending on the type of anaesthesia used, you may be instructed to fast for a certain period before the surgery. This ensures an empty stomach during the procedure and reduces the risk of anaesthesia-related complications.

Arrange Transportation: Since cataract surgery involves using anaesthesia, you cannot drive yourself home after the procedure. Therefore, arrange for a family member or friend to accompany you to the hospital and drive you home afterward.

Inform Your Surgeon: Inform your surgeon about any changes in your health or if you develop a sickness, such as a cold or fever, before the surgery. These factors can potentially affect the timing of the procedure.

Treat blepharitis before surgery: Blepharitis is an inflammation of the eyelids. It happens when small oil glands near the base of the eyelid become clogged, but allergies and other conditions can also cause it. It is important to treat blepharitis before cataract surgery. If you have been diagnosed with blepharitis, your doctor may prescribe medications to control inflammation and fight infection. 

Manage dry eye: Dry eye is a common eye condition that happens when your eyes do not make enough quality tears and don’t provide sufficient lubrication. If your doctor determines that you have dry eye, he/she will probably suggest treating it before surgery. You may be prescribed artificial tears or other topical medications. Using eye drops and other medications as directed is essential to improve the ocular surface before cataract surgery.

What Are The Benefits Of Laser Cataract Surgery?

Laser Cataract Surgery is a highly effective procedure that offers numerous benefits to people with cataracts. Some of the key benefits of cataract surgery include:

Improved Vision: The cataract surgery lens helps to restore clear vision by concentrating light properly onto the retina. After the surgery, many people experience a significant improvement in their visual clarity.

Reduced Visual Symptoms: Cataracts can lead to various visual symptoms such as blurred vision, difficulty reading, glare or sensitivity to light, reduced night vision, colour distortion, etc. Cataract surgery can help alleviate these symptoms.

Increased Quality of Life: Cataract surgery can enhance a person’s independence and overall quality of life. It helps them recover functional vision and perform tasks like driving, reading, and participating in hobbies or social activities.

Clearer Colours: Cataracts can cause colours to appear dull, faded, or yellowed. By removing the clouded lens and planting an artificial IOL, cataract eye surgery can restore the ability to perceive colours accurately.

Potential Decrease in Eyeglass Dependence: Depending on the type of cataract surgery and artificial lenses placed, you may be able to see better than you have in a while. With advanced intraocular lens implants, your vision may be corrected entirely so that you can see properly without glasses or contacts.

Long-term Benefits: Cataract surgery provides long-term benefits. Once the cataract is removed and an IOL is placed, it does not regrow or return. The advantages of improved vision typically persist for the long term, allowing people to enjoy clear vision for years to come.

Prevents injuries from falls: Falls are a leading cause of death and injury among older adults. Cataract removal can reduce the risk of falls.

What Are The Recovery Tips and Precautions To Follow After Cataract Surgery?

Recovering from cataract surgery is generally a smooth process, but it is essential to follow your surgeon’s post-operative instructions for optimal healing and vision improvement.

Here are some general tips for a smooth recovery after cataract surgery:

Follow your surgeon’s instructions: Your surgeon will provide specific post-operative instructions tailored to your situation. It is crucial to follow these instructions diligently, including the use of prescribed eye drops, medications, and any recommended restrictions or precautions.

Use prescribed eye drops: Your surgeon will prescribe eye drops to prevent infection, reduce inflammation, and help with healing. Follow the recommended schedule and technique for applying the drops. Be sure to wash your hands thoroughly before administering the drops.

Protect your eyes: After surgery, it is important to protect your eyes from injury and infection. Use the protective shield or eyeglasses provided by your surgeon, especially while sleeping, to prevent accidental rubbing or bumping of the eyes. Avoid activities that may expose your eyes to dust, wind, or potential irritants.

Rest and relax: Give your eyes ample rest and avoid strenuous activities for the first few days following surgery. Resting helps promote healing and reduces the risk of complications. Reduce activities that may strain your eyes, such as reading, using electronic devices, or watching TV excessively.

Avoid rubbing or touching your eyes: It is crucial to avoid rubbing or touching your eyes during the recovery period. Touching your eyes can increase the risk of infection and disrupt the healing process. If you experience itching or discomfort, consult your surgeon for appropriate remedies.

Keep the eye area clean: Follow your surgeon’s instructions on how to clean the eye area. Use a gentle, non-irritating cleanser, and avoid getting water or soap directly into your eyes. Be cautious when washing your face to prevent accidental contact with the eyes.

Attend follow-up appointments: Regular follow-up appointments with your surgeon are essential for monitoring your progress and addressing any concerns. Attend all scheduled appointments and inform your surgeon of any changes or issues you may be experiencing.

Be patient with your vision: It is normal for your vision to fluctuate and gradually improve in the days and weeks following cataract surgery. Your vision may be initially blurry or hazy, but it should gradually clear up as your eyes heal. If you have any concerns about your vision, discuss them with your surgeon.

Maintain a healthy lifestyle: A healthy lifestyle can support your overall eye health and aid in the recovery process. Eat a balanced diet rich in fruits, vegetables, and nutrients. Stay hydrated, get regular exercise, and avoid smoking, as smoking can impede the healing process and increase the risk of complications.

Potential Risks or Complications Associated with Cataract Surgery

Cataract surgery is generally considered safe and effective, but like any surgical procedure, it carries some potential risks and complications. It is important to be aware of these possibilities and discuss them with your surgeon before undergoing the surgery.

Here are some potential risks and complications associated with cataract surgery:

Infection: Although rare, there is a risk of infection after cataract surgery. Signs of infection may include increased redness, pain, swelling, or discharge from the eye. Prompt medical attention is necessary if an infection is suspected.

Inflammation: In some cases, inflammation can occur after cataract surgery. This is managed with anti-inflammatory eye drops, but severe or prolonged inflammation may require additional treatment.

Swelling of the cornea: Following cataract surgery, the cornea can experience swelling, a condition called corneal edema. This can cause blurred or hazy vision. Most cases resolve on their own, but in some instances, medication or other interventions may be necessary.

Retinal detachment: Retinal detachment is a rare but serious complication that can occur after cataract surgery. It involves the separation of the light-sensitive retina from its underlying tissue. Symptoms may include a sudden increase in floaters, flashes of light, or a curtain-like shadow in the field of vision.

Secondary cataract: In some cases, a condition called posterior capsular opacification (PCO) can develop months or years after cataract surgery. PCO causes the back portion of the lens capsule to become cloudy, resulting in vision changes similar to those caused by cataracts.

Dislocated or misplaced intraocular lens (IOL): During cataract surgery, an artificial intraocular lens is implanted to replace the clouded natural lens. In rare instances, the IOL may become dislocated or misplaced, requiring additional surgery to reposition or replace it.

Glaucoma: Cataract surgery can sometimes lead to an increase in intraocular pressure, causing or exacerbating glaucoma. Glaucoma can usually be managed with medication or other treatments.

Vision changes: While cataract surgery generally improves vision, some patients may experience changes in vision quality, such as glare, halos, or difficulty with night vision. These symptoms are usually temporary and tend to improve over time.

The risks and complications associated with cataract surgery are relatively rare, and the vast majority of patients experience successful outcomes. Your surgeon will evaluate your individual circumstances and discuss the potential risks and benefits of the procedure with you in detail.

Is cataract surgery covered under insurance?

Yes, cataract surgery is covered by medical insurance in Nepal. Insurance makes it easier for patients to cover the overall expense of cataract surgery. However, the terms and conditions around the coverage and the amount you can claim may vary for each patient.

Cataract surgery, including phacoemulsification and SICS are covered by health insurance. Though the cost of each technique is different, the insurance plan will cover the cost of treatment entirely or partially depending upon Policy and type of Insurance taken.