No one in the world is free from aging. It is only natural that cataract, a disease of aging is the most commonly performed non-emergency, daycare surgery in the world. Here I have dealt with questions that cataract patients commonly ask me.
How do I know that I have developed cataract?
Almost everyone over the age of 40 to 45 will have a cataract in their eye. It is nothing but an age-related conversion of the soluble lens proteins in our eyes to insoluble proteins. But the problem begins when cataracts become dense enough to hamper vision, at which stage you may need surgery for your cataract.
Symptoms related to cataracts are diminution of vision (which will not improve even on changing your glasses), floaters (sensation of a floating object in front of your eyes), colored halos around lights, polyopia (seeing multiple images of a single object), and excessive sensation of brightness compared to others while looking at lights.
What causes cataract?
Cataract in 90 % patients is age-related but you can get cataract due to injury to the eye, certain diseases such as Wilson's disease, muscular dystrophy, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, etc. You can develop cataract from certain medications like steroids and also have cataract since birth (congenital cataract).
Can cataract be cured/prevented from maturing by using drops? Can glasses help in case of diminution of vision due to cataract?
At present, there are no non-surgical measures to cure cataract progression or help with diminution of vision in cataract. There are also no proved measures to slow down the progression of cataract. Glasses and drops will not work. Surgery is the only option available.
I am having difficulty in seeing things far away and nearby. How can I tell if I have cataract or if it is just myopia which can be cured with glasses?
The simplest thing is a pin-hole test. You can take a piece of paper, poke a hole in it using a pen tip and hold it close to each eye and look through the hole. If, in case, you do see things clearly through the hole, it means you have a refractive error (example myopia) and if you do not see better through the hole, then you have cataract.
Of course, the best way to find out if you have cataract is through slit-lamp examination in dilated pupils carried out by the eye specialist.
Can cataract simply not go away if I wait? [OR] My doctor has asked me to wait till the cataract matures and only then go ahead with surgery.
Cataract will not go away unless surgically treated. If left untreated for prolonged periods, it can cause conditions like phacolytic/phacoanaphylactic glaucoma, which may cause the patient to lose his vision permanently.
The current standard of care in cataract surgery is “phacoemulsification”. In this surgery, a high precision ultrasound probe is inserted into the eye to cut the cataract and remove it out of your eye. The ultrasound energy used to remove harder, more mature cataracts is a lot more than what is used for early cataract. Also, the lesser the energy used during surgery, the sooner the patient can see better after surgery. So, it is imperative that surgery is done at the right time and it is not postponed for prolonged periods.
What can I expect when I visit the doctor in case I have cataract?
The eye doctor will take a history and do an examination on a slit-lamp, and he/she will look into the nerve of your eye.
If you do have cataract and have a healthy retina, the doctor will expect a good vision post-surgery and will take you up for surgery. If in case he finds problems in your eye, or he expects poor vision potential after surgery, he may defer surgery or explain to you the pros and cons of surgery and let you decide.
After the decision for operating has been made, you will have to undergo “biometry”. This determines the power of the intraocular lens which will be put into your eye after the cataract has been removed during surgery.
After this, you may be asked to choose a lens type that you want to be inserted in your eye and to book the date of surgery.
My doctor has offered me several types of lenses. Which one should I choose?
In most hospitals, there are package deals regarding lenses. In case you want to decide by yourself, ask the doctor/counselor to give you the details of lenses in each package and choose the lens which has UV absorbing/yellow coating, has zero or negative asphericity, square edge optics and a hydrophobic lens. There are practically no differences between locally manufactured and imported lens.
There are also multifocal lenses and toric lenses.
My doctor said that I have cataract and need surgery. How much time do I have to get the surgery done? Until when can I postpone the surgery?
As previously stated, cataract will not get cured by itself or go away with time. You have to undergo surgery now or later, and the vision outcomes are better if you get it done sooner than later. But cataract surgery is always an elective procedure and no doctor can force it on you to get a surgery done unless you have very advanced or complicated cataracts.
It is very hard to accurately predict how long you will safely be able to wait, as the cataract matures at different rates in different people. No one will be able to say for sure.
How much time off work should I take for surgery? How long will I be hospitalized/unable to work?
Cataract surgery is a daycare surgery, meaning that you will not be hospitalized. You come on the day of your surgery. The surgery takes around 45 minutes in most centers and then you can go home. You will be asked to follow up with the doctor regularly to monitor your condition after surgery.
The case in most centers is they may ask you to take around four days off, one day for the surgery and another three days for the healing. From then, you can start with your routine work. Of course, you will have to put in your postoperative eye drops.
What care should I take after surgery?
Each center has slightly different rules, but most of them ask you not to wash your hair with water for around five days, use your postoperative medicines regularly as instructed, wear dark goggles after surgery (three days indoors and outdoors and for upto a week outdoors), avoid eye rubbing, avoid strenuous work and lifting weights, and regular follow-ups.
In case you have any problems, you can ring up the doctors and ask them. If having pain or diminished vision, kindly visit the doctor in person without delay.
Can cataract grow back again after surgery? How long do the lenses that you put in after surgery last? For how long will the vision after cataract surgery last?
In around 33 % of cases, there will be the formation of “after cataract” which is the formation of a membrane of leftover lens cells after surgery. The lens inserted after surgery will be within the patient’s eye throughout life, but there may be after cataract formation over the lens. This will need cleaning with a laser. Usually, this problem does not happen in all the patients and generally happens several months after surgery.
For more information consult a cataract specialist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist/cataract