Cataract

A cataract is a condition where the natural lens in the eye becomes cloudy and hard and are usually a part of normal aging process. If the blurred vision due to cataract is disturbing your daily lifestyle, the cataract may need to be removed.

The latest technique of cataract removal is Femto-Second Laser Assisted Blade-Less Cataract Surgery also popularly known as Robotic Cataract Surgery. The laser is accurate to the level of 5 microns thereby enhancing its precision, safety and visual outcomes over regular phaco surgery

What is Cataract?

To understand cataract, one has to visualize that an eye behaves like a camera with a transparent lens focusing light on the reel of the eye i.e. retina. The picture so formed on the retina is then sent to the brain via a nerve to complete the process of seeing. When this lens starts becoming opaque or white, the problem is labeled cataract. The condition happens when certain proteins in the lens form into abnormal clumps. These clumps gradually enlarge and interfere with vision by distorting or blocking the passage of light through the lens.

So when the lens is partially opaque, it is called an immature cataract and some light can pass through to help perform some routine functions. However, when the opacity increases to engulf the entire lens, vision is totally cut off and the cataract is called mature.

What are the usual symptoms indicating Cataract?

There is a painless gradual decrease in vision. Early cataract is associated with difficulty in reading in normal light conditions, and extra illumination is required. Excessive glare and reduced sharpness can make night driving difficult. Some experience a rapid changes in the number / power of glasses. In advanced cases there is complete loss of sight and lens becomes pearly white in colour.

If you experience any of the following issues, schedule an appointment with your eye doctor immediately:

  • Cloudy or blurry vision
  • Double vision (diplopia)
  • Fading of colours
  • Seeing halos around lights
  • An increased sensitivity to glare
  • A distortion of vision that makes objects appear as if you’re looking at them through a veil.

What are the problems associated with Cataract?

There is a painless progressive reduction of vision. Initially some help is achieved by changing the spectacle number, but in advance cases the spectacles also prove to be ineffective. Cataracts are the world’s leading cause of blindness, accounting for approximately 42 percent of all cases of blindness in all the countries, luckily its easily treatable in the present age through a simple surgery.

Who are normally affected by Cataract?

Cataract is a long-term problem that usually starts developing around the age of 40 and intensifies by the time an individual attains the age of 50 to 60. It is also caused by eye-trauma, long-term diabetes, corticosteroid medications or radiation treatments.
Some infants are also afflicted by cataract, which is caused as a result of infections during pregnancy. The disorder can also be a symptomatic of metabolic disease affecting the body’s processing of carbohydrates, amino acids, calcium or copper among infants and young kids. If left untreated, cataracts might also lead to blindness.

What is the treatment for Cataract?

There is no medication for treating cataract but surgery has long proven to be an effective treatment of the disorder. With the advancement in technology, it is now safer than ever to get your vision corrected with minimal risks to your vision.
The decision to have surgery depends on the degree to which your vision in impaired. Although some persons with cataracts find that their vision improves by using eyeglasses, magnifying lenses or stronger lighting, the only real way to cure cataracts is by surgery. If cataracts affect both eyes, each eye operation is scheduled and performed separately.

The common surgical procedures are:

  • Extracapsular cataract extraction. In this procedure, the lens is either broken up using ultrasound waves (a process called phacoemulsification, or phaco), then extracted through a tiny hollow tube, or it is removed in one piece. The normal lens capsule surrounding the lens is left intact.
  • Intracapsular cataract extraction. In this technique, both the lens and the lens capsule are removed. This technique is now performed only in very rare cases.

Once the lens is removed, it may be replaced by one of three options:

  • An intraocular lens (an artificial lens placed in the eye during cataract surgery);
  • A contact lens; or
  • Special cataract glasses with very powerful magnification.

Currently, about 99 percent or more of patients use an intraocular lens.

How long does it take to recover from the surgery?

Modern cataract surgery takes just a few minutes to administer and the recovery period is also minimal. In the first week after surgery, it generally is recommended that the patient keep his or her eye covered at all times, either with eyeglasses or an eye shield, to protect it from being bumped or rubbed. A small amount of pressure can easily open the incision, and protecting the eye prevents this. The patient is also asked to refrain from

  • Bending with the head below the waist,
  • Lifting more than 10 pounds, and
  • Straining (on the toilet, for example) to the point of holding one’s breath.

A few weeks after the surgery, the patient may be prescribed glasses for near work. The artificial lenses last a lifetime and complications due to the lens are rare and are easily corrected.

When should you call your Ophthalmologist?

Call your eye-doctor whenever you have trouble seeing clearly. If you are older than 40, schedule an eye examination with your doctor every two years, even if you have not noticed any change in your vision.

Types Of Cataract Surgery

1.Femto Laser Cataract Surgery – FLACS  (Femto Laser Assisted Bladeless Cataract Surgey, Robotic Cataract Surgery)

2. Zepto Pulse Cataract Surgery

3.Micro Phaco Surgery

4.Regular Phaco Surgery

$99 /m

MICRO
PHACO
SURGERY

STICH-LESS

  • US – FDA Approved
  • Manual Capsulotomy*
  • Stitch-Less

$99 /m

REGULAR
PHACO
SURGERY

STITCH-LESS

  • US – FDA Approved
  • Manual Capsulotomy*
  • Stitch-Less
* Capsulotomy is one of the most critical step in a Cataract Surgery which influences the final visual outcomes.

Types of Intra Ocular Lenses (IOL’s)

There are three types of lens options is each category of Cataract Surgery i.e Regular Phaco, Micro Phaco, Laser Cataract Surgery

Monofocal Lenses – Provides good vision for distance
Multifocal Lenses – Provides good vision at varying distances
Toric Lenses – Corrects cylinder or astigmatism in addition to spherical number

IOL OPTIONS FOR FEMTO LASER CATARACT SURGERY

Lenses used in Laser Cataract Surgery are premium and highly advanced lenses which require outmost surgical precision to lie in exactly in the optical center of eye. Such kind of accuracy and precision can only be obtained in Laser Cataract surgery.

Aurium are monofocal lenses manufactured by Medennium(USA). These lenses provide excellent vision for distance. In addition these lenses are also photo chromatic, which means they become lightly tinted during day time or bright light and thus prevent harmful UV rays from entering the eye and damaging the retina. Under normal room lighting conditions, these lenses become totally transparent.

Zeiss trifocal lenses are multifocal type lenses manufactured by Zeiss (USA). These are the only lenses which provide excellent vision for near, intermediate and distance.

Zeiss toric are manufactured by Zeiss (USA). These lenses correct both cylinder and spherical component of vision with excellent and precise results.The plate haptic design offers remarkable rotational stability

IOL OPTIONS FOR ZEPTO PULSE CATARACT SURGERY and MICRO PHACO CATARACT SURGERY

Lenses used in Micro Phaco surgery are ultra soft lenses which can easily go through a micro incision of 2.2mm

Acrysof IQ is an imported monofocal lens manufactured by Alcon (USA). These lenses provide excellent vision for distance. For near vision however, a person may require additional reading glasses. This lens also contains a yellow pigment chromatophore which blocks harmful UV rays and the blue rays from entering the eye and damaging the retina.

Tecnis Symphony is a multifocal lens manufactured by Abott (USA). This lens provides excellent distance and intermediate vision (computer working), however for near work or very fine work one may require additional reading glasses.

These lenses have all the properties of Acrysof IQ along with cylinder correctiion capability. An eye can have two types of power–spherical power which is because of the natural lens within the eye and cylinder power which is because of the dissymmetry in the curve of the cornea. A normal lens can only correct the spherical power leaving behind the cylinder power which has to be later corrected by additional prescription glasses. Toric lens corrects both the spherical and cylinder power in the eye. Toric lenses are recommended if you have a high pre-existing cylinder or astigmatism in your eye. This lens is manufactured by Alcon (USA).

IOL OPTIONS FOR REGULAR PHACO CATARACT SURGERY

Lenses used is Regular Phaco are slightly hard and have to go through a 3.0mm incision.

Aurovue lenses are manufactured by an Indian Company – Aurolab. These lenses are Monofocal type lenses, which means they provide good vision only for distance. For near work or fine work, one may need to wear additional spectacles. These lenses are considered as entry level options for cataract surgery and are recommended for somebody on a low budget.

Akreos AO are similar to Aurovue lenses, however these are imported lenses and are manufactured by Baush &Lomb (USA). These lenses are Monofocal type lenses, which means they provide good vision only for distance. For near work or fine work, one may need to wear additional spectacles. These lenses are considered as entry level options for cataract surgery and are recommended for somebody on a low budget.

Acrysof SP are imported monofocal lenses manufactured by Alcon (USA). These lenses provide excellent vision for distance. For near work or fine work, one may need to wear additional glasses. These lenses are also preferred in Diabetic Patients. It is also a recommended option for somebody opting for a monofocal lens in Regular Phaco surgery.

Multifocal lenses provide good vision at varying distances i.e Near, Intermediate & Distance.

iDiff lenses are multifocal lenses manufactured by Care Group. These lenses provide good vision for near and distance, which means that a person can easily carry out regular day to day activities with distance vision and also do near work such as reading and writing comfortably without use of additional spectacles. iDiff Lenses however do not correct intermediate vision.

An eye can have two types of power–spherical power which is because of the natural lens within the eye and cylinder power which is because of the dissymmetry in the curve of the cornea. Monofocal and Multifocal Lenses can only correct the spherical component of the eye leaving behind the cylinder power which has to be later corrected by additional prescription glasses. Toric Lenses can correct both spherical and cylinder components of eye. Toric lenses are recommended if you have a high pre-existing cylinder or astigmatism in your eye.

Latest News In Cataract

Dr Chaudhary performs live Micro Phaco Cataract Surgery at Annual Delhi Ophthalmic Conference (DOS), 2017

Posted on April 22, 2017

Dr Sanjay Chaudhary performed Live Micro Phaco Surgery at Delhi Ophthalmic Society (DOS) annual conference, 2017. The surgery was performed at Eye7 Chaudhary Eye Centre, Lajpat Nagar and was live telecast to Ashoka Hotel, New Delhi, the venue of the conference. The surgery was witnessed by over thousand eye specialists, followed by a live discussion.

Dr. Chaudhary performs Delhi’s first Zepto Cataract Surgery

Posted on April 22, 2017

Dr. Sanjay Chaudhary performed Delhi’s first Zepto Pulse Cataract surgery at Eye7 Daryaganj, 2017. Zepto Cataract surgery is the latest advancement in digitalised Cataract surgery which enhances the precision, safety & final visual outcomes in Cataract surgery experience.

Russian Ambassador At Eye7 For Blade-Less Femto Laser Cataract Surgery (FLACS)

Posted on December 8, 2016

Ambassador Extraordinary and Plenipotentiary of the Russian Federation, His Excellency Alexander M. Kadakin, visited Eye7 Lajpat Nagar and underwent Femto-Second Laser Cataract Surgery. His Excellency is seen here thanking Dr Sanjay Chaudhary for a wonderful Cataract surgery experience.

Dr. George Baikoff awarding innovators award to Dr. Sanjay Chaudhary for best innovations in 2016 -Chaudhary’s Bimanual IA Cannula at Jaipur Innovators Meet

Posted on December 8, 2016

Dr Chaudhary was honoured with “Best Innovators Award” by Dr. George Baikoff for his exceptional work in improving the designs of IA Cannulas.

Dr Chaudhary Performs India’s First Live Blade-Less Femto Laser Cataract Surgery In India At DOS Conference

Posted on December 8, 2016

Dr Sanjay Chaudhary performed India’s FIRST Femto Second Blade-Less Cataract Surgery on Lensx System(Alcon-USA) which was live telecast from Eye7 to Ashoka Hotel, Delhi, during Delhi Ophthalmic Society annual conference, attended by over 3000 eye care specialists from around the world.

Gaurav Chopra (“Rathore” Of Uttran) With His Mother Who Underwent Cataract Surgery At Eye7

Posted on December 7, 2016

Gaurav Chopra, actor of a popular TV show – Uttran visited Eye7 Daryaganj with his mother who underwent Cataract Surgery. He is seen here with his mother thanking Dr. Sanjay Chaudhary for a wonderful Cataract surgery experience.

What to expect after the operation?

There is usually no visible scarring but at times the white of the eye can have any degree of redness

You may go home with an eye pad and shield, or just a shield. The pad can be removed after the first hour. The shield should be worn at night for the first week.

The eye may feel gritty and sometimes you may experience some mild headache. These symptoms are common. The discomfort should rapidly improve over the next 24 hours. There should be no worsening of your symptoms. If your discomfort or headache should deteriorate, contact your doctor immediately.

Your vision will normally be much better by Day 2. Sometimes there can be some blurring or misting in the eye, but this should improve over the course of the day. If you feel your vision is becoming more blurred, contact your hospital immediately.

If you take part in a sport that risks a poke in the eye, you should discuss returning to these activities with your surgeon before the operation. You should not go swimming for the first 2 to 4 weeks to minimize the risk of infection. When cycling in the first few weeks following surgery, keep your sunglasses on to reduce the impact of dust.

When can I return to work?

The majority of patients with cataracts are elderly and usually retired from work. Cataracts can, however, also occur in much younger patients.

Every person recovers differently and has different needs. Cataract surgery normally has a very quick recovery and the majority of individuals can normally get back to work almost immediately.

Jobs that are more physically demanding and involve exposure to liquids or dust might require a more graduated return to full activities, but are best discussed with your surgeon.

Will I need to use glasses after surgery?

The lens which is placed in the eye is of a fixed power. The power of the lens for a particular eye is calculated with the help of an eye ultrasound. After surgery, routine distance activities can be carried out without glasses. For reading, glasses would be required.

You may opt to chose for lenses which provide you vision for distance and near. in such cases dependency on glasses are reduced

Is there a lens which can give me good clarity for both distance and near vision?

Yes. These are called multifocal intra-ocular lenses or extended range sense sand give good vision without glasses for distance and reading. However in certain eye condition, a need for using a little spectacle correction may be felt for very fine work.

Can an immature cataract be operated?

It is easier and safer to operate on an immature cataract. As the cataract matures, it tends to become harder requiring more energy to do the same job. Beyond a certain limit, excess energy may cause harm to the eye.

If one eye has had a conventional cataract surgery with IOL, can Phaco or Femto be done in the other eye?

Yes.

What is the difference between a foldable and a non-foldable lens?

Foldable (soft) lens has a diameter of 6.0 mm and is made of either Silicon or Soft Acrylic. It can be injected through a needle into the eye through the 2.2 mm opening made for the surgery. The lens unfolds automatically to take its position. Non-foldable (hard) lens has a diameter of 5.5 mm. A 2.2 mm incision has to be enlarged to 5.5 mm to introduce this lens. However the incision still remains self-sealing and requires no sutures, but it may induce some curvature changes in the eye.

What are the investigations required before performing this procedure?

The Blood Pressure (BP) and Blood Sugar should be in control. E.C.G and a medical checkup may be required in some cases.

How is the IOL power calculated for a particular eye?

Today, cataract surgery is not simply about removing the cataract from eye and replacing it with an IOL (Intra Ocular Lenses). A lot depends on a near perfect IOL power calculation. The vision can therefore be customized to suit your requirement i.e. distance dominant, near dominant or intermediate. There are two ways to calculate the IOL power.

The Ultrasound method

Here an ultrasound machine called an A scan is used. The eye is numbed with anesthetic eye drops and the ultrasound probe in a water shell is brought in close approximation to the eye (immersion technique). The moment the probe is in the right position, 10 rapid readings are taken in quick succession. The best reading is picked up for calculations.

The Optical method

Here an optical biometer like the lenstar is used. A diode laser light is passed into the eye, and the reflection echo are noted by a special sensor. The time taken to record the reflected echo is interpreted as the axial length of the eye which determines the IOL power calculation. This technique is highly accurate, and is considered the gold standard for IOL power calculation.
Both the above methods are used in our major centers to cross check the calculations.
(corrections for this page by web designer : the first picture will be replaced by the ultrasound machine and underneath write ‘Ultrasound A Scan’. Under the second picture write ‘Optical biometer – Lenstar).

I have both cylinder and spherical number. Can both be corrected by cataract surgery?

Cataract surgery has now become a refractive surgery and the goal is not just to to remove the opacified cataractous lens but also to reduce dependency on glasses.

A routine Cataract surgery can only correct the spherical component of the eye leaving behind the cylinder power which has to be later corrected by additional prescription glasses.

With advancements in surgical techniques and IOL (artificial lens) designs, today both spherical and cylinder components of eye can easily be corrected with highest precision.

The cylinder component in Cataract Surgery can be corrected by three ways

  1. LRI or Limbal Relaxing Incisions: In this technique, a Femto Laser is used to give highly precise incisions at the periphery of the cornea to induce cylinder correction. Since these incisions are given by a laser, it can only be coupled with a Femto Cataract Surgery.
  2. Toric Lenses with Verion Digital Axis Marking: Toric lenses are special lenses which have both cylinder and spherical component build in one lens. Since cylinder axis varies in individual eyes, the lens has to be aligned to specific axis of the individual. In such cases even a minor deviation from the original axis can cause significant disturbance in final visual outcomes.

Now with the introduction of Verion Digital Axis Marking system, these toric lenses can be aligned with outmost precision, upto 1 degree.

  1. Toric Lenses with Manual Marking: As discussed above, the final visual outcome in a toric lens depends on how precisely it is aligned to the original cylindrical axis of eye. Since the manual markings cannot be as precise as digital markings, the manual system may give slightly inferior results compared to the digital system.

Cataract

Femto Laser Cataract Surgery – FLACS (Femto Laser Assisted Bladeless Cataract Surgey, Robotic Cataract Surgery)
Zepto Pulse Cataract Surgery
Micro Phaco Surgery
Regular Phaco Surgery

Doctors

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          Dr. Gaurav Kakkar

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              Dr. Alka Pandey

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                Dr. Sarika Jindal

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                  Dr. Anju Sharma

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                    Dr. Raj Anand

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                      Dr. Pawan Gupta

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                        Dr. Sanjay Chaudhary

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                        Dr Sanjay Chaudhary is the founder and director of the Eye7 group of eye hospitals.


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