Cataract is the opacification / milkiness of the natural lens of the eye. Due to this opacification , the patient would experience progressive loss of vision . When cataract matures to become absolutely white and opaque , there is total vision loss.
Cataract is multifactorial in nature . Commonest reason of getting cataract is age. However there is no pre-determined age when cataract may develop. However cataract seems to develop early in people suffering from Diabetes .Other reasons are malnutrition , use of steriod medications , blunt injury and injury with sharp objects. People who are exposed to the sun for pronged periods of time or are welders by profession, may get cataract early . Genetic factors may contribute to getting cataract early on in life too.
Cataract may even develop by birth too , when it is called , congenital cataract .Such cataract may develop due to genetic reasons or due to the effect of radiation , malnutrition during development or due to the intake of certain drugs by the mother during pregnancy. Cataract due to genetic reasons may cause more then one child to be affected in the family.
What is the treatment of cataract ?
Treatment of cataract involves removal of the cataract and implantation of an artificial lens inside the eye.
Cataract surgery is done by a technique called Phacoemulsification , in which the cataract is dissolved using an ultrasonically vibrating titanium needle through a micro incision and then implantation of an injectable soft foldable lnes inside the eye. Often no stitches are required . Post surgical recovery is usually very quick and the patient is able to see within 2-3 hours after surgery.
Surgery is carried out with the the most modern Alcon Infiniti and Alcon Centurian Torsional phacoemulsification systems used all over the world .
Why do we need to implant a lens inside the eye after cataract operation?
Cataract is formed in the natural lens of the eye. Since it has become opaque and had to be taken out , we need to replace that with an artificial lens of pre-calculated power.
What are the types of lenses available for implantation ?
Following are the types of lenses available :
Posterior Chamber Lenses :
# Monofocal Lenses : As the name suggests these lenses have one focus and these lenses are the most commonly used . The aspheric version of this variety of lenses provides the best possible vision to the patient. It is generally planned to implant a lens with a power which would provide un-aided distant vision to the patient as far as possible . The patient would need to use glasses to read and for doing fine work. An example of such lens would be the Alcon Acrysof series of lenses ( Multi-piece , Single piece , Aspheric IQ , IQ Toric ) , Auroview lenses from Aurolab .
# Multifocal Lenses: Again as the name suggests , these lenses are manufactured on the time tested Acrysof Panoptix lens range. Suitability of a patient for this lens has to be determined on an individual basis. Spectacles may be required for very fine visual requirements .
# Toric Lenses :This category of lenses incorporates cylindrical correction in it's optic in addition to spheric correction. This is useful in patients of pre existing irregular cornea , for the reduction / elimination of cylindrical number. Cylindrical numbers in the range of 0.75 D to 4.11 D may be treated with these lenses. This lens is also available in the Acrysof platform . Patients implanted with these lenses benefit highly in vision. Custom made lenses may be needed for some patients in which the readily available lenses may not be enough to correct their eye condition.
# Aspheric Multifocal + Toric Lenses : These lenses combine the properties of all the above mentioned lenses and are helpful is specific clinical situtations and specific visual requirements.
# Extended Range of Focus Lenses : These lenses give excellent distant and intermediate visibility while for very fine work , glasses would still be needed. The good thing about this variety of lenses is the absence of glare and haloes at night especially during driving. Even though glasses are required for doing very fine work , a patient may actually not require to wear glasses for more than 85% of the time. Alcon Vivity Spherical and Alcon Vivity Toric are the lenses that we are using for this purpose.
# Iris Supported Lenses (Artisan Lens) : This is a very special design of lens which has very specific indications. In the broader sense, it is implanted in patients with deficient or absent posterior capsule in which the afore mentioned lenses cannot be implanted. This lens is fixed to the brown iris of the eye with small clips on either side of the lens. Implantation can be doen on the front or the back of the iris. This lens may need to be implanted in patients with dislocated lenses , cases of trauma , post vitreo-retinal surgery , as secondary lens implants etc.
# Scleral Fixated Intraocular Lenses : These are implanted in clinical conditions where there is absence of capsular support. The lens , as the name suggests is fixed to the sclera of the eye.
# Customised Lenses : At times , patients may exhibit extreme amounts of ametropia such that Intraocular lens required for their eye may not be available off the shelf . Hence customised lenses may have to be designed of specifications suitable to a particular eye.
# Piggy-Back Intraocular Lenses : Piggy-back lenses may be required in patients who have undergone a successful cataract surgery with intraocular lens implantation but unfortunately due to some reason have ended up with a large undesirable number of glasses.Piggy-back lens of a suitable power and diameter is implanted over an already implanted lens to reduce or eliminate the residual number .
Will I need to wear glasses after Lens Implantation ?
Though we try to make great effort in trying to minimising the need of glasses after intraocular lens implantation , you may still need to use glasses after operation for cataract. After monofocal and monofocal toric lens implantation , near vision glasses are almost certain to be needed. After trifocal lens implantation , the need for glasses is minimised for all distances. After implantation of Extended depth of focus lenses , there may not be much need for distance and intermediate tasks but fine near work would require glasses.
Is it advisable for people who drive a lot , especially at night to get multifocal/ trifocal lenses implanted ?
For people who do a lot of driving , especially night driving , it is advisable to avoid mutifocal lenses because they may suffer from glare from oncoming traffic lights. Such persons may instead opt for extended depth of focus lenses which is a good trade-off between monofocal and multifocal lenses because there is minimal glare while driving and most chores may be performed without the need to wear glasses.
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Disclaimer : Intraocular Lens implantation is a very precise science where we try our level best to provide the best outcomes . However it is not possible to create vision like nature has created .