When a person complains of cataract symptoms, he has to undergo certain tests to confirm his eye cataract.
Once it is confirmed, he is taken up for treatment, which is mainly surgery provided the ophthalmologist is satisfied the patient fulfills all the required parameters.
Testing for cataract, surgery options for cataract, and their complications that may arise after cataract eye surgery are discussed in this article
Preoperative tests for cataract surgery
- Visual acuity test for cataracts uses the conventional Snellen’s eye chart to test for close and distant vision. In a mature cataract, the patient cannot read better than 20/200 on the Snellen’s or visual acuity chart. In an immature cataract, the patient can distinguish letters at levels better than 20/200.
- A refraction test or vision test determines if you need any change in the prescription of your glasses or contact lens.
- Color contrast sensitivity test determines whether you can differentiate the various shades of gray, which you will not if you are having a cataract.
- Glare testing checks your tolerance against the light with different light sources of varying potential.
- Tonometry measures the fluid pressure inside your eyeballs, to rule out glaucoma.
- Retinal test. For this test, the ophthalmologist puts eye drops into the eyes to dilate the pupils. With the help of an ophthalmoscope, the ophthalmologist examines the lens of the eyes for any opacity that may have developed in the lenses of both eyes. This test will also help to rule out any other eye pathology, which may have reduced your vision. You can see the opacity of a mature cataract even with the naked eye using a torch.
- Ocular imaging studies such as sonography, CT scan, or MRI are requested when a significant posterior pole pathology is suspected.
- ECG is done to confirm the patient’s general fitness for surgery and rule out any heart problem.
- A blood sugar test is done to confirm that the blood sugar levels are within normal limits and the patient is fit for surgery.
Treatment of cataract
About 3 million Americans undergo corrective eye cataract surgery every year and 9 out of 10 regain their good eyesight.
If both eyes have developed cataracts, the doctor performs surgery only on one eye at a time. After seeing the prognosis of the surgery on the first eye, he takes up the second eye for surgery after the due period, which is usually one week.
After the cataract has matured and you cannot see clearly even with your glasses, surgery is the only proper option.
In cataract eye surgery, the ophthalmologist makes an incision into the capsule of the lens and removes the cataract lens. The surgery for cataract takes about 30 minutes and the patient is sent home the same day.
Indications for cataract surgery
A cataract develops gradually over time and so do vision disturbances. You may have blurred vision or even double vision.
When you find that, you are unable to or find it difficult to perform your daily routine activities, you should decide to see your ophthalmologist for relief.
Your routine activities will include reading, working on a computer, or driving at night. The quality of your life is hampered and you feel the desperate need to alter that.
However, delaying surgery and letting the cataract worsen does not alter the prognosis of surgery performed a little late.
However, certain risks do prevail.
A cataract is said to be mature when the lens becomes opaque, usually white. No light rays can pass through the lens and you cannot see anything with that eye. In such cases, you can visualize the daily life problems you will face. You will be absolutely blind in that eye and totally helpless in performing any duty.
It takes years for a cataract to mature. However, there are certain exceptions when a cataract is known to harden in just 2 to 3 days. This happens in case of trauma to the eye or when the blood glucose levels in a diabetic have risen very high.
This is the result of glucose entering the eye lens and getting converted to sorbitol, which cannot be metabolized. The osmotic gradient causes the influx of water, as a result of which the lens becomes opaque and swells.
The mature cataract can become hypermature when cortical material escapes out of the capsule leaving the lens wrinkled and shrunken. The danger with hypermature cataracts is the complication of phacolytic glaucoma.
There are, therefore, risks for letting a cataract stay unattended. Ideally, you should let your ophthalmologist take the decision of surgery when the cataract has matured.
Types of cataract eye surgery
There two types of cataract surgeries and your ophthalmologist will decide which type will suit you best.
Extracapsular surgery is the type followed most today. In this type of surgery, the ophthalmologist makes a small incision in the capsule of the lens. The lens is then broken into tiny fragments by sound waves using an ultrasound probe.
The fragmented pieces are then sucked out through the same probe. This procedure is called Phacoemulsification. The eye surgeon then implants an intraocular lens (IOL) back into the capsule in place of the removed lens.
Sometimes, the lens is too mature and dense to be dissolved by the ultrasound technique. In such cases, a larger incision is required to be made so that the whole lens is removed from the capsule and a new IOL is then implanted through the ultrasound probe.
The eye surgeon then sutures the incision. This surgery requires an injection of local anesthesia to be injected into the eye.
Intracapsular surgery for cataracts is not performed nowadays. In this surgery, the eye surgeon removes the lens along with the capsule and the new lens implant is then placed in a new position in front of the iris.
This procedure is useful in cases of eye trauma where there is damage to the capsule of the lens.
Laser eye surgery
Laser eye surgery for cataracts is an option, which is not popularly followed.
In this procedure, the eye surgeon makes an incision in the capsule of the lens and breaks the lens into small pieces with the help of the laser. He then removes the fragments of the cataract lens.
However, laser treatment for cataracts is useful when the posterior surface of the lens capsule becomes cloudy, sometimes years after cataract surgery. This produces a blurring of vision.
The surgeon makes an opening into the affected part of the capsule to restore vision. This is a painless procedure and takes little time.
Postoperative care after cataract surgery
Within few hours after surgery, most patients can see clearly, though healing in the operated eye is not complete.
Depending on the IOL your doctor chose for your cataract surgery, it may take three to six weeks before your vision fully stabilizes.
For faster recovery and to prevent complications, follow certain do’s and don’ts.
- Try not to sneeze or vomit immediately after surgery.
- Wear dark glasses for the number of days as advised. Be sure to use them outdoors.
- Do not drive for a couple of days after surgery.
- Make periodic visits to your eye surgeon as advised.
- Use the prescribed eye drops several times during the day to prevent infection and inflammation.
- Do not bend or stoop, lift heavy objects, or do any strenuous activity for a few weeks. This will prevent extra pressure from being exerted in the eye.
- Try not to sleep on the side of the operated eye. You can sleep on your back or on the opposite side. Avoid sleeping on your stomach because it will exert extra pressure on the eye.
- Do not rub your eyes. Wear a protective eye shield
- To reduce the risk of infection, avoid swimming or bathing in a hot tub during the first week.
- Stay less mobile to avoid bumping into any objects.
What you can do and when, after surgery
- You can take a shower and wash your hair after day one.
- Watch light television or work on a computer after two days.
- You can start driving two days after surgery.
- You can start your exercises after two weeks post-surgery.
Cataract surgery recovery time
After a couple of days post-surgery, any discomfort in te eye, if present should disappear. In most cases, there is complete healing within eight weeks by which time full activity can be resumed.
Once the vision is stable, your ophthalmologist will prescribe glasses, if required.
Complications after cataract surgery
Cataract surgery has a very high success rate. However, as with any surgery, the possibility of complications does exist.
Your risk of complications increases if you have another accompanying eye disease or a serious medical condition.
Occasionally, cataract surgery fails to improve vision because of underlying eye damage from other conditions, such as glaucoma or macular degeneration.
The complications that may arise are:
- Infection/inflammation in the operated eye
- Bleeding in the eye
- Swelling and/or clouding of the cornea
- Drooping eyelid
- Dislocation of the artificial implanted lens
- Endophthalmitis is the inflammation of the endophthalmitis, which is the innermost coat of the eyeball. This is a serious complication and if not controlled can result in loss of vision in that eye.
- Retinal detachment is a condition wherein the retina peels off. This is a medical emergency and can result in loss of vision in that eye.
- Posterior capsular opacification is a complication, which occurs after cataract surgery and involves cloudiness of the posterior part of the capsule. If it hinders visibility, then an opening is made in this part of the capsule with the help of a laser to allow light rays to pass through and let the object be seen.
- Secondary cataract
- Loss of vision
Intraocular lens (IOL) for cataract
An intraocular lens (or IOL) is a small, synthetic, artificial, clear, and transparent lens that replaces the eye’s natural lens, which the eye surgeon removes during cataract surgery. IOLs are only used for those who are 18 years and older.
IOLs come in different focusing powers, similar to prescription eyeglasses or contact lens. In order that you are served the right lens, the ophthalmologist will measure the length of your eye and the curve of your cornea to acquire the right focusing power of your IOL.
Most IOLs are made of silicone, acrylic, or other plastic material. The lens stays in position permanently after it has been implanted.
It is also coated with a special material to protect the eyes from the harmful effects of the sun’s harmful ultraviolet rays.
Normally, a mono-focal lens is implanted and the use of eyeglasses may be required to see near or distant objects clearly. However, more expensive multifocal lenses are also available and the use of eyeglasses with such a lens may or may not be required.