Over fifty percent of people over the age of 60 (and quite a few younger than that) suffer from cataracts. Almost everyone develops cataracts as they grow older. Cataract formations occur at different rates and can affect one or both eyes.

A cataract is a progressive clouding of the eye's natural lens.It interferes with light passing through the eye to the retina. Aging and other factors cause proteins in the eye's lens to clump together forming these cloudy areas. Early changes may not disturb vision, but over time cataracts typically result in blurred or fuzzy vision and sensitivity to light. People with progressed cataracts often say they feel as if they're looking through a waterfall or a piece of wax paper.

Symptoms of Cataracts:

Diagnosing Cataracts:

Your eye doctor can perform a contrast sensitivity test to determine how much your vision has been affected by a cataract. But typically, when decreased vision affects your everyday activities or hobbies, a cataract should be treated.

Treating Cataracts:

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery.

Cataract Surgery:

The operations done for cataract are the following (the list includes only established standard procedures):

1. Phacoemulsification with foldable Intraocular Lens (IOL) implantation (No-Stitch Surgery).
2. Extra-capsular Cataract Extraction (ECCE) with or without Intra-ocular Lens (IOL) Implantation.

Intra-capsular Cataract Extraction (ICCE). Pars Plana (PP) Lensectomy.

In Phacoemulsification the incision is smaller (3.2 mm) and the nucleus of the lens is converted to a pulp using high frequency sound waves and sucked out. Then a foldable IOL is inserted through small incision and positioned into capsular bag or the incision may be enlarged and non-foldable IOL may be implanted (although sacrificing the advantage of small incision). The main advantages of this operation are early rehabilitation and decreased occurrence of high astigmatism (cylindrical power in glasses), though the final outcome after a few months is the same in both the procedures. All these operations are done under local (or topical) anesthesia which makes the eye and surrounding area numb / senseless, and the patient although conscious does not feel any pain. The general anesthesia , which has its own risks, is used only in children and uncooperative patients.

ECCE with IOL implantation is the conventional procedure. It involves making an incision (about 6-8 mm) at the edge of cornea (junction of black with the white of the eye in the upper part) followed by making an opening in the capsule of the lens. Through these openings the nucleus (hard portion) of the lens is expressed and cortex (soft portion) of the lens is sucked out. IOL is inserted and positioned either inside the capsular bag or over the capsule (if the capsular support is deficient then IOL is positioned in the anterior chamber or may not be implanted at all).The incision is then sutured (stitched) using micro-fine polymer thread (# 10.0 or finer). In most cases these sutures are not required to be removed.

Intraocular Lens (IOL)

Intra-ocular Lenses (IOL) are small (5-7 mm) lenses made of a soft polymers viz., silicone, acrylic or PMMA and are implanted inside the eye in place of natural lens. The greatest advantage of IOL is a clear wide field of vision and the fact that the patient does not have to constantly wear thick glasses. However, glasses with low power may be still be required to be worn especially for reading distant and near small print. The reason being that unlike natural lens the IOL has a fixed power (estimated by doing Ultrasound of the eye) which is usually adjusted such that the mid-range or routine viewing distances are seen clearly, and for distances closer or further low powered glasses may still be needed.. Since the IOL stays in the eye lifelong therefore there should not be any compromise on the quality of the IOL. Indian IOLs, though structurally quite good, are not yet optically comparable to imported brands (e.g. Bausch & Lomb, Pharmacia, ORC, Domilens, Allergan, Iolab, Hoya, Alcon, Corneal, etc.)

Multifocal Foldable IOL

A recent advance in the field of cataract surgery is introduction of Multifocal Foldable Intraocular Lens (Available lenses are Acysof Restor and Technis Multifocal IOL) . This lens has multiple zones of varying converging powers on its front surface and is made of silicone.. The distant objects, mid-range and near objects, all are in focus and thus there is virtually no need of any glasses. Multifocal IOLs offer the advantage of clarity in the entire viewing range but they have poor comtrast and color saturation, some patients may also experience haloes and glare. However, these are only minor problems which the person gets easily used to. These IOLs are definitely an option to get rid of glasses after cataract surgery.