Most cataracts develop when aging or injury changes the tissue that makes up the eye's lens. Proteins and fibers in the lens begin to break down, causing vision to become hazy or cloudy. Some systemic disorders that cause other health problems, like diabetes can increase your risk of cataracts.

Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens. It remains a permanent part of your eye. For some people, other eye problems prohibit the use of an artificial lens.

Diagnosis

To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:

• Visual acuity test. A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. The decrease in visual acquity is the commonest complaint a cataract patient will present with.
• Slit-lamp examination. A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. This helps doctor to identify the type of cataract and associated abnormalities of lens apparatus and plan your surgery accordingly.
• Retinal exam. To prepare for a retinal exam, your eye doctor puts drops in your eyes to open your pupils wide (dilate). This makes it easier to examine the back of your eyes (retina). Using a slit lamp and 90D lens or a special device called an ophthalmoscope, your eye doctor can examine your retina to assess the expected visual outcome after cataract surgery.
• Applanation tonometry / NCT. This test measures fluid pressure in your eye. There are multiple different devices available to do this. High pressure might indicate at times to postpone one’s cataract surgery

Treatment

When your prescription glasses can't clear your vision, the only effective treatment for cataract is surgery.

When to consider cataract surgery

Talk with your eye doctor about whether surgery is right for you. Most eye doctors suggest considering cataract surgery when your cataract begins to affect your quality of life or interfere with your ability to perform normal daily activities, such as reading or driving at night.

It's up to you and your doctor to decide when cataract surgery is right for you. For most people, there is no rush to remove cataracts because they usually don't harm the eyes. But cataracts can worsen faster in people with certain conditions, including diabetes, high blood pressure or obesity or already mature cataracts.

If you choose not to undergo cataract surgery now, your eye doctor may recommend periodic follow-up exams to see if your cataracts are progressing. How often you'll see your eye doctor depends on your situation.

What happens during cataract surgery

Cataract surgery

Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens. It remains a permanent part of your eye.

Cataract surgery is generally done on an outpatient basis, which means you won't need to stay in a hospital after the surgery. During cataract surgery, your eye doctor uses a local anesthetic to numb the area around your eye, but you usually stay awake during the procedure and can communicate freely with the doctor during surgery.

These days all cataract procedures are done by phacoemulsification (MICS) only unless indicated otherwise. A small keyhole incision of 2.2 mm is given through which your cataractous lens can be dissolved by ultrasonic vibrations and foldable IOL of your choice can be implanted through same incision.

Cataract surgery is generally safe, but like any other procedure in body it carries a small risk of infection. It may also increase the risk of retinal detachment in some patients.

After the procedure, you'll have some discomfort, mild redness or foreign body sensation for a few days. Healing generally occurs within a few days to weeks.

If you need cataract surgery in both eyes, your doctor will schedule surgery to remove the cataract in the second eye after you've healed from the first surgery in most of cases.

Intraocular lenses

These days with advent of newer lenses and machines the treatment is tailored to one’s specific needs and eye details. It’s not one shoe fits all type, that used to be the norm earlier. IOL Master machine calculates certain parameters of your eye and helps doctor to decide which type of lens would be most suitable to your eyes taking into account your specific requirements.

Monofocal IOLs

Earlier these were the only lenses available for all types of patients. After surgery with monofocal lens implant, the distant vision is clear but patient will need glasses for their near work and may also need slight power for distance also in some cases.

Monofocal lenses with increased depth of focus such as technis eyhance gives a good intermediate vision along with clear far vision

TORIC IOL s

Needed in some patients with high astigmatism to minimize dependence on glasses for distant vision. doctor will guide you about this if these are required. Especially when both eyes are implanted trifocal lenses.

Multifocal IOLs

Will give you good vision for near and far but intermediate vision is not that clear

TRIFOCAL IOL s

With today’s life style where one spends lot of his time on system, this is the most preferred IOL chosen by patients as they are able to see clearly at all distances and one will almost be independent of glasses for all their routine work.

Extended depth of focus (EDOF) lenses-such as technis symphony gives good range of vision for far and intermediate distance.

Lifestyle and home remedies

To deal with symptoms of cataracts until you decide to have surgery, try to:

• Make sure your eyeglasses or contact lenses are the most accurate prescription possible
• Use a magnifying glass to read if you need additional help reading
• Improve the lighting in your home with more or brighter lamps
• When you go outside during the day, wear sunglasses or a broad-brimmed hat to reduce glare
• Limit your night driving

Self-care measures may help for a while, but as the cataract progresses, your vision may deteriorate further. When vision loss starts to interfere with your everyday activities, consider cataract surgery.

Preparing for your appointment

It's a good idea to be well prepared for your appointment so that you can make the most of your time with your doctor. Here's some information to help you get ready.

What you can do

• List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins or supplements that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• List questions to ask your doctor.

For cataracts, some basic questions to ask your doctor include:

• Are cataracts causing my vision problems?
• What kinds of tests do I need?
• Will cataract surgery correct my vision problems?
• What are the potential risks of cataract surgery? Are there risks in delaying surgery?
• What will cataract surgery cost, and will my insurance cover it?
• How much time will I need to recover from cataract surgery?
• Will any usual activities be restricted after cataract surgery? For how long?
• After cataract surgery, how long should I wait before getting new glasses?
• If I don't want surgery right now, what else can I do to cope with my vision changes?
• How will I know if my cataracts are getting worse?
• I have these other health conditions. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you begin experiencing symptoms?
• Do you have your symptoms all the time or do they come and go?
• Do you experience vision problems in bright light?
• Have your symptoms gotten worse?
• Do your vision problems make it difficult for you to drive?
• Do your vision problems make it difficult to read?
• Do your vision problems make it difficult to do your job? Including Previous refractive procedures such as Rk or Lasik !
• Have you ever had an eye injury or eye surgery?
• Have you ever been diagnosed with an eye problem, such as inflammation of your iris (iritis)?
• Have you ever received radiation therapy to your head or neck?