Many people are affected by cataract as it is one of the common eye conditions seen after the age of 45 or 50. The lens in one or both the eyes gets cloudy and hampers the normal vision of the individual. The main reason for this cloudy appearance is due to the clumping of the proteins present in the lens due to ageing or other systemic factors. The person with cataract has blurred vision, sees faded colours, poor night vision, double vision, cannot tolerate very bright light, etc.

The main components of the eye include the pupil, iris, lens, and retina. The pupil allows passage of light, from the object in sight, through the lens and to the retina where it forms the image signal and sends it to the brain. Lens is an important part of the eye which is responsible for generating a clear image. It contains proteins and water as the main components. The different proteins arrange themselves in a specific manner so that the lens appears clear.

How is Cataract formed?

Ageing is one of the crucial factors responsible for causing cataract. The other factors include injury to the eye, diabetes, kidney disease, presence of other eye disease such as uveitis or glaucoma, prolonged usage of steroids in the form of eye drops or oral medications, exposure to radiation, and hereditary .  With ageing and these other factors, the proteins in the eye lens lose their uniform structure and become clumped. These clumped proteins appear hazy and give a cloudy appearance to the lens which is the onset of cataract. (Figure 1)

cataract
Figure 1. Cataract

Types of Cataract
There are different methods for classifying the different types of cataract. These different methods of classification include:

Based On the Affected Part of Lens

  • Nuclear cataract
  • Cortical cataract
  • Posterior Capsular cataract, etc.

Based On the Cause of Cataract

  • Congenital cataract
  • Secondary cataract,
  • Traumatic cataract,
  • Radiation cataract, etc.

Overview of Treatment
Clumping of the lens proteins is the only reason for the cause of cataract. This clumping is irreversible with medication, and thus, surgery is the only method used to treat cataract. During this surgery, the doctor removes the affected lens and an artificial lens called the Intra-Ocular Lens (IOL) is implanted in the eye. Thus, allowing the passing of the light through it and sending proper image signal to the brain.

Specialists can undertake different types of surgeries. With the advancement of science and technology, different surgical methods for treatment of cataract have come up. These different surgical techniques include:

  • Microincision Cataract Surgery: The surgeon makes a small incision on the cornea to remove the affected lens. The size of the incision in this method is 2.2 mm, thus the name, micro-incision. The process of emulsification helps in emulsifying the affected lens which is then removed. The doctor then inserts a foldable IOL which replaces the original lens. This is a quick procedure which is painless and stitch-less. It also leads in quick healing and recovery. The smaller size of the incision leads to markedly reduced astigmatism after surgery.
  • Phacoemulsification: The techniques uses phacoemulsification process for emulsifying the cataract. It needs an incision of 2.8 mm. An ultrasonic phacoemulsification probe helps to emulsify and remove the  cataract. This process is also stitch-less. On removal of the cataract, a foldable IOL is implanted.
  • Small Incision Suture-less Cataract Surgery: In this type of surgery, the incision is not made on the cornea, but a larger (6mm) scleral tunnel incision made. This procedure is useful when phacoemulsification is not possible as in very advanced or hypermature cataract which pose a risk and are not suitable for phacoemulsification procedure. This does not cause damage to the cornea. The removal of cataract takes place is done manually followed by implantation of IOL.

Types of Intra-Ocular Lenses (IOLs)
There are different IOLs based on the power and function like Monofocal IOLs, Toric IOLs, and Multifocal IOLs. (Figure 2 and 3):

Monofocal IOLs: correct only distance vision and near vision glasses are still required after surgery.

Toric IOLs: When the pre-operative astigmatism is significantly high, a toric IOL is chosen.

Multifocal IOLs: These IOLs reduce the dependence on glasses to a very large extent and patient can enjoy clear vision for both distance and near without spectacles after surgery.

intra-ocular-lenses-cataract
Figure 2. Intraocular lenses

intraocular-lenses-cataract-treatment
Figure 3. Types of Intra-ocular lenses

The most suited type of treatment and the choice of IOL can be recommended by specialists at Neoretina. With the help of advanced diagnostic techniques, we can accurately diagnose and suggest the right path of treatment. Enjoy better vision and get rid of cataract with the help of modern techniques and surgery.

 

 

Dr Abhilasha Baharani

Dr Abhilasha Baharani

DNB FRCS (Glasg) FICO Uvea & Cataract Specialist at Neoretina
Dr. Abhilasha Baharani is a specialist in Uveitis and Ocular inflammation. Her areas of expertise are Uveitis & Ocular Immunology- management of ocular tuberculosis, immunosuppressive therapy for non-infectious uveitis & scleritis, phacoemulsification in small pupil, complicated cataracts and ocular manifestations of systemic diseases. She studied MBBS at Kasturba Medical College Mangalore and DNB at Aravind Eye Hospital & Post-Graduate Institute of Ophthalmology, Tirunelveli. She did her fellowship in Uveitis & Ocular Inflammation at Aravind Eye Hospital & Post-Graduate Institute of Ophthalmology, Madurai and a second fellowship in Ocular Inflammatory Disease in Vitreoretinal Disorders at the Royal Victoria Eye and Ear Hospital, Dublin, Ireland where she became well-versed with newer immunosuppressive agents and use of biologic blockers. She is a member of the International Ocular Inflammation Society and is an active member of the state and national academic societies. She has received the Carl Herbort Award for her research paper at the Uveitis Society of India Annual Meeting in 2012 and Award of Distinction and Award of Merit for her research papers at the International Ophthalmology Congress- Innovations and Challenges in Glaucoma & Uveitis, Singapore, 2014.
Dr Abhilasha Baharani