WHAT ARE THE SYMPTOMS AND SIGNS OF CATARACT

Common symptoms of cataract are as follows:

1. Glare. One of the earliest visual disturbances with the cataract is glare or intolerance of bright light; such as direct sunlight or the headlights of an oncoming motor vehicle.

2. Coloured halos. These may be perceived by some patients owing to breaking of white light into coloured spectrum due to presence of water droplets in the lens.

3 Doubling or Trebling of objects): It is also one of the early symptoms. It occurs due to irregular refraction by the cataractous lens

4. Black spots in front of eyes. Stationary black spots may be perceived by some patients.

5 Blurring and distortion of images  may occur in early stages of cataract.

6. Loss of vision. It is painless and gradually progressive in nature.

Signs. Following examination should be carried out to look for different signs of cataract:

1. Visual acuity testing. Depending upon the location and maturation of cataract, the visual

acuity may range from 6/9 to just PL +

2-Slit Lamp examination: It is a non invasive test to grade the cataract which forms the basis of Cataract surgery

Pupil dilatation is required for the slit lamp testing

Indirect ophthalmoscopy is done to rule out any retinal disorders  which can affect cataract management outcome.In mature cataracts Retina cannot be seen because of dense lens opacity therefore For such cases USG B scan of the eye is advised

Grade of Description of Colour of

hardness hardness nucleus

Grade I Soft White or

greenish yellow

Grade II Soft-medium Yellowish

Grade III Medium-hard Amber

Grade IV Hard Brownish

Grade V Ultrahard Blackish

(rock-hard)

WHAT WILL HAPPEN IF THE CATARACT IS LEFT UNTREATED

IF the cataract is left untreated the cataract can become hypermature leading to various complications like
1. Phacoanaphylactic uveitis-  Cataract is usually a painless condition but hypermature cataract may leak lens proteins into anterior chamber which may act as antigens and induce antigen-antibody reaction leading to uveitis manifested by redness and pain in eyes.
2. Lens-induced glaucoma
3. Subluxation or dislocation of lens-Hypermature lens may get subluxated or displaced because of lens support (Zonules) weakness

HOW IS CATARACT TREATED

. Non-surgical measures

1. Treatment of cause of cataract- Especially in complicated cataracts secondary to uveitis or steroids

2 Measures to improve vision in the presence of  immature cataract or if patient willing to wait for surgery for personal reasons

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 Refraction-Though it changes rapidly with the progression of cataract, it should be corrected at frequent intervals.IF patient doesn’t improve with correcting glasses then cataract becomes unavoidable.

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B. Surgical management

Indications

1. Visual improvement. depending upon the individual visual needs This is by far the most common indication. When surgery should be advised for visual improvement varies from person to person. So, an individual should be operated for cataract, when the visual handicap becomes a significant deterrent to the maintenance of his or her usual life-style.

2. Medical indications. Sometimes patients may be comfortable from the visual point (due to useful vision

from the other eye or otherwise) but may be advised cataract surgery due to medical grounds such as

_ Lens induced glaucoma,

_ Phacoanaphylactic endophthalmitis and

_ Retinal diseases like diabetic retinopathy or retinal detachment, treatment of which is being hampered

  by the presence of lens opacities.

3. Cosmetic indication. Sometimes patient with white cataract with impaired retinal function  may want to undergo cataract surgery with no hope of getting useful vision, in order to obtain a black pupil.

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 WHAT DOES CATARACT SURGERY DO?

Cataractous lens is removed and new artificial intraocular lens placed in lens bag

 TYPES OF CATARACT SURGERY

ECCE: Old obsolete.Not performed in regular cataract cases but is advised in certain conditions

SICS- A small incision is made on white portion (sclera of eye). Cataractous lens is removed manually from the incision.Incision size is usually 5.5 mm o 6mm since entire nucleus is to be removed manually.It is recommened in cases where the cataract is very hard to be emulsified through phacoemulsification procedure.Therfore we don’t advise patients to wait for cataract surgery to mature till the end stage

Phacoemulsification: .Cataract lens is brokem down into pieces by Ultrasonic probe and then emulsified and sucked out.This doesn’t require big incisons.3-4  mm incision is enough for Phacoemulsification.No stitch is required since its  self sealing wound.It is the most widely used surgical procedure now

ANESTHESIA USED IN CATARACT SURGERY

Cataract surgery can be performed under local anesthesia which can attained either by giving injection or by no injection technique.It is for the surgeon to decide that which anesthesia  will be appropriate fo which patients.Since all patienst cannot cooperate with no injection technique because of apprehensiveness or anxiety

WHAT IS AN IOL

IOL (Intraocular Lens) is made of plastic or silicone and remains permanently inside the eye.it provides the best optical substitute for the natural lens.thin glasses may still need to be worn at times for distance viewing

 And almost always for near vision since the artificial lens doesn’t have capabaility to change its focussing capacity.

Post chambr iol are placed using the capsule of lens as a support for the lens.newer pciol can be folded and placed in the bag via smaller incision of phacoemulsification

WHAT ARE THE COMPLICATIONS OF CATARACT SURGERY

It is one of the most successful surgery however being a major eye operation some complications can develop  and must be considered before giving consent for surgery

Infection: Since the eye is opened for this surgery a serious internal infection could develop and permanently harm or even destroy eye and vision.this can be controlled by medications.sometimes additional surgery is required so that eye is not completely lost.

Risk of infec: 3-5 per 1000

Hemorrahge

Eyes may bleed internally resulting in unsual surgical complication.if bleeding cannot be controlled then vison can be damaged or lost.chances: 1 in 10000

Retinal detachment

Slight disturbance to internal dynamics of eye and vitreous gel movement causes one or more small tears to form in the retina.the patient may then experience flashes of light and black spots  interfering with vision.these tears can progress to re detachment and loss of vsion.even ifrd occurs, it cabn be treated surgically

Cystoid macular Edema: swelling of central area of retina called the macula can occur.some blurring and distortion of images can occur.it occurs rarely

Double vsion:.Due to anesthesia on the ocular musckes temporal=ry doubkle vision can occur since coordinated eye movements are controlled by the ocular muscles

Posterior Capsular Opacification: transparent post capsular support of iol becomes translucent and doesn’t allow complete transmission of light thus interfering with vision.patients think that their cataract is developing again but it is not the fact.that opoacity can be treated by laser procedure which is an opd rocedure.laser is able to create a small hole in the posterior capsule enabling pts to see cleary once again

WHAT IS LASER CATARACT SURGERY

In phacoemulsification , An ultrasonic probe used to fragment hard nucleus so that it can be sucked out of the ye through a small opening.Laser can be used for this purpose but laser procedure is still not practised extensively

Laser surgery has no added advantages over phacoemulsification

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WHAT IS NO INJECTION/NO STITCH/NO PAD TECHNIQUE

No injection means no local anesthesia given.Eye is anesthetised by using topical drop application

No stitch:Because the entry into the eye is constructed in such a way that it is self sealing ,stitch is not required in phacoemulsification

No pad:Since anesthesia is topical bandage is not applied.We however at our clinic apply bandage in cases of phacoemulsification for atleast 24 hours to prevent eye from developing any post operative infection.

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WHAT HAPPENS ON PATIENTS VISIT TO DR KUMAR RAVI'S EYE CLINIC

All patients undergo detailed slit lamp and fundus examination which will take around 1 hour. After examining, if patients are  advised for cataract surgery  the additional tests like DBR  and and laboratory blood  investigations are  advised

DBR helps in calculation the exact power of Intraocular Lens which is to be implaned to give clear vision to our patients

Lab investigations with physician fitness is done prior to planned surgery

Pt has to come 2 hours prior to planned surgery.Doesnt need to get admitted.Can have breakfast and come to hospital for cataract operation

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                                                      GLAUCOMA

Answers by one of the

best Glaucoma specialists in Kolkata

Dr Kumar Ravi

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WHAT IS GLAUCOMA

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Glaucoma is a condition that causes damage to your eye's optic nerve and gets worse over time. It's often linked to a buildup of pressure inside your eye. Glaucoma tends to be inherited and may not show up until later in life.

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The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to your brain. If the damage continues, glaucoma can lead to permanent vision loss. Without treatment, glaucoma can cause total permanent blindness within a few years.

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WHAT CAUSES GLAUCOMA

It’s the result of an intrinsic deterioration of the optic nerve, which leads to high fluid pressure on the front part of the eye.

 Normally, the fluid, called aqueous humor, flows out of your eye through a mesh-like channel. If this channel gets blocked, the liquid builds up. The reason for the blockage is unknown, but doctors do know it can be inherited, meaning it’s passed from parents to children.

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Less common causes include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside the eye, and inflammatory conditions. It’s rare, but sometimes eye surgery to correct another condition can bring it on. It usually affects both eyes, but it may be worse in one than the other.

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WHO ARE AT RISK FOR GLAUCOMA

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People with a family history of glaucoma

People over 40 years of age

People with diabetes

People who have used steroids for longer period of time

People with physical eye injuries

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HOW IS GLAUCOMA DIAGNOSED

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A comprehensive eye check up by an eye specialist is the best way to detect glaucoma. A complete eye check up including measuring intraoculkar pressure and evaluating the drainage angle of the eye and the optic nerve.Also Visual field tests are used to evaluate the peripheral vision of each eye

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HOW IS GLAUCOMA TREATED

Your doctor may use prescription eye drops, laser surgery, or microsurgery to lower pressure in the eye.

Eye drops. These either reduce the formation of fluid in the eye or increase its outflow, thereby lowering eye pressure. Side effects may include allergies, redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Be sure to tell your doctor about any other medications you’re taking or are allergic to.

Laser surgery. This procedure can slightly increase the flow of the fluid from the eye for people with open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include:

Trabeculoplasty: Opens the drainage area

Iridotomy: Makes a tiny hole in the iris to let fluid flow more freely

Cyclophotocoagulation: Treats areas of the middle layer of your eye to reduce fluid production

Microsurgery. In a procedure called a trabeculectomy, the doctor creates a new channel to drain the fluid and ease eye pressure. Sometimes this form of glaucoma surgery fails and has to be redone. Your doctor might implant a tube to help drain fluid. Surgery can cause temporary or permanent vision loss, as well as bleeding or infection.

Open-angle glaucoma is most often treated with various combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors in the U.S. tend to start with medications, but there’s evidence that early laser surgery or microsurgery could work better for some people.

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