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Vishnu Eye Clinic - Laser Foundation : Patient Education

What is cataract?

Simply put, cataract is the clouding (Opacification) of the natural lens, which prevents light rays from reaching the retina. At an early stage, a change in glass power could be a quick solution. However as the disorder grows, vision gets progressively worse – until only perception of light remains.


What are the causes of cataract?

Ageing is the most common cause of cataract. Every person gets it sooner or later, especially people over 60yrs of age. 
Other causes include diabetes, injury, usage of certain medications, and secondary to other eye diseases such as uveitis and glaucoma. 
Cataract can occur early in persons suffering with diabetes, myopia (short sight) and as a hereditary predisposition.
- Cataract is usually painless, accompanied by gradual blurring of vision.
- Double vision or seeing multiple images.
- Trouble seeing under poor light conditions and sometimes even in excessive sunlight.
- Sensitivity to glare – which can make night driving difficult.
- Difficulty in distance vision as well as in reading.


When should you opt for surgery?

This is a decision that depends largely on the patient himself. 
When the cataract begins to affect vision to a degree that it hampers daily activities such as reading and driving, surgery should be considered.


What is Phacoemulsification?

Phacoemulsification at present is the universally accepted standard of care for cataract surgery. 
In this process, ultrasound energy is utilized to break up the cataract (emulsify) into microscopic fragments which are taken out of the eye.


What is MICS?

Surgical wounds have now become smaller and this technique is known as Micro-coaxial Phacoemulsification or MICS.
MICS is Phacoemulsification of the cataract through a wound of only 1.8 mm, with implantation of an intra-ocular lens through the same opening.
The process of wound healing and refractive stabilization is faster in MICS as compared to traditional methods.


What are the options in Intra-ocular Lenses (IOLs)?

Majority of IOLs implanted are mono-focal, meaning they can focus light rays from one particular distance only. In these cases, distance objects are clear and one requires glasses only for reading.
IOLs can be rigid or foldable. Foldable lenses require smaller wounds to insert.


What are Multifocal IOLs?

Multifocal IOLs have many different segments inbuilt onto the same lens, which allows for clear distance as well as near vision without spectacles for most activities.


What about Toric IOLs?

Monofocal IOLs essentially only correct the spherical refractive error. Patients suffering from pre-existing astigmatism will need spectacle correction for distance vision as well as near vision. Toric IOLs eliminate the need for glasses for distance vision.
With recent developments, multifocal IOLs have been introduced, enabling correction for distance, near and cylindrical erro


What are Accomodative IOLs such as Crystalens HD?

Accomodative IOLs are lenses that mimic the natural eye at a young age. At present, the only accommodative IOLs available provide good intermediate vision (such as for reading text on a computer screen), but most patients will require glasses for reading from near.


What are the pre-op requirements?

- Patients need to be in reasonably good general health. Diabetes, hypertension, cardiac problems need to be controlled and cared for before surgery. 
- Patients need to undergo detailed check-up of the eye and a dilated examination of the retina.
- Patients need to get their eyes scanned to determine the curvature and length of their eyes in order to decide the model and power of the intra-ocular lens to be implanted.


Can I take my routine medications on the day of surgery?

You can take all the medications prescribed by your general physician on the day of surgery. However, diabetics need to skip their diabetic medications and Insulin on the morning of the surgery unless specifically instructed by your doctor.
Do not forget to take your morning dose of anti-hypertensive medications. Normally, blood thinning medications such as Aspirin and Clopidogrel are generally stopped 3-5 days prior to surgery. Please ask your physician regarding this.


What can one expect on the day of surgery?

Cataract surgery is a ‘walk-in and walk-out’ procedure. It is done under topical anaesthesia (eyedrop anaesthesia).Rarely, a patient may require an anaesthetic injection before surgery. Anaesthetic drops numb the surface of the eye and the surgery can be comfortably and painlessly performed. 

The procedure lasts approximately 10 minutes excluding the preparation time of a similar duration. Pre-operative dilating drops are applied, which take about 1-1.5 hours to take effect. The patient can expect to spend close to half a day at the hospital on the day of surgery.


FREQUENTLY ASKED QUESTIONS ON POST-OPERATIVE CARE.

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Is there a lot of discomfort or pain after surgery?

Cataract surgery is pretty much painless, and so is the post-operative period. There might be mild irritation, or a ‘foreign body’ sensation for a few days. Mild redness and watering of the eyes may be noticed, which too will subside in a few days.


What do I do after the surgery?

Bed rest is not required after surgery. Patients can carry on with their daily activities like walking, eating, watching TV etc. One needs protective glasses only when outdoors.


Is there any post-operative treatment?

There is a graded schedule for eye drops post surgery, however no tablets or injections are used. 
Normally the patient is advised to start with 3 types of eye drops for a period of 6 weeks.


Can patients resume normal work after the surgery?

Yes. Infact, patients can even work the day after surgery. They can resume routine activities like yoga and sports 3 days after the procedure. Dusty and polluted work environments are however best avoided atleast for a month after surgery. The patient can work from home or from the office, but must be diligent in applying eye drops as advised. As glass correction is given to the patient only 4-6 weeks after surgery, reading may be slightly difficult. But this is much better after implantation of multifocal IOL


Are there any post-operative restrictions?

The patient needs to prevent water from coming in direct contact with the eye for at least 10 days after surgery. However, they can properly sponge their hair and face on the day after surgery.
Bathing (taking careful precautions for the eye) can be resumed after a day as well. 
There are no restrictions on bending, chewing food or lifting moderate weights around the house.
All in all, one can be pretty much normal after the surgery except for a few minor precautions. 


When can I see properly?

Vision will be bright and clear a day after surgery. Full vision will be restored gradually after a few days. Certain objects may seem excessively bright and blue in color for a couple of days, as the cataract was not allowing light into the retina (and cutting off the blue light) and the brain got disused to seeing blue. This is temporary


Will I need glasses after surgery?

Although we use highly specialized equipment (Immersion A-scan, Pentacam etc) to predict the IOL power to be implanted, there is always possibility of minor errors in IOL power. This may leave residual spectacle power, which can be corrected with glasses.


How does one clean their eyes after surgery?

One would not need to specifically clean the eye after surgery. Mopping the face (eyes closed) with a towel should suffice. 
If in case there are deposits of medicines on the eyelids or lashes, one can make use of sterile swabs and clean the outside of the eyelids and lashes.


Can I travel after surgery?

There is no restriction on travelling. Patients can travel even on the day after the procedure, as long they remember to apply eye drops on time.


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