CATARACT, PHACO (STITCHLESS SURGERY), FOLDABLE LENSES

WHAT IS CATARACT

Cataract (local term ‘Safed Motia’) is a clouding of the natural lens inside the eye, causing blurred vision. When the cataract has advanced sufficiently to impair daily routine and even glasses do not help much, surgery is the only option. Medicines cannot reverse cataract changes in the eye. In cataract surgery, the lens inside your eye that has become cloudy is removed and replaced with an artificial lens (called an Intra-Ocular Lens or IOL) to restore clear vision. With modern surgical techniques cataract is operated in the immature (partly opaque) stage only, it is not advisable to wait for the cataract to mature (totally opaque) as it can cause complications.

Cataract
Intra-Ocular-Lens
Intra-Ocular
  • Oldest & Most Reputed private Eye Hospital (Estd. 1962) which is certified by QCI (QUALITY COUNCIL OF INDIA)
  • Dr.Rohit Grover is the first IOL Implant surgeon of the region to start PHACOEMULSIFICATION with FOLDABLE IOL in 1994. The most experienced eye surgeon of the region doing Cataract surgeries with IOL implant since 1985.
  • YAG Laser for after-cataract since 1990.
  • All the Surgeons at Grover Eye Laser Hospital are highly trained and routinely doing cold Microincision phacoemulsification (MICS, with only 1.2mm to 1.8mm incision) with implantation of Micro Incision Lens and other IOLs with best results for past many years
  • Grover Eye Laser Hospital has the largest most modern and sophisticated Eye Operation Theatre in the city and is well equipped with critical care facilities
  • This centre offers a varied choice of advanced high end intraocular lenses with surgeons having a vast experience in every type of complicated Cataract surgery, in diabetic, in infants & children, in dislocated or subluxated lens, cataract in traumatic conditions or Eyes with Uveitis or Glaucoma or poorly dilating pupil
  • We provide comprehensive eye care of international standards with success rates comparable to the best eye centres in the world
  • Latest State Of The Art Equipment for Diagnosis & Treatment
  • We have High end pre- operative, operative and postoperative services
  • Best Treatment at affordable rates and transparent manner
  • Good Nursing care with Indoor facilities for outstation patients
  • CASHLESS ADMISSION & HOSPITALIZATION AVAILABLE WITH ALL LEADING INSURANCE COMPANIES & TPA'S. Hospital is empanelled with all insurance companies, TPA's, ECHS, CGHS, prestigious corporate bodies and government / semi-government organizations

Newer introductions in Foldable I.O.L. varieties include High Contrast lens, Aspheric IOL , Toric IOL (which correct astigmatism /cylindrical number) and Multifocal IOL (which gives good vision for both near and distance), Extended focus, Trifocal and Multifocal Toric, MICS being done in routine.

Phaco

Operation Theatre

Various Cataract Surgery techniques are as follows :-

1. ECCE (With stitches CATARACT SURGERY)

In Extra-Capsular Cataract Extraction surgery the cataract is removed manually through a very large, nearly 160° cut is made in the eye and a non-foldable IOL is used.

2. Manual sics

Manual small-incision cataract surgery (MSICS; also SICS or SECCE) is a small-incision form of extracapsular cataract extraction (ECCE). A cut of nearly 60° or 6 mm. is made. Compared to traditional ECCE, MSICS has the advantage of a self-sealing sutureless wound. A non-foldable or foldable IOL may be used.

3. pHACO (stitchless CATARACT SURGERY)

In PHACO-EMULSIFICATION or ‘PHACO’ a thin ultrasonic probe sucks out the cataract through a tiny opening (2.8mm) after breaking the cataract into smaller pieces and emulsifying the cataract using very thin hollow titanium probes operating at 40 kHz. to 60 kHz. frequency.

After removal of cataract, foldable I.O.L.s made of transparent silicone or acrylic polymer are inserted which can pass through this very small Phaco opening and open up to their full size once inside the eye. The minute incision is so safe for the eye that it needs no suture or stitch to close it and the patient is back to routine activities within a few hours to days.

ADVANTAGES
  • Overall shorter duration of surgery .
  • Smaller incision- hence lesser complications related to the incision size.
  • Lesser induced astigmatism because of smaller incision so better vision .
  • No stitch, no bandages, and minimal precautions.
  • No restriction on normal activities.
  • Fast recovery of good vision in a matter of days.
  • Final spectacles at one or two weeks.
  • Early visual rehabilitation.

This technology was pioneered in North India at Chandigarh’s oldest and best eye hospital, Grover Eye Laser & E.N.T Hospital in 1994.

4. MICRO-INCISION CATARACT SURGERY (MICS)

Microincision cataract surgery (MICS) is advanced PHACO (stitchless) cataract and Foldable IOL implant surgery through incision as small as 1.2 mm to 1.8 mm. MICS favors the use of fluidics, reducing the use of phacoemulsification power and therefore more gentle for the eye.

Main advantages of MICS are
  • The control and avoidance of surgically induced corneal astigmatism therefore clearer vision
  • The decrease of postoperative corneal aberrations that results in better vision.
  • Smaller incision means faster healing and less chances of infection this is of greater importance especially in diabetic patients etc.
  • No stitch, no injection, no bandage, faster visual recovery.
Phaco

PHACO MACHINES

Phaco

MICS PHACO ( STITCHLESS CATARACT EYE SURGERY )

5. Cataract Laser Surgery, FLACS - FEMTO LASER ASSISTED CATARACT SURGERY.

Recently, femtosecond laser is being used in the initial few steps in cataract surgery which are

  • Creating corneal incisions to allow the surgeon access to the cataract.
  • Removing the anterior capsule of the cataract.
  • Initial partial fragmentation of the cataract.
  • Rest of the steps of cataract surgery for removal of cataract is then completed with Phaco machine only and same foldable IOL is put inside the eye as in routine Phaco surgery.
  • Creating peripheral corneal incisions / LRI to reduce astigmatism (when needed in limited cases only).

The biggest disadvantage of laser cataract surgery (or, more accurately, laser-assisted cataract surgery) is that it significantly increases cataract surgery cost and in fact takes more time to do. Many studies have shown that while femtosecond lasers may help during certain steps of cataract surgery, they do not necessarily improve cataract surgery safety, recovery time and visual outcomes.

An experienced eye surgeon can deliver equally good or even better result with the use of advanced PHACO machine only. Wrongly called robot laser surgery, the technology is not fully mature though it is being tried at a few hospitals. Hopefully as and when improved models of femtolasers are launched in the next few years along with injectable liquid polymer lenses or Light adjustable lenses more and more doctors will accept this new technology

LIMITATION OF FEMTOSECOND CATARACT PROCEDURE

The procedure is not advocated in patients with poorly dilating pupils, and in those with advanced glaucoma. It is not the procedure of choice for patients with corneal opacities and at present this has no advantage over PHACO surgery in routine cataract, IOL surgery.

Limitation Of  Femtosecond Cataract Procedure

TYPES OF IOLS

Many types of IOLS are available to choose from during cataract surgery, depending on your specific needs. Mostly foldable IOLs are used now a days.

1) MONOFOCAL IOLs

They have a single power, normal, aspheric, UV coated etc. options are available.

2) MULTIFOCAL IOLs

They correct nearsightedness and farsightedness so requirement for glasses is minimized.

Now a days Accommodating, Trifocal and Extended focus IOLs are also being used to improve intermediate vision in addition to distance and near vision also.

How does the Multifocal / Extended focus IOL work?

These IOLs have several concentric rings of prisms. Each ring splits the light into various components, therefore, nearly 50% of the light is focused for distance and 50% for near. When the distance object is in focus, the near is out of focus and vice versa. Thus the person is able to see both distance and near objects clearly. Multifocal IOLs are suitable for implantation for majority of patients with cataract depending upon individual needs. Eyes with high cylindrical power need TORIC MULTIFOCAL IOL .

3) TORIC IOLs

A significant proportion of the population has astigmatism (cylindrical refractive errors) that is not corrected with standard IOLs resulting in need for spectacles for both distance and near vision. With the availability of cutting edge technology it is possible today to implant such people with customized IOLs which have capability to correct the cylindrical errors as well. These IOLs are known as TORIC IOLs and are available in both single focus and multifocal platforms. The use of these IOLs offers greater chances of spectacles free vision to the patient.

Discuss various IOL options with our trained counselors and also confirm with our experienced eye surgeons

HOW IS THE IOL POWER CALCULATED FOR A PARTICULAR EYE (BIOMETRY)

Today cataract surgery is not simply about removing the cataract from eye and replacing it with an IOL (Intra Ocular Lenses). A lot depends on a near perfect IOL power calculation. The vision can therefore be customized to suit your requirement i.e. distance dominant, near dominant or intermediate. There are various formulas, ways to calculate the IOL power. Besides corneal power (keratometry), eye Axial Length (AL) is an important parameter of these calculations. AL is measured by the following machines which also include the IOL power calculation modules.

The Ultrasound method : Here an ultrasound machine called an A scan is used. The eye is numbed with anesthetic eye drops and the ultrasound probe in a water shell is brought in close approximation to the eye (immersion technique). The moment the probe is in the right position, 10 rapid readings are automatically taken in quick succession. The best reading is picked up for calculations.

The Optical method : Here an optical biometer like the Lenstar / IOL Master is used. A diode laser or OCT light / partial coherence interferometry light is passed into the eye, and the reflection echo are noted by a special sensor. The time taken to record the reflected echo is interpreted as the axial length of the eye which determines the IOL power calculation.

PRE-OPERATIVE INSTRUCTIONS FOR PATIENTS

The patient is required to visit the hospital in advance when his / her detailed pre-operative examination is carried out.

  • We lay special stress on detailed pre-operative examination which includes vision checkup, tonometry for all patients, a detailed fundus examination and biometry for calculating the Power of I.O.L.to be inserted in the Eye during Surgery .
  • In certain cases special tests like B-Scan, Corneal Topography, Endothelial count, Specular Microscopy & OCT etc. may be indicated.
  • All patients undergoing cataract surgery are asked to get their blood sugar levels checked and to get their physician's clearance before the surgery.
  • The patient is instructed to start using the pre-operative medicines 1 to 2 days prior to surgery.
  • Patient must have a light breakfast in the morning.
  • The patient should take a head bath in the morning of the day of surgery or a night before.
  • A responsible relative or attendant must accompany the patient for surgery.
  • The patient must bring along all his reports and prescribed list of current medications including any other medication which the patient is taking
  • The patient should inform the hospital staff nurses & operating doctor about all other medicines that he / she is taking. Do not stop taking any medication that he / she is using for other diseases like High BP, Asthma etc. and should take the same on the morning of the surgery also. OMIT ANTI DIABETIC MEDICATION on the morning of surgery. It is to be taken after surgery with something to eat.
  • Patient should stop medication like blood thinner, medicine for benign Prostrate Hypertrophy at least 72 hours before surgery and also inform his physician and eye surgeon about this.
  • Almost all eye surgeries including cataract, retinal etc. are day care eye surgeries not requiring overnight stay in our hospital. Outstation patients or those with special requirements can be provided one day free-of-charge stay at our hospital if needed.

FOR G6PD PATIENTS:

Patients must bring this condition to the notice of the doctor before starting any per operative medications.

FOR GLAUCOMA SURGERY:

Ask the doctor for any special instructions as per your case.

For SURGERY Under GENERAL ANESTHESIA ( GA )

Fasting time should be 6 to 8 hours prior to time of surgery. Patient must not have any solid or liquids in this period except few sips of water to take any medications for high blood pressure, cardiac problems, asthma etc.

FOR THOSE ON ANTICOAGULANT TREATMENT

If you are using any anticoagulants like aspirin, Ecosprin, Loprin etc - Stop it 72 hours before the date of surgery.If using long acting anticoagulants such as Warfarin, Clopidogrel etc - Stop the tablets 7 days earlier. The same can be restarted the day after your surgery.

PROSTATE (BHP) PATIENTS USING TAMSULOSIN (Uromax, Uroflo, Flomax etc.) :-

Stop 4 to 7 days beforehand after discussing with your doctor.

ACTIVITIES TO BE EXPECTED AFTER SURGERY / POST OP INSTRUCTIONS

  • You must not drive yourself home! Please make arrangements beforehand for a ride.
  • It is advised to wear protective glasses even at night and in bed for the first 3 days after surgery. This is to prevent accidental rubbing of the eye.
  • You will be informed of all post- operative care and instructions by the Nurse at time of discharge along with the printed discharge summary and list of post-op medicines.

    Glasses are generally prescribed within 1-3 weeks of surgery as per the healing.

    ANY INCREASE IN REDNESS OR PAIN OR SUDDEN DECREASE IN VISION NEEDS AN URGENT CHECK-UP WITH THE DOCTOR.This may be a sign of serious infection in the eye.

    CLEANING YOUR EYE:-

    For the first week following surgery you should protect the eye from injury. Do not rub or put pressure on the eye. For cleaning the eye lids use sterilized cotton or special sterile wipes available at the hospital.

    PUTTING EYE DROPS:-

    • Never use a pin / needle to open the eye drop bottle. Screw on the cap tight to open it.
    • Retract the lower lid and instill one drop of the prescribed eye drop into the eye. Eye drops should be used as per the prescription. Only 1 drop at a time is enough.
    • Keep both eyes closed for at least 10 minutes after each eye drop.

    PROTECTING YOUR EYES:-

    • Put on dark glasses throughout the day for one week.
    • Wipe tears below the margin of the dark glasses. Do not touch the eye.
    • Do not place cotton wool between the glasses and the eye.
    • Do not sleep on the operated side for 2 days.
    • For the first 5 days from the time of operation, take a bath below the neck. Face and hair can be washed after 5 days. But avoid getting water inside the eye.

    ACTIVITIES:-

    • Avoid strenuous activities.
    • Avoid getting dust or sweat in your eyes.
    • Do not lift any heavy objects for about one week .

FAQs

PRE-OPERATIVE FAQs

  • Age-related cataract: Most cataracts are related to aging.
  • Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.
  • Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems such as diabetes. Also, cataracts are sometimes linked to steroid use.
  • Traumatic cataract: Cataracts can develop soon afteran eye injury, or years later.

Cataract is an aging process in majority. Currently there is no medical treatment to reverse or prevent the development of cataract. Once it forms, there is only one way to achieve clear vision again, and that is to physically remove the cataract from the eye by Surgery. Avoid environmental exposures which have been associated with Cataract formation such as prolonged exposure to sunrays, ultra-violet light, prolonged use of corticosteroids, smoking and abuse of alcohol .

There are no restriction after surgery. You do not need bed rest. The patient can have normal diet without any restrictions.

Yes. IOLs are specially recommended for diabetic patients. However your diabetes should be adequately controlled before Cataract surgery. Diabetic Retinopathy (effect of diabetes on retina) tests should be done before and regularly after cataract surgery also.

A small incision is made into the eye. Ultrasonic energy probe is used to emulsify lens and suck it out through a tiny needle. An Intraocular Lens or IOL is inserted to replace the removed lens.

Cataract removal is one of the most common operations performed in the world today. It is also one of the safest and most effective. In more than 90 percent of cases, people who have cataract surgery have better vision afterward.

With current technology it is easier and safer to operate on an immature cataract. As the cataract matures, it tends to become harder requiring more energy to do the same job. Beyond a certain limit, excess energy may cause harm to the eye. More than 30 years ago doctors by compulsion had to wait for cataract to mature as then technology to remove cataract in correct immature stage was not available. You should not wait to let your cataract mature fully but get it done at the right time when it starts interfering in your vision.

Your cataract can progress and reach a stage where glaucoma may develop or may progress to a stage where suture-less surgery is not possible.

  • When cataracts cause enough loss of sight to interfere with a person's work, it is probably time to remove them.
  • Surgery may be performed as soon as visual disability caused by the cataract begins to affect your quality of life.
  • Surgery is the only effective way to remove the cloudy lens from the eye

There are many diseases of retina (Parda) and glaucoma (Kala Motia) where the symptoms are similar to those to cataract. In these conditions if treatment is not taken in time the vision will be permanently lost and it may never be recovered. Any diminution of vision calls for an immediate consultation at a good eye hospital.

The IOL, lens once put inside your eye remains there permanently. You do not need to get it replaced usually within a lifetime span even for cataracts operated in childhood. If there is a specific medical complication, the IOL can be removed or replaced if needed, but this is usually a very rare occasion. Doctors at our hospital are trained for such rare operations also.

This is a permanent lens fitted inside the eye which does not cause any discomfort or irritation. Like you do not feel your natural lens, you will not even feel the artificial lens (IOL) inside the eye. If irritation occurs dry eyes is the commonest reason for such a problem in old age. Consult your doctor if needed.

This lens (IOL) does not require any cleaning as it is permanently fitted inside the eye. This is different from contact lenses that generally young people use instead of spectacles.

Visual recovery is subject to other clinical conditions of the eye. If your retina is damaged or cornea is not healthy or you have any other eye problems vision will be compromised even after the surgery.

Floaters or flying objects are permanent spots inside the eye and you would see them more clearly after the cataract surgery.

Avoid surgery of both eyes on the same day. Give some gap between surgery of both the eyes.

It will depend on the vision of the second eye. Second eye surgery can be planned within next 3-5 days.

These are lenses implanted in the eye to work with the crystalline (natural) lens to correct spectacle errors. Because an ICL can correct a wider range of myopia or hypermetropia than laser refractive procedures, implantable contact lenses are often turned to as an alternative to patients unfit for LASIK surgery. Implantable contact lenses are often referred to as phakic IOLs, which may cause some confusion when trying to distinguish between an ICL and an IOL. The term "phakic" refers to an eye with the natural lens still intact.

Therefore, the main difference between implantable contact lenses and traditional IOLs is the fact that an ICL works in conjunction with the eye's crystalline lens in a young patient with glasses but no Cataract and an IOL replaces the eye's natural lens in a Cataract patient. ICLs are of various types, spherical ICL, TORIC ICL, Phakic-Multifocal done only at certain certified centres including our hospital.

Unlike IOLs, ICL is made from Collamer. Because of the collagen base in Collamer, it is biocompatible with the eye and may provide superior optical performance.

Foldable (soft) lens has a diameter of 6.0 mm and is made of either Silicon or Soft hydrophilic / hydrophobic Acrylic. It can be injected through a needle into the eye through the 1.8 to 2.8 mm opening made for the surgery. The lens unfolds automatically to take its position. Non-foldable (hard) lens usually has a diameter of 5.5 mm. A 2.8 mm incision has to be enlarged to more than 5.5 mm to introduce this lens. However the incision may still remain self-sealing and require no suture, but it may induce some curvature and cylinder number changes in the eye.

Prior to cataract surgery, your optometrist and ophthalmologist will perform a comprehensive eye exam & tests to check the overall health of your eyes. Additional measurements of the curvature of the cornea (keratometry) and the length of your eye ball is measured (biometry test) before cataract surgery. These measurements are essential to help cataract surgeon to select the proper power of the intraocular lens and give you the best possible vision after surgery. In certain cases special tests line B-Scan, Corneal Topography, Endothelial count, Specular Microscopy & OCT etc. may be indicated.

Yes. These are called multifocal intra-ocular lens, accommodating or extended focus IOL and give good vision without glasses for distance, intermediate and near. However in certain cases a need for using a little spectacle correction may be felt for very fine work. With Multifocal or Extended focus IOL insertion, eye glasses for distance and near also can be avoided for most routine activities, though no IOL can ever assure absolute zero number.

OPERATIVE FAQs

The patient should not stop taking any medicines he is using for other diseases and should take the same on the morning of the surgery also. If so instructed, OMIT ANTI DIABETIC MEDICATION on the morning of surgery. It is to be taken after surgery with something to eat.

Patient should stop medication like blood thinner, medicine for Benign Prostrate Hypertrophy at least 72 hours before surgery.

You total stay at the hospital will be for about four to five hours .

We recommend you to have light breakfast and the medications as advised at home . Get some light meals to eat during your stay at hospital .

The area around your eye will be washed and cleansed. Eye drops will be put in your Eye to dilate your pupil before surgery .

POST-QPERATIVE FAQs

It depends on your comfort levels. It is better to keep restriction on watching TV and computer work for initial 4-5 days after surgery.

The lens which is placed in the eye is of a fixed power. The power of the lens for a particular eye is calculated with the help of an eye biometry test. After surgery, routine distance activities can generally be carried out without glasses or with minimal number. For reading, glasses would be required. Glasses are prescribed about two to three weeks after cataract surgery. Glasses are given for distance in few cases. Almost all Monofocal IOL patients will require near or reading glasses.

You can start as soon as you feel comfortable. Glasses are given 2 weeks after surgery .

You will simply be asked to avoid rubbing your eye, avoid water splash in eye or doing any strenuous activity for a few weeks after surgery.

No. You can resume your normal diet after the surgery. Diabetics should strictly adhere to their recommended sugar free diet.

Oral tablets are required for a total of 5 days and eye drops need to be instilled for four to five weeks.

Yes , to prevent dust or physical injury to the eye eg. by inadverdant or accidental rubbing of the eye. The lenses we use have built in UV filters. They protect you from UV LIGHT also.

It is recommended to avoid these for two weeks. Light exercise can be started within a few days.

Avoid washing your face for 5 days. You can shave after four to five days . Do not splash water directly in eye for 3 to 4 weeks.

It is better to avoid hair dye and makeup for two weeks.

Your driving at night is improved once cataract is removed. Patients with Multifocal lOLs may notice a ring of light around headlights and other light sources. These halos are mild, tend to diminish with time.

The eye may feel gritty and sometimes you may experience some mild headache. These symptoms are common. The discomfort should rapidly improve over the next 24 hours.

Your vision will normally be much better by Day 2. If you feel your vision is becoming more blurred or pain is increasing contact your hospital immediately at hospital phone numbers or Emergency helpline number as given on your prescription slip.

You should not go for swimming or splash water in your eyes for 4 weeks to minimize the risk of infection. When going outdoors in the first few weeks following surgery, keep your sunglasses on to reduce exposure to dust, accidental injury etc.

Every person recovers differently and has different needs. Cataract surgery normally has a very quick recovery and the majority of individuals can normally get back to work almost immediately. Jobs that are more physically demanding and involve exposure to dust might require a more gradual return to full activities.

Once a cataract has been removed, it cannot develop again. However, over time, patients may notice that their vision has once again become hazy. This condition, which can occur with any type of IOL, is known as secondary or posterior capsular opacification (PCO). It is due to the thickening of the posterior capsule on which IOL rests .This is called After cataract or ‘Jhilli’. The other use of laser in cataract patient is for making a small central opening or clearing the after-cataract (Jhilli) which at times forms behind the IOL. This is done by Q-switched Nd:YAG Laser which is a very simple OPD procedure.

As with any surgery, pain, infection, swelling and bleeding are possible. Cornea or retina swelling or Retinal detachment may occur in a few people. Be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately. Hospital numbers on your papers or emergency number.

MYTHS AND FACTS

Cataract is the only cause of painless progressive loss of vision. You need not consult doctor till vision is completely lost.

Truth: There are many diseases of retina (Parda) and glaucoma (Kala Motia) where the symptoms are similar to those to cataract. In these conditions if treatment is not taken in time the vision will be permanently lost and it can never be recovered. Any diminution of vision calls for an immediate consultation. Don’t make your own diagnosis.

There are too many precautions for diet and rest after surgery.

Truth: There is no restriction after surgery. You do not need bed rest. You can go for evening walk the same day. The patient can have normal diet without any restrictions.

Cataract surgery is dangerous.

Cataract surgery is one of safest operations done today. More than 96% of surgeries are successful and complications even if they occur can be managed in most cases.

I am too old to get a lens implant.

Truth: Old age is not a contraindication for lens implant. Phacoemulsification & IOL surgery takes less time than the conventional cataract surgery and does not cause any stress. It saves the elderly patient from the trouble of wearing thick glasses. We have successfully operated patients of even more than 100 years age at our hospital.

I can not get lens implant because I live in dusty / village surroundings.

Truth: The lens is fitted inside the eye and is not exposed. Therefore it is very safe for people doing manual labor or working in dusty environment. It in fact all the more important for them and it avoids the use of troublesome glasses in such situations.

I am afraid the lens will not last longer.

Truth: Once successfully implanted the lens lasts lifelong. It doesn’t get dissolved or damaged even over decades (lens expected life is more than 100 years).

I want cataract & IOL surgery but I am scared of pain.

Truth: The whole procedure is short and painless. The helpful & friendly staff at our hospital will make you feel at home.

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