Diagnosis of cataract
Cataract is diagnosed during a comprehensive eye exam. Your ophthalmologist will perform a series of tests including vision test (visual acuity), refraction, glare test etc. You will also have your eyes dilated so that your eye doctor can examine in the back of the eyes including vitreous and retina. In the end of your eye exam, your eye doctor will let you know if you have a cataract.
The treatment of cataract is only surgery. Cataract surgery involves removing of natural cloudy lens and replacing it with an artificial lens (Intraocular lens or IOL). Taking consideration of the degree of cataract, how much it has affected your daily life, visual prognosis and other relevant factors, your ophthalmologist will advise you if you need a cataract surgery soon or can wait little longer.
Who needs cataract surgery?
- It is indicated in people who are having severe visual problems like increased sensitivity to light, blurring of vision and being not able to focus on near and distance objects. Cataract extraction can be a better option.
- When a cataract is affecting the health of the eye by causing conditions such as Glaucoma and retinal pathologies than cataract extraction is a better option.
- There are cosmetic indications of cataract as well where the removal of cataract in the eye which has mature cataract and is blind can be removed to get a black pupil.
Is there non-surgical treatment for cataract?
The only treatment for cataract is surgery but there are non-surgical methods for the management of cataract as well. The symptoms caused by cataract can be improved but the damaged part of the lens cannot be brought back to its original form. The non-surgical ways to improve the vision in patients having cataract includes:
Prescription eye glasses
When you have a cataract, the ability of the lens to focus is changed due to the metabolic changes in the lens. Prescription glasses can help to cope with these changes. However, when the cataract progresses, your eye glass prescription may change and may need new glasses again. This is a temporary solution to relieve blurred vision. Your ophthalmologist may ask you to wait until cataracts are removed.
If you have a nuclear sclerosis (a type of cataracts), your vision may be impaired in the bright light as the pupil constricts and using dark glasses or sunglasses can help you see better. Using dark glasses can also prevent glare from oncoming headlights or other bright light.
Medication (use of mydriatics)
Mydriatic eye drops are commonly used in eye doctors’ office to dilate eyes for examination purpose. These drops are also used to improve vision when you have a cataract. When you have cataract in the center of the lens, in the bright light when your pupil constricts, your vision will be impaired. By dilating your eye, the lens allows the light pass through the peripheral part of the lens, which improves your vision.
Childhood cataract (congenital cataract)
If your infant has a congenital cataract (born with a cloudy lens), it is advised by ophthalmologists to perform the surgery before 17 weeks of age to prevent visual impairment. If the surgery is done on time, some of the important complications such as sensory nystagmus- (oscillatory rapid movements of the eyes that can be vertical or horizontal movements), amblyopia – (where the eye cannot receive inputs properly) and glaucoma can be prevented. Glaucoma is usually common in congenital cataracts and ophthalmologists advise for such surgeries to get delayed until the glaucoma is treated. The surgical removal of the cataract that is present since birth depends on the type of cataract, the density of cataract and the age of the patient.
Surgical treatment of cataract
Extra capsular cataract extraction-(ECCE)
It is a type of eye surgery in which the lens of the eye is removed but the elastic capsule that covers the lens is kept intact for the placement of new intraocular lens. The following steps are involved during surgery.
- Irrigation and aspiration of the lens matter
- This is a method in which the soft part of the lens is removed by inserting a special needle in the lens, then a lavage is done and aspiration of the soft part of the lens where the cataract is aspirated when necessary.
Manual Small Incision cataract surgery
In this technique the cataract is removed through a suture less and self-sealing valvular sclerocornea tunnel incision.
This method takes a very minimum time to get the surgery done by giving an incision through the limbus to reach the lens and remove the nucleus of the lens.
Intra capsular Cataract Extraction
This is the removal of the cataract within the capsule of the lens by methods such as Expression method, Arrugas method and Cryoextraction.
Pars plana lensectomy
In this procedure, cataract is removed through the pars plana and indicated usually in congenital cataract.
This is a modern technique in cataract surgery where an ultrasonic device is used to emulsify the lens, when the lens becomes more liquid it is than irrigated and aspirated, once the opaque lens is removed then a new lens is inserted replacing the one which had cataract. This procedure is known as Phacoemulsification.
This is the second method after ECCE (extra capsular cataract extraction) to surgically treat congenital cataract. In this method, a small incision is given in the crystalline lens and then the lens having the cataract is removed along the vitreous part.
Complications of cataract surgeries
During the operation there can be complications such as suprachoroidal hemorrhage which is a dangerous one, rupture of posterior capsule and there can be presence of blood in the anterior chamber which may happen during surgery.
Most of the complications usually occur post operatively such as infections that may affect the eye, corneal edema, wound leakage, prolapsing of the iris, raised intraocular pressure, presence of blood in the anterior chamber and double vision in one eye. Your vision may be blurred but will start clearing up after a few hours to few days. Depending on various reasons, blurring of vision may last for few months after cataract surgery.
Prevention of cataract
Preventing cataract means minimizing the risk factors of cataract such as cessation of smoking, stopping excessive use of alcohol, maintaining a healthy and balance diet to prevent health conditions such as hypertension and Diabetes, developing a good habit of doing exercises daily. There are also many ways to prevent the eye directly from external risk factors such as not seeing into the sunlight directly and using sunglasses or dark glasses in the bright light. People working in hospital settings or other places where there is an exposure to ionizing radiations, ultra violet rays or gamma rays, such persons should wear protective shields or equipment that can block these emitting rays from entering the eye. If you are taking steroids, you should consult you ophthalmologist to discuss minimizing risks of taking it for a long time. If you have already developed cataracts, consult with your ophthalmologist to prevent further complications resulting from untreated cataracts. An eye examination is necessary for everyone to check for the proper functioning of the eye and it is more important to see an eye doctor if you are noticing symptoms of cataract such as blurred vision, glare, halos, blurred vision with new glasses.