Cataract Surgery Overseas

What is cataract?

The human eye has a natural lens, which is normally transparent and forms a clear image of the outside world in the eye. When this lens develops haziness/opacity, the sight is decreased or may be even completely lost. This is called cataract. 

What are the symptoms?

The most important symptom of cataract is a decrease in vision for distance and/or near objects. Other features can be decreased vision in bright or low light, decreased contrast, altered colour appreciation, seeing many images of one object, rapid changes in the number/power of glasses, or sometimes pain, redness and eye watering. In advanced cases there is a complete loss of vision and the pupil becomes pearly white in colour. 

What is the treatment of cataract?

Once it is confirmed that the patient has cataract, the treatment is essentially surgical. Whenever the patient feels their vision has decreased to a level where it interferes with their daily activities surgery can be performed before the cataract gets mature. The surgeries performed for cataract are:

• Phacoemulsification PHACO with foldable IOL 
• Small Incision Cataract Surgery (SICS) with Intra-ocular Lens (IOL) Implantation

Phacoemulsification

PHACO is a very small incision (only about 3mm) made into the clear part of the eye (cornea) and the hard core (nucleus) of the lens converted into a soft pulp using high frequency sound waves and sucked out. Then a foldable lens (IOL) is injected through the small incision and positioned into the capsular bag. 

The main advantages of this operation are early rehabilitation and decreased occurrence of astigmatism (cylindrical power in glasses). The procedure is performed under local or topical anaesthesia. 

Intra-ocular Lenses (IOL)

Intra-ocular Lenses (IOL) are small 5-7mm lenses made of a soft polymer (Silicone or Acrylic) and are implanted inside the eye in place of the natural lens. The greatest advantage of IOL is a clear wide field of vision and the fact that the patient does not have to constantly wear thick glasses. 

However, glasses with low power may still be required for reading distant and near small print because unlike natural lenses the IOL has a fixed power which is usually adjusted such that the mid-range or routine viewing distances are seen clearly. Since the IOL stays in the eye throughout life, no compromise should be made on the quality of the IOL.

Multifocal IOLs offer the advantage of clear distant and near vision hence, reduce the dependence on glasses, but suffer the disadvantage of lower contrast, lower colour saturation and a subjective compromise in image quality. 

SICS (Small Incision Cataract Surgery)

SICS has virtually replaced the conventional cataract surgery for difficult situations. Here, although the incision made is slightly larger (5-6mm) and the nucleus is removed using fluid pressure, yet no stitches are required and the recovery is much faster and more comfortable than the conventional surgery. 

To conclude, the surgeon, the surgical technique and the quality of the IOL are no the only factors that decide the result of cataract surgery. It also depends on the condition of the eye, the cornea, the retina and the presence of systemic diseases like diabetes, hypertension, asthma, infections, etc. 

The quality of the operation theatres, the ancillary and the backup facilities, the training of the support staff, etc also have a significant influence on the success of the surgery. Ensuring good quality in all these areas leads to an increase in the surgical cost for the patient, but it must be understood that our eyes are worth a lot more.

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