Cataract SurgeryPATIENT CARE

Cataract surgery: an ultimate patient’s guide

What should you do if you are told that you have cataract. It’s a step wise guide to help you decide what to pick when you have multiple options to choose. The aim is to enable you to take an informed decision at every cross road of your treatment plan.

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You had  problem in reading the fine print in the newspaper . You went to a doctor and he/she says you have cataract. You ask him why is it has happened, and he/she consoles you that it’s simply because of aging and not much you could have done. When you ask him/her, what should you do, the often the answer is “go for surgery”.

Such an experience leaves a patient with more question than any answer to his problem. here is the list of steps you should take to handle it.

Step one: Do not panic.

Cataract is a very common clinical condition and is treatable.

At any point of time, there are about 20 million people in whole world who have cataract, and about third of them are in India. Around half a million people undergo cataract surgery every year in India alone, which means that it is very much treatable. Internet has lot content on this topic, but I would recommend NIH and Wikipedia as reference sites for basic information about cataract. Do not correlate that information with your case as it will leave you more confused.  Ask you doctor the questions you have about yourself.

Step two: Confirm why you developed the cataract?

Usually its age, but there could be others reasons also. There are many types cataract, and many ways to classify it. Do not try to find the answers on internet because it require lot of professional expertise to decide the cause. Just because you have , diabetes, does not mean you are having a diabetic cataract.  Ask your doctor to explain. Its important to know the reason . discuss with your doctor, the other medical conditions , you have,  like diabetes, hypertension, asthma, thyroid dysfunctions etc.

Step three: Do you actually need surgery?

Just because you have the cataract, does not automatically means you immediately require surgery. Mostly it is the compromised vision resulting from the cataract that people decide to have the surgery. Sometimes there could be other reasons as well, which are decided by your doctor only. You should discuss with your doctor, the extent to which your vision is compromised due to cataract, in involved eye and with both the eyes open, and the likely visual gain after cataract surgery in these situations.

An important reason for people to be unsatisfied with surgical outcome, is the lack of significant improvement in vision after surgery. You should also discuss what exactly is the room for improvement in your vision after surgery, in involved eye and with both the eyes open.

Step four: Can it be postponed?

Mostly it is not an emergency. Discuss with your doctor, about the duration for which it can be conveniently postponed. Cataract due to aging, unless contraindicated by the doctor, can be easily postponed for few months to accommodate more pressing employment and family matters.

Step five: when to get operated?

I think the two conditions mentioned below should be met before surgery is planned in age related cataract.

  1. Reasonable expectation of improvement in vision after surgery
  2. Stable associated diseases like, diabetes, hypertension, asthma etc.

Step six: where to get operated?

There are no rule of thumb to identify a good hospital from the rest, but certain general guidelines may be followed.

  1. Prefer a hospital/ facility which accredited by some accreditation agencies like NABH in India.
  2. Dedicated eye hospitals have better developed facilities for eye care that an eye department in a multi-specialty hospital.
  3. A facility with multiple eye surgeon practicing different eye specialties has better services than single surgeon facility.
  4. If you have personal acquaintance with the reputed individual surgeon, that’s the best choice.

Step seven: what type of surgery should you have ?

Most commonly surgical method for age related cataract is Phaco-emulsification with posterior chamber lens implantation, commonly known as Phaco. It’s neither required nor  possible in every patients.  There are other surgical methods also which are required in certain conditions in certain types of patients. You should discuss with your doctor which surgery is best in your situation. You should never insist for a particular type of surgery with your doctor.

Step eight: what type of anesthesia should you have ?

It’s same as surgery. Topical anesthesia in which the eye is anesthetized with a drop of anesthetic, is common way the age related cataract is operated, but there are other methods of anesthesia which are required in certain situations. You should discuss with your doctor which anesthesia is best in your situation. Insisting for surgery under topical anesthesia only, is a bad idea.

Step nine: what type of lens should be implanted ?

Posterior chamber lens are commonly used, unless it is not possible to implant that lens in eye due to medical reasons. They rigid and fold-able. Fold-able lens are better. They are available by different brands, and place of manufacturing (Indian /imported). Often the imported lens are expensive. I could not find a single scientific report which says that visual gain after surgery has any relation with the brand or the place of manufacturing of lens.

Monofocal and a multifocal lens

Other important issue is to decide between monofocal and a multifocal lens. The latter is supposed to provide functional vision for both near and distance, but lens are expensive. But that does not guarantee spectacle free life after the surgery. Some cases may still need glasses for certain type of task, even after an uneventful cataract surgery with multi-focal lens. Moreover it is associated with certain type of vision related complications like glare and reduced contrast of images. An article by Dr. Evans appropriately explain the pros and cons. If you want to know more, than there are many good scientific publications on this issue. Discussion with your doctor is the best way out. If you are still in doubt, gamble on mono-focal lens.

Robotic/Laser assisted cataract surgery

It’s a new technique in which some critical surgical steps are done using high precision laser. Other steps are common between laser assisted and traditional method. The down side is that it is more expensive that traditional method. The available scientific evidence by researchers (Popovic MDay AC) does not document any significant in the visual outcome after either of these techniques.

 Step ten: What are complications of surgery of surgery?

Complications during and after surgery are associated with every surgical procedure. Cataract surgery is no exception to this rule.

 Posterior capsular Rent ( PCR ) is (relatively common complication ) occurring during the surgery  and Endoththalmitis ( infection in the eye after cataract surgery) is uncommon complication happening after completion of the cataract surgery. These may require vitreo-retinal surgical support.  Discuss with your doctor regarding the availability of back up facility in hospital and its policy regarding the management of this complication.

Step eleven: Post operative care  after cataract surgery

Eye hygiene, protection and regular use of eye drops/medications constitutes the basic post operative care. But the care is individualized as per surgery and patient parameters. Its important to clearly understand it and follow the instructions issued.

share you opinion  on this issue in the comment section. Point out the issues i have left or you have a different take.

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