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Cataract is the commonest cause of blindness anywhere in the world and it accounts for about seventy-five percentage of curable blindness in India. Cataract develops when the crystalline lens inside our eye becomes opaque. The lens turns opaque when it exposed to toxic substances or metabolic imbalance in the blood, heat, excessive sunlight, trauma, etc.
Cataract is commonly thought to be a disease of old age. This is only partly true. Although about half the people over seventy will have some amount of cataract, it can occur at any age. In India cataract is not uncommon in the age group 45 to 55 years.
Life after cataract surgery used to be a night-mare about two decades ago. The patient had to take bed rest for a week. He had to wear thick glasses after surgery. Vision would be very hazy without spectacles. The patient was thus forced to a life behind glasses. The objects he saw through his specs would appear much larger than their actual size. Thus even with glasses he would not get perfect vision.A new era has dawned with intraocular lens implantation. Here an artificial lens is used to replace the opaque cataractous lens. The quality of life dramatically improved for cataract patients after the introduction of intra ocular lens. With an intraocular lens implantation the patient could get as much or even better vision than he had before he developed cataract.
In conventional cataract surgery a 10 mm opening is made into the eye to remove the opaque cataractous lens and to introduce a clear artificial lens. The opening is sutured securely once the surgery is over.
Cataract surgery has now gone a step further with phacoemulsification. This surgery is popularly known as key hole cataract surgery as a very small opening is made to remove the cataract and to insert the artificial lens.
Phacoemulsification uses ultrasound energy to fragment the cataractous lens into small bits. These small bits are then sucked out of the eye through a 3 mm opening. The small opening into the eye is fashioned into a valve which is self sealing. Therefore no suture is required.
The diameter of the artificial lens which is to be placed inside the eye varies from 5.5 to 6.5 mm. To introduce this through a 3 mm opening we have to fold the lens into two. The lens is unfolded inside the eye and placed within the bag which originally carried the cataract.
After phacoemulsification and foldable intraocular lens implantation the patient can go back home after a few hours. Bed rest is not required. Next day onwards the patient can carry out his routine activities. The patient must take special care to avoid dusty and crowded places. He must especially avoid contact with people suffering from cold and cough. Post operative hygeine is very important in any type of surgery, whether key hole or conventional. Medicines must be applied ritually after as instructed by the doctor.
After modern cataract surgery a seventy year old man virtually becomes a 40 year old, as far as the eye is concerned. Thus cataract is no more a disease to be feared if detected early and operated in time.
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