Introduction
The natural lens

The natural lens, like the cornea, makes sure that the light rays which enter the eye are properly focussed on to the retina. This results in a sharp image on the retina. The natural lens is transparent and clear which enables light to pass through it easily.

What is Cataract?
Clouding or opacification of the natural lens is cataract. Cataract caused by old age (most commonly) or other reasons affects the clarity and the visual acuity. The lens startes loosing its transparent and become transluscent and then opaque. Cataract is the most common cause of vision impairment and blindness in the world.


What are the Symptoms of cataract
  • blurred vision
  • double vision
  • sensitivity to light
  • the need for more light when reading
  • diminished night vision
  • changed prescription power for glasses

Senile cataract

Senile cataract is by far the most common type of cataract. Senile cataract can be compared to getting wrinkles and turning grey. Due to an aging population, this type of cataract is on the increase.

When Is It Time To Consider Cataract Surgery?

Time for cataract surgery depends on many factors inclusing your quality of life, your occupational needs, personal health, grading of cataract, associated complications (if any), etc. Typically down time for surgery is limited, so if you have some help, chances are good you will recover quickly and experience a much better quality of life.
For the most part, patients interested in surgery should ask their doctors about it sooner rather than later.
If your eye doctor recommends you wait, ask them their reasons for suggesting this. They may have a legitimate concern about your health you need to address.
As a patient, you owe it to yourself to take care of your body, including your eyes. Your doctor can help you decide the best time to have surgery if you develop cataracts. For some people, despite their age, cataracts remain a minor problem. If cataracts do impair the quality of your life however, you deserve the opportunity to do something about it, with as little down time as possible.

How are cataracts treated?

The cataract is treated by surgery. An eye surgeon will remove your cloudy lens and in most cases, replace it with a clear, man-made focusing lens (intraocular lens implant, or IOL). The replacement lens implant remains permanently inside your eye and does not degrade.
Cataract surgery is usually a day case procedure, which means that you will go home on the day of your operation. However, you may wish to arrange for someone to stay overnight with you at home on the day of surgery.

What surgical procedures are available for cataract surgery?

Apart from conventional surgical methods, the most advanced technology PHACOEMULSIFICATION is the most preferred mode of treatment. It is highly safe, easy, efficient and restores good vision as compared to conventional methods.

Is the surgery carried out under local anaesthetic?

YES. 99.9 % cases are performed under local or topical anesthesia. Rare cases may require general anesthesia.

What are the risks involved in undergoing cataract surgery?

The potential risks associated with cataract surgery are very, very rare. However, they include blindness, haemorrhage, infection, glaucoma, retinal detachment, capsule tear and vitreous displacement, wound dehiscence and iris prolapse, cystoid macular oedema, deterioration in diabetic retinopathy, intraocular lens implant dislocation and lens implant power miscalculation. Some patients may require further surgery following cataract surgery.

Can I have non-surgical methods of treating cataract?

NO. At present only surgical correction is the measure to treat cataract.

When will I be able to see clearly after cataract surgery?

Most patients see good within a day or two after cataract surgery. Few patients may see blur in the initial 1-2 weeks due to slower healing responses which improves over a period of few weeks.

Is my cataract surgery covered under insurance?

YES. Now a days most of the hospital (including DR. AGARWAL EYE HOSPITAL) are recognized and listed in the panel of various insurance companies, corporates and government offices. You can avail insurance from them.

What type of intraocular lenses (IOLs) are available?

At. Dr Agarwal's Eye Hospital, a variety of IOLs are available. The selection of IOL depends on the status of the cataract, patients needs, doctors recommendation and insurance packages. Details of these can be seen on the website and also counselors provide the patient with complete information prior to cataract surgery.

AFTER CATARACT SURGERY
Will I require any eye medication following surgery?

Yes. Few medications will be started following your cataract surgery which will fasten up healing and recovery. It is very essential that you instill these medications as per the doctors advice and never miss a dose.

What must I avoid following surgery?

Avoid touching or rubbing the operated eye.
Not to lift heavy loads like bucket etc.
No head bath or face wash for at least 15 days.

Will I need glasses following surgery?

You may require glasses following a cataract surgery depending on your pre-operative refractive sttus, type of lens implantation and healing response of your eye. After about 6 weeks of surgery, you will be provided with glasses (if required)


Part 2 - Complicated Cataract Surgery
PEDIATRIC CATARACT

Out of 10,000 born children, at least 5-10 have pediatric cataract. Most of the pediatric cataract develops without any known ocular/systemic cause. Important causes include genetic disorders, intrauterine infections, metabolic disorders, trauma, etc. Whenever a child is diagnosed to have cataract, a careful and detailed evaluation is performed to look for its cause and presence of any associated ocular/systemic disease. Laboratory tests are done and pediatrician consultation is taken if required. Highly skilled and internationally trained pediatric cataract surgeons at Dr. Agarwal�s Eye Hospital offer a seamlessly smooth and safe cataract surgery. The child is not given any food (solid/liquid) 6 hours before surgery. After the surgery, the child regains consciousness with a few hours. During the first few hours of consciousness, no solid food is given to the child. Slowly and in small quantities liquid diet is provided. Post-operative care instructions are given to the parents. Vision rehabilitation therapy is explained to the parents. Regular follow-ups are essential.

TRAUMATIC CATARACT

Trauma is a leading cause of visual loss both in children and adults. Trauma may not only cause cataract but also damage to cornea, iris, retina and other structures of the eye. Complete examination and investigations are done to assess the condition and treatment is given accordingly. Dr. Agarwal�s Eye Hospital specializes in providing such world-class quality care. The innovative techniques of traumatic cataract surgery at our hospital are internationally appreciated and practiced.

POST LASIK / PRK / RADIAL KERATOTOMY (POST REFRACTIVE SURGERY) CATARACT SURGERY

As more and more patients undergo refractive surgery to improve their quality of vision and quality of life, the population of post-refractive surgery cataract patients will be increasing in the near future. As refractive surgery leads to a change in cornea, IOL power calculations with traditional and older methods leads to wrong powers. At Dr. Agarwal�s Eye Hospital, we aim to provide the best eye care and quality vision. We have mastered the techniques for IOL Power Calculations in such patients and are thus able to deliver perfect results and superior vision after cataract surgery in patients with a history of LASIK / PRK / Radial Keratotomy or any other refractive procedure. The IOL powers are calculated using the FDA approved machine �IOL Master� which is incorporated with special formulae that are internationally accepted and widely used.

LIMBAL RELAXING INCISIONS (LRIs)

LRI as a minor procedure performed on the surface of the cornea to modify its shape to treat astigmatism. When a patient has astigmatism (Cylindrical power of spectacles), the cornea is not perfectly round, but more like an egg-shape. Thus the patient has no proper focused vision as shown in the figure below:


20/20 Vision

With astigmatism, the rays of light do not converge into a single point but form a line on the retina. There are various types of astigmatism including regular, mixed and irregular astigmatism. Currently, Excimer lasers in the US are approved for treatment of regular and mixed astigmatism.


With Astigmatism

With astigmatism, the rays of light do not converge into a single point but form a line on the retina. There are various types of astigmatism including regular, mixed and irregular astigmatism. Currently, Excimer lasers in the US are approved for treatment of regular and mixed astigmatism.

LRIs are incisions placed on the outer edge of the cornea (limbus) which result in round cornea and improved and clearer vision.

The procedure is very safe, easy, and can be performed within few seconds. LRI is an elective procedure. There is no / little discomfort during and after the procedure. The corneal shape stabilizes over the next week, resulting in a clearer vision without the need of spectacles.

Many patients who have pre-existing astigmatism develop cataract with age. LRIs performed during or after cataract surgery can completely reduce this astigmatism and provide the patient better post-operative vision without glasses.


Few patients develop astigmatism after a routine cataract surgery. These patients require cylindrical spectacles for clearer vision. LRIs offer them a chance to permanently reduce this astigmatism and have a spectacle-free life.

TORIC INTRAOCULAR LENSES (Toric IOLs)

Patients with coexisting cataract and astigmatism can now avail simultaneous treatment of cataract and astigmatism in a single surgical procedure. Toric IOLs are special imported IOLs designed to correct astigmatism and are implanted after a routine cataract surgery (phacoemulsification).

Custom-designed (patient-specific) Toric IOLs are implanted inside the eye after cataract surgery. Thus the patients get spectacle-free vision after cataract surgery, even if they had a pre-existing astigmatism.

Toric IOLs implantation is a highly ultra-modern technology and is performed by skilled Cataract Surgeons at Dr. Agarwal�s Eye Hospital. The most commonly used Toric IOLs are manufactured by the STAAR Surgical and Alcon Laboratories.


POST LASIK / PRK / RADIAL KERATOTOMY (POST REFRACTIVE SURGERY) CATARACT SURGERY

As more and more patients undergo refractive surgery to improve their quality of vision and quality of life, the population of post-refractive surgery cataract patients will be increasing in the near future.

As refractive surgery leads to a change in cornea, IOL power calculations with traditional and older methods leads to wrong powers.

At Dr. Agarwal�s Eye Hospital, we aim to provide the best eye care and quality vision. We have mastered the techniques for IOL Power Calculations in such patients and are thus able to deliver perfect results and superior vision after cataract surgery in patients with a history of LASIK / PRK / Radial Keratotomy or any other refractive procedure.

The IOL powers are calculated using the FDA approved machine �IOL Master� which is incorporated with special formulae that are internationally accepted and widely used.


PEDIATRIC CATARACT

Out of 10,000 born children, at least 5-10 have pediatric cataract. Most of the pediatric cataract develops without any known ocular/systemic cause. Important causes include genetic disorders, intrauterine infections, metabolic disorders, trauma, etc.

Whenever a child is diagnosed to have cataract, a careful and detailed evaluation is performed to look for its cause and presence of any associated ocular/systemic disease. Laboratory tests are done and pediatrician consultation is taken if required.

Highly skilled and internationally trained pediatric cataract surgeons at Dr. Agarwal�s Eye Hospital offer a seamlessly smooth and safe cataract surgery.

The child is not given any food (solid/liquid) 6 hours before surgery. After the surgery, the child regains consciousness with a few hours. During the first few hours of consciousness, no solid food is given to the child. Slowly and in small quantities liquid diet is provided.

Post-operative care instructions are given to the parents. Vision rehabilitation therapy is explained to the parents. Regular follow-ups are essential.


TRAUMATIC CATARACT

Trauma is a leading cause of visual loss both in children and adults. Trauma may not only cause cataract but also damage to cornea, iris, retina and other structures of the eye.

Complete examination and investigations are done to assess the condition and treatment is given accordingly.

Dr. Agarwal�s Eye Hospital specializes in providing such world-class quality care. The innovative techniques of traumatic cataract surgery at our hospital are internationally appreciated and practiced.


GLUED IOL

Glued IOL is an innovation by Dr. Amar Agarwal by which specialized IOLs can be implanted in eyes in which a standard IOL cannot be implanted. Dr. Agarwal�s Eye Hospital is the 1st and most successful eye hospital in Glued IOL technique.

Patients who are aphakic (IOL not implanted after cataract surgery in past) can now benefit from GLUED IOL technology and need not to wear thick glasses. Most importantly, no sutures are applied in this technique. In older techniques, sutures were applied making the surgery complicated.

This technique is covered under the Tamil Nadu Chief Minister Life Saving Disease Scheme (KKT) and KKT card holders can avail this treatment free of cost.


SURGERIES FOR COMPLEX CASES

Apart from routine cataract and other surgeries, doctors at Dr. Agarwal�s Eye Hospital are pioneered in successfully performing surgeries in complex cases.


Part 3 � Investigations
  • IOL Master:

    This is the World�s Best machine for calculation of IOL power. It is a non-contact technique during which the patient is seated comfortable with his chin on a chin rest. The machine automatically directs a light into the eye and does calculations without touching the eye. The patient does not feel anything and the machine does its work in few seconds. It is fast, easy, non-contact and 100% accurate technology. It also helps to calculate IOL power for post Refractive Surgery patients.

  • B-Scan:

    Also called as Ultrasound Scan of the eye is performed to assess the posterior segment (the fundus, retina, optic nerve) of the eye. B-scan is a safe and non-invasive procedure. Patient doesnot feel any pain/discomfort. Scanning is completed within a couple of minutes.

  • A-scan:

    A-scan or Biometry calculates the total length of the eye and IOL power of the eye. The readings of this machine are very accurate. The cornea is gentle touched with pain/discomfort to the patient. In cases of premium IOLs, refractive IOL and TORIC IOL and post-refractive surgery IOL calculations, IOL Master is used.

  • Specular Microscopy:

    With the help of this machine, the health of the cornea (anterior surface of eye) is evaluated. The most important part of the cornea is the most inner layer called as the endothelium. Specular Microscopy is performed before all surgical procedures for maximizing safety of the cornea. It also helps during corneal transplantation procedures.

  • Anterior Segment OCT:
    AS-OCT is the most efficient machine to evaluate the anterior segment of the eye (cornea, iris, anterior chamber and lens). It is utilized in all cases for LASIK, PRK, corneal transplantation, Phakic IOL, etc. Dr. Agarwal�s Eye Hospital is equipped with the FDA approved Visante AS-OCT. The eye of patient is not touched (just like in IOL Master). Within seconds the machine takes all measurements and provides with vital information.
  • Indirect Ophthalmolscopy:
    Indirect Ophthalmoscopy is the standard and most useful technique for assessment of fundus. It is also utilized for retinal laser treatment of diabetic retinopathy, etc. In this procedure, the patient lies down. The doctor uses the instrument tied around his head. Light is shown in the eye of the patient. The patient may have a little glare but the examination is finished within a few minutes. There is no pain during the procedure.
  • Non contact Tonometry / Applanation Tonometry:
    Intraocular Pressure (IOP) measurement is taken with no contact technique causing no discomfort to the patient. Applanation Tonometry is performed to accurately calculate the IOP.
  • Syringing:

    It is a painless procedure, done to evaluate the patency of the Naso-lacrimal duct through which the tears flow out of the ocular surface. It the duct is patent, the patient can feel water in throat.

  • Autorefraction:

    The machine calculates approximate power of your spectacles and helps the doctor to give you a perfect power of glasses. Patient needs to sit in front of the machine and automated readings are taken without touching the eye within seconds.


Part 4 � Intraocular Lenses Offered

After cataracy surgery, Intra-ocular Lens is implanted in the eye to provide vision. There are many types of IOLs available according to the need of the patient.

  • Indian IOLs:
    • Monofocal IOLs:
      Lens
      These are standard IOLs implanted in the eye after cataract surgery for correction of distance vision only. Patients will require glasses for near vision and computer use.
    • Multifocal IOLs:
      Lens
      Specialized IOLs. Patients are totally free of glasses for distance, intermediate and near vision for all routine purposes.
  • Foreign IOLS:

    These are made of the most pure forms of acrylic/silicone materials causing no interference with intraocular structures.

    • Monofocal IOLs:
      Similar to Indian monofocal IOLs but are manufactured and imported from imported. They provide better quality of vision and are more efficient. Commonly used IOLs are:
      • Naspro IOL:
        Aberration free IOL in budget section
      • Tecnis IOL:
        Best night vision quality.
      • Acrysof IQ IOL:
        More UV protection and excellent results.
      • B&L Akroes AO IOL:
        Increased Stability and smaller incision.
      • Zeiss Meditec XL Stabi Sky IOL
        Manufactured by Carl Zeiss, providing best optical clarity.
    • Multifocal IOLs:

      Similar in function to Indian IOLs but completely manufactured in abroad and are imported. Made of highest quality of materials which do not interfere with the structures of the eye. Most commonly used IOL is the Zeiss Acrilisa Multifocal IOL and AMO Rezoom IOL.

      Multifocal
      Multifocal
    • Microincision IOLs:

      Specialized and thinner IOL for superior stability and extra-ordinary performance. Cataract Surgery is performed through 1.7mm incision and this IOL is implanted thus recovery is almost instantaneous. Most commonly used is B & L MIL IOL.

      Microincision
      Microincision
    • Toric IOLs:
      Toric
      These are monofocal IOLs implanted in patients with pre-existing astigmatism and cataract. Provides spectacle free vision even when patients had astigmatism before surgery. Most commonly used is the Acrysof Toric IOL.
    • Multifocal Toric IOLs:
      Multifocal
      As the name suggests, these Toric IOLs are implanted in patients with pre-existing astigmatism and cataract. They provide spectacle-free vision at all ranges of work, distance, near and intermediate.
    • Accommodative IOLs:
      Accomdate IOL
      Also Called as CRYSTALENS, the world�s Best and Most preferred IOL which mimics the actual working of a human eye. The IOL provides purest quality of vision at all ranges of vision.
    • Customized Aberration Free IOLs:

      These IOLs are totally aberration free making the light rays straight while entering the eyes. These are specially designed for Dr. Agarwal�s Eye Hospital.


Cataract Surgeries
  • No Anesthesia cataract surgery with IOL Implantation
  • Topical anesthesia cataract surgery with IOL Implantation
  • Sutureless cataract surgeries with IOL implantation
  • Very high spectacle power correction via cataract surgery
  • Phacoemulsification
  • Phakonit
  • Microphakonit
  • Cataract surgery in special cases
  • Pediatric cataract surgery
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. Courtesy: National Eye Institute
Cataract Eye