Treatment of cataracts

As cataracts develop very slowly and are not usually painful, many people do not know they have them initially. Early on the patient’s vision becomes blurry, like looking through a fogged-up window. However, as the clouding progresses, the vision gradually gets worse. Stronger lighting and eye glasses can help improve vision early on, but eventually it becomes hard to read, drive a car (especially at night), or to carry out everyday tasks. Even seeing people’s facial expressions become difficult, though the patient’s long-distance vision is usually more severely affected at the start.
When your vision is impaired in this way, you will need surgery. Fortunately, cataract surgery is usually a very effective and safe procedure. Many people do not know this, and so they live with blindness and severe incapacity which could easily be treated by surgical removal of the lens and its replacement by an artificial one.

Types of surgery

Modern cataract surgery is remarkably safe and painless; recovery is rapid, and return to activity and normal vision is only a matter of days. Surgery is generally performed as an outpatient procedure (unless there are other reasons to be kept in the hospital), and is done under local anaesthesia. The actual procedure lasts around fifteen minutes in most cases.

It seems as if many patients are well aware of the choices of cataract surgery, and even those from remote villages often ask for ‘phaco’ surgery. The full name of Phaco is Phacoemulsification, in which a process where a high-frequency ultrasound probe breaks up the cataract into small pieces. These pieces are then gently suctioned out of the eye.

Once the cataract is removed, the surgeon inserts an artificial lens in its place. Because the incision used in Phaco surgery is so small, the lens is folded up (so-called ‘foldable lens’) and then expands to its full size once in the eye.

This lens is called an Intra-Ocular Lens or IOL. There are a number of types of foldable IOLs, and they also range considerably in cost. Though the low-cost lens can produce remarkably good results, there does appear to be more clarity and an approximation of normal vision with the higher-end lenses.
There are advantages to Phaco surgery, in that it uses a very small incision, as small as 2 mm or less; and usually no stitch is needed. This means that the healing time is significantly reduced, and the overall recovery is more rapid. The size of the incision can also influence the chance of near perfect vision in the hands of a skilled Phaco surgeon.
At the end of the surgery, an eye shield needs to be used to protect the eye, and specific eye drops are prescribed. It is important to follow up with the surgeon the next day, then at one week, and finally around a month later. To read more about cataracts, one source is http://www.nei.nih.gov/health/cataract/webcataract.pdf.
Another type of surgery commonly used is called Small Incision Cataract Surgery (SICS). It is a safe and effective form of cataract surgery with a short operation time and low complication rate, and is less expensive and requires less skill than Phaco surgery. It does, however, need a larger incision, which is why Phaco is preferred by many.