Cataract & Refractive Surgery Services

Trinity Eye Hospital is fully equipped with the most modern technology for performing suture less cataract surgeries. The Department of Cataract has made tremendous progress in the last years. We are one of the few institutions in the world to have the 2 top platforms for cataract surgery - the Centurion (It is the only intelligent phaco platform that dynamically optimizes cataract removal) and Infinity (Alcon) . All these machines can be used for the latest Micro-Coaxial Cataract Surgery (MICS), or removal of the cataract through a 2mm (or less) incision with the implantation of foldable intraocular lenses (IOLs). We offer our patients the latest in IOL technology including the accommodative Crystalens HD, the ReSTOR & Tecnis multifocal IOLs and the astigmatism correcting Toric IOLs. We offer the latest generation of multifocal IOLs with astigmatism correction and the Implantable Collamer Lens as an option in correcting refractive errors. To minimize calculation errors in the implanted IOLs we now have the Immersion Biometry and the non-contact Lenstar which works by the laser interferometry principle.

Cataract is the leading cause of decreased vision and blindness in our country. It can be cured by a simple cataract extraction microsurgery, which, these days is performed using advanced technology in a short time.Cataract is clouding of the natural lens which results in decrease in vision. If detected early and treated we can avoid the complications resulting from ruptured Cataract us Lens.
 

Causes
Most common cause is Senile Cataract due to ageing. Every person over the age of 60yrs will at some stage develop cataract. Other causes include diabetics, injury, intake of Certain Medications, Secondary Cataract due to other problems in the eye. Cataract can also present since birth due to hereditary, predisposition. This is called Congenital Cataract.

Symptoms
Painless Blurring of Vision which is progressive
Glare, especially while driving in the night
Double Vision
Near Vision appears better than before but distant vision is blurred.

When can one undergo cataract surgery?
Whenever the cataract affects your daily activities like reading, driving and working, it should be considered. Early on, a change in glass power may help. Later on, Surgery is the only treatment for cataract. DO NOT WAIT FOR THE CATARACT TO MATURE.

Cataract Surgery
During Surgery the cataract Lens is removed and replaced by the Intra Ocular Lens, which lasts for the entire life time. Summer or Rainy seasons have absolutely no effect on the outcome of the cataract surgery.

Cataract Treatment
Surgery can be performed manually through 5- 6 mm wounds called SICS (Small Incision Cataract Surgery). Phacoemulsification is at present universally accepted as the standard of care for cataract surgery. Ultrasound energy is used in phacoemulsification to break up the cataract (emulsify) into microscopic fragments which can be sucked out of the eye.

MICS
The surgical wounds have progressively become smaller and now the latest technique is " Micro-coaxial Phacoemulsification" or MICS.
MICS is phacoemulsification of the cataract through a wound of 2.2 mm or less, with implantation of an intra-ocular lens through the same wound.
Wound healing and refractive stabilization is faster in MICS than in traditional phaco.

Intra - Ocular Lenses (IOLs)
The majority of the IOLs implanted are mono-focal. They can focus light rays from one particular distance only. Normally distance objects are clear and one needs glasses for reading. Intra ocular lens can be rigid or foldable. Foldable lens will need smaller wounds to insert.

Multifocal IOL
The latest multifocal IOLs are designed to provide good distance vision, intermediate and near vision. They reduce the patient's dependence on spectacles. These lenses have multiple concentric rings of different focal length which brings everything from near to far into clear focus. Those lenses can be used only in suitable patients. It is not advised to patient using lot of night driving.

Toric IOLs
Traditionally used monofocal IOLs correct only the spherical refractive error. Patients with pre existing astigmatism will need spectacle correction for distance vision and near. Toric IOLs eliminates the need of glasses for distance. Recently multifocal IOLs have also been introduced with this option, thus correcting for distance, near and cylindrical error.

Toric Multifocal IOLs
Astigmatism is a refractive error in which the curvature of the cornea is different in different meridia. The shape is more akin to an American football rather than a regular football. People with astigmatism were earlier not suitable for multifocal IOLs. Now with the introduction of Toric Multifocal IOLs, it is possible to correct this astigmatism and also provide good near vision to this group of people.

Pre-OP Care
One needs to be in fairly good general health.
Diabetes, hypertension, cardiac problems (if any) need to be controlled before surgery. One needs to do a detailed check up of the eye and a dilated examination of the retina. Specific to the eye ones need to undergo scans of the eye to find out the curvature and the length of the eye to decide on the model and power of the intraocular lens to be implanted.

Surgery is a " walk in- walk out" procedure.
Surgery is mostly done under topical anesthesia.
Anesthetic drops numb the surface of the eye and the surgery can be comfortably and painlessly performed. The eye remains open after surgery.
Some patients may require an anesthetic injection before the surgery. A routine surgery lasts approximately 10 minutes with the preparation time being of similar duration. Pre-operatively dilating drops are applied which take between 1 – 1.5 hours to act. One could expect to spend half a day at the hospital on the day of surgery.

Post-Operative Care
Cataract surgery is pretty much painless and so is the post-operative period. There is mild irritation (or foreign body) sensation for a few days. There may be mild redness & watering of the eyes which again subside in a few days. There is no need for bed rest after surgery. One can walk, eat normally, watch TV and be normal around home on the day of the surgery. One needs some protective glasses only when outdoors.
There is a graded schedule for eye drops after surgery.No tablets / injections are used.
One would start with 3 types of eye drops, which would be stopped over a period of 6 weeks. One can resume work even the day after surgery. One could either work from home or office, but one should remember to apply the drops as advised. Normally till the glass correction is given 4-6 weeks after surgery, reading may be difficult, but this is much better after implantation of a multifocal IOL.Temporary glasses can be given the day after surgery.

One could resume routine exercise & yoga 2-3 days after surgery.
One should avoid water from directly getting into the eyes for 10 days after surgery. One could sponge the hair and face properly even the day after surgery. Normal bathing (taking precautions for the eye) can be resumed the day after surgery. Bending down, chewing food or lifting moderate weights are not at all a problem after surgery. The vision will be bright and pretty much clear the day after surgery.

Full vision will be restored gradually in a few days’ time. One would not normally need to specifically clean the eye after surgery. Mopping the face with a wet towel (with the eyes closed) should suffice. If there are deposits of medicines on the eyelids or lashes one could use fresh ear buds, moisten them with an antibiotic eye drops and clean the outside of the eyelids (and lashes) with them.

Objects may appear excessively bright & blue in colour for some days. This is because the cataract was not allowing light to reach the retina and most of the blue light was being cut off. The brain gets disused to seeing blue. All these complaints are temporary.