Sight is our most precious sense enabling us to enjoy the beauty of the world in which we live. For centuries, developing cataract doomed a person to blindness.

Before understanding cataract, it is important to know how a normal eye works. The eye is like a camera. The lens in a camera allows light to pass through and focuses that light on the film at the back of the camera for a clear picture.

Cataract development is part of the normal ageing process. Almost all people above the age of 60 years have cataract of a variable degree, although it can occur at any age. In some people cataract development is aggravated by an eye injury, presence of diabetes, use of medications or other eye diseases.

Cataracts that occur due to the ageing process cannot be prevented as the ageing process itself cannot be prevented. Using the eyes for reading and similar activities have nothing to do with cataract formation. Avoiding the use of eyes will not prevent cataract.

Till date as per all authentic medical research no medication exists to prevent or cure a cataract. The only known treatment for cataract is surgery.

It is one of the oldest, safest and most successful forms of surgery. It requires a very short hospital stay and is generally performed under local anaesthesia. The patient is awake during surgery but does not feel any discomfort or pain. Patients are ambulatory and discharged immediately after surgery.

For the surgery a small opening is made in the eyeball. The front part of the lens capsule which is a thin membrane enclosing the entire lens is cut, making a smooth round opening in the front part of the capsule. All cloudy lens material is removed by a routine cataract procedure or by phacoemulsification.

The back of the lens capsule is left in place so that the artificial lens implant will be able to rest securely within it. If the lens capsule is not able to hold the implant it can be placed in front of the iris i.e. the coloured part of the eye.

Routine cataract surgery requires an incision 11-12 mm in size. Phacoemulsification is performed through a 1.4-2.75 mm incision using a thin titanium probe, which emits high-speed ultrasound waves, vibrating at 40,000 times per second. This breaks the cataract into tiny pieces, which are then aspirated or sucked out of the eye through the same probe.

Small and micro incisions such as those used in phacoemulsification are preferable because they seal themselves immediately after surgery and heal very quickly. It is only a reflection of our unshakable commitment to quality that we are perhaps the first institution in Delhi to acquire the Millennium Phacoemulsification System, the latest top-of-the-line phacoemulsification machine available in the world. We also now have the Alcon Legacy Series 20000 Phacoemulsification System, as well as the Sovereign Phacoemulsification System with WhiteStar technology for delivering "Cold Phaco" which has the advantage of significantly reducing the ultrasonic energy to break up the cataract. A small incision causes less tissue damage and increases surgical safety. No-stitch or one-stitch may be used in phacoemulsification surgery whereas in Non-Phaco I.O.L. surgery, 6-8 crossed stitches are used. These cause changing curvature of the eyeball and hence a delay in the final spectacle prescription. Another advantage of small incisions is that they are less likely than other incisions to cause a focusing problem known as astigmatism. The postoperative rehabilitation is faster and you can return to your normal work and activities very soon. This is currently the most effective method for removing cataracts.

Your eye surgeon will be the best judge to decide whether you can undergo
phaco-surgery.

Each patient undergoing cataract surgery at our centre is examined in detail to assess the endothelial count of the cornea using the automated specular microscope. The endothelium is the inner most layer of the cornea which is responsible for its transparency. Preoperative assessment of the endothelial count enables us to identify patients in whom this layer is weaker (low cell counts), therefore are not suitable for the phacoemulsification procedure, and in whom surgery by the conventional technique would be safer. Again based on findings of the endothelial count by specular microscopy it may be necessary to alter certain medication used at the time of surgery. If necessary we are using BSS/BSS Plus and Healon/ Healon GV, which are imported medicines, to minimize loss of the already depleted endothelial cell counts during surgery.

Other relative contraindications to having phacoemulsification surgery would be very poorly dilating pupils, certain corneal diseases and very hard cataracts as the amount of energy required to break up the cataract would probably damage the eye.

In the above eyes, conventional cataract extraction with intraocular lens implantation still remains a safe, economical and effective method of treatment of cataract, since the ultimate visual outcome in both the conventional procedure and phacoemulsification are comparable. The difference lies only in the rate of healing.

No surgeon in the world can perform a surgery with guaranteed results. However, almost all patients regain good vision following cataract surgery. The calibre of vision obtained after a successful cataract surgery with I.O.L. also depends upon the health of other structures of the eye.

Eye disease or problems in the cornea, retina or optic nerve may limit the potential for clear vision even when the cataract surgery itself has been successful. However, it might not always be possible to evaluate the condition of the retina, optic nerve, in advanced cataracts pre-operatively.

Phaco or Non-Phaco Cataract with I.O.L. surgery is not a magica1 procedure and need not necessarily restore normal vision immediately. Blurred vision is common immediately after surgery. As the eye heals over a period of time, vision improves gradually.

Contrary to a popular myth cataract cannot be removed with lasers. Surgery done by phacoemulsification is commonly termed "Laser Surgery" by many people.

However, in a large number of patients undergoing cataract surgery by the modern technique, the back part of the lens capsule thickens over a period of time and causes blurred vision. This is known as a secondary cataract. This is not a complication. The condition is treated with a "YAG Laser" with full restoration of vision.