DR.

ASHRAF SAYEED
MBBS, DOphth, FCPS, MS

PROFESSOR
DEPARTMENT OF OPHTHALMOLOGY
BIRDEM
CATARACT
Any opacity of the crystalline lens of the eye or its
capsule.

A cataract is a cloudiness or opacity in the normally

transparent crystalline lens of the eye. This
cloudiness can cause a decrease in vision and may
lead to eventual blindness.
Factors that speed up cataract formation
• Unknown
• Diabetes
• Eye inflammation
• Eye injury
• Family history of cataracts
• Long-term use of corticosteroids
• Radiation exposure
• Surgery for another eye problem
• Increasing age
• Dehydration
• Vitamin A,C,E deficiency
• Too much exposure to ultraviolet light (sunlight)
• Adult cataracts develop slowly and painlessly
• Vision slowly gets worse
• Mild clouding of the lens often occurs after age
60, but it may not cause any vision problems
• By age 75, most people have cataracts that
affect their vision
 Visual problems may include the following changes

• Sensitive to glare
• Cloudy, fuzzy, foggy, or filmy vision
• Difficulty seeing at night or in dim light even in
daylight.
• Double vision / uniocular polyopia.
• Loss of color intensity
• Problems seeing shapes against a background
• Difference between shades of colors
• Halos around lights
• Frequent changes in eyeglass prescription
• Paradoxial improvements – Second Sight.
 Types of Cataract
• The lens consists of
three layers
• The outer layer is a thin,
clear membrane
• It surrounds a soft, clear
material (cortex)
• The hard center of the
lens is the nucleus
• A cataract can form in
any part of the lens
The following may help people who have an early
cataract

• Better eyeglasses
• Better lighting
• Magnifying lenses
• Sunglasses
• Patients often
describe trying to
look through a
fogged-up window
• Clouded vision can
make it more difficult
to drive a car, read,
or see details
If a cataract is not bothersome, surgery is
usually not necessary

Surgery is done if normal activities, such as

• Driving
• Reading
• Computer
• Video screens,
- even with glasses are difficult to perform
 Clinical Findings

• Decreased visual acuity

• Wall chart or near-vision card
• Slit lamp -structures are
viewed in small sections to
detect any small abnormalities
 Dilated Exam

• Dilating drops - to dilate

the pupils wide and
provide a better view of
retina and the optic
nerve.

• It allows the
ophthalmologist to
examine the lens for
signs of a cataract and
stage and position
 Causes of painless Vision Loss

• Cataract
• Retinal detachment
• Macular degeneration
• Diabetes mellitus
• Glaucoma
• Retinal artery occlusion
• Sometimes a cataract should be removed even
if it doesn't cause major problems with vision
But preventing the treatment of another
eye problem, such as
– Age-related macular degeneration
– Diabetic retinopathy or
– Retinal detachment
 Epidemiology

• Cataracts are the leading cause of blindness in

the world
• More than 1.3 million cataract procedures are
performed in the U.S. each year
 History

• The earliest reference to cataracts can be found

in Hindu writings from the 5th century BC
• The word Cataract comes from the Greek word
meaning “Waterfall”
• Until the mid 1700’s, it was thought that cataract
was formed by opaque material flowing, like a
waterfall into the eye
The earliest written reference to cataract surgery is
found in Sanskrit manuscripts dating from the 5th
century BC. They are thought to have been written
by the Hindu surgeon Susruta. He practiced a type
of cataract surgery known as couching or
reclination, in which the cataractous lens was
displaced away from the pupil to lie in the vitreous
cavity in the back of the eye.
When to Seek Medical Care

•Eye-care professionals may mention during a

routine eye exam about early cataract development
even if not yet experiencing visual symptoms

•Patient is the first person to notice changes vision

that may require cataract surgery

•Since cataract development rarely causes any

long-term damage to the eye, cataract surgery
should be considered only when visual symptoms
begin to develop
Removal of cataract is most commonly done by
one of the following methods.

1.Intra Capsular Cataract Extraction

2.Extra Capsular Cataract Extraction
3.Phacoemulsification
What doctor expect after the surgery?

•Return for visits within the first few days and

again within the first few weeks after surgery

•Using several eye drops which help protect

against infection and inflammation

•Maintain some restrictions on activities such as

lifting heavy objects and bending forward or
stooping to the ground.
What patient expect after the surgery?

• Within several days vision is improving, and they

will able to return to work.

•Once vision has stabilized, will fit glasses if

needed.

•If possible no glasses for optimal vision.

What are the different types of intraocular lenses
implanted after cataract surgery?

As the natural lens plays a vital role in focusing light

for clear vision,
artificial-lens implantation needs best visual results -
• V/A
• Peripheral vision
• Depth perception
• Image size should not be affected

There are a variety of intraocular lens

•Monofocal,
•Toric,
•Multifocal intraocular lenses.
 Monofocal lens

• Equal power in all regions of the lens

• Can provide high-quality vision at a single

focal point (near or distance)

• Require only a light pair of spectacles for

vision correction

• Do not correct astigmatism

 Toric lens

•Have more power in one specific region in the lens to

correct astigmatism, which can further improve
unaided distance vision for many individuals.

•Requires positioned in a very specific configuration.

•While toric lenses can improve distance vision and

astigmatism, they still require corrective lenses for all
near
 Multifocal lens

• Variety of distances, including distance,

intermediate, and near

• Can cause significantly more glare than monofocal

or toric lenses

• Cannot correct astigmatism

• LASIK to correct astigmatism

• Designed for good
distance vision
and near vision

• Can reduce the need for

glasses in activities like
reading, watching
television, or watching a
movie
Prevention
•At present, there is no real effective way to prevent the
formation of cataracts
•Prevention by controlling other eye diseases that can
cause cataracts
•Minimizing exposure to factors that promote cataracts as
wearing sunglasses can filter out UV light, reducing
exposure to harmful UV radiation
•Some people take vitamins, minerals, and herbal extracts
to decrease cataract formation
• No scientific data prove that these remedies are effective.
•No topical or oral medications or supplements are proven
to decrease the chance of developing cataracts.
early and mid time post-operative complications:
Endophthalmitis
Uveitis
Retained lens matter
Corneal Edema
Wound Leak
Wound Dehiscence
Hyphaema
Astigmatism
Retinal Detachment
Posterior retinal detachment with retinal tear of
hemorrhage
Exacerbation of Diabetic retinopathy
Toxic anterior segment syndrome
Toxic lens syndrome
Late Post-Operative Complications

Endophthalmitis
Retinal detachment
Cystoid macular edema
Exacerbation of diabetic retinopathy
Displacement of Intra ocular lens
Persisting astigmatism
Secondary glaucoma
Post-capsule opacification.
Anterior capsule phimosis
 Complications of Surgery

• Vitreous Loss- 3.1%

• Vitreous Hemorrhage-0.3%
• Uveitis-1.8%
• Increased Eye Pressure- 1.2%
• Retinal Detachment- 0.7%
• Endophthalmitis- 0.13%
 TODAY’S CATARACT SURGERY

• Greatly improved technology - A marvel of

medical technology
• Usually no hospital stay or long recovery
period - Outpatient procedure
• Surface or Local anesthesia
• Tiny incision - heals rapidly
• Little of no discomfort
• Safer, faster and more comfortable
than ever
 THE CATARACT PROCEDURE

• The clouded natural lens is removed

• A man-made lens is inserted
• The new lens is an intraocular lens
(IOL)
Preoperative evaluation

•A pre-operative evaluation by an eye surgeon is

necessary to confirm the presence of a cataract and to
determine if the patient is a suitable candidate for
surgery.

The degree of reduction of vision due, at least in large

part, to the cataract should be evaluated.

•Co existence of other sight-threatening diseases, such

as age-related macular degeneration
Preoperative evaluation
•In cases of uncontrolled glaucoma, a combined
cataract-glaucoma procedure (Phaco-trabeculectomy)
can be planned and performed.

•The pupil should be adequately dilated using eyedrops

•if pharmacologic pupil dilation is inadequate,

procedures for mechanical pupillary dilatation may be
needed during the surgery.

•The patients with retinal detachment may be

scheduled for a combined vitreo-retinal procedure,
along with PC-IOL implantation.
Preoperative evaluation

•Patients taking tamsulosin (Flomax), a common drug

for enlarged prostate, are prone to developing
intraoperative floppy iris syndrome (IFIS), which must
be correctly managed to avoid any complication

•Prospective studies have shown-

risk is greatly reduced if the surgeon is informed of the
patient's history with the drug beforehand, and has
appropriate alternative techniques prepared
• Anaesthesia,
• Exposure of the eyeball using a lid speculum,
•Side port
•Dye
•Entry into the eye through a minimal incision (corneal or scleral)
• Viscoelastic injection to stabilize the anterior chamber and to help
maintain the eye pressurization
• Capsulorhexis
• Hydrodissection
• Hydro-delineation
• Ultrasonic destruction or emulsification of the cataract after nuclear
cracking or chopping
• Cortical aspiration of the remanescent lens,
• Capsular polishing
• Implantation of the, usually foldable, intra-ocular lens (IOL)
• Viscoelastic removal
• Wound sealing / hydration
• Anaesthesia,
• Exposure of the eyeball using a lid speculum,
•Side port
•Dye
• Entry into the eye through a minimal incision
• Viscoelastic injection to stabilize the anterior
chamber and help to maintain the eye pressurization
• Capsulorhexis
• Hydrodissection
• Hydro-delineation
•Ultrasonic destruction or emulsification of the
cataract after nuclear cracking or chopping
• Cortical aspiration of the remanescent lens,
• Capsular polishing
• Implantation of the, intra-ocular lens (IOL)
• Viscoelastic removal
• Wound sealing / hydration
Dr. Stephen G. Slade performed the first laser
cataract surgery in the United States on
February 26, 2010 with the LenSx®
femtosecond laser
Creating corneal incisions
Typically, these incisions are made with a hand-held
surgical blade. In laser cataract surgery, they are
created with a laser.
Performing an anterior capsulotomy.
Typically, an anterior capsulotomy is performed with a
hand-held cutting tool. In laser cataract surgery, this step
is performed with a laser.
Lens fragmentation
Typically, this is done with an ultrasonic probe. In laser
cataract surgery, this step is performed with a laser.

IOL implantation. After the cataract has been broken up

and removed, the eye's natural lens is replaced with an
intraocular lens (IOL), such as a multifocal IOL or an
accommodating IOL to correct presbyopia. This step is
not changed by laser cataract surgery.
limbal relaxing incisions (LRI)

This step involves making a precise, partial-

thickness radial incision in the peripheral cornea
to alter the shape of the front of the eye and
thereby correct astigmatism Typically, a LRI is
created with a hand-held, bladed tool (much like
how RK was performed). In laser cataract surgery,
this step may soon be performed with a laser.