What are the symptoms of a cataract?

The earliest symptom is decreasing vision. In the beginning, it is only a little general haze. The patient feels that one eye is not seeing well. Later on, the haze or cloudiness increases until the problem is serious.

In the white type of cataract, the decrease in vision is felt both in the day and the night, since the transparency is disturbed all over. On the other hand, in the brown nuclear type, the vision is markedly decreased in the sun but is good at night.

The patient may also complain of double vision or even multiple vision from the same eye. This doubling or multiple images occur due to irregular change in refractive index in the lens.

What are the stages of cataract?

There are four stages:

(a) The early (incipient) stage

(b) Immature swelling (intumescent) stage

(c) Mature stage

(d) Hypermature stage

(a) The early (incipient) stage

This is the earliest stage in which there may be mild blurring or clouding of the vision. Usually the clouding is not sufficient to signicantly affect the vision.

(b) Immature swelling (intumescent) stage

At this stage the opacification of the lens is enough to obstruct vision and cause difficulty in doing work. If the eye is illuminated from the side, the edge of the pupil casts a shadow on the lens.

This stage is also known as the intumescent or swelling stage because the lens swells up a little and tends to shallow or decrease the anterior chamber (the liquid space between the back of the clear cornea and the front of the lens and iris).

(c) Mature stage

Here the lens becomes completely white or deep amber in colour. The iris edge no longer casts a shadow. Vision drops to only perception of hand movement and the ability to locate light directed to the eye from various directions.

In the old-fashioned method of removal of cataract, this was the ideal stage for extraction.

(d) Hypermature stage

The lens becomes shrunken with white spots and the cataracts undergo degeneration. Occasionally the lens may partially dislocate or even suffer from secondary glaucoma. This is not a favourable time for surgery.

Can cataracts be cured by drops without operation?

There are a variety of drops available on the market which are said to control cataracts, though there is no outright medical treatment. Some patients seem to have gained relief by use of the drops. By and large, though the cataract may not go away, it is possible that surgery may be delayed by the drops. However, your doctor would be the best guide for this.

When can cataracts be operated? Do you have to wait until all the vision is gone?

A very frequently asked question. The best time is when the cataract is mature or in the latter part of the immature stage, just before it tends to mature. Too early is not safe and too late makes the operation difficult and dangerous.

A simple rule of thumb is the stage when one can only see the top letter or the top lines in a chart, 6/36 to 6/60, as the earliest time for surgery.

What needs to be done prior to a cataract operation?

Usually your doctor will ask you to have your blood and urine checked up. Often, a cardiogram (E.C.G.) for the heart, a chest examination and a clear certificate from your dentist is required.

Your doctor would also like to know the full details of all the drugs you have taken in the last 6 months and if you are taking any at present. Again, past history of any long illness or blood pressure or diabetes is important to him.

After the operation date is fixed what should I do for my personal grooming?

For men, have a haircut, and if the eyebrows are bushy have them trimmed short. Have a head bath a day before the operation and shave on the morning of the surgery.

For ladies, since you will not be permitted to go to the beauty parlour, for 2 months after surgery, you may have your hair trimmed as you desire now. A head bath a day prior to surgery is an advantage. Please do not apply any make-up at all—not even a "touch" of lipstick.

What clothes should I bring to the hospital?

Usually the hospital will provide you night dress or pyjamas, but for eye surgery you may bring your own, and are free to wear them.

No sponge or bath is given for the first two days following surgery, for its strains the patient.

Will I have any pain after the operation?

A feeling of soreness is common but usually there is no pain at all. A few tablets of aspirin are really all that is ever needed. The stitches are felt slightly but it is a sensation which you get used to in a few days and before you even know it, they are out.

By and large, cataract surgery is really a very comfortable operation to have.

How do we operate quicker now-a-days than in the past?

There are new wonderful medications available which have changed the time-table for operations. One such drug is an enzyme, chymotrypsin, which dissolves the zonules (ligaments) holding the lens in the eye. This makes removal of the lens easy. Again, newer advances in surgery techniques have made removal a more simple proceedure. Superior ultra-thin microscopic sutures permit the wound to be made airtight, thus permitting virtual immediate mobility.

What are the chances of good vision after a cataract operation?

Removing a cataract is for all practical purposes like opening the door of a room. If the back of the eye and the retina is normal, you see normally. However, if you have blood pressure or diabetes or if the retina is diseased, you see proportionately less.

It is an operation which has a high degree of success and provided the eye is normal, can give almost normal vision with corrective glasses.

Dustin Flores

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