THIS IS A DETAILED IN-DEPTH ARTICLE ON THE MOST FREQUENTLY ASKED QUESTIONS ON PHACO SURGERY (CATARACT REMOVAL SURGERY) WHICH TRIES TO CLEAR ALL THE COMMON DOUBTS IN SIMPLE & EASY TO UNDERSTAND LANGUAGE.
SPEND A FEW MINUTES AND READ IT PATIENTLY & THOROUGHLY TILL THE END TO CLARIFY ALL THE MISCONCEPTIONS REGARDING THE PHACOEMULSIFICATION SURGERY OF EYES FOR CATARACT REMOVAL.
These are generally the most common questions patients ask before cataract surgery like..
Q1. I have cataract in both eyes. How early / in which Season can I get them operated? Can both eyes be operated simultaneously?
Q2. What is the difference between Non- Foldable & Foldable lenses? Any difference between an Aspheric & Yellow Aspheric lens?
Q3. What is the difference between Micro-incision Cataract Surgery (MICS) n Routine PHACO? How are Microincision lenses different from routine Phaco-lenses?
Q4. What are "PRE-LOADED" and other "PREMIUM" lenses?
Q5. Will i need glasses if i get Multifocal Lens / Trifocal Lens implanted in both eyes?
Q6. My friend got it done with a simple unifocal lens. They dont wear glasses! Can’t i be done in same way?
Q7. What is FEMTO-PHACO / Robotic Cataract Surgery? Is there any difference as compared to the routine Phaco procedure ? What is ZEPTO catarct surgery ?
Q8. Can cataract come again after lens implantation? What is the life of lens implant used?
Q9. What are the tests required before surgery? Will Blood thinners & other medications continue or need to be stopped?
Q10. How much rest is required after surgery? What all precautions to be kept after surgery? How much duration of medicines is to be put after surgery?
Q11. Is the surgery painful? Will an injection be given during surgery? Will my eye have a patch/eyepad?
Q12. My vision has not improved much with glasses after surgery, and I am still unable to see very clearly. Why is that?
Q13. What is the cost & success rate of surgery?
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LETS TRY TO ANSWER THEM ONE BY ONE.
Q1. I have cataract in both eyes. How early / in which Season can I get them operated? Can both eyes be operated simultaneously?
Whenever there is a significant amount of blurring / glaring / coloured halos formation in any eye,which is troubling in your routine day-today activities of life, that is the time when you should wait no more, and undergo Cataract surgery with lens implantation (unlike olden days when stichless Phaco-surgery was not available,when one used to wait for Ripening / Maturing of cataract, which when delayed further could turn to Lens-induced Glaucoma and the vision may be completely and permanently lost).
The other eye can be safely operated anytime after 5-7 days depending on patient’s choice & level of eye comfort. Surgery can be safely done in ANY SEASON. Hot/Rainy season should only matter to those who don't even have a proper roof over their heads !!!
Q2. What is the difference between Non-Foldable & Foldable lenses? Any difference between an Aspheric & Yellow Aspheric lens?
A non-foldable lens is much cheaper but needs 6.5-7 mm of Large incision size which will require ‘Sutures’ to close. So we don’t recommend it with Phaco technique which is meant for sutureless surgery. A foldable lens goes through a 2.5-3mm Phaco incision itself which is made in a "self sealing" manner and doesn’t require any sutures to close it. There are different kinds of foldable lenses available both in Indian (Export) & Imported variety (Imported lenses being much more costly).
Aspheric foldable lenses are designed to maintain the Normal Asphericity of the Refractive pathway of eye which should result in Slightly Better Sharpness, Clarity, Colours & Contrast as compared to a non-aspheric / simple spherical lens.
Yellow Aspheric lenses are more costly but have additional Chromophobic color filters in it to block harmful spectrum of UV sun-rays from entering into the eye and damaging the Retina over a long period of time, many years post surgery (although strictly speaking there are no Greatly Proven Long-term Results)
Q3. What is the difference between Micro-incision Cataract Surgery (MICS) n Routine PHACO? How are Microincision lenses different from routine Phaco-lenses?
Microincision lenses are slightly more thinner and sleeker designs which go through sub-2.5 mm incision of MICS-Phaco size as compared to an around 3mm incision size through which routine Phaco lenses are designed to go inside the eye. Theoretically MICS lenses may provide a slightly lesser time to heal and lesser chance of residual astigmatic number remaining for distance vision, but practically if one doesn’t wants to spend extra on lenses, then even routine Aspheric / Yellow Aspheric Foldable Lenses are almost similar and good enough in all respects to MICS lenses. Both the lens techniques are SUTURELESS.
Q4. What are "PRE-LOADED" and other "PREMIUM" lenses?
These days there is an option of Fully "PRE-LOADED" lenses in majority of the Latest Aspheric lenses (yellow as well as non-yellow chromophobic) which come in their special PRE-INSERTED CARTRIDGE-INJECTOR system designs (unique to individual companies and lens models) which are ready to inject DIRECTLY INSIDE THE EYE without the need of any manual handling by the operating surgeon and a complicated lens loading system on the operation table with the help of a scrubbed assistant, into the lens delivery cartridge which carries theoretically a risk potential for damage to the lens optic or the haptic while folding & loading and is also liable for a very rare possibility of infection by the surgical instruments which are touching the lens surface while loading it into the injector. These PRELOADED lenses directly come packed inside their special injectors STREIGHT from the manufacturing company's factory and open DIRECTLY INSIDE your eye for the FIRST TIME (rather than on the operation table first and then being assembled by the surgical team). These PRELOADED lenses can cost upto around 1.3-1.4 times in amount than their NON-PRELOADED versions.
Also, there are lot many varieties of "PREMIUM LENSES" (usually which are NON-PRELOADED) in the form of Toric lenses / Multifocal lenses /Toric-multifocal lenses / TRIFOCAL lenses / Accommodative and Extended range of vision lenses also called as EDOF-Lenses (both in Indian and Imported varieties having different prices). These lenses are much more costlier than routine aspheric lenses and have their own specific set of indications as well as limitations and are ‘Not Routinely Recommended In Every eye’ unless really useful for the patient profile of work, having no contraindications of use & of course only if the patients can afford them.
TORIC LENSES help to reduce the ‘Cylindrical component’ of residual number for distance vision and will reduce dependency on distance glasses after surgery (but near glasses will still be required).
MULTIFOCAL LENSES have both distance and near vision power inside the lens so if implanted in both eyes judiciously, they may altogether reduce the need of wearing any kind of glasses for distance and reading range.
TRIFOCALS and EXTENDED DEPTH OF FOCUS (EDOF) Lenses have 3 ranges i.e. DISTANCE , NEAR as well as additional INTERMEDIATE RANGE (Which is mostly used for COMPUTER SCREEN WORK if you have such work alot)
But there is no 100% guarantee with any kind of lens for complete removal of the residual spectacle number. It may come somewhat near to zero but a little bit may remain (but then it may not be significant enough that the person feels the need for it, to wear all the time especially if implanted in BOTH EYES one after the other.)
some eg of these lenses are
•• BIFOCALS (TECHNIS-M/F) (outdated) no intermediate , only improves near range apart from giving distance vision
•• EDOF without rings (Also called extended or enhanced Unifocals / monofocal -PLUS lenses) like TECNIS - EYEHANCE / SIFI-EVOLUX / Rayner-EMV / Physiol-ISOPURE / Caregroup-MAGNIFICENT etc lenses which WILL require reading glass for NEAR (as it improves only intermediate range) (but NO GLARES / HALOS / STARBURST as no rings)
•• EDOF with rings (TECNIS-SYMPHONY / ALCON-VIVITY / MINI-WELLFUSION / AURO-VIVID etc ) improves intermediate range with "some" near range
•• TRIFOCALS (TECNIS-SYNERGY / ALCON-PANOPTIX / ZEISS-LISATRI / VIVINEX-GEOMETRIC (Latest) Improves intermediate with good near range (All TRIFOCALS also have rings, so some chances of glare n haloes around bright point source of lights esp in dark)
•• TORICS to be considered and added if corneal cylinder power more than 1 dioptre on preoperative keratometry (1.25DC or more)
Q5. Will i need glasses if i get Multifocal Lens / Trifocal Lens implanted in both eyes?
In Unifocal/Monofocal lenses there is no power for near. So near glasses will Always Be Needed after surgery. Some amount of induced number comes for distance vision also in most cases (but one may or may not feel the need to wear it if Far-vision is grossly clear). So cataract surgery ‘Never’ guaranties full removal of glasses number post surgery.
Yes of course if a Multifocal or Trifocal or EDOF lens is implanted in Both eyes judiciously, then the need to wear distance as well as any near glasses is almost eliminated as they contain power for multiple ranges (depending on your nature of work and need) by having multiple power rings in it (the edges of these rings may cause a little glare / haloes especially in night.) But all said and done, a very little amount of number may still be required to enhance vision for "extra clarity" for distance vision or extra fine near work (which is hardly ever required by the patient once the Neuro-adaptation is completed by your brain in accordance with the new optical lens systems implanted in your eyes)
Q6. My friend got it done with a simple unifocal lens. They dont wear glasses! Can’t i be done in same way?
It is impossible for vision to be good for all ranges if a unifocal implant is put inside both the eyes unless one eye is made more clear for seeing distance and other eye is made deliberately more clear for seeing near. This is called as the concept of ‘MONOVISION’
But then the eye which is good for distance won’t be good for near & the eye which is good for near won’t be good for distance. But with both the eyes open, one is able to see clearly for both distance as well as near even with a unifocal lens implant in both eyes.
This concept of monovision might not suit everybody and once the lenses are put, the procedure generally can’t be reversed if you are unable to get used to it !
Q7. What is FEMTO-PHACO / Robotic Cataract Surgery? Is there any difference as compared to the routine Phaco procedure ? What is ZEPTO catarct surgery ?
FLACS or “Femtosecond Laser Assisted Cataract Surgery” is the latest cutting tool technology for cataract segmentation (as compared to the traditional high frequency ultrasonic energy utilized by all types of Phacoemulsification matchines for breaking up of cataract inside the eye). This laser is actually extensively being used in Refractive Surgeries like Lasik & SMILE to get rid of spectacles, which is now also being tried to assist in some INITIAL steps of routing Phaco-procedure, making the cataract surgery “Bladeless”, more simplified, accurate and (possibly) more safe.
But at the end, beside the initial few steps, rest all the steps of Phacoemulsification surgery are still performed in the same usual manner, with the same routine "PHACO-matchine" itself. So Femto laser hasn’t yet fully replaced the Phacoemulsification machine / procedure as far as Cataract surgery goes (Unlike Glasses Removal Surgery where FEMTO laser is almost on a verge to replace the EXCIMER laser or LASIK-Laser with the recently introduced SMILE procedure)
No doubt FLACS is THE Latest technology on the horizon of the FUTURE of cataract surgery, but the FUTURE seems somewhat FAR at present in this "PHACO-Dominant Era" as the Femto Surgery cost increases to more than 3-4 tmes the routine Phaco-MICS surgery cost (excluding lens)
And yes, the ROBOT is just a different machine i.e. the FEMTOSECOND Laser machine, to ASSIST in cataract segmentation in the first half of the surgery. The rest whole of the Cataract surgery is STILL VERY MUCH performed by HUMAN HANDS only with the usual time tested PHACO technology.
ZEPTO- cataract surgery (also sometimes called Partial Robotic surgery ) uses precision pulse technology using a nitenol metal ring to perform the most impoortant iniatial rate limiting step of cataract surgery called CAPSULORHEXIS with robotic precision (Zepto Surgery cost increases to more than 2 times the routine Phaco-MICS surgery cost, excluding lens)
Robotic surgery is mainly indicated in hard / mature / complicated cataracts only mostly.
Q8. Can cataract come again after lens implantation? What is the life of lens implant used?
Once the cataract is removed it can never come again. The clear lens implant that is put (whichever quality) is for lifetime and doesn’t require any replacement ever. Although there is thin membrane behind the Lens (which is actually the posterior most membrane of the cataract itself which is generally transparent) on which we support the new Lens, which commonly becomes cloudy and opacified, and vision may again start deteriorating a few months to few years after surgery (regardless of the type of lens used).
If the haziness becomes significantly troublesome, it can be cleared by a simple outpatient ‘YAG laser treatment’ procedure which just takes a few seconds.
Q9. What are the tests required before surgery? Will Blood thinners & other medications continue or need to be stopped?
Generally there is no bleeding in cataract surgery, so nowadays we don’t really recommend stopping blood thinners before surgery unless really warranted depending on your case. You have to discuss this with your treating physician and eye surgeon before getting the surgery date fixed. Generally some routine blood test like Hemogram and blood sugars, sometimes along with urine examination and ECG are required, which your eye surgeon will suggest before giving you the date for surgery. If sugars are high or some infection in the body is detected, it needs to be controlled first.
Q10. How much rest is required after surgery? What all precautions to be kept after surgery? How much duration of medicines is to be put after surgery?
Generally some preoperative eyedrops and tablets are started a few days prior to surgery. The Post-surgery eyedrops will continue for at least 4-5 weeks regardless of the type of technique used. No bed rest is required and you may move around and watch TV / read from the other eye even on the same day after you come back home from surgery. Few minor precautions are to be kept for 3-4 weeks like no splashing of water directly inside eye/ rubbing or pressing of eye / no heavy work etc. Your vision may be slightly blurry for an initial few days after surgery due to the inflammation inside the eye caused by the surgical procedure itself, which gradually improves within a few days as the post-operative anti-inflammatory eyedrops are started. For initial few days there might be some amount of obvious irritation , redness, watering or discomfort in the eye which may vary from person to person and eye to eye, again which generally improves over a few days once the eyedrops are started.
Q11. Is the surgery painful? Will an injection be given during surgery? Will my eye have a patch/eyepad?
Surgery itself is not painful at all, as your eye will be anaesthetized by some or the other numbing means. Some surgeons prefer to give a small injection near the corner of eye which might pinch a little only for few seconds (after which you will not feel ANY BIT OF SENSATION OF PAIN OR TOUCH whatsoever) and some do the surgery with anaesthetising drops / gel in which case surgery sensations are felt more & much more patient cooperation is required during surgery in the form of keeping the operated eye steady n keep looking straight into the operating microscope light without making much eye movements. In cases where an injection is given, a small eye-pad may be kept for a few hours / overnight. A pad may also be sometimes needed for a few hours even when no injection is given !
Q12. My vision has not improved much with glasses after surgery, and I am still unable to see very clearly. Why is that?
There may be some other Corneal / Retinal problem which might need additional eye tests and treatment by your eye doctor. A detailed eye examination after few weeks of surgery should be repeated to find out the cause.
Sometimes few Retinal problems may be Pre-existing before your cataract surgery and your eye doctor may advice certain retinal scanning procedures like Optical Coherence Tomography (a type of high definition CT scan of your retinal layers called OCT if the media is hazy due to cataract) or a B-scan Ultrasound of the eye to check weather or not there is any retinal or choroidal detachment / vitreous haemorrhage inside your eye (if there is no proper fundal view of the retina due to your dense near-mature or mature cataract).
All said and done, still some subtle retinal abnormalities may go undetected in scans due to the decreased penetration of scanning rays because of the underlying cataractous lens hindering their passage into the eye upto the retinal layers, and they may be detected only once the surgery is done and the lens is put and your eye is subjected to repeat scanning few days or weeks after surgery (in case your visual recovery is sub-optimal after the healing is complete)
Q13. What is the cost & success rate of surgery?
Cost of Routine Phaco surgery can vary from Rs 15,000 to 60,000 depending on the Centre , cost of Lens implant, n some other factors like your Job Entitlement Category / Mediclaim Policy (wherever applicable) & from hospital to hospital. FLACS charges may go till 1 Lac or even more Per Eye.
Generally Robotic surgery (Femto-FLACS or ZEPTO) and PREMIUM LENSES are NOT COVERED in Mediclaims
Whatever technique used, cataract surgery has an extremely high success rate of nearly more than 99%. Of course there is no surgery anywhere in the world which is guaranteed 100% safe (even walking on road is never 100% safe, some vehicle might hit you even if you’re on the pavement! That doesn’t mean we stop stepping outside!! )
But something which is more than 99% safe & with proven results beyond doubts for DECADES together now, IS SAFE… ! …Period !!