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 !!!

STAR SHAPED POSTERIOR SUB-CAPSULAR CATARACT
COMPLICATED WHITE HYPER-MATURE SENILE CATARACT (HMSC)

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 self sealing and doesn’t require any sutures. 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 other better & "Premium" lenses?

There are lot many varieties of premium lenses in the form of Toric lenses / Multifocal lenses /Toric-multifocal lenses / TRIFOCAL lenses / Accommodative and Extended range of vision lenses (both in Indian and Imported varieties having different prices). These lenses are much more costly 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 indicated, 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 any range. 

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.) 

DIFFERENT TYPES OF INTRAOCULAR LENSES

Q5. Will i need glasses if i get multifocal lens implanted in both eyes?

In Unifocal 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 lens is implanted in Both eyes, then the need to wear distance as well as near glasses is almost eliminated as they contain power for both distance as well as near vision 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 little number may still be required to enhance vision for extra clarity for distance vision or extra fine near work.

MULTIFOCAL LENS IMPLANT AFTER CATARACT SURGERY
THE RINGS IN A MULTIFOCAL LENS 

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 ?

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". 

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.

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. 

POSTERIOR CAPSULAR OPACIFICATION (PCO FORMATION)
CIRCULAR CENTRAL OPENING MADE BY YAG LASER Restoring Vision

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 improved with glasses after surgery, but 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. 

Q13. What is the cost & success rate of surgery?

Cost of Phaco surgery can vary from Rs 10,000 to 60,000 depending on the 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. Whatever technique used, cataract surgery has an extremely high success rate of nearly 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 IS SAFE ! …Period !!