Loss of vision is one of the scariest experiences for most people. It denotes a total loss of control over even the activities of daily life like grooming — cutting nails, shaving, trimming hair or beard etc. — cooking, eating, especially when it involves eating fish, meat, or fruits like guavas which might need a bit of careful eating. It can mean more accidents, especially if you miss a stair or the corner of the bed, or not see some pebble lying on the road, and even the loss of your precious independence as you begin to rely on others to get through the day’s activities. It can also interfere with relaxation such as reading books, watching TV, playing video games, or embroidery.
Typically, people associate cataracts with aging. This is because cataracts are caused by a film growing across the lens of the cornea in the eyes; thus blurring vision, or even completely blocking it. The only difference between geriatric cataract (cataract in older people) and pediatric cataract is that usually elderly people get cataracts in both eyes; while children who are born with it as when the lens did not form properly during pregnancy, or get it very early due to some chromosomal problem like Down’s syndrome, might suffer from a clouding of the lens in only one eye, or both.
It could be due to type 1 diabetes, some serious injury to the eye, any radiation treatment the child might have to undergo, or even having been put on steroids for something like congenital asthma. The worst is that children will either not know that they have some issue with their vision, or when they do realize it, might not be able to explain it to their parents. There is also the unfortunate tendency of people to discount a child’s narrative. Safest is to get your little sweetheart’s eyes checked regularly. Though there are many claims of the efficacy of alternate medicine in “curing” or preventing cataracts; your ophthalmologist will inform you that surgery is the only option for a long term solution for the treatment of cataracts.
Left untreated, cataracts can cause complete blindness over time. Some kinds of treatment are simplistic, and ineffectual in the long run; such as waiting for the cataract to progress, or vision correction by using glasses or lenses of a higher power. Others involving the use of eye drops containing an amino acid called acetylcarnosine can at best be considered experimental treatment for cataracts. More definitive research is required before it can be considered a viable treatment option. Cataracts caused by preliminary diabetes is occasionally reversed by bringing blood sugar levels under control, and preventing fluctuations.
Many eye specialists opine that though cataract is not wholly preventable; you can try to ward it off as long as possible. Your diet has a major role to play in the health of your eyes as much as for the rest of the body. When you eat fruits and vegetables that are rich in antioxidant vitamins like vitamins A, C and E, and phytochemicals like lutein and zeaxanthin; it might reduce the risk of cataracts. Citrus fruits like oranges, cantaloupe, lime, strawberries, Kiwi fruit, and avocados; and vegetables like carrots, broccoli, tomatoes, Brussel sprouts, red and green peppers help in making your eyes healthy. Remember to make whole food grains a part of your daily menu. Avoid direct exposure to sunlight for long periods. If for some reason you must be out in the sunlight for long, wear sunshades which have UV control to protect your eyes.
There is unlikely to be any family in India where at least one family member hasn’t undergone cataract surgery. Your eye doctor will decide on the surgery schedule when the clouding of the eye is posing serious safety concerns, and endangering the patient’s independence or eyesight. This is one discipline which has seen radical changes over the last two decades making it one of the safest procedures. Another reason why you may be recommended cataract surgery is when the cataract makes it difficult for your ophthalmologist to examine the back of your eye to monitor or treat other eye problems. Such issues might include age-related macular degeneration or diabetic retinopathy.
Except for very old people, and those who have multiple co-morbidities; normally cataract surgery is an outpatient procedure as it involves removal of the lens of the cornea which has become cloudy, and replacement with an intraocular lens (IOL) — an artificial lens. Lasers are used to make incisions, remove the anterior capsule of the lens; fragment the cataract to utilize less phacoemulsification (phaco) energy to break it up and remove it; create peripheral corneal incisions to reduce astigmatism.
Phacoemulsification involves the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces. These are then gently removed from the eye using suction. The main reason why it has become the preferred technique of cataract surgery is that it can be performed with smaller incisions, and greater accuracy than previous surgical techniques for cataract removal. This promotes swifter healing, and reduces the risk of cataract surgery complications, such as a retinal detachment.
However, if the patient’s health issues demand it, your ophthalmologist might decide to keep her/him under observation for a day prior to, and after the surgery to be able to intervene immediately if any emergency occurs. These would be patients with high blood sugar; those suffering from some kind of cancer; a patient who has tumors in the brain; and those with severe cardiac issues. In case a patient has cataracts in both eyes, then two separate operations will be carried out several weeks apart.
Your doctor will carry out an eye exam which would include refraction to determine accurately the degree of myopia (nearsightedness), hyperopia (farsightedness), and/or astigmatism, and assess which lens would be best suited for your eyes. Do not eat or drink anything 12 hours prior to undergoing surgery. You might also be advised to temporarily suspend use of any ongoing medication which might cause bleeding. If you are diabetic, bring blood sugar levels under control, and make arrangements to ensure you receive proper after care. It could be a family member who oversees that you take the necessary medicines after the operation, and that you follow restrictions. Your doctor might also advise antibiotic eye drops for use two days before the surgery to eliminate the risk of surface infection creating complications during the recovery period.