How to choose the right lens for cataract surgery

 

Cataract surgery is one of the very commonly done eye surgeries.  Crores of patients world wide undergo cataract surgery to regain their sight

In cataract surgery, an artificial lens is implanted. An Intraocular lens (IOL) helps the patient to restore lost vision as well as correct the refractive error they had prior to surgery

Different lens types are available to match patients lifestyle and eye requirements

Ophthalmologist will help you prior to surgery in choosing the best suited lens for your eyes. Your lifestyle requirements, budget and insurance coverage is also considered while offering you the best.

Lets understand the various artificial lenses available for your eyes

The options we have are

• Monofocal IOLs are made to focus at a particular fixed distance. Most patients who opt these monofocals, get it fixed for distance vision. These patients usually require reading glasses.

• Multifocal IOLs  are designed in such a way that they help you with distance as well as near work such as reading. The newer trifocals help with intermediate distance which is our screen viewing distance (mobile, laptop usage)

• Extended depth-of-focus i.e. EDOF lens: they are designed for distance and intermediate work. But the patients who opt them require some reading glasses

• Toric lenses designed to correct astigmatism. They can be monofocal, multifocal or EDOF

Some of the cost, insurance and lifestyle factors which are considered before planning the surgery are as follows...

What can I afford?

Most of the insurance companies and insurance policies usually cover monofocal intraocular lenses. Hence when someone opts for premium lenses such as multifocals, toric or EDOF, out of pocket expenses are incurred. But many corporate policies and policies which have high coverage do cover premium lenses. Sentra clinic and hospital's insurance team will help you with all the insurance related process.

Do you spend a lot of time reading, working on screen etc?

If you like doing a lot of near work you can considered multifocal lens. Also you can set your monofocals in such a way that you can do near work without glasses and for distance you will require glasses. Another option is one eye you can set for distance and other for near work with monofocal lens. This is called mono vision. But this may not suit everyone. Also with Multifocals, some patients do require glasses for some activities.

Do you drive at night?

Multifocal lens can give rise to glare and halos which are mostly experienced with bright lights. This can be uncomfortable to some while driving at night. Hence discuss this with your ophthalmologist before opting for multifocal lens.

Do You Have Astigmatism or cylindrical number in spectacles?

Astigmatism can be corrected by Toric lenses which helps in greater clarity of vision post surgery. Your ophthalmologist will discuss the need for toric lenses if they find it suitable for you

Are you suffering from any other eye disease?

Multifocal and EDOF lenses are usually not ideal for patients with pre existing diseases such as diabetic retinopathy (diabetic eye disease), glaucoma, macular degeneration etc. They allow less light to pass, hence may increase difficulty for patients. Monovision as described above can be considered to reduce dependence on glasses.

I hope above information helps you to converse better with your ophthalmologist. The above mentioned information is just a point of view. Your ophthalmologist will be the best suited person to guide you with the lens choice

Lets understand what is retina and various diseases which can affect retina

What is Retina?

The retina is the innermost layer of the eye, and it features many light-sensitive photoreceptor cells.

These cells detect light and convert it into electrical signals

Retinal tear

A retinal tear happens when there is a tear or hole in the retina. This typically occurs when the vitreous,

which is a jelly-like substance in the eye, attaches to the retina and pulls hard enough to tear it. This can

happen when the vitreous detaches as part of the aging process, or it can result from trauma.

Retinal tears can cause blurry vision, the sudden onset of floaters, or flashes of light.

It is important for people to receive treatment for a retinal tear, as it may result in retinal detachment.

This is a more serious condition that affects vision.

Retinal detachment

Retinal detachment occurs when a buildup of fluid, which usually enters through a retinal tear, causes

the retina to detach from the choroid, which is the eye layer that provides it with oxygen and nutrients.

Retinal detachment is a medical emergency that, without treatment, may lead to permanent vision loss.

Retinopathy

Retinopathy results from damage to the blood vessels at the back of the eye, which causes fluid to leak. This accumulation of fluid can affect the retina and result in changes to vision. Conditions that can cause retinopathy include diabetes, high blood pressure, anemia etc

Diabetic retinopathy i.e diabetic eye disease is a common complication of diabetes, with evidence suggesting that it is a leading cause of blindness among adults in the India

Epiretinal membranes

Epiretinal membranes (ERMs), also called macular puckers or cellophane maculopathy, make up a thin layer that forms on the retina’s inner surface. It is usually scar tissue from a medical condition or injury. ERMs often do not cause symptoms, except when they affect the macula or the center of the retina, which is important in perceiving visual details and features. A person may notice distortion of their central vision.

Macular hole

Similar to retinal tears, macular holes are small breaks in the macula that occur due to an unusual pulling between the vitreous and the retina. Aging is the most common cause of macular holes. Eye injuries may also result in macular holes.

Macular degeneration

Because macular degeneration is more common among older adults, eye doctors usually call it age-related macular degeneration (AMD). With this condition, the macula deteriorates and causes distorted central vision, which may worsen over time and cause permanent vision loss. It is a common cause of loss of vision in elderly

Retinitis

Retinitis refers to the inflammation of the retina. It usually results from viruses and bacteria. For example, Lyme disease, syphilis, and Dengue fever may cause retinitis. Autoimmune conditions, such as  Behçet’s disease  and lupus, may also cause this condition.

Retinitis pigmentosa

Retinitis pigmentosa is a rare genetic degenerative condition that causes a breakdown and loss of cells in the retina. This can cause a progressive loss of vision.

Macular edema

Macular edema is a condition that occurs due to fluids building up in the macula, causing it to swell. Several conditions can cause macular edema, including AMD, diabetes, and retinal vein occlusion.

Retinal vein occlusion

Retinal vein occlusion, or eye stroke, is a blood vessel disorder wherein branches of the retinal vein become occluded, causing fluid and blood to spill onto the retina. The blockage cuts off circulation, which can cause nerve cells to die, leading to vision loss.

Diagnosis

To examine and diagnose eye conditions such as retinal disorders, ophthalmologists will typically first ask about the person’s medical history. This allows them to look for factors that may affect their vision, such as underlying conditions. They will then perform a comprehensive eye exam with a particular focus on the retina and the macula. They will use a special instrument called an ophthalmoscope to investigate the inside of the eye.

The ophthalmologist may use eye drops to widen (dilate) the pupil to see the inner eye better. They may also request an eye ultrasound and give numbing eye drops to prevent discomfort as they scan the eye. Ophthalmologists may also take images of the retina using optical coherence tomography (OCT). They may also request dye tests such as fluorescein angiography to look for leakage in the blood vessels.

Treatment

The goals of treatment will be to preserve and restore vision or to prevent and slow down the damage in the retina.

Treatment for retinal disorders varies depending on the type and extent of the condition. Options may range from medications and vitamins to injections, surgery, and laser treatments.

An individual’s eye specialist will discuss the most suitable treatment options for their condition.

5 steps to prevent diabetic retinopathy

Diabetic retinopathy is a complication of diabetes mellitus due to uncontrolled blood sugars
These five steps can help you prevent diabetic retinopathy.
1. First step is to track your blood sugars and glycosylated hemoglobin regularly
This helps us to be aware of our blood sugar and also it helps us to maintain a blood sugars

2. 2nd step is to reach your ideal weight. Reaching your ideal weight helps in multiple ways. It helps you to cut down on diabetic medications and also gain fitness. The ideal way to maintain weight and to reduce access fat in the body is to take low fat vegan diet.

Low fat vegan diet not only helps you to loose weight but can help you with reversing chronic illnesses
I am going to cover more details on low fat vegan diet in my next blog

3.The third step is to add physical activity in your daily routine activities.
Simple ways to add more physical activity in your daily routine activity is as follows  a.Choose the staircase
b.Do the household chores
c. Instead of using a car or a bike you can think of walking towards the nearby grocery store
d.Nitric oxide dump
From this doing nitric oxide dump thrice daily one and a half hours post meal can have a wonderful effect on your blood sugars. Nitric oxide dump is a useful exercise as it helps the major muscle groups i.e the pelvic and the shoulder muscles to utilise to utilise blood sugars without the requirement of insulin. This helps you to reduce the sugar spike after a meal and hence reduces the requirement of Anti diabetic medication.

4. The 4th standard fourth step is very important.  We need to focus on a serum cholesterol and blood pressure these two are sister concerns when it comes to diabetes mellitus.
High blood pressure and the raised serum cholesterol deteriorates and helps in progression of diabetic retinopathy.
Once you lose weight, it also helps you to control your blood pressure and also your serum cholesterol

5. The 5th step to prevent diabetic retinopathy is to kick the smoking.
Smoking helps in faster progression of diabetic retinopathy hence leaving smoking can be a good way to prevent diabetic retinopathy.
Quitting smoking can help you gain good health in multiple ways. Smoking is injurious to not only diabetic patients but also to non diabetic patients at it increases the risk of heart disease multiple cancers and other chronic illnesses