The term ‘cataract’ is used to describe the clouding of the natural lens of the eye. The vision dims because the cataract prevents light from passing beyond the lens and focusing on the retina. For nearly all patients cataracts are caused by an aging of the natural lens that leads to a breakdown of its proteins. This results in a progressive clouding of the lens. While the average patient typically doesn’t get visually significant cataracts until age 60 or beyond, there are a number of risk factors that are known to cause cataracts earlier in life. In fact, some babies are born with cataracts as a result of genetic defects or infection while in the womb.

What Causes Cataract?

The lens of the eye is located immediately behind the iris and is responsible for 33% of the eyes focusing power. At birth it is like jelly, but unfortunately with age it gradually hardens and loses its ability to change shape. Evidence of this hardening normally starts to affect us in our mid-forties when many require reading glasses for close work. This is called Presbyopia. The lens is made mostly of water and protein. Specific proteins within the lens are responsible for maintaining its clarity. Over many years, the structures of these lens proteins are altered, ultimately leading to a gradual clouding of the lens. Rarely, cataract can present at birth or in early childhood as a result of hereditary enzyme defects, and severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataract to occur earlier in life. With further increase in age, the lens continues to harden and starts to become more compact and cloudy, reducing initially quality of vision and later obstructing vision and interfering with day to day activities. A cloudy of opaque lens is called a cataract and unfortunately is inevitable.

What Are Cataract Symptoms ?

The typical symptom of cataract formation is a slow, progressive and painless decrease in vision of variable degrees. The loss of transparency of the lens may be so mild that vision is hardly affected, or so severe that no shapes or movements are seen. Common symptoms of cataract include.

  • A painless blurring of vision
  • Prescription changes
  • Poor night vision
  • Glare, or light sensitivity
  • Double vision in one eye
  • Fading or yellowing of colors
  • Frequent eyeglass
  • Needing brighter light to read


When to Seek Medical Care- Eye-care professionals may mention during a routine eye exam that you have early cataract development even if you are not yet experiencing visual symptoms. Although your doctor will be able to tell when you first begin to develop cataract, you will generally be the first person to notice changes in your vision that may require cataract surgery. Clouding of the lens may start to be seen at any age, but it is uncommon before the age of 40.

However, a large majority of people will not begin to have symptoms from their cataract until many years after they begin to develop. Since cataract development rarely causes any long-term damage to the eye, cataract surgery should be considered only when visual symptoms begin to develop. Whenever significant vision problems are noted, you should schedule an exam by an eye-care professional.

Typical symptoms may include blurry vision, difficulty with glare or night vision, poor color vision, or frequent changes in eyeglass prescription. For an early cataract changes, vision may be improved by simply changing your eyeglass prescription, using a magnifying lens, or increasing lighting when you do visually demanding tasks.

Eventually, cataract get to a point where the only effective intervention is surgery. This decision is made based mainly on the degree of visual limitation the patient is experiencing.


The Risk Factors Include :

Age : Most people older than 60 years have cataract.

Medical conditions : Diabetes and other systemic diseases, glaucoma, and metabolic abnormalities can cause cataract. We can work to control these causes.

Eye injuries : These are called traumatic cataract. A blow to the eye, great heat or cold, chemical injury, exposure to radiation and other injuries can lead to cataract formation. We can limit this with immediate treatment.

Ultraviolet radiation (UVA or UVB) : Long-term exposure to sunlight is believed to speed the development of cataract. We can help prevent this with proper protection in your glasses.

Smoking : All studies indicate that smokers are twice as likely to develop cataract as nonsmokers and that quitting can reduce the risk for developing cataract. We will try to help you with this.

Exams And Tests :

To detect a cataract, the eye-care provider examines your lens. A comprehensive eye examination usually includes the following:

Refraction: Your eye doctor should determine if glasses would improve your vision.

Glare testing : Vision may be significantly altered in certain lighting conditions and normal in others; in these circumstances, your doctor may check your glare symptoms with a variety of different potential lighting sources.

Potential acuity testing : This helps the ophthalmologist get an idea of what your vision would be like after removal of the cataract. Think of this as the eye’s vision potential if the cataract was not present.

Contrast sensitivity testing : This check for your ability to differentiate different shades of gray, which is often this limited by cataract.

Tonometer : a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)

Pupil dilation : The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataract.

IOL Master : A new dimension in optical biometry to improve postoperative refractive results. It is a gold standard in biometry (calculating IOL power)

  • Today, cataract treatment involves a lot more than the replacement of the crystalline lens. Refractive improvement is often also required. Premium IOL are now being increasingly used to meet patient demands. Hence accurate IOL power calculation is an absolute must. The IOL Master provides you with highly precise measuring data as a basis for optimum vision for patient.
  • The IOL Master can also be used to precisely and reliably measure problematic cases such as staphyloma, highly myopic, or silicone-filled eyes.
  • The Haigis-L formula offers a convenient solution for eyes subsequent to refractive surgery performed for the correction of myopia and hyperopia. The calculation of phakic implants is also possible.


Types of Intraocular Lenses (IOLs)

The two most common types of lenses are:

Anterior Chamber Lenses (ACIOL): These lenses are placed on top of the iris, the brown part of the eye. It is not the physiological position of the natural lens of the eye, and this type of lens is not the preferred IOL after non-complicated cataract surgery. ACIOLs are implanted in case the posterior capsule of the lens is deficient or damaged.

Posterior Chamber Lenses (PCIOL): These lenses are tucked into the place over the residual posterior capsule in the physiological position of the natural lens of the eye and are the preferred lenses.

The rest of this article will discuss the major types of advanced PCIOLs available for implantation after modern cataract surgery, namely, phacoemulsification, Microincision cataract surgery . These lenses are collectively called premium IOLs.

Types of Premium IOLs

Premium IOLs are of three broad categories:

Monofocal Lenses

Monofocal lenses, unlike the natural lens of the eye, can only restore vision for one distance, that is for distance, or for near. The power of the monofocal lenses is usually calculated so that the patient does not need glasses for distance vision. After having a monofocal lens implantation, you will need reading glasses or even bifocals which are glasses for both distance and near, depending on your preexisting refractive error (especially astigmatism).

Choosing which distance will depend upon your lifestyle and what you do during your day.

Long distance – if you do a lot of driving, watch television or are a keen golf player then improving your long distance vision could help. You will still require glasses for reading and up close activities.

Middle distance – this is the distance for working on a computer or reading music

Short distance – if you do a lot of reading then improving your short distance vision could be a good option for you. You will still require glasses for distance activities such as driving or watching TV or a movie.

Below are the various types and brands of premium Monofocal Lenses:

Aurium (Monofocal): Aurium monofocal lenses are manufactured by Medennium(USA). These lenses are photochromatic, which means they become lightly tinted during daytime or bright light and thus prevent harmful UV. Under normal room lighting conditions, these lenses become transparent.

Acrysof IQ (Monofocal): Acrysof IQ is an imported monofocal lens manufactured by Alcon (USA). These lenses provide excellent vision for distance. For near vision, however, a person may require additional reading glasses. This lens contains a yellow pigment chromatophore which blocks harmful UV rays and the blue rays from entering the eye and damaging the retina.

Aurovue(Monofocal): An Indian Company – Aurolab manufactures Aurovue lenses. These lenses are considered as entry-level options for cataract surgery and are recommended for somebody on a low budget.

Akreos AO(Monofocal): Akreos AO are similar to Aurovue lenses. However, these are imported lenses and are manufactured by Bausch & Lomb (USA).

Acrysof SP(Monofocal): Acrysof SP is imported monofocal lens, manufactured by Alcon (USA). These lenses are also preferred in Diabetic Patients. It is also a recommended option for somebody opting for a monofocal lens in Regular Phaco surgery.

2. Multifocal Lenses

Multifocal IOLs are lenses which offer an acceptable restoration of vision for both near and distance. While choosing an IOL, it is important to remember that multifocal lenses provide you freedom from glasses for both near and distance, and can be customized to your active lifestyle. However, your doctor will discuss with you the apparent drawbacks of these lenses, namely glare, and a decrease in contrast sensitivity. In case you do not want to wear glasses for near or distance and do not want to go ahead with the added expense of a multifocal IOL, your doctor will discuss monovision with you. Following are the best multifocal lenses:

Tecnis Symphony (Multifocal):

Tecnis Symphony is a multifocal lens manufactured by Abott (USA). This lens provides excellent distance and intermediate vision (computer working).

Tecnis Symphony is a multifocal lens manufactured by Abott (USA). This lens provides excellent distance and intermediate vision (computer working).

iDiff (Multifocal): iDiff lenses are multifocal lenses manufactured by Care Group. These lenses provide good vision for near and distance, which means that a person can easily carry out regular day to day activities with distance vision and also do near work such as reading and writing comfortably without use of additional spectacles. iDiff Lenses, however, do not correct intermediate vision.

Tridiff (Multifocal): Tridiff lenses are multifocal lenses manufactured by Care Group. These lenses provide good vision for near, intermediate and distance, which means that a person can easily carry out regular day to day activities with distance vision, also do intermediate distance work such as working on the laptop and also carry out near work such as reading and writing comfortably without the use of additional

Alcon Pantopix (Multifocal): It is the largest introduction in multi-focal lenses. The lens is able to provide excellent vision in for distance, immediate and near.

3. Toric Lenses

An eye can have two types of power, spherical power which is because of the natural lens within the eye and cylinder power which is because of the dissymmetry in the curve of the cornea. Monofocal and Multifocal Lenses can only correct the spherical component of the eye leaving behind the cylinder power which has to be later corrected by additional prescription glasses. Toric Lenses can correct both spherical and cylinder components of the eye. Toric lenses are recommended if you have a high pre-existing cylinder or astigmatism in your eye. Below are the recommended Toric lenses:

Acrysof IQ (Toric): These lenses are designed to correct astigmatism at the time of cataract surgery. This lens is manufactured by Alcon (USA).

Acrysof Toric (Toric): These lenses have all the properties of Acrysof IQ along with cylinder correction

Zeiss (Toric): The lens is manufactured by the German company Carl Zeiss and is one of the benchmarks in superior cylinder correction.

Which is the best IOL for you?

In medicine, like life, there is no single best answer. Your doctor will discuss with you the potential benefits of each of these lenses, and help you select the one best suited for your lifestyle and visual needs, as well as your expectations from the cataract surgery.

Lifestyle and priorities: In case you have a very active lifestyle that involves a lot of precise focusing outdoors, like golf, you may compromise your near vision but not your distance vision. If you travel a lot, you might prefer to not be dependent on glasses at all, preceding a bit of precision for both near and distance vision. On the other hand, if you enjoy sewing or embroidery, you will want perfect near vision.

Pre-existing diseases: In case of certain eye diseases like advanced glaucoma, corneal disorders or age-related macular degeneration, you may not be a good candidate for specific lenses, like the multifocal lens. Your eye doctor will perform a comprehensive eye exam and discuss its results and implications with you, to help you choose the best possible lens for your eye.

Costs: These lenses are more expensive than traditional IOLs, adding an incremental value to the cost of cataract surgery. The premium lenses come at a price that is usually not covered by insurance companies.

Types of Cataracts

Cataracts come in various forms, each with its distinct characteristics and impact on vision. The most common type is known as age-related cataracts, which gradually develop over time due to natural aging processes. They typically occur when proteins in the lens of the eye clump together, causing clouding and obstruction of vision. Another type is congenital cataracts, which are present at birth or develop shortly afterward. These can be caused by genetic factors or certain infections during pregnancy.

  Traumatic cataracts, on the other hand, result from eye injuries that damage the lens. They may occur immediately after the incident or manifest years later. Additionally, radiation or drug-induced cataracts can occur as a side effect of certain medications or treatments, such as chemotherapy or prolonged exposure to radiation. Recognizing the different types of cataracts allows for accurate diagnosis and appropriate treatment to restore one’s vision and quality of life.

Symptoms of Cataract

Cataracts, a common eye condition particularly among older adults, can have discernible symptoms that often require medical attention. One of the primary indicators is experiencing clouded or blurred vision, as if looking through a foggy window. This condition makes it difficult to see details, even when wearing prescription eyeglasses or contact lenses. Furthermore, individuals with cataracts often struggle with brightness, noticing increased sensitivity to sunlight or artificial lighting. As the condition progresses, colours may appear faded, dull, or less vibrant than before.

A notable symptom is the development of halos around lights, such as street lamps or headlights. Additionally, night vision may significantly deteriorate, making it particularly challenging to navigate in dimly lit environments. Regular eye examinations play a pivotal role in identifying these symptoms and enabling medical professionals to recommend appropriate treatment options to mitigate the impact of cataracts. With timely intervention, individuals can regain clearer vision and enhance their quality of life.

Treatment for Cataract

There are several effective cataract treatment options available that can restore clarity to your vision. Cataract surgery is commonly recommended to remove the cloudy lens and replace it with an artificial one. During the procedure, a skilled eye surgeon carefully removes the affected lens and replaces it with a clear intraocular lens (IOL). This allows for improved vision and a significant reduction in cataract-related symptoms. The surgery is typically performed as an outpatient procedure, ensuring a convenient and efficient experience for patients. With advancements in surgical techniques, such as laser-assisted cataract surgery, the treatment has become even more precise and tailored to individual needs. Recovery after cataract surgery is generally swift, with most patients experiencing improved vision within a few days. Following surgery, regular check-ups with the ophthalmologist are essential to monitor progress and adjust any necessary post-operative care. With the remarkable advancements in cataract treatment, those affected can regain clear vision and continue to enjoy life to its fullest extent.

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