Cataract is the commonest cause of blindness anywhere in the world and it accounts for about seventy-five percentage of curable blindness in India. Cataract develops when the crystalline lens inside our eye becomes opaque. The lens turns opaque when it exposed to toxic substances or metabolic imbalance in the blood, heat, excessive sunlight, trauma, etc.

Cataract is commonly thought to be a disease of old age. This is only partly true. Although about half the people over seventy will have some amount of cataract, it can occur at any age. In India cataract is not uncommon in the age group 45 to 55 years.

Life after cataract surgery used to be a night-mare about two decades ago. The patient had to take bed rest for a week. He had to wear thick glasses after surgery. Vision would be very hazy without spectacles. The patient was thus forced to a life behind glasses. The objects he saw through his specs would appear much larger than their actual size. Thus even with glasses he would not get perfect vision.

A new era has dawned with intraocular lens implantation. Here an artificial lens is used to replace the opaque cataractous lens. The quality of life dramatically improved for cataract patients after the introduction of intra ocular lens. With an intraocular lens implantation the patient could get as much or even better vision than he had before he developed cataract.

In conventional cataract surgery a 10 mm opening is made into the eye to remove the opaque cataractous lens and to introduce a clear artificial lens. The opening is sutured securely once the surgery is over.

Cataract surgery has now gone a step further with phacoemulsification. This surgery is popularly known as key hole cataract surgery as a very small opening is made to remove the cataract and to insert the artificial lens.

Phacoemulsification uses ultrasound energy to fragment the cataractous lens into small bits. These small bits are then sucked out of the eye through a 3 mm opening. The small opening into the eye is fashioned into a valve which is self sealing. Therefore no suture is required.

The diameter of the artificial lens which is to be placed inside the eye varies from 5.5 to 6.5 mm. To introduce this through a 3 mm opening we have to fold the lens into two. The lens is unfolded inside the eye and placed within the bag which originally carried the cataract.

After phacoemulsification and foldable intraocular lens implantation the patient can go back home after a few hours. Bed rest is not required. Next day onwards the patient can carry out his routine activities. The patient must take special care to avoid dusty and crowded places. He must especially avoid contact with people suffering from cold and cough. Post operative hygeine is very important in any type of surgery, whether key hole or conventional. Medicines must be applied ritually after as instructed by the doctor.

After modern cataract surgery a seventy year old man virtually becomes a 40 year old, as far as the eye is concerned. Thus cataract is no more a disease to be feared if detected early and operated in time.

Divya Prabha^® Eye Hospital

Kumarapuram

Thiruvananthapuram

Diabetes is a leading cause of blindness among working-age adults in India. Yet with early diagnosis and timely treatment, diabetic eye disease can be controlled. The key is an eye examination through dilated pupils at least once a year. People with diabetes may develop eye problems as a complication of the disease. People with diabetes are 25 times more likely to become blind than people without diabetes. Almost half of all people with diabetes will develop some degree of diabetic eye disease. Early detection and timely treatment of diabetic eye disease can reduce your risk of vision loss and blindness.

What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness. Diabetic eye disease may include:

• Diabetic retinopathy- damage to blood vessels in the retina.
• Cataract- clouding of the eye’s lens.
• Glaucoma- increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

Who is most likely to get diabetic retinopathy?

Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime.

What are the symptoms of diabetic retinopathy?

Often there are none in early stages of the disease. Vision may not change until the disease becomes severe. Nor is there any pain. Blurred vision may occur when the macula- the part of the retina that provides sharp, central vision – swells from leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. But, even in more advanced cases, the disease may progress a long way without symptoms. This is why regular eye examinations for people with diabetes are so important.

How is diabetic retinopathy detected?

If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam. That means eye drops are used to enlarge your pupils. This allows the ophthalmologist to see more of the inside of your eyes to check for signs of the disease.

Can diabetic retinopathy be treated?

Yes. Your eye care professional may suggest laser surgery in which strong light beam is aimed onto your retina to shrink the abnormal vessels. Laser surgery has been proved to reduce the risk of severe vision loss from this type of retinopathy by 60%. If you have macular edema, laser surgery may also be used. In this case, the laser beam is used to seal the leaking blood vessels. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

Can diabetic retinopathy be prevented?

Not totally, but your risk can be greatly reduced. Better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

How common are the other diabetic eye diseases?

If you have diabetes, you are also at risk for other diabetic eye diseases. Studies have shown that you are twice as likely to get a cataract as a person who does not have the disease. Also, cataracts develop at an earlier age in patients with diabetes. Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

What can you do to protect your vision?

Finding and treating the disease early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. So, if you have diabetes, make sure you get a dilated eye examination once a year.