International Guideline for Cataract Surgery
The choice to have cataract surgery should be made based on the patient’s clinical severity of the disease and degree of visual impairment.
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Cataract extraction is an operation that can be performed on both eyes at the same time. Extracapsular cataract extraction (ECCE), manual small incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery are all viable options. Any of these procedures can be done with or without intraocular lens (IOL) implantation.
There are a few considerations to take into account when deciding whether or not to have cataract surgery.
- Severity: If the cataracts are causing significant visual impairment.
- Degree of Visual Impairment: If the cataracts are only causing mild visual impairment.
- Risks: Risks should be discussed with your doctor before making a decision about whether or not to have surgery.
- Benefits: Surgery should only be done when the patient will likely benefit from it. In mature or intumescent cataracts, operations should be done as soon as possible.
- Surgery: In general, cataracts should not be operated on if the patient has no perception of light in that eye. The exceptions are when the cataract becomes intumescent or for cosmetic reasons. The poor prognosis for any visual recovery has to be made known to the patient.
Assessment of Cataract Severity
The diagnosis of cataract involves a visual examination to determine the depth and progression of the condition.
A visual acuity evaluation on the Snellen /logMAR /decimal chart is required. This is not, the only consideration when selecting surgery date.
Your eye doctor can check your lens for indicators of a cataract using a slit lamp or a specialized instrument that is called an ophthalmoscope.
The contrast sensitivity, glare, and brightness clarity tests provide further information on the overall visual impairment caused by cataracts.
A dilated/ undilated eye examination using a slit lamp is the usual method of diagnosing cataracts. It allows to visualize the cataract and its severity.
The intraocular pressure (IOP) should be measured to rule out glaucoma, which can cause cataract like symptoms.
The pupillary reaction test helps to determine if the cataract is affecting the pupil’s ability to constrict and dilate.
Extraocular muscle assessment test is done to check for any restrictions in the eye muscles’ range of motion.
This test checks the pressure in your eye’s fluid. There are many different devices available to perform this task.
- Biometry: Optical laser interferometry biometry (OLIB), ultrasound A-scan, and optical coherence tomography (OCT) can all be used to measure a person’s biometrics.
- Keratometry: Manual or Automated Measurement
- Ultrasound B-scan: In situations where a thorough view of the retina is impossible, ultrasonic B-scans may be useful.
- Corneal Topography: The magnitude, axis, and regularity of corneal astigmatism should be evaluated during a corneal topography evaluation to determine if toric IOLs are required.
- Aberrometry & Retinal Optical Coherence Tomography (OCT): May be performed if available
- Visual Function Questionnaires: In Limited Circumstances
- General health assessment of the patient (for example, the ability to lie flat, cooperate, and communicate)