Dr. Harsh Goel

Any patient who needs to undergo cataract surgery must be evaluated in a thorough manner so as to establish the requirement, appropriateness, expected surgical problems, expected benefits and co-morbid conditions having an influence on cataract surgery.

The preoperative assessment consists of -

A test for your existing glasses prescription:

It is useful for your cataract surgeon to know your existing glasses prescription in cases where there is a high refractive error (people who are very short or long sighted), in order to plan to correct this error after cataract surgery.

A full ocular examination: This includes looking at:

• The eyelid anatomy and inflammation.
• The state of the tear film, dry eye changes could make surgery difficult
• The presence of abnormalities in the cornea that could make visualisation of the cataract difficult during surgery.
• The amount of dilation the iris undergoes with dilating drops.
• The type of cataract. Soft cataracts can be aspirated. Hard cataracts need more ultra-sound energy and surgical time to break up and remove. White cataracts may need trypan blue staining to visualize the capsule
• The measurement of intra-ocular pressure. With this test, we aim to exclude glaucoma and ensure optimal control of immediate pre-operative and intra-operative eye pressures often with extra eye drops that temporarily lower eye pressure.

Biometry Tests: This is a simple pre-operative measurement. It calculates the correct power of artificial intra-ocular lens. They will be implanted into your eye once your cataract is removed.

Corneal Topography: This is a test to map out the corneal curvature in greater detail. It is used prior to premium IOL Implantation like Toric IOLS either monofocal or multifocal , to ensure avoid postoperative refractive errors. This extra test is only required if the biometry readings show larger than normal differences in keratometry readings.

Optical Coherence Tomography (OCT): This test allows detailed visualisation of the macula (the central sensitive part of the retina used for fine vision). If the ophthalmologist suspects any macula changes that may prevent a patient from visual improvement after cataract surgery, he always suggest optical coherence tomography.

Blood Pressure Measurements: It is very important to know your blood pressure measurements before your cataract operation. The risk of having a bleed at the back of your eye during cataract surgery (supra-choroidal haemorrhage) is very small (1 in 10000). But is higher if you have uncontrolled blood pressure.

Blood Sugar Measurements in Diabetic Patients: Cataract surgery itself does not affect your blood sugar measurements if you are diabetic. A routine checkup of blood sugars in diabetics before cataract surgery is done and the surgery if often delayed if the levels were greater than 20mmol/L as the risk of post-operative infection is higher.

Here are some ways to care for your eyes

If you are diabetic then it is important that you consult a ophthalmologist for regular check-ups. Diabetes is known to be one of main causes for blindness across all age groups. If you suffer from bouts of blurred vision then it is not likely due to a long term vision problem. It is temporary and usually occurs due to fluctuating blood sugar levels in the body.

How diabetes affects your eyes?
The lens of your eyes can swell if you are a diabetic, and this can impair your ability to see causing blurry vision. In order to rectify this problem, it is important for you to get your blood sugar levels under optimal levels. This entire procedure of reducing blood sugar levels may take three months or more.

Eye problems that are caused by diabetes
The major eye problems that can occur due to diabetes are

1. Cataract: Cataract occurs when the lens of your eyes become foggy or cloudy. Although cataract mostly occurs to people who are middle aged or above sixty, you can get affected by this disorder at an earlier age if you are diabetic. Also, the deterioration or clouding of the lens progresses at a much faster rate than usual. Cataracts lead to an inability to focus as the retina is covered by cloudy layer.
2. Glaucoma: This is another disorder that can occur due to diabetes. This is characterized by the buildup of pressure in the eye due to the fluids within it not draining properly. This intense pressure damages the nerves and blood vessels in the eyes, thus impairing your ability to see.
3. Diabetic Retinopathy: Diabetic retinopathy is a disorder characterized by damage to the vessels in the retina that carry blood. It can occur if you have either of the type 2 or type 1 diabetes. If not treated in time it can lead to blindness.

If you have a history of diabetes or even borderline diabetic tendencies, it is highly advisable to constantly check your blood sugar levels and also get your eye checked at regular intervals, especially if you feel even the minutest vision problems.