Phacoemulsification or Phaco

Phacoemulsification is a technique used to treat cataracts and restore vision. It is modern-day cataract surgery. Before we delve into how the procedure of phacoemulsification or phaco is performed, let us understand the cataract condition. A cataract is a type of vision problem where the eyes' lens gets cloudy due to the breakdown of proteins. This cloudiness on the lens causes blurry vision. In general, people in their middle-ages and over are diagnosed with cataracts. However, there are incidents of childhood cataracts where babies are born with cataracts due to genetic factors. Hence, it is a leading cause of blindness and low vision worldwide. The gold standard for treating cataracts is surgery. Phacoemulsification is a widespread technique used in cataract surgery. The term phacoemulsification stands for emulsification and aspiration of the lens affected by a cataract. The lens is not literally liquified but broken down into smaller pieces using ultrasound energy and a surgeon-guided automated irrigation and aspiration system. Following this, the surgeon then implants a foldable intraocular lens (IOL) to provide the patients with a clear lens with perfect vision.

Some of the benefits of the phacoemulsification process of cataract extraction are:

1. Deepens the anterior chamber of the eye and rapidly reduces the intraocular pressure (IOP) of the eye
2. Good sealing of the incision (cut)
3. Quick wound healing
4. Negligible postoperative reactions
5. Faster recovery of vision

Phacoemulsification is required as the choice of treatment when there is reduced vision due to one of the following:

1. Posterior subcapsular cataract: Marked effect on the near vision and slightly on the distant vision
2. Nuclear cataract: Moderately affects the near-sightedness with moderate glare and produces moderate near-sightedness
3. Cortical cataract: Slightly affects the distant and near vision with moderate glare
4. Brown cataract
5. Mature cataract 
6. Nuclear opalescence: Cataract that causes increased glare and near-sightedness
7. Traumatic cataract: Cataract formation after an injury
8. Posterior polar cataract: Round, a discoid, opaque mass of cataract formation in the central posterior part of the lens
9. Subluxated cataract (caused due to dislocated lens) with capsular support devices

1. Cataract surgery is suggested when the reduced vision interferes with a person’s daily routine. Some of the signs and symptoms of cataracts are:
2. The reduced visual clarity of objects near or far away
3. The appearance of coloured halos
4. Increased sensitivity to light
5. Double vision
6. Reduced contrast sensitivity
7. Abnormal white reflection on the pupil

If the cataract symptoms are seriously impairing your vision, then it may be time for you to get the cataract treated. Please consult your ophthalmologist (eye doctor) for further advice on your condition. Putting off the cataract surgery beyond this stage may result in the following: 

1. Poor vision at night
2. The appearance of glare or streaks around the lights
3. Hazy, cloudy, or blurry vision
4. Reduced colour vision
5. Sensitivity to bright light
6. Full or partial blindness in extreme stages

While performing the phacoemulsification, the surgeon makes a small incision (cut) on your cornea after measuring using a small instrument called a keratome 

Following the incision, the surgical procedure is conducted using the following steps:

1. Irrigation:  Your surgeon will guide a constant stream of fluid to the eyes' surface through the incision.
2. Aspiration: Your surgeon will use the phaco probe and a Sinskey chopper to break up the lens with the cataract and extract it.

Before the surgery, your surgeon will:

1. Enquire about any medications you are taking regularly
2. Advise you to stop certain medications temporarily before surgery
3. Advise you to not eat any solid food six hours before your procedure
4. Prescribe some eye drops if necessary to apply a few days before surgery
5. Measure the eye to be operated to ascertain the focusing power of the intraocular lens (IOL)
6. Brief you on the procedure you are about to undergo and answer any queries that you may have.
7. You will be scheduled for a meeting with the anaesthesiologist a few days before the surgery, where the anesthesiologist will:
8. Explained the process of local anaesthesia as the procedure is performed on an outpatient basis.
9. Look into your medical history and examine you to check for your fitness for anaesthesia
10. Advice you on how to make temporary changes to your routine oral medications

Cataract removal surgery is one of the most common outpatient procedures. You may expect the following on your day of surgery:

1. You will be guided to a pre-operative room by a nurse and requested to sign the consent form.
2. The nurse will place an intravenous line to administer medicines during the procedure. The nurse will:
   1. Ask you about the last time you had anything to eat or drink
   2. Inquire about your medical history and allergies
   3. Ask you about any symptoms you are experiencing current
   4. Check your vitals like blood pressure, heart rate and body temperature

1. Position during the surgery: Supine or lying horizontally flat on your back is the preferable position for most eye surgeries, including phacoemulsification.
2. Cleaning and draping:
   1. Your face will be draped except the surgical site
   2. Your face will be cleaned at regular intervals
3. Anaesthesia:
   1. You may be given eye drops or an injection around the eye to numb the area.
   2. You will be awake throughout the surgery.
   3. You will see some movements and lights but not what the surgeon is doing to your eye.
4. You can expect the following during the surgery:
   1. Your surgeon will look through a special microscope and make a small cut near the edge of the cornea.
   2. Through this cut, the surgeon will reach the lens with the cataract in your eye with a small instrument, break up the lens with the cataract and remove it.
   3. Then, your surgeon will put (implant) a new lens there.
   4. The incisions they make for cataract removal are self-sealing incisions which heal themselves over time and require no stitches.
   5. Your surgeon will then place a shield over your operated eye to protect it until it heals.
   6. Next, you will be sent to the recovery room.
5. Monitoring:
   1. The nurse in the operating room will ensure you are placed safely while transporting you to the recovery room.
   2. Your surgeon will monitor the IOP continuously to improve the outcome of the surgery.

After the surgery, you will be sent to the recovery room. Then:

1. You will be kept under observation in the recovery room for 15-30 minutes.
2. You may be given painkillers and antibiotics to relieve pain and prevent any infections.

After completely recovering from anaesthesia after 30 minutes,

1. You will be given a prescription that lists all the necessary medications. 
2. Then, you will be advised on how to use the medications like:
   1. How to clean the operated area
   2. The correct method of instilling the eye drops
3. You will be advised to wear sunglasses outdoors to reduce the glare.
4. You will be discharged and sent home wearing an eye patch and eye shield.
5. You can remove the eye patch and shield two to three hours after reaching home.
6. You will be asked to wear the eye patch on the first night after surgery.
7. You will be asked to strictly follow the prescription of a set of antibiotics and topical steroid drops. 
8. Generally, depending on the surgery, the antibiotics are discontinued after the first week (within seven to ten days), and the topical steroids and non-steroids are continued for about three to six weeks.
9. Though you may experience an immediate improvement in vision after the surgery, it will improve steadily over the next four to five weeks.

First Follow up Appointment

The first follow up visit is usually after 30 days, unless there are any postoperative complications, which your ophthalmologist will list out.