A question for my readers

Someone I know has developed cataract.  That is a little weird – I had always thought of cataract as something that strikes people who are 65 and above.  Certainly not a young person’s disease.  I had also thought of cataract as something that strikes people who cooked in smoke-filled kitchens over charcoal burning stoves, not researchers toiling in labs.

Certainly this person has none of the risk factors associated with cataract.  He does not even qualify for “excessive exposure to sunlight” (now, who would think sitting indoors all day is actually good for you?)

But anyway, he has cataract. Indisputably.  Two doctors have told him so, and his eye tells him the same thing daily.  So now he is wondering whether to have the surgery in India or in the US.

My question is – is cataract surgery in India better than in the US?

Two reasons for asking this question:

–  Something like cataract is commonplace in India, and Indian surgeons would have performed hundreds, if not thousands, of surgeries, so I imagine Indian surgeons are, if anything, more experienced at cataract surgery than their US counterparts.

– Research on the Internet tells me that in the US, post-cataract, there is a 20%  to 30% chance of developing scar tissue after the lens implantation.  This is what the New England Eye Center says about cataract surgery:

Cataracts are removed with sound waves not laser light. In 20-30% of patients undergoing cataract surgery, a thin film of scar tissue will form behind the implant lens and cause the vision to be blurred. Often patients will feel that their cataract has “grown back.” In these cases, an opening can be made in the scar tissue with a laser, and the vision will usually be restored.

I have never heard about such scar tissue formation in cataract surgeries in India.  Certainly not that 20% to 30% of people need laser treatment after cataract surgery.

So dear blog readers – I am sure many of you are doctors, or medical students.  Tell me, is the rate of scar tissue formation as high as 20% even in India?  Am I just mistaken that it does not happen in India, or not as much?

Or is there any difference in the way cataract is treated in India and in the US?

Even if you are not in medicine, you may still have anecdotal knowledge of someone you know who had cataract surgery.  Have you heard of this happen in India – scar tissue formation, I mean?

I would love all your opinions, and any anecdotal examples you know.

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26 thoughts on “A question for my readers

  1. Lekhni:

    I hope your friend’s eye gets better.

    IANAD, FWIW, YMMV and all other disclaimers apply:

    Speaking from personal experience (dad had cataracts in both his eyes), and though this was several years ago, I do not *remember* scar tissue formation being an issue in either eye. (I can check with my mother to confirm this, if the information will help alleviate your friend’s worries.)

    India offers EXCELLENT treatment options. (No data-point in the US, so I can’t give you any pros/cons.) I’ve visited a couple of eye hospitals in India (Delhi, Hyd) and they were both very impressive in all aspects.

    Good luck.

  2. Lekhni,
    Cataract surgery is like a child’s game to any surgeon. It’s a hugely relatively simple procedure that the Interns get tired doing it in the first month of their rotation. In any case, that was just a fun FYI 🙂

    Scar formation may form. Sometimes the clean up isnt great, sometimes it’s just the body’s way of the capsule thickening if the extraction was not complete. These days(actually even 12 years ago in india), they do remove the whole lens and not leave the capsule behind.
    Scar removal’s a laser outpatient thing. Nothing to hugely worry about.

    If the person’s here, go for it here(USA). Cat surgery isn’t all that expensive, complicated or does it require intensive post-op care. If you are in India, LVP’s good, and so Sankara Nethralaya in Madras. But seriously, the procedure is painless, 20 minute outpatient thing. So any reputable hospital in India would work.

    Different cataracts differently aged folks. The most tragic being congenital ones. Now, seeing such kiddos is when you really thank your stars.
    *phew.

  3. Have you heard of this happen in India – scar tissue formation, I mean?

    Absolutely! Depends on the kind of extraction to a large extent. Extracapsular Cataract extraction fondly called ECCE with IOL implant almost always will have some bit of capsule left over which could become opaque with time.

    O alright, will shutup. Scanman should give you more funda. 🙂

  4. km: I agree with you on both counts – India does offer excellent treatment options. I do agree with Rads on both LVP and SN being great hospitals.

    And like you, I have never heard of instances of scar tissue formation. Maybe it’s just me…maybe scar tissue is less of an issue if there is no IOL involved..

    The 20% statistic did seem too high, and that’s what I still don’t understand..

    maxdavinci: I agree that LV Prasad is very good, and I also think very highly of Sankara Nethralaya.

    rads: Thanks, that was very helpful in understanding why scar tissue forms.

    The reason laser treatment is a concern is because it increases his risk of retinal detachment..

    Scan Man did get back to me, he said the statistic for scar tissue formation is 1% to 6% worldwide, not 20%. He advises doing the surgery in the US.

    I am wondering why the surgeons here quote a 20% – 30% statistic if it is only 6% on average..

  5. To add to KM’s (and your) point:

    I’d think that considering it’s (relatively) cheaper in India, and that Indian patients are not as restricted thanks to HMOs and therefore more likely to get operations done, plus the existence of numerous charitable eye-camps etc, and the level of competition involved forcing doctors to be quite good – the choice would be to do it in India.

    Plus, you get to have family fuss about you and feed you home-food. That’s got to be worth 6 bonus points right there.

  6. I had cataract surgery six years ago in England: done privately by a well-known Harley Street surgeon. The capsules were left in and a lens implanted in each eye. The two operations were, as recommended, done on different occasions. No scar tissue has formed so far, and the results have been unusually good. Retinal detachment is a particular issue if one is very short-sighted, in which case extra-capsular surgery is generally not recommended.
    From what I have heard cataract surgery in India is as advanced as anywhere else. And as you say Indian surgeons have a wealth of experience to draw on.
    One other point: I had drops put in my eyes before the operation, not the kind of anaesthetic which requires that the eye be bandaged and you are not able to see for a day or two. I could see well straightaway, although it took a week or so for the vision to become entirely normal.

  7. Anecdotal 2 cents – my dad got cataract surgery done in India last year. It was a straight-forward outpatient procedure, using lasers. Also had assorted aunts and uncles that have had the op, and no complications that I’ve heard of.

    Having said all that, I would still look at doing the op in the US, as long as insurance/financials is not an issue.

  8. My father-in-law (age well north of 80) had cataract surgery on one eye done last year at Shankar Netralaya in Madras. It went off without a hitch, no post-op complications. In and out in a couple of hours.
    Kamini.

  9. It is true that cataracts are generally age-related but not always. On the same day I had my cataract surgery an eye surgeon from South Asia had his: he was in his later forties.

  10. Speaking from personal experience (appa had cataract in both eyes), the operation was done in India and was done extremely well. He did not have have issues post-cataract and recovered well from the surgery.

    That said, there are risks associated with this surgery and the doctors did explain that to us before the surgery. For one there is infection, that can happen very easily in the eye and one needs to be extremely careful. Also there is a chance of tissue and in some cases, the eye power might change and hence they usually wait for about 45 days before testing the vision.

  11. ??! I definitely agree with you on the big advantage of getting it done in India – getting fussed over by family and eating home food 🙂 What’s more, it’s mango season too…

    Candadai Tirumalai: Thank you for sharing your cataract experience, and the results. As you say, retinal detachment is an issue only when you are very short-sighted (which he is). You are right that the laser treatment should not be a concern to most people.

    I also wonder whether South Asians have a higher propensity to develop cataract…

    BPSK: Right, you can see the Indian surgeons are really good 🙂 Cost/Insurance is not an issue, so let’s see what he decides.

    Cynic in Wonderland: I agree. We do have some wonderful hospitals in India for eye care.

    Kamini: No subsequent scar tissue formation? It’s not really much of a complication if it happens – I think there is some blurring and it feels like you have a little of the cataract back again..

    A-kay: Thanks for sharing…I guess most people don’t have any of those complications, but the doctors warn you anyway..

  12. The anecdotal evidences and based on my personal experiences, CAT operation in India is simple, risk less and a child’s play. Most of the Indian are highly susceptible to this disease and it is considered similar to the regular common cold, cough and fever these days. Even a fameless hospital in some remote township is capable of handling this case and the doctors attend ‘n’ number of such cases almost every day.

    Having said all that, I would still suggest you to go to some renowned hospital like shankar netralaya (Chennai), Apollo Multi specialty hospital, Arvind eye hospital (Madurai and Coimbatore).

    It is just a walk-in surgery and nothing much to worry and think about it. The post op care is sketchy and effortless.

  13. >>What’s more, it’s mango season too…
    You did NOT just remind us of the fact that we’re missing out on the mangoes. Why, why, why for the love of chausas, why?

  14. pierre Let’s see what he decides..if it is India, it will definitely be one of the hospitals you mention..

    ??! If it makes you feel better, I am missing out on mango season too 😦 The Mexican and Costa Rican mangoes are no match for the Indian ones..

  15. i will do a mango post soon just to make all of you jealous. it might not make me feel better but you know what they say about misery.

    *and since we’re all Beatles-y this week, cue “The world is treating me ba-ha-ha-had, Misery!”*

  16. Lekhni: no, no scar tissue formation. We were very happy with the pre and post operative care, as well as how the procedure itself was done.
    Good luck to your friend.
    Kamini.

  17. Space Bar: I am jealous already, do you need to rub it in? I can imagine you eating all those Banganapalles and Imam Pasands and practically drinking those Rasalus… Sigh.. sometimes it helps not to have an overactive imagination..

    Celine: Thanks 🙂 I hope you find my other posts interesting too.. though, I know, my brand of advice/ information is usually to be taken with a bucket of salt 😉

    Vijay: Will do! That sounds very interesting. I’m already wondering about who else to tag, though…any volunteers?

    Kamini: Thanks…let’s see what he decides..

  18. As many of your readers have commented, cataract surgery is basic, and could be done in India or anywhere, for that matter. Scar formation can be easily treated by zapping it with a laser, AFAIK.
    You didn’t leave your url at my blog, BTW, hence the delay in response.
    🙂

  19. My brother had juvenile-onset cataract at 26 years, and two years back, when he was 30, he had a laser operation in the States to correct it. There was no scar formation.

  20. lekhni,

    Cataract surgieris in India is really good. I had to do an eye surgerey (not cataract) and Agarwal/Sankar Netralaya/ Vijaya Hospitals in Madras had very good doctors with a reasonably good track record. Based on my experience (I did a case study on medical tourism to India) and some anecdotal evidence I can say that Madras is good hub for eye related surgeries. So it can be done in India.

  21. My young friend had her cataract operation in the US. She had a very difficult time because of scar tissue formation.

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