Cataract is a condition of clouding of the natural lens of the eye. The eye’s natural lens is typically clear and helps in clear vision. A person affected by cataracts will always have blurred vision and will feel like he is looking through a frosty or fogged-up window.
Due to cataracts, people find it difficult to perform daily tasks like reading, driving, and seeing correct facial expressions when talking with their friends. Research has shown that cataracts are one of the leading causes of vision loss in people over 40 years of age, and nearly more than half of Americans above 80 are already affected by cataracts or have undergone cataract surgery.1
Cataracts do not affect your vision suddenly instead it grows slowly over time and starts interfering with clear vision. Initially eyeglasses and stronger light help in seeing clearly but as the cataract grows you will have blurred vision.
The good news is that you can easily restore your vision by opting for cataract surgery. Cataract surgery is one of the safest and most effective surgical procedures to restore vision.
What are the types of cataracts?
Cataracts: 5 Major Types You Need to Know
There are 5 major types of cataracts, each with distinct characteristics, causes and effects on vision. Knowing and understanding cataract type is helpful in early detection and effective treatment. Below are the 5 major types of cataracts:
1. Nuclear Cataracts
Nuclear cataracts are one of the most common cataracts from which people are diagnosed. A nuclear cataract is associated with ageing. As a person ages, it develops in the centre of the lens. In nuclear cataract conditions, the lens becomes gradually yellow and hardening of the lens is observed.
Symptoms:- The most common symptom is blurred vision and the person experiences difficulty in seeing in low light conditions. The color perception changes mainly in the brightness and vibrancy of colors.
Causes:- The primary cause of nuclear cataracts is ageing, and secondary factors are genetics, smoking and prolonged exposure to UV rays.
2. Cortical Cataracts
Cortical cataracts are developed on the edges of the natural eye lens and appear as white. As the cataract condition progresses, wedge-shaped opacities start progressing towards the centre of the lens.
Symptoms:- The main symptoms of cortical cataracts are glare, contrast sensitivity, and peripheral vision. People suffering from cortical cataracts face challenges while navigating during bright sunlight or at night.
Causes:- The main reason for cortical cataracts is ageing but they can be accelerated if a person is suffering from other conditions such as diabetes, and systemic diseases like hypertension and hyperlipidemia.
3. Subcapsular Cataracts
Subcapsular cataracts develop at the backside of the lens and affect vision often rapidly. Subcapsular cataracts are more common in people who are affected with diabetes or those who are taking steroid medications.
Symptoms: The main symptoms of subcapsular cataracts are seeing halos around lights, glare, and severe impact on night vision compared to other types of cataracts.
Causes:- People affected with diabetes, steroid use, or conditions like high myopia have a high chance of developing subcapsular cataracts.
4. Congenital Cataracts
Congenital cataracts are developed in early childhood or present at birth. Congenital cataracts can be caused due to maternal infections during pregnancy, genetic factors, or metabolic disorders.
Symptoms:- With the increased sensitivity and location, congenital cataracts can lead to the development of amblyopia (lazy eye). If the condition is not treated promptly it can impair visual development
Causes:- Genetic factors and maternal health issues during pregnancy are the major cause of congenital cataracts. Click to read more about Childhood Cataracts.
5. Traumatic Cataracts
Traumatic cataracts are developed due to injury or trauma to the eye or around the eye. This type of cataract can develop immediately or years after the initial injury.
Symptoms:- Sudden vision changes after injury, experiencing blurriness to cloudiness after trauma.
Causes:- The main common cause is injury and it can be due to sports, accidents, or from any harmful object. Even a minor injury in the eye can lead to the formation of cataracts.
Understanding the difference between types of cataracts is very important for early detection and effective treatment. If you or someone you know is experiencing vision changes, or have any symptoms shared above, then it’s time to see an Ophthalmologist for eye examination and treatment. You can also do self tests for cataracts at home but seeing an eye surgeon is necessary for confirmation. Next, we will see the risk factors & causes of cataracts.
8 Risk Factors for Cataracts: Are You at Risk?
Understanding the risk factors for cataracts is important for maintaining eye health. Although there are some factors which can’t be controlled but still understanding the risk factors of cataracts helps in prevention.
1. Age: Understanding the Connection to Vision Changes
Age is the primary risk factor for cataracts. As we grow older, the protein in the lens of the eye starts to clump together and lead to cloudiness. The process is very slow and people are not able to notice the vision changes but as the cataract progresses it starts leading to blurred vision.
As you cross the age of 40 years, regular eye examination is necessary to monitor eye lens health and identify any early signs. Regular eye exams help in catching cataracts before they make a severe impact on the eye lens.
2. Family History: The Genetic Link
If you have a family history of cataracts, then it increases your risk of getting affected by the condition. If your parents or siblings are affected by cataracts then you are also at higher risk.
Understanding family history is important to protect your eyes. Discuss with your eye care provider to prevent cataracts if cataracts are common in your family.
3. Obesity: Surprising Effects on Eye Health
Excessive weight is linked to several health diseases, including the risk of cataracts as well. Obesity can contribute to systemic inflammation and oxidative stress, both adversely affect lens health. Numerous studies support the association of cataracts with obesity
Maintaining an ideal weight according to your height and age through a balanced and healthy diet is essential for good health. Regular exercise and a healthy diet help in maintaining a balanced weight. Maintaining a healthy weight not only reduces your risk of developing cataracts but also helps in preventing other conditions like diabetes and heart disease. Incorporating regular exercise and a healthy diet into your daily routine are effective strategies to prevent cataracts at a younger age.
4. Eye Injuries: Trauma and Its Consequences
Eye injuries can lead to the formation of cataracts instantly or years later after the trauma. Eye injuries can happen due to accidents, sports related impacts, or even in any surgical process related to eye. Any trauma over the eyes or around the eyes can immediately cause changes in the lens structure and it can lead to clouding of the lens over time.
Protecting eyes during activities that pose the risk of eye injury is essential. Always wear protective eyeglasses during sports, while working in a hazardous environment, and always be extra cautious while handling sharp objects. Any eye injury can result in cataract formation, so we need to be careful and adopt the necessary safety steps to protect our eyes.
5. Long-Term Corticosteroid Use
Long-term use of corticosteroids has been associated with an increased risk of cataracts. Corticosteroids when used in the form of eye drops particularly increase the risk of cataracts. Corticosteroids are mainly prescribed for inflammatory conditions, if you are on long-term corticosteroids it is essential to discuss the risk with your health care provider.
Depending upon your condition, your healthcare provider may start alternative treatment to mitigate the risk of cataracts associated with previous medications. Also, regular eye monitoring is necessary to notice any changes in the lens.
6. Hypertension: Effects on Eye Health
High blood pressure levels or hypertension negatively affects health including your eyes. Due to high blood pressure, the eye’s blood vessels can get damaged, leading to the formation of cataracts.
It is essential to manage your blood pressure levels by eating a healthy diet that is low in sodium, doing regular exercise and meditating. Incorporating these changes into your lifestyle helps protect your vision. Regular monitoring of blood pressure levels is important to detect any potential health issues at early stages and it helps to reduce the risk of complications like heart diseases and heart stroke.
7. Poor Nutrition: Foods That Protect Your Eyes
If your diet lacks essential vitamins, protein & other nutrients, it can contribute to cataracts. Eating a balanced healthy diet which is rich in proteins, vitamins and healthy fats promotes overall eye health. One should include leafy greens, colorful fruits, spinach, kale, carrots, fish, and nuts in your meals.
These food choices will not only benefit your eyes but also contribute to your overall health.
8. Lifestyle Choices: The Importance of Healthy Habits
Certain lifestyle choices can lead to the formation of cataracts. Factors like smoking, drugs, excessive alcohol consumption, steroids and no physical activity increase the chances of development of cataracts.
Adopting a healthy lifestyle is essential for good health. Quitting smoking, limiting alcohol and doing regular exercise help in reducing the risk of cataracts and other health issues. Regular exercise & balanced diet help in maintaining a healthy weight which improves cardiovascular health, which in turn benefits the eyes.
By being aware of the risk factors for cataracts, you are ready to take a proactive approach to improve and protect your vision. By incorporating healthy lifestyle choices you minimize the chances of development of cataracts.
5 Signs & Symptoms of Cataracts: When to Seek Help
Recognizing the signs and symptoms of cataracts at an early stage is important for treatment. If you are experiencing any of the symptoms shared below, then consult your Ophthalmologist.
1. Blurry Vision: The First Indication
Blurry vision is often the first indication and most noticeable symptom of cataracts. Once the eye lens becomes clouded, a person starts experiencing difficulty in seeing clearly, especially in low light conditions or at night. They do not have a focused image and find difficulty in reading, writing, watching television, or performing daily tasks.
As the severity of cataracts increases over time the blurriness becomes worse over time making it more challenging to focus on any object. If you notice such symptoms, then it’s a strong indication that you are affected by cataracts or any other eye problem.
2. Sensitivity to Light: A Common Complaint
Increased sensitivity to light is also one of the common symptoms of cataracts. You will notice these symptoms, especially at night while driving or during the peak sunlight in the day. You will feel uncomfortable or blind.
This sensitivity can increase with glare making more harder to see in bright conditions. To manage the conditions temporarily use sunglasses offering UV protection but if the sensitivity is pronounced, please consult your eye specialist to examine the condition and treatment.
3. Halos Around Lights
Many peoples who are affected by cataracts complains about seeing halos or rings around the light. The conditions arise because when the light passes through the cloudy lens it scatters causing visual disturbance.
Seeing halos around light can be dangerous especially when you are driving at night. If you are experiencing these symptoms see your eye health specialist immediately because it could be an indication that your cataracts are progressing.
4. Faded Colors
Another symptom of cataracts is the perception of faded or dull colors. As the cataract progresses, it reduces the lens’s ability to distinguish between different hues and the vibrancy of colors. The bright color appears muted to the affected person.
If you notice these changes, there are chances you are affected by cataracts or any other vision issues. In both cases, it should be evaluated by an eye specialist.
5. Frequent Prescription Changes
If your eyeglasses or contact lens prescription is changing very frequently, then it could be an indication of the development of cataracts. While it is normal for vision to change over time, the reason could be ageing, unhealthy diet, excess screen time or any other vision issues but if the prescription is changing frequently it can be frustrating and you should discuss this with your eye care provider to assess your lens health and further treatment options.
Top 7 Causes of Cataracts: What You Should Be Aware Of
People can be affected by cataracts due to many factors, some of which can be controlled while others are not. Understanding the causes of cataracts helps in eye protection. Below are the top 7 causes of cataracts.
1. Aging: The Primary Cause of Cataracts
Aging is the most common risk factor for the development of cataracts. As people age, the protein in the eye lens clumps and leads to the cloudiness of the lens. The process can take several years, slowly developing the condition before symptoms become noticeable.
Most people who have crossed the age of 70 will have the formation of cataracts to some degree. Protein-rich diet will help slow down the process of the formation of cataracts if it is due to aging. Taking regular eye examinations is essential for early detection and treatment.
2. Genetics: Hereditary Influences on Cataract Development
Genetics plays an important role in the likelihood of developing cataracts in a person. If you have a family history where most of the people are affected by cataracts as they age then it increases your risk.
Discuss the family history with your Ophthalmologist and do regular eye screening for early detection. Take a healthy diet and include more protein in your diet.
3. Diabetes
Your blood sugar levels significantly affect your eye health. People with high blood sugar levels are on a higher risk of developing cataracts. Diabetes can lead to changes in the lens, causing it to become cloudy.
A person who has diabetes has a higher chance of developing cataracts at a younger age when compared to those without the condition. Manage your blood sugar levels effectively to enhance your eye health.
4. Ultraviolet Light
Prolonged exposure to UV (Ultraviolet) rays increases the risk of cataracts. UV rays reaching into the eyes damage the lens over time and lead to cloudiness.
Wear sunglasses that block 100% UVA & UVB rays whenever you are outside during the daytime. The sunglasses will help to protect the eyes and will reduce the risk of cataracts. Best 10 Cataract Sunglasses for more information.
5. Smoking
Smoking is one of the major factors in the development of cataracts. Research has shown people who smoke are at higher risk of cataracts.2 The toxins present in tobacco smoke easily damage the lens and accelerate the aging process of the eyes. Research has consistently shown in smokers there is a risk of development of cataracts in smokers, particularly nuclear type as compared to non-smokers.
If you quit smoking today, you significantly reduce your risk of cataracts and other health conditions like lung cancer, stroke etc. Quitting smoke will improve your overall health and well-being.
6. Alcohol Consumption
Excessive alcohol consumption can lead to the risk of developing cataracts. Heavy drinking has been associated with cataracts and it also contributes to oxidative stress in the body which impacts lens clarity.
The Blue Mountains Eye study research repor3t submitted by RG Cumming & P Mitchell shows people who smoked and drank heavily have a higher chance of developing nuclear cataracts.
Limiting alcohol intake will benefit your eye health as well as reduce the risk of other health issues.
7. Medications: Common Drugs Linked to Cataracts
Certain medications when used for the long term can increase the risk of cataracts such as corticosteroids. If you are on long-term medications for managing specific health conditions, then it’s important to discuss the side effects of drugs with your healthcare provider. Regular eye checkups will help in detecting any vision changes.
By Understanding the above causes for cataracts you can take significant steps to mitigate the risks. Steps like quitting smoke, limiting alcohol consumption, and controlling blood sugar levels will help in preventing or delaying the onset of cataracts.
Cataract Diagnosis & Examination: 6 Essential Steps
If you are experiencing vision issues or suspect that you are affected by cataracts, an eye examination by an Ophthalmologist is necessary for proper diagnosis. You can also do self-tests for cataracts at home but a detailed eye examination by an eye care professional is essential.
Let’s discuss the key steps involved in the diagnosis & examination process for cataracts.
1. Comprehensive Eye Exam
A comprehensive detailed eye exam is the first step to diagnosing cataracts. In this process, your eye surgeon will review your medical history, details about other health issues, vision problems, history of any eye injury and any medications you take.
Your eye surgeon may conduct various tests to evaluate your eye health and vision functionality. Your eye surgeon will use special equipment (Ophthalmoscope) to examine the back of the eye, including the lens and retina to check any signs of cataracts or any other vision issues.
2. Visual Acuity Test
Visual acuity test is used to check your ability to see at different distances. This is usually done by using an eye chart which contains letters or symbols, and you are asked to read them out by covering one eye at a time.
Visual acuity test is very helpful in determining how much your vision is affected by the cataracts.
3. Slit-Lamp Examination
In a slit lamp examination, a specialized microscope is used which provides a magnified view of the eye. It helps doctors to see the lens and check for cloudiness. During this process, your eye surgeon will shine a bright light into your eye and will use the slit lamp to assess the lens for cloudiness.
A slit lamp test is very important to determine cataracts and their severity.
4. Retinal Exam
In a retinal exam, your doctor will dilate your pupils by using eye drops. Once the pupil is dilated it provides a clear view of the back side of the eye. The main purpose of the retinal exam is to assess the health of the retina and optical nerve, looking out for any signs of damage or disease in the eyes.
5. Tonometry: Measuring Eye Pressure
To diagnose other eye health issues along with cataracts, your eye surgeon can conduct a tonometry test. Tonometry tests measure the pressure inside your eyes by using a puff of air or a small probe to measure intraocular pressure.
6. Additional Imaging Tests
In a few cases, an eye surgeon can recommend additional imaging tests to get a more detailed examination of eyes to understand eye health. They can recommend OCT (Optical Coherence Tomography) or ultrasound to get detailed images of the eye.
Management & Treatment: 7 Key Aspects of Cataract Surgery
Cataract surgery is the most effective surgical procedure to restore vision affected by cataracts. Understanding the aspects and treatment is important to prepare for the surgery and ensure the best outcomes. Let’s discuss the 7 essential key aspects of cataract surgery.
1. When to Consider Surgery: Understanding Timing
Choosing the right time for cataract surgery is important to restore vision and maintain good quality of life. As we know cataracts are a common part of aging but vision can be restored by quick and successful cataract surgery.
Considerations for cataract surgery
a. Quality of Life:- Cataract surgery is generally recommended when cataract symptoms start affecting your daily life activities like reading, writing, driving, watching television, or becoming a roadblocker during the engagement of any hobbies.
If you find cataract symptoms are affecting your independence and overall happiness, then it is the right time to consider cataract surgery.
b. Symptom Progression:- If you feel your symptoms are getting worse and vision changes are frequent despite using stronger eyeglasses or contact lenses, then you should consider for surgical process
2. Surgical Options: Traditional vs. Laser Surgery
To treat cataracts, there are two primary techniques available for performing cataract surgery i.e. traditional phacoemulsification and laser-assisted surgery. Understanding the basic difference between both of these methods will help you to decide which one to opt for.
a. Traditional Surgery
In a traditional phacoemulsification process, an eye surgeon makes a small incision in the eye and uses an ultrasound waver to break up the cloudy natural lens. The lens is broken down into tiny fragments, these tiny fragments are suctioned out from the same probe which was used to emit ultrasound waves to break up the cloudy lens.
Once the cloudy lens is suctioned out, a new artificial intraocular lens (IOL) is inserted into the eyes to restore vision. The phacoemulsification process has been performed for decades and very high success rate.
The recovery period is around 2 weeks and the person can resume his normal activities within a week.
b. Laser Surgery
Laser surgery is an advanced method to perform each step with greater precision and more accuracy. During the process, a laser will create an incision and will break up the cloudy lens more accurately than manual methods. In a laser surgery process have fast recovery and less swelling.
The cost of laser surgery is high when compared to the phacoemulsification method but it is the more accurate method and has reduced recovery time making it worthwhile.
It’s important to discuss with your eye surgeon which surgery will be the best fitted in your specific case and preference.
3. Pre-Surgery Consultation
Pre-surgery consultation with your eye surgeon before cataract surgery is important to ensure successful surgery. It will allow you to clear your doubts regarding surgery outcomes, recovery period, cost, complication & risk assessment.
What to Expect During Your Pre-Surgery Consultation?
a. Medical History Review:- During this process, your surgeon will ask for detailed medical history, current health status, pre-existing health conditions if any, current medications, and any previous injury or trauma. These details are important to tailor the surgical approach for each individual according to their health needs.
b. Test and Measurements:-Your surgeon needs to perform additional tests to measure the curvature od your cornea and assessment of the overall health of your eyes. The test results will help in determining the appropriate IOL type for your vision needs.
c. Patient Education:- The patient needs to understand what the surgery entails, what the steps involved in the surgical process, what are the potential risks, how long the cataract surgery will take, the time for recovery and other questions.
4. Recovery Expectations: What Patients Should Know
Understanding the recovery procedure and time, do’s and don’ts after cataract surgery helps in alleviating patient anxiety and promotes a smoother recovery.
What should the patient know during the recovery phase after cataract surgery?
a. Immediate Post-Operative Care:- Once the cataract surgery is completed, a patient will rest in the recovery area before discharging. This is essential to monitor any complications or other health issues the patient may experience after surgery. However patient can experience mild discomfort, sensitivity to light, blurry vision or weakness due to stress.
b. Activities to restrict:- Post eye surgery, patients are advised to avoid any strenuous activity like swimming, heavy lifting and bathing for one or two days. It is essential to follow your eye surgeon’s restrictions to promote healing.
c. Vision Improvement Timeline:- Many patients notice improved vision within in few days but for others it can take up to several weeks before vision completely stabilizes. Follow-up appointments with your eye doctor are essential during that phase to monitor progress.
5. Follow-up Care: Ensuring Optimal Results After Cataract Surgery
Follow-up care is important after cataract surgery to ensure proper healing of the eyes and no complications. Once the surgery is completed, follow-up visits with your Ophthalmologist occur after a day or two and then at regular intervals over the following months.
During the appointment, your Ophthalmologist will check your vision, recovery status and expected functionality of IOL. In case you are experiencing any unusual symptoms like pain, infection, changes in vision then you should immediately contact your Ophthalmologist.
Once the initial recovery is completed, make sure to visit your eye care provider regularly as suggested by them for an eye examination. This is essential to monitor overall eye health and address any further issues related to age which may develop in future.
6. Potential Risks: Being Informed Before Cataract Surgery
Like any other surgical process, cataract surgery also carries some risks. However, these risks do not have any serious complications but understanding the risks is essential to make a decision.
Common risks for cataract surgery include infection, bleeding, swelling, and retinal detachment. However, most of the risks can be easily managed by your eye surgeon. Understanding risk will help you to weigh between the benefits and risks.
Before surgery, your surgeon will discuss these risks and complications and if you have any questions and doubts then it is the right time to discuss the same with your surgeon.
7. Long-Term Outcomes: What to Expect Post Cataract Surgery
Long-term outcomes of cataract surgery are very positive. Most of the patients get improved vision immediately after the surgery and many achieve 20/20 vision or better after recovery.
Few patients may still require glasses for performing certain tasks like reading, driving etc. It is essential to get regular eye checkups even after cataract surgery because cataract surgery can treat cloudy lens issues but it cannot prevent other age-related issues such as glaucoma or macular degeneration.
Post-cataract surgery people report a better quality of life, they are now able to enjoy activities which were restricted before due to poor vision like driving, swimming, playing sports etc.
4 Types of Cataract Surgery: Which One is Right for You?
When opting for cataract surgery, it is important to understand and discuss the various surgical techniques available with your surgeon. Each surgery type offers distinct advantages and is best suited for specific cases. Below is a detailed overview of four common types of cataract surgery to help you choose which one will be best for you.
1. Phacoemulsification: The Most Common Technique
Phacoemulsification is one of the most common surgical processes performed to treat cataracts. It is very effective, safe, and has minimal invasiveness.
Phacoemulsification Procedure
a. The surgeon injects local anaesthesia to comfort the patient during the surgical process.
b. Next, a small incision less than 3mm is made to the cornea which allows access to the eye’s interior.
c. To break down the cloud lens, a phacoemulsification device is then inserted into the eye interior which emits high-frequency ultrasound waves and breaks down the lens into small fragments. These small fragments are suctioned out from the same incision.
d. Once the cataract is completely removed, an IOL (intraocular lens) is implanted. There are different types of IOLs such as monofocal, multifocal and toric lenses. The choice of IOL depends upon specific needs.
Benefits of Phacoemulsification Surgical Procedure
a.High Success Rate:- Phacoemulsification surgery has a high success rate achieving more than 95%, with the majority of patients achieving visual acuity.
b. Quick Recovery:- Post-operative discomfort for the patients is very minimal and healing is very fast. The patient can return to normal routine and begin their activities within a few days after the surgery. As the incision is very small, the tissues are damaged much less and support faster recovery.
c. Less dependence on Glasses:- Depending upon the IOL type chosen for implantation, very few patients require glasses after surgery.
2. Extracapsular Cataract Extraction
Extracapsular cataract extraction is an old technique that is still in use in specific scenarios. This method is used when the cataract is too dense or eye anatomy does not allow it to perform phacoemulsification. In this procedure, a larger incision is made typically 10-12 mm and the entire cloudy lens is removed in one piece.
Once the cataract is removed, an IOL is inserted through the same incision to restore vision.
Benefits of Extracapsular Cataract Extraction Process –
a. Use in Advance Cases: This process is mainly used when it is difficult to break advanced cataracts using ultrasound. It is a much more reliable option than less viable options.
b. Established Technique: The extracapsular extraction surgical process is been practised by surgeons for many years, which gives them extensive experience and a solid understanding of surgical procedure outcomes.
3. Intracapsular Cataract Extraction
The intracapsular cataract extraction process is the less preferred choice by eye surgeons today. Still, it can be used in a few situations like where the patient has dense cataracts, traumatic cataracts, or any other condition that can complicate the surgical process.
In the Intracapsular cataract extraction surgical process, cloudy lenses and surrounding capsules are removed as a single unit. In this process, a larger incision is required similar to the extracapsular method. Once the extraction is completed, a new IOL is implanted. Due to the absence of lens capsules, very few options for IOL are available in this technique.
Intracapsular cataract extraction surgical process is very useful in conditions where patients had any previous eye surgeries or have any other underlying condition.
4. Femtosecond Laser Surgery
Femtosecond is an advanced surgical method that uses cutting-edge technologies. Due to its proven results and precision, it has gained popularity. The method involves using the femtosecond laser to create an incision in the cornea and soften the cataract.
To remove the cloudy lens surgeon creates the precise opening in the eye capsule through a femtosecond laser. By using laser technology, surgeons achieve more accuracy and less trauma to the eye which helps in faster recovery and excellent results.
Choosing the Right Cataract Surgery for You
When it comes to deciding what surgical process to opt for to treat cataracts, several factors play an important role i.e. severity of cataracts, type of cataracts, cost, your overall eye health and your personal preference.
Your eye surgeon will assess your case and will recommend the best surgical process for your eyes according to their expertise and your eye condition. Discussing the surgical options with your eye surgeon is important to understand the risks and benefits associated with each surgical process.
It is always recommended to choose the latest and advanced surgical method recommended by your eye surgeon to treat cataracts and faster recovery.
Cataract Lens Types: 3 Options Explained
Choosing the right intraocular lens (IOL) for your cataract surgery is very important to get the desired vision outcomes after the surgical process. Different types of IOLs are available according to your vision needs, understanding the difference between them will help you choose the best lens for your cataract surgery. There are three primary types of IOL lenses used in cataract surgery.
1. Monofocal Lenses
Monofocal lenses are the most used IOL lens in cataract surgery. They help to restore the patient’s clear vision post-surgical process at a single distance i.e. they can be set to focus near, intermediate, or distance vision.
To set the best focal point for your monofocal lens, your eye surgeon will discuss your vision needs. You can choose your vision needs according to your lifestyle. For example, you can choose to lens focus at a distance if you are not much involved in activities like reading, writing etc. However, to perform activities which require accurate near vision you will still need to use reading glasses.
Monofocal lenses are the best choices for people as they are more affordable when compared to other lenses and are widely available in the market. It is always recommended to choose a focal point according to your daily activities for a high satisfaction rate
2. Multifocal Lenses
Multifocal lenses are more advanced lenses which provide improved vision at multiple distances, eliminating the need for glasses after cataract surgery.
Multifocal lenses contain different zones which are designed for vision correction at various distances i.e. near, immediate, and far. Once the lens is implanted our brain learns to adapt to different zones and allows most patients to see clearly without any additional eyewear.
Multifocal lenses are more costly as compared to monofocal lenses and are not covered in all the insurance plans in USA.
3. Toric Lenses
Toric lenses are used when the patient is affected by astigmatism. They are specifically designed to correct astigmatism. Astigmatism is a common eye condition caused by an irregular shape of the cornea or lens in the eye.
In the toric lens, different powers are incorporated in specific medians of the lens to correct astigmatism. During the cataract surgical process, the toric lens is positioned very carefully to align with the steepest part of the cornea to counteract the effects of astigmatism
Like multifocal lenses, toric lenses also come with a higher cost and proper alignment is crucial for effectiveness.
Cataract Surgery Costs in the USA: 5 Key Factors
Cataract surgery cost in USA is influenced by several factors like the type of surgery, geographical locations, surgeon experience, lens type and facility. Below is a detailed overview of each factor and an estimated dollar amount and details on insurance coverage.
1. Type of Surgery: How It Affects Prices
The type of surgery is one of the major factors which significantly impacts the overall cost.
a. Phacoemulsification
This is one of the most performed techniques and can range from $3000 to $5000 per eye depending upon surgeon experience and hospital choice. Most of the insurance plan covers the cost of the surgical processes, and Medicare but any out-of-pocket cost may vary according to your vision needs and specific plan.
b. Extracapsular and Intracapsular Extraction
The cost of extracapsular and intracapsular extraction surgery lies between $4000 to $7000 per eye. Insurance coverage is variable depending upon medical necessity and your policy specifications.
c. Femtosecond Laser Surgery
This is the most advanced cataract laser surgical process and typically costs $5,000 to $10,000 per eye. Most of the insurance provider covers the cost of basic surgical procedures but additional fees for laser technology could be out-of-pocket expenses.
2. Geographic Location:
Costs of cataract surgery vary significantly depending upon where you choose to get the surgical process.
a. Urban vs Rural Areas:- In urban areas, the cost of cataract surgery is high due to its demand and overhead as compared to rural areas. Cities like New York, and Los Angeles might cost 20% more compared to other places.
If you are living in New York or California, your cataract surgery can cost you up to $4,000 to $10,000 per eye. For people who opt for surgical processes in states which have lower costs of living, like Texas or Florida, cataract surgery can cost $3,000 to $6,000.
b. Insurance Networks:- Before choosing the eye surgeon and hospital, make sure to verify your surgeon and hospital are in-network for your insurance. Any out-of-pocket expense can increase the cost by 30% or more.
3. Surgeon’s Experience: Why It Matters
a. Expertise and Training:- Highly experienced surgeons charge more fees as compared to less experienced surgeons. The cost can increase from $1000 to $2000. The benefit of choosing an experienced surgeon is better outcomes and fewer complications.
b. Track Record of Surgeons:- Many surgeons with strong reputations and better track records charge higher prices. The higher prices are justified by a proven track record, success rates and patient satisfaction.
c. Specializations:- Eye surgeon who specializes in advanced technologies like laser surgery typically charges $1000 to $2000 more than a standard procedure.
4. Facility Fees: Understanding Total Costs
Facility fees associated with hospitals and surgical centres impact the cost of cataract surgery.
a. Type of Facilities:- Outpatient surgical centres charge low fees typically between 1,000 to $3,000 as compared to the hospital which can range from $2,000 to $5,000 for the same procedure.
b.Overhead and Amenities:- Facilities with advanced technologies and experienced staff along with high-end amenities come with additional costs and impact the overall prices. Make sure to check with your insurance provider what portion of the facility fee is covered to reduce your out-of-pocket expenses.
5. Lens Type: How Choices Impact Overall Price
The types of lenses (IOL) chosen during cataract surgery also affect overall cost. However, it is recommended to choose the best lens according to your vision needs for successful outcomes.
a. Monofocal Lenses
Monfocal lenses are mostly covered by insurance and are included in the overall surgical fee. Depending upon the insurance plan patients need to pay between $0 to $500 as out-of-pocket expense.
b. Multifocal and Toric Lenses
These are advanced lenses and may cost up to $3000 per eye. Most insurance providers do not fully cover these lenses and patients may need to pay the difference out-of-pocket.
c. Customization
Any customization or if you opt for premium lenses which are not covered in your insurance plan will increase the overall cost. It is important to discuss all the options with your surgeon to understand the financial implications.
Insurance Coverage for Cataract Surgery in the USA
Cataract surgery is expensive, and understanding insurance coverage is important for managing costs. Below are the five key points you should consider when buying insurance coverage for cataract surgery in the USA.
1. Understanding Coverage Options
When reviewing health insurance policies and features, it is essential to understand policy coverage like medical necessity, lens coverage, and pre-operative and post-operative care.
a. Medical Necessity:- Most healthcare insurance plans cover cataract surgery when it is deemed a medical necessity and prescribed by Ophthalmologist. It means cataracts are hampering your daily life activities and you are struggling with your vision.
b. Lens Coverage:- Most insurance plans cover basic monofocal lenses as standard but to restore your vision with advanced lenses (Multifocal or Toric lenses) you may need to pay out-of-pocket expenses. These lenses are not covered by insurance vendors due to their higher costs.
c.Additional Services:- Check what additional services are provided by your insurance provider like diagnostic tests of the eye, pre & post-operative care, and patient transportation etc.
2. Pre-Authorization: Steps to Take Before Cataract Surgery
Pre-authorization is the stage when your insurance provider evaluates the necessity and cost of the procedure before actual surgery happens.
a.Documentation:-First you or your eye surgeon needs to submit the documents including diagnostic tests and other details supporting that cataract surgery is medically necessary to your insurance provider.
b. Time Frame:- Make sure to initiate your pre-authorization process for cataract surgery well in advance of your surgery date. The approval process can take from a few days to several weeks. Any delay in approval can push back your surgery.
c. Follow-Up:- Make sure to do regular follow-ups with your insurance provider after applying to confirm pre-authorizations has been approved to avoid any out-of-pocket or unexpected cost.
3. In-Network vs. Out-of-Network Providers
Most insurance vendors offer better coverage within their in-network providers. If you choose a surgeon and facility that is in-network then your out-of-pocket expense will be lower as compared to out-of-network providers.
With out-of-network providers, a higher cost is associated because the insurance plan covers a smaller percentage of the procedure which eventually raises out-of-pocket expenses. For maximum benefit, make sure your surgeon and the surgical facility are in-network with your insurance provider.
4. Co-pays and Deductibles: Financial Considerations
a. Co-pays:- Few insurance plans require a co-pay for surgical procedures. In this process, you need to pay a fixed amount at the time of process and the rest is taken care of by your insurance provider according to your insurance coverage.
b. Deductibles:- This is the out-of-pocket expense you need to pay before your insurance covers your surgical cost. Make sure to check your plan’s deductible to avoid last-minute surprises.
c. Out-of-Pocket Maximums:- Once you reach the limit of out-of-pocket maximum for the coverage year, you can get some additional financial relief. Make sure to read documents and familiarize yourself with your insurance plan’s out-of-pocket maximum.
5. Medicare and Medicaid Plans for Cataract Surgery
If you are enrolled in a government health care program i.e. Medicare and Medicaid, there are specific guidelines for cataract surgery expense coverage.
a. Medicare Coverage
Medicare Part B covers the cataract surgery cost if it is deemed medically necessary. The coverage includes the cost of a monofocal lens and surgery itself. However, patient needs to pay 20% of the medicare approved amount once their deductible has been met
Eligibility Requirements for Medicare Coverage are:-
Age- Individuals should be 65 or older
Disability – Individuals who are below the age of 65 must have been receiving Social Security Disability Insurance for at least 2 years.
Specific Conditions:- People who are diagnosed with specific conditions like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) may qualify regardless of age.
b. Medicaid Coverage
Medicaid coverage varies from state to state because this program is jointly run by federal and state for low-income individuals and families. Eligibility criteria and benefits vary from state to state.
Eligibility Criteria for Medicaid Coverage are:-
Income: The income of individuals or families must be below a certain threshold decided by the state government.
Family Size & Categorical Groups:- Eligibility criteria often depend upon family size, with different thresholds set by states for couples, individuals and families. Categorical Groups include families with children, pregnant women, elderly family members, and persons with disability.
Preventing Cataracts: 5 Proven Strategies
As we know, cataracts are a common disease as we age, but you can still follow several proactive methods and strategies to reduce your risk of cataracts. Below are the five proven strategies you can follow to prevent cataracts for a long time.
1. Regular Eye Exams
Regular eye inspection by an Ophthalmologist is necessary to check overall eye health and helps detect cataracts at an early stage.
a. Early Detection:-Regular eye exam helps in identifying early signs of cataracts, which in turn helps in timely intervention and management of cataracts.
b. Personalized Recommendations:- Based upon eye examination results, your Ophthalmologist will provide you with personal recommendations to reduce your risk and keep your eye healthy by adopting preventive measures.
c. Frequency of Eye Exams:-One should get tested on their eyes twice a year to reduce the risk of cataracts or if there are other risk factors such as diabetes or any family history of eye diseases.
2. Healthy Diet
Your food should support your eyes and overall health. Your diet should be full of nutrients, proteins, vitamins and healthy fat to maintain your eye health and may help in preventing cataracts.
a. Antioxidant-Rich Foods:- Intaking foods which are high in antioxidants helps in protecting eye lenses from oxidative damage. Include foods rich in Vitamin C & E in your diet like citrus fruits, berries, nuts, and green leafy vegetables to increase oxidants.
b. Omega-3 Fatty Acids:- Foods which are rich in omega-3 fatty acids support eye health and reduce the risk of cataracts. Include fatty fish like salmon & mackerel in your diet to incorporate omega-3 fatty acids.
c. Colorful Vegetables:- Colored vegetables and fruits like carrots, peppers, and sweet potatoes which are rich in beta-carotene promote good vision.
3. UV Protection: Importance of Sunglasses
Protecting your eyes from UV and other harmful rays is vital in reducing the risk of cataracts and other eye diseases.
a. Always wear quality sunglasses which are capable of blocking 100% UVA and UVB rays. For reducing glare you can also choose polarized lenses which will provide additional comfort and protection.
b. While working or travelling outdoors remember to wear a wide hat to get extra protection from UV rays.
c. If your work nature does not require you to work in direct sunlight then be mindful of sun exposure. Avoid going out during peak hours (10 a.m. to 4 p.m.) to minimize UV exposure.
4. Avoiding Smoking and Excessive Alcohol
Your lifestyle choices have a direct impact on your eyes and overall health. Choose a healthy lifestyle like regular exercise, healthy food, avoiding smoking and excessive alcohol to lower the risk of developing cataracts.
a. Smoking:- Consumption of tobacco in any form is linked to increased risk of cataracts. Quitting smoking will be very helpful in improving overall health and will lower the risk of developing cataracts.
b. Alcohol Consumption:- Research4 has shown evidence that excessive alcohol intake has an increased prevalence of nuclear cataracts. Limiting alcohol consumption will lower the risk of cataracts.
5. Managing Health Conditions: Diabetes and Hypertension
People with chronic health conditions like diabetes, hypertension, cancer, stroke etc. are at higher risk of developing cataracts. It is essential to manage these conditions to lower the risk of cataracts.
a. Diabetes:- People with diabetes are at higher risk of developing cataracts as they age. Diabetes management through a healthy diet, medications, exercise and meditation is essential for stable blood sugar levels.
b.Hypertension:- High blood pressure levels also lead to the development of cataracts. Regular monitoring and adherence to your physician’s prescribed medication will help manage the condition.
If you are suffering from any chronic conditions it is necessary to do regular health checkups and follow up with your healthcare provider to reduce the risk of cataracts and other health complications.
Post-Op Care After Cataract Surgery: 6 Essential Tips
Once the cataract surgery is completed, post-operative care is essential for successful vision restoration, and recovery. Below are the 6 essential tips to follow after cataract surgery for successful outcomes.
1. Medications
Post cataract surgery, your eye surgeon will prescribe medications to aid the healing process and prevention of infection.
a. Eye Drops:- Your eye surgeon will prescribe antibiotic and anti-inflammatory eye drops to reduce inflammation and infection. Make sure to follow the prescribed schedule carefully without fail for a successful outcome and to speed up the healing process.
b. Adherence to Dosage:- It is important to take your medicine dosage on time without fail and not stop taking the medication until your doctor asks. Missing any dosage will slow down the healing process and can lead to complications such as eye infection etc.
c. Managing Side Effects:- If you experience any reaction to the medication you are using such as increased redness, pain or increases in swelling around the eyes, contact your healthcare provider immediately to manage the same.
2. Activity Restrictions: What to Avoid After Cataract Surgery
To ensure a smooth recovery after cataract surgery, it is essential to avoid certain activities.
a. Avoid Strenuous Activities:- Do not get involved in any strenuous activity such as heavy lifting, vigorous exercises or any other activity which can strain your eyes for at least a week or two. Discuss with your eye surgeon before you resume these kinds of activities, and only resume once they give the go-ahead.
b. No Swimming:- Avoid swimming or any other water activity such as hot tubs, or water sports for at least two to four weeks post-cataract surgery to reduce the risk of cataracts.
c. Limit Screen Time:- It is essential to limit screen time to give eyes rest and recovery after cataract surgery. Prolonged exposure of eyes to the screens for the first few days post cataract surgery can lead to eye strain.
3. Housework After Cataract Surgery
Household work can add risk to your recovery after a cataract surgery. It’s important to know what activities are safe to perform post-cataract surgery.
a. Light Cleaning:- You can do light cleaning but avoid any task that requires bending or straining your eyes such as vacuuming or floor scrubbing.
b. Dust & Allergens:- Minimize your eye’s exposure to dust and allergens. Wear black glassware to protect your eyes from the bright lights, dust & allergens. During your recovery period after cataract surgery ask someone else to handle the cleaning tasks till you recover completely.
c. Avoid sharp objects:- Avoid contact with sharp objects and if necessary be cautious while handling them as they could be the reason for any accidental eye injury.
4. Signs of Complications
Being aware of any signs of complications for a smooth recovery. It is important to seek immediate medical advice in case of any complications.
a. Increased Pain or Redness:- If you feel significant pain or redness in the eye it could be a sign of an infection or any other issue. While some discomfort is normal after cataract surgery if the complications are increasing, seek medical attention immediately.
b. Changes in Vision:- Sudden vision changes like increased blurriness or flashes of light are also other critical complications and require immediate medical attention by your eye doctor.
c. Persistent Symptoms:- If you experiencing persistent symptoms like swelling around the eyes, excessive tearing, or sensitivity to light even after a few days after cataract surgery, reach out to your eye care provider.
5. Follow-Up Appointments: Ensuring Proper Healing
Make sure to attend follow-up appointments scheduled by your eye surgeon post-cataract surgery. During these appointments, your eye surgeon will assess your eye condition and will make changes in your post-operative plan according to your eye condition.
These appointments will also help your eye doctor evaluate your vision changes and any signs of complications. You can discuss your concerns with the doctor during these visits and ensure you understand and follow the healing process.
6. Long-Term Eye Care: Maintaining Your Vision Health
Once your cataract surgery is successful and your eyes are healed from surgery. It is essential to do long-term care for the eyes to maintain eye health. Schedule regular eye exams with your Ophthalmologist to monitor your vision. This will help in any early detection of issues and help in preventing any complications.
Maintain a healthy lifestyle by incorporating regular exercise in your daily routine, eating a balanced and healthy diet, and protecting your eyes from UV rays to support vision health.
Managing chronic conditions such as diabetes or hypertension helps contribute to your overall eye health.
Understanding Childhood Cataracts: Causes, Symptoms, and Treatments
Cataracts are mostly associated with aging but they can affect children also. Cataracts in children can lead to significant vision impairment if not treated. We will discuss the causes, symptoms, and treatment for childhood cataracts.
What Are Childhood Cataracts?
Childhood cataracts are a condition which occurs due to the clouding of the eye’s lens in children, which affects their ability to see clearly. Childhood cataracts can develop during birth or in early childhood due to trauma or other health conditions. The eye lens is very crucial for focusing light on the retina, any changes can disrupt this process.
Types of Childhood Cataracts
There are three main types of childhood cataracts:-
a. Congenital Cataracts:- These cataracts are present at the time of birth and are often linked to genetic factors or other health conditions during the pregnancy.
b. Developmental Cataracts:- These types of cataracts develop in childhood due to trauma or other health conditions.
c. Secondary Cataracts:- Secondary cataracts are developed due to the result of other medical conditions such as diabetes or steroid use.
Common Symptoms of Childhood Cataracts
Identifying early symptoms of childhood cataracts is crucial for effective treatment. Common symptoms include cloudy or blurred vision, light sensitivity, and leukocoria.
a. Cloud or Blurry Vision:- In this condition, the child may squint or experience difficulty in seeing clearly.
b. Light Sensitivity:- Increased sensitivity to bright light may be observed and can be a potential sign of cataracts.
c. Leukocoria:- Leukocoria refers to the medical term in which abnormal white or greyish-white reflection is observed during physical examination or in photographs.
Treatment for Childhood Cataracts
The treatment option for cataracts is surgery only. The type of surgery depends upon the eye conditions such as Phacoemulsification, Extracapsular Cataract Extraction, Intracapsular Cataract Extraction and Femtosecond Laser Surgery Click here to read more about cataract surgery types.
FAQ’s About Cataract Surgery
1. How Long Between Cataract Surgery on Each Eye?
The duration between cataract surgeries for each eye is one to four weeks. This waiting period allows the first eye to heal properly before proceeding with the second eye.
If you face any complications or issues after cataract surgery in the first eye then your eye surgeon can assess the eye and plan a second surgery accordingly.
It is best to consult your eye doctor for personalized recommendations regarding the timings of your cataract surgeries, according to your eye health and cataract severity.
2. How Long Can Cataract Surgery Be Postponed?
Cataract surgery can be postponed for a while like 15 to 20 days depending upon how much cataracts are interfering with your quality of life.
Delaying cataract surgery adds further potential complications. Cataracts can progress over time and make your vision worse than before. Due to poor vision, you will not be able to perform our daily tasks.
Consult your eye surgeon to understand the risks of delaying cataract surgery.
3. When Can You Drive After Cataract Surgery?
Most patients are advised not to drive for a week at least. It is important to feel comfortable and confident before resuming driving after cataract surgery.
Your surgeon will assess your eye health before he recommends you resume your daily activities. Once your eyes are healed completely and you have clear vision you can resume driving.
4. How Long Does It Take to Recover from Cataract Surgery?
Recovery from cataract surgery varies among individuals and depends upon several factors like post-op surgery care, healthy diet, medication intake, and lifestyle choices.
a. Immediate Recovery:- Once the cataract surgery is completed, most patients experience improved vision within a few days but full recovery of eyes and overall health can take up to a few weeks.
b. Healing Timeline:- Initial healing takes for a week to two but full recovery can take up to a month or longer.
5. What are the restrictions after cataract surgery?
For smooth recovery, there are certain restrictions after cataract surgery.
a. Swimming and Water Exposure:- You should stay away from swimming pools, hot water and water bodies at least two weeks to prevent eye infection post cataract surgery.
b. Activity Limitation:- Avoid driving, heavy lifting, bending, and other strenuous activities to reduce the risk of complications for a few weeks.
c. Eye Protection:- Wear sunglasses to protect your eyes from dust, bright light & UV rays. Do not rub your eye in the initial healing phase after surgery.
6. What is the recovery time for laser cataract surgery?
Laser cataract surgery has a shorter recovery time compared to other cataract surgeries. Your eyes are recovered within a week or two but the complete healing process can take longer. It’s important to make follow-up appointments with your eye surgeon to monitor your eye recovery and recommendations.
7. Can cataract surgery correct astigmatism?
Yes, cataract surgery can correct astigmatism. Your surgeon will use toric intraocular lenses (IOLs) which are specially designed to correct astigmatism and will also provide clear vision.
8. What are moxifloxacin eye drops used for?
Moxifloxacin eye drops are antibiotics used to treat bacterial infections of the eye. Your Ophthalmologist can prescribe moxifloxacin after cataract surgery to prevent infections and promote healing.
9. What should I expect after cataract surgery?
After cataract surgery, you will feel some discomfort like swelling around the eyes, temporary blurriness, and itching around the eye. However, you will start noticing improved vision in a few days and these discomforts will go away.
10. Does cataract surgery improve vision?
Yes, Cataract surgery improves vision by removing the cloudy natural lens from the eyes and replacing it with a clear IOL(intraocular lens). With a new lens, you will have clear and improved vision.
11. What are multifocal lenses for cataract surgery?
Multifocal lenses are intraocular lenses (IOLs) they are specially designed to provide clear vision at multiple distances i.e. near, far and distant. With the use of multifocal lenses, you no longer need to wear corrective eyewear.
12. How long does the actual cataract surgery take?
The actual cataract surgery time is between 20 to 30 minutes for each eye. However, other processes are involved during surgery such as assessment of the eye, giving anaesthesia to the patient, etc. The actual procedure is really quick but needs additional time for surgery preparation and post-operative monitoring.
13. What are the potential complications of cataract surgery?
While cataract surgery is one of the safest surgeries but like any other surgery it has complications too such as infection, inflammation, bleeding, retinal detachment, or persistent blurry vision.
It’s important to discuss the risks and complications with your eye surgeon before surgery happens.
14. What is macular degeneration?
Macular degeneration is a condition which affects the central part of the retina and leads to vision loss. There are two types of macular degeneration i.e. dry & wet.
15. What is the CPT code for cataract surgery?
The most common CPT code used for cataract surgery Is 66984, however, this code can vary depending on the procedure performed. Make sure to check with your surgeon for accurate coding.
17. Can dogs undergo cataract surgery?
Yes, dogs can also undergo cataract surgery same as humans to restore vision affected due to cataracts. Their surgery will be performed by a veterinary ophthalmologist.
18. What should I do after cataract surgery?
After cataract surgery, make follow-up appointments with your ophthalmologist. Follow their post-operative instructions such as taking rest, medications and avoiding activities suggested by your eye surgeon.
19. What kind of eye drops are used after cataract surgery?
Post-cataract surgery, your surgeon will advise you on antibiotic and anti-inflammatory eye drops to prevent infection and reduce inflammation. Make sure to use them without missing as suggested by your eye care provider.
20. Will Medicare cover cataract surgery?
Yes, medicare covers cataract surgery when prescribed by an ophthalmologist and it is deemed medically necessary for restoring clear vision. Medicare covers the cost of surgery procedures and the cost of standard intraocular lenses. If you are opting for a premium lens or another lens which are not covered by Medicare, then you will need to pay the difference between the cost.
21. Can you fly after cataract surgery?
Yes, you can fly after cataract surgery but make sure to follow your surgeon’s advice. Most people wait for a week or two before they opt for flying. Read more details in the guide can you fly after cataract surgery?
22. Are cataracts hereditary?
Genetics plays a role in developing cataracts but there are also other factors which increase the risk of developing cataracts such as food choices, exercise, working conditions, exposure to UV rays and others.
- https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts ↩︎
- https://pubmed.ncbi.nlm.nih.gov/1501324/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/9338677/ ↩︎
- https://pubmed.ncbi.nlm.nih.gov/36418504/ ↩︎
Reviewed By
Dr. Sonam Aggarwal
lMBBS, MD(C.Medicine)