Krishna (name changed), 70, a farmer in Kancheepuram, Tamil Nadu, was having trouble with vision in one of his eyes. He also kept on putting off his eye screening for a long time. However, one fine day he had to be rushed to the hospital with severe eye redness and pain. On examining him, doctors found that his cataract — the cloudy layer on the natural lens of the eye, or crystalline lens — had ruptured. As a result, he lost the vision in his right eye. Like him, despite the availability of advanced cataract surgery treatment facilities, many patients delay eye surgery owing to lack of awareness and personal reasons, say doctors.
In India, 55% of all blindness is attributed to cataracts. Unlike developed countries like the US, where cataracts mostly affect people over 70 years, Indians as young as 50 are developing cataracts. This is largely due to factors such as exposure to ultraviolet rays, excessive heat, and poor nutrition, according to Dr Amar Agarwal, chairman of Dr Agarwals Eye Hospital.
“We have advanced techniques for cataract surgery today, a long way from what it was 40 years ago. Back then, patients had to spend days in the hospital, recovery was slow, and there was significant pain. The incision used to be 12mm, but with the latest techniques and tools, it has been reduced to less than 2mm. Patients can be discharged within hours and can resume their activities within days,” said Dr Mohan Rajan, CMD of Rajan Eye Care Hospital. Doctors say that small incisions with almost no scarring have revolutionised the landscape of cataract surgery procedure today.
Ultrasound and laser-assisted
Phaco cataract surgery is one of the latest techniques where the surgery is performed with a 3mm incision. It is done using an ultrasonic probe to emulsify the cataract. It is a type of phacoemulsification surgery, where the cataract is broken into small pieces using ultrasound energy and removed with suction. “It is the most common method of surgery today. Phakonit can also be performed, which involves an incision of under 1mm,” said Dr Amar Agarwal.
Forty years ago, only mature cataracts were removed, but today, a thin layer of cataract can also be removed using advanced techniques. Microincision Cataract Surgery (MICS) and Femtosecond Laser-assisted cataract surgery (FLACS) are examples of such advancements. “FLACS is a robotic-assisted, precise, and minimally invasive technique that uses a laser to remove the cataract and replace it with an artificial lens,” explained Dr Rajan.
In FLACS, the number of steps that the surgeon performs manually is minimised. The laser does the work of breaking down the cataract before we do phacoemulsification. “The laser itself performs most of the steps, such as making a small incision and creating a small opening in the capsular bag that holds the cataract, allowing access to the cataract,” said Dr Supriya Sriganesh, executive director of Nethradhama Hospitals, Bengaluru.
However, in extreme age groups – infants and the very elderly - cataract surgery can be challenging. "In older adults, the support structure for the lens is weak, while in infants, the eye is still growing and smaller in size. Additionally, in cases of mature cataracts, surgery can be more complicated because the cataract is harder to break down," said Dr Meena CK, senior cataract and paediatric ophthalmologist at Little Flower Hospital, Angamaly.
Precision and vision correction
In FLACS, precision is the key because modern cataract surgery is not just about removing blindness anymore. “Patients now seek not only restored vision but also high-definition clarity, often eliminating the need for spectacles altogether,” said Dr Upasana Khanna, consultant, ophthalmology, Asian Hospital, Faridabad.
“In patients with astigmatism, a small incision is also made on the cornea to correct the vision so patients don’t require glasses after cataract surgery, and dependency on glasses completely comes down. This improves the recovery time and dependency on glasses,” added Dr Supriya.
Advancements in intraocular lenses (IOLs) have also played a crucial role. Traditionally, standard monofocal lenses were implanted after cataract removal, restoring distance vision but requiring patients to use reading glasses. “Today, premium lenses such as multifocal and toric IOLs can correct vision at multiple distances and address astigmatism, significantly reducing dependence on glasses,” Dr Khanna said.
“These new lenses allow us to offer vision correction tailored to individual patient needs. The goal is no longer just sight restoration but optimising vision to a level that patients never thought was possible,” said Dr Khanna.
Another breakthrough technology aiding precision in cataract surgery is optiwave refractive analysis (ORA). This sophisticated software conducts real-time assessments of the eye, providing overlapping images that help guide incision placement and lens positioning. “By offering intraoperative measurements, ORA ensures the most accurate power calculations for the lens implant. This level of customisation significantly enhances post-surgical vision quality,” she added.
Cost factor
However, these advancements come at a cost. The use of femtosecond lasers and premium lenses can increase the total expense of cataract surgery.
“A traditional cataract surgery may be relatively affordable, but incorporating FLACS can add an additional `70,000 to `80,000. It’s an investment in precision, but one that many patients find worthwhile for the long-term benefits,” Dr Khanna said.
Improving accuracy with AI
AI-powered robotic systems are now assisting surgeons, minimising risks, and ensuring better surgical consistency. "One of the major breakthroughs in this field is the adoption of 3D visualisation technology, which enhances depth perception and accuracy during complex cataract and retinal surgeries. While currently available only in select hospitals, it will become a standard in the coming years," said Dr Prashaant Chaudhry, senior consultant & head, ophthalmology and refractive surgery, Aakash Healthcare, Delhi.
Another advanced technique gaining traction is the Zepto method, which uses precision pulse technology to create a perfectly sized and centred capsulotomy — a critical step in cataract removal. "Zepto technology enhances safety and consistency, providing better results than conventional methods," Chaudhry explained. As AI continues to revolutionise cataract surgery, patients can expect safer, faster, and more effective treatments. With technology evolving rapidly, eye care specialists believe these advancements will soon become the standard of care across India.
(With inputs from Anna Jose @ Kochi, Rishita Khanna @ Bengaluru,
Ashish Srivastava @ New Delhi)