Cataract (Motia) in Pakistan: Symptoms, Surgery and Why No Eye Drop Can Cure It

Cataract is the clearest example in Pakistani medicine of a solvable problem left unsolved. The Pakistan National Blindness and Visual Impairment Survey, which examined 16,507 adults (95.5% of those enumerated) and was published in the British Journal of Ophthalmology, found cataract to be the single largest cause of blindness at 51.5% — ahead of corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Overall, 85.5% of the causes of blindness identified were avoidable.

The same survey programme estimated that 904,000 adults in Pakistan have cataract requiring surgical intervention. Cataract surgery is a routine day procedure with a high success rate; the barrier is almost never the medicine, it is reaching it — cost, distance, awareness, and waiting until vision has already gone.

At a glance

• Cataract causes 51.5% of blindness in Pakistan — more than every other cause combined
• 85.5% of blindness in the national survey was avoidable
• An estimated 904,000 adults need cataract surgery
• Surgery is the only treatment: no drop, tablet or oil removes a cataract
• Diabetes accelerates cataract and adds separate retinal risk — both need checking

Motia kya hai?

Aankh ke andar ek qudrati lens hota hai jo saaf shishe ki tarah hota hai. Umar ke saath — ya diabetes, chot, steroid ya dhoop ki wajah se — yeh lens dhundla hone lagta hai. Isi dhundlepan ko "motia" kehte hain. Roshni lens se guzar kar saaf tasveer nahi banati, is liye nazar dhundli hoti hai, raat ko gaari ki batti se chundhiya jata hai, aur rang phike lagne lagte hain.

Sab se ahem baat: motia ka koi qatra, koi goli aur koi surma ilaj nahi hai. Bazaar mein "motia utarne wale qatray" bikte hain — koi bhi motia ka ilaj nahi karta. Wahid ilaj ek chhota sa operation hai jis mein dhundla lens nikaal kar us ki jagah masnoi lens (IOL) daal diya jata hai. Yeh aam tor par bay-hoshi ke baghair, sirf aankh sunn kar ke, usi din ghar wapsi ke saath hota hai.

Aur purani soch ke bar-aks: ab motia ke "pakne" ka intezar karne ki zaroorat nahi. Jab nazar rozmarra kaam — parhna, gaari chalana, seena-piroana — mein rukawat daalne lage, tab operation ka waqt hai. Zyada intezar karne se motia sakht ho jata hai aur operation mushkil aur khatray-wala ho jata hai.

Symptoms

• Gradual, painless clouding or blurring of vision (nazar dhundli hona)
• Glare and haloes around lights, worst when driving at night
• Colours appearing faded or yellowed
• Needing more light to read, or frequent changes of spectacle prescription
• Double vision in one eye
• Reduced contrast — struggling with steps, kerbs and low light
• Occasionally a temporary improvement in near vision ("second sight") before things worsen

Cataract is painless and gradual. Sudden vision loss, eye pain, redness or seeing flashes and floaters is not cataract and needs same-day assessment.

Causes and risk factors

• Age — the dominant cause
• Diabetes, which brings cataract on earlier and progresses it faster; see our guide to diabetes
• Prolonged sunlight and ultraviolet exposure, relevant across much of Pakistan
• Long-term steroid use, including steroid eye drops taken without supervision
• Eye injury or previous eye surgery
• Smoking
• Congenital cataract in infants, which must be picked up early — a white pupil in a baby's eye is an emergency referral, not something to watch

How it's diagnosed

An eye specialist (ophthalmologist) confirms cataract on slit-lamp examination and measures how much vision it is actually costing. Before surgery, the eye is measured to select the correct intraocular lens power, and the retina is examined — important because cataract and diabetic retinopathy often coexist, and only one of them is fixed by lens surgery. Anyone with diabetes should be having a dilated retinal examination regularly regardless of cataract.

Treatment

• Surgery is the only cure. The clouded lens is removed — usually by phacoemulsification through a small incision — and an artificial intraocular lens is implanted
• Typically a day procedure under local anaesthetic, taking well under an hour, with vision improving over the following days
• Post-operative drops for several weeks, and avoiding rubbing the eye, dusty environments and heavy lifting as advised
• Lens choice — a standard monofocal lens is excellent and usually leaves you needing glasses for one distance; premium lenses cost more and suit some people better. This is a conversation to have before surgery, not on the day
• Follow-up matters, including after free surgical camps: complications are uncommon but are treatable when they are seen
• Posterior capsular opacification — clouding that can occur months or years later, treated with a quick laser procedure, not repeat surgery

The one thing that is not treatment: eye drops, tablets, kajal, surma or oils marketed as dissolving cataract. Money spent on those is money not spent on the surgery that works.

When to see a doctor

• Vision interfering with reading, driving, work, cooking or prayer
• Increasing night-time glare
• Any diabetic, annually, whether or not vision has changed
• A white or grey appearance in the pupil, at any age — and urgently in a child
• Urgent: sudden vision loss, eye pain, redness, flashes, floaters or a curtain across vision — these are different conditions, and some are sight-threatening within hours

Frequently asked questions

Kya motia ka qatra se ilaj mumkin hai?

Nahi. Koi bhi qatra, goli ya surma dhundle lens ko dobara saaf nahi kar sakta. Sirf operation se hi nazar wapas aati hai.

Should I wait for the cataract to "ripen"?

No — that advice belongs to older surgical techniques. Modern surgery is done when vision impairs daily life, and a very dense cataract makes the operation harder, not easier.

Will I still need glasses after surgery?

Most people with a standard monofocal lens see clearly at distance and use reading glasses for near work. What is realistic depends on the lens chosen and the eye itself.

Can both eyes be done at once?

Usually they are done separately, a few weeks apart, so one eye is recovering while the other still works. Your surgeon will advise based on your eyes.

Sources

• "Causes of blindness and visual impairment in Pakistan: The Pakistan National Blindness and Visual Impairment Survey," British Journal of Ophthalmology (PMC)
• "Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey" (PubMed)

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