Cataract surgery

Overview

Cataract surgery is a procedure to remove the lens of the eye and, in most cases, replace it with an artificial lens. A cataract causes the lens to become cloudy when it is typically clear. Cataracts can eventually affect vision.

Cataract surgery is performed by an eye doctor, also called an ophthalmologist. It's performed on an outpatient basis, which means you don't have to stay in the hospital after the surgery. Cataract surgery is very common and is generally a safe procedure.

Why it's done

Cataract surgery is done to treat cataracts. Cataracts can cause blurry vision and increase the glare from lights. If a cataract makes it difficult for you to carry out your usual activities, your health care team may suggest cataract surgery.

When a cataract interferes with the treatment of another eye problem, cataract surgery may be recommended. For example, doctors may recommend cataract surgery if a cataract makes it difficult for your eye doctor to examine the back of your eye to monitor or treat other eye problems, such as age-related macular degeneration or diabetic retinopathy.

In most cases, waiting to have cataract surgery won't harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever.

When considering cataract surgery, keep these questions in mind:

• Can you see to safely do your job and to drive?
• Do you have problems reading or watching television?
• Is it difficult to cook, shop, do yardwork, climb stairs or take medicines?
• Do vision problems affect your level of independence?
• Do bright lights make it more difficult to see?

Risks

Complications after cataract surgery are uncommon, and most can be treated successfully.

Cataract surgery risks include:

• Swelling.
• Infection.
• Bleeding.
• Drooping eyelid.
• Artificial lens moving out of place.
• Retina moving out of place, called retinal detachment.
• Glaucoma.
• Secondary cataract.
• Loss of vision.

Your risk of complications is higher if you have another eye disease or a serious medical condition. Sometimes, cataract surgery doesn't improve vision because of underlying eye damage from other conditions. These may include glaucoma or macular degeneration. If possible, it is good to evaluate and treat other eye problems before deciding to have cataract surgery.

How you prepare

Food and medications

You may be instructed not to eat or drink anything 12 hours before cataract surgery. Your eye doctor also may advise you to stop taking any medicine that could increase your risk of bleeding during the procedure for a short time. Let your doctor know if you take any medicines for prostate problems, as some of these medicines can interfere with cataract surgery.

Antibiotic eye drops may be prescribed for use one or two days before the surgery.

Other precautions

You can typically go home on the same day as your surgery. However, you won't be able to drive, so arrange for a ride home. Also arrange for help around home, if necessary, because your eye doctor may limit activities, such as bending and lifting, for about a week after your surgery.

What you can expect

Before the procedure

A week or so before your surgery, your eye doctor performs a painless ultrasound test to measure the size and shape of your eye. This helps determine the right type of lens implant, called an intraocular lens, or IOL.

Nearly everyone who has cataract surgery will be given IOLs. These lenses improve your vision by focusing light on the back of your eye. You won't be able to see or feel the lens. It requires no care and becomes a permanent part of your eye.

A variety of IOLs are available. Before surgery, you and your eye doctor will discuss which type of IOL might work best for you and your lifestyle. Cost also may be a factor, as insurance companies may not pay for all types of lenses.

IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires several stitches to close.

However, many IOLs are flexible. This allows a smaller incision that requires few or no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.

Some of the types of lenses available include:

• Fixed-focus monofocal. This type of lens only helps to see far away. Reading glasses will generally be needed for reading.
• Accommodating-focus monofocal. This type of lens can respond to eye muscle movements and help to see near or far away.
• Multifocal. This type of lens has different areas that help to see near, medium and far away. These lenses are like glasses with bifocal or progressive lenses.
• Astigmatism correction, also called toric. If you have a significant astigmatism, a toric lens can help correct your vision.

Discuss the benefits and risks of the different types of IOLs with your eye surgeon to determine what's best for you.

During the procedure

Cataract surgery, usually an outpatient procedure, takes an hour or less to perform.

First, eye drops are placed in your eye to dilate your pupil. You'll receive medicines to numb the area. You also may be given a medicine to help you relax, called a sedative. If you're given a sedative, you may remain awake, but groggy, during surgery.

During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.

Surgical methods used to remove cataracts include:

• Using an ultrasound probe to break up the lens for removal, called phacoemulsification. During phacoemulsification (fak-o-e-mul-sih-fih-KAY-shun), your surgeon makes a tiny incision in the front of your eye, called the cornea. A needle-thin probe is then inserted into the lens where the cataract has formed.

  Your surgeon then uses the probe, which transmits ultrasound waves, to break up the cataract and suction out the fragments. The very back of your lens, called the lens capsule, is left intact to put the artificial lens in. Stitches may be used to close the tiny incision in your cornea once the procedure is done.

• Making an incision in the eye and removing the lens in one piece, called extracapsular cataract extraction. Extracapsular cataract extraction is used less frequently. This is because it requires a larger incision than that used for phacoemulsification. Through this larger incision your surgeon uses tools to remove the front capsule of the lens and the cloudy lens. The very back capsule of your lens is left in place to serve as a place for the artificial lens to rest.

  This procedure may be performed if you have certain eye complications. With the larger incision, stitches are required.

Once the cataract has been removed by either phacoemulsification or extracapsular extraction, the artificial lens is implanted into the empty lens capsule.

After the procedure

After cataract surgery, expect your vision to start getting better within a few days. Your vision may be blurry at first as your eye heals and adjusts.

A cataract is usually yellow- or brown-tinted before surgery. This causes colors to look dull. After your surgery, colors may seem brighter because you are looking through a new, clear lens.

You'll usually see your eye doctor a day or two after your surgery, the following week, and then again after about a month to monitor healing.

It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pushing on your eye.

Your eye doctor may ask you to wear an eye patch or protective shield the day of surgery and for a few days after. Your doctor also may recommend wearing the protective shield when you sleep during the recovery period.

You may be prescribed eye drops or other medicines to prevent infection, reduce swelling and control eye pressure. Sometimes, these medicines can be injected into the eye at the time of surgery.

After a couple of days, most of the discomfort should disappear. Often, complete healing happens within eight weeks.

Contact your doctor immediately if you experience any of the following:

• Vision loss.
• Pain that persists despite the use of nonprescription pain medicines.
• Increased eye redness.
• Eyelid swelling.
• Light flashes or multiple new spots, called floaters, in front of your eye.

Most people need glasses, at least some of the time, after cataract surgery. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for eyeglasses. This is usually between one and three months after surgery.

If you have cataracts in both eyes, your doctor usually schedules the second surgery after the first eye has healed.

Results

Cataract surgery restores vision in most people who have the procedure.

People who've had cataract surgery may develop a secondary cataract. The medical term for this common issue is known as posterior capsule opacification, also called PCO. This happens when the back of the lens capsule becomes cloudy and impairs your vision. The lens capsule is the part of the lens that wasn't removed during surgery and that now holds the lens implant.

PCO is treated with a painless, five-minute outpatient procedure. This procedure is called yttrium-aluminum-garnet, also called YAG, laser capsulotomy. In YAG laser capsulotomy, a laser beam is used to make a small opening in the clouded capsule. This opening gives light a clear path to pass through.

After the procedure, you usually stay in the doctor's office for about an hour to make sure your eye pressure doesn't rise. Other problems are rare but can include retinal detachment where the retina moves out of place.