Cataract surgery

During cataract surgery, an eye doctor (ophthalmologist) removes the clouded lens from your eye and, generally, replaces the lens with an artificial lens. Cataract surgery is very successful in restoring vision — more than 95 percent of people who have a cataract removed have no complications and enjoy improved vision.

When is the best time for cataract surgery?

The decision to have cataract surgery is one that you and your eye doctor should make together. You'll probably have plenty of time to consider and discuss your options. In most cases, waiting to have surgery won't harm your eye. If your vision is still quite good, you may not need cataract surgery for many years, if ever. In younger people or people with diabetes, however, cataracts may progress rapidly, making the need for surgery more immediate.

Base your decision on the degree of vision loss and how much the cataract affects your daily life. Can you see to do your job and drive safely? Do you have problems reading or watching television? Is it difficult to cook, to shop, do yardwork, climb stairs or take medications? How active are you? Do vision problems affect your level of independence?

The answers to these questions are different for each person. An older person who isn't very active may have less need for sharp vision than does a younger person who needs to drive a car and earn a living. Some people with only minor vision loss from a cataract might want surgery because of problems with glare or double vision. Sometimes a cataract should be removed even if it doesn't cause major problems with vision — for example, if it's interfering with the treatment of another eye problem, such as age-related macular degeneration, diabetic retinopathy or retinal detachment.

If you have cataracts in both eyes and decide to have surgery, your ophthalmologist typically schedules two separate surgeries. This allows time for the first eye to heal before the second eye surgery takes place.

What happens during cataract surgery?

Typically, two things happen during cataract surgery — the clouded lens is removed, and a clear artificial lens is implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.

Before surgery, your eye doctor measures the size and shape of your eye to determine the proper power of the lens implant. The measurements are made with a painless ultrasound test. Cataract surgery is typically an outpatient procedure that takes less than an hour. Most people are awake and need only local anesthesia. On rare occasions some people may need general anesthesia.

Surgical methods used to remove cataracts include:

• Phacoemulsification (fak-o-e-mul-sih-fih-KA-shun). During this procedure, your surgeon removes the cataract but leaves most of the outer layer (lens capsule) in place.

  During phacoemulsification, your surgeon makes a small incision — about 1/8 inch or 3 millimeters (mm) long — where the cornea meets the conjunctiva and inserts a needle-thin probe. The surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The lens capsule remains in place to provide support for the lens implant.

• Extracapsular cataract extraction. If your cataract has advanced to the point where phacoemulsification can't break up the clouded lens, your surgeon may do an extracapsular cataract extraction. This procedure requires a larger incision, about 3/8 of an inch (10 mm), where the cornea and sclera meet. Through this incision your surgeon opens the lens capsule, removes the nucleus in one piece and vacuums out the softer lens cortex, leaving the capsule in place.

Once the cataract has been removed by either phacoemulsification or extracapsular extraction, a clear artificial lens is implanted into the empty lens capsule. This implant, known as an intraocular lens (IOL), is made of plastic, acrylic or silicone. It requires no care and becomes a permanent part of your eye. You'll likely need reading glasses after cataract surgery.

Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires no stitches. The surgeon can fold this type of lens and insert it into the empty capsule where the natural lens used to be. Once in place the lens unfolds to about 1/4 inch (6 mm) in diameter.

Recent advances in IOLs include lenses that filter out ultraviolet light — also known as blue-blocking lenses. Other types of IOLs provide multifocal vision — being able to see things both near and at a distance. Multifocal lenses offer reasonably good near and distance vision. However, vision at the intermediate range is sometimes less than satisfactory. Glare is reportedly a problem with multifocal lenses, but design improvements are ongoing.

Anatomy of the eye

Anatomy of the eye

Your eye is a complex, compact structure measuring about 1 inch in diameter. In an instant, it can receive millions of pieces of information about the outside world, which are quickly processed by your brain.

Close

Cataract surgery

Cataract surgery

During phacoemulsification — the most common type of cataract surgery — the rapidly vibrating tip of the ultrasound probe breaks up the cataract, which your surgeon then suctions out (top). After removing the cataract, your surgeon inserts the lens implant into the empty capsule where the natural lens used to be (bottom).

Close

After cataract surgery

With phacoemulsification and foldable lens implants, surgical incisions are very small, and no sutures are required. If all goes well, you'll heal fast and your vision will start to improve within a few days. If your surgery requires a larger incision and sutures, full healing can take up to eight weeks.

Normally you can go home on the same day of your surgery, but you won't be able to drive, so make sure to arrange for a ride home. It's also a good idea to make sure you have necessary help because your doctor may limit activities such as bending and lifting for a few days. You'll typically see your eye doctor the next day, the following week and then again after a month so that he or she can check the healing progress.

It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pressing on your eye. Clean your eyelids with tissue or cotton balls to remove any crusty discharge. You may wear an eye patch or protective shield the day of surgery. Your doctor may prescribe medications to prevent infection and control eye pressure. After a couple of days, all discomfort should disappear. Often, complete healing occurs within eight weeks.

Contact your doctor immediately if you experience any of the following signs or symptoms after cataract surgery:

• Vision loss
• Pain that persists despite the use of over-the-counter pain medications
• Increased eye redness
• Light flashes or multiple spots (floaters) in front of your eye
• Nausea, vomiting or excessive coughing

Most people need to wear glasses after cataract surgery. Astigmatism — a focusing problem that occurs when your cornea isn't curved evenly in all directions — is a common result of the surgery but is less of a problem when the procedure involves a small incision. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for eyeglasses.

If you have cataracts in both eyes, your doctor will treat one eye at a time, and it's usually a month or two before you can schedule surgery for the other eye.

Risks of cataract surgery

Complications after cataract surgery are relatively rare, and most can be treated successfully. They include inflammation, infection, bleeding, swelling, retinal detachment and glaucoma. The risks are greater for people who have other eye diseases or serious medical problems. Occasionally cataract surgery fails to improve vision because of underlying eye damage from conditions such as glaucoma or macular degeneration. It's important to evaluate and treat such eye problems, if possible, before making the decision to proceed with cataract surgery.

The second cataract

You may have heard of a second cataract, or aftercataract. This condition occurs when the back of the lens capsule — the part of the lens that wasn't removed during surgery and that now supports the lens implant — becomes cloudy and impairs your vision. Another term for this condition is posterior capsule opacification (PCO). PCO can develop months or years after cataract surgery. It happens about 25 percent of the time. The gradual clouding is the result of cell growth on the back of the capsule.

Treatment for PCO is simple and quick. It involves a technique called YAG laser capsulotomy, in which a laser beam is used to make a small opening in the clouded capsule to let light pass through. "Capsulotomy" means "cutting into the capsule," and YAG laser is an abbreviation of yttrium-aluminum-garnet laser, the type of laser used for the procedure.

Laser capsulotomy is a short, painless outpatient procedure that usually takes less than five minutes. Afterward, you typically stay in the doctor's office for about an hour to make sure your eye pressure doesn't increase. In some people, particularly those who have glaucoma or are extremely nearsighted, YAG laser surgery can raise eye pressure. Other complications are rare but can include swelling of the macula and retinal detachment.