Cataract surgery is a procedure to remove the lens of the eye, which in most cases is replaced by an intraocular lens. The lens of the eye is usually clear. Cataracts cause the lens to become cloudy and ultimately affect vision.
Cataract surgery is performed in an outpatient clinic by an ophthalmologist, which means there is no need to be hospitalized after surgery. Cataract surgery is very common and generally safe.
Reason for surgery
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Cataract surgery is an effective way to treat cataracts. Cataracts cause blurred vision and are prone to glare from light. If the cataract makes it difficult to perform normal activities, your doctor may recommend cataract surgery.
When cataracts interfere with the treatment of other eye conditions, patients may be advised to undergo cataract surgery. For example, if a cataract makes it difficult for an ophthalmologist to examine the fundus to monitor or treat other eye conditions, such as age-related macular degeneration or diabetic retinopathy, the doctor may recommend cataract surgery.
In most cases, waiting for cataract surgery won’t hurt the eye, so there’s time to consider which treatment option to take. If vision is still good, cataract surgery may not be needed for many years.
When considering cataract surgery, keep these questions in mind:
- Is it safe to work and drive?
- Have trouble reading or watching TV?
- Is it difficult to do sports such as cooking, shopping, doing housework, climbing stairs, or taking medicine?
- Can vision problems affect independence?
- Does light exposure affect vision?
Complications after cataract surgery are rare, and most can be successfully treated.
Risks of cataract surgery include:
- IOL dislocation
- retinal detachment
- secondary cataract
- loss of vision
Your risk of complications is higher if you have another eye disease or have a serious health problem. Sometimes cataract surgery does not improve vision due to damage to the eye from other underlying conditions, such as glaucoma or macular degeneration. If possible, it may be beneficial to evaluate and treat other eye problems before deciding to have cataract surgery.
what to do
diet and medication
Your doctor may ask you to avoid eating or drinking for 12 hours before cataract surgery. Your doctor may also recommend that you temporarily stop taking any medications that may increase your risk of intraoperative bleeding. Be sure to tell your doctor if you are taking medications for prostate disease, as some medications may interfere with cataract surgery.
Your doctor may prescribe antibiotic eye drops to use a day or two before surgery.
You will usually be able to go home on the day of surgery, but you will not be able to drive, so arrange for a vehicle to take you home. If necessary, help near home should also be arranged, as your doctor may restrict you from certain activities, such as bending and lifting, for about a week after surgery.
What you can expect
About a week before surgery, your doctor will do a painless ultrasound to measure the size and shape of your eye. This helps determine the appropriate type of lens implant (intraocular lens or IOL).
Almost all patients who have had cataract surgery will have an intraocular lens implanted. These lenses focus light on the back of the eye to improve vision. You cannot see or feel the lens. No care is required for the lens, it is a permanent part of your eye.
There are a variety of intraocular lenses (IOLs)available with different functions. Before surgery, you can discuss with your ophthalmologist which intraocular lens (IOL)is best for you and your lifestyle. Cost may also be a factor you need to consider, as insurance companies may not pay for all types of lenses.
Intraocular lenses are made of plastic, acrylic, or silicone. Some intraocular lenses can block UV rays. SomeIOLsare hard plastic and are inserted through an incision that requires several stitches (sutures) to be placed on the incision.
However, some intraocular lenses (IOLs)are flexible and can be implanted through a small incision, followed by a few stitches, and may or may not require sutures. The doctor folds this type of lens and inserts it into the empty capsule where the original natural lens was. Once inside the eye, the folded intraocular lens (IOL)unfolds, filling the empty capsule.
Available lens types include:
- Monofocal lens with fixed focus. This type of lens has only one focusing strength for far vision. Usually, you need to use reading glasses when reading.
- A monofocal lens with adjustable focus. Although these lenses have only one focusing strength, they can respond to eye muscle movements and shift focus to objects that are near or far away.
- Multifocal lens. These lenses are similar to glasses with bifocal or progressive lenses. Different areas of the lens have different focusing strengths, which are adapted to the near, mid, and far-fields of vision, respectively.
- Astigmatism-correcting (toric) lenses. If you have significant astigmatism, a toric lens can help correct your vision.
Discuss the benefits and risks of different types of intraocular lenses (IOLs) with your ophthalmologist to determine which type is best for you.
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Cataract surgery (usually an outpatient procedure) can be done in less than an hour.
First, your doctor will put eye drops in your eyes to dilate your pupils. Your doctor will give you local anesthesia to numb the area and may give you a sedative to help you relax. If you are sedated, you may stay awake during the procedure but feel drowsy.
During cataract surgery, the cloudy lens is removed and a clear artificial lens is usually implanted. However, in some cases, cataracts can be removed without implanting an intraocular lens.
Surgical methods used to remove cataracts include:
- Use an ultrasound probe to break up the lens for removal. During phacoemulsification surgery, the surgeon makes a small incision in the cornea of the eye (cornea) and inserts a fine needle-like needle into the lens where the cataract is formed.
- Your surgeon then uses a probe that emits ultrasound to break up (emulsification) the cataract and aspirate the debris. The backmost part of the lens (lens capsule) is left intact and can be used to place the artificial lens. After surgery, sutures are used to close the tiny incision in the cornea.
- An incision is made in the eye, and the lens is removed. This is a less commonly performed procedure called extracapsular cataract extraction, which requires an incision larger than that required for phacoemulsification. Through this larger incision, the surgeon uses surgical tools to remove the anterior capsule of the lens and the cloudy lens that makes up the cataract. The dorsal lens capsule is left in place and can be used to place the artificial lens.
- This procedure can be done if you have certain eye complications. In larger incisions, sutures are required.
After the cataract has been removed by phacoemulsification or extracapsular extraction, an artificial lens is implanted into the empty lens capsule.
After cataract surgery, expect your vision to start improving within a few days. Your vision may initially be blurred as your eyes heal and adjust.
After surgery, your vision may be brighter because you are seeing through your new clear lenses. Before cataract surgery, the lens is usually yellow or brown, making the color less obvious.
Typically, you will see your eye doctor a day or two after surgery and a week after surgery, and then again about a month later to monitor healing.
It is normal to experience itching and mild discomfort for a few days after surgery. Avoid rubbing or squeezing your eyes.
On the day of your surgery, your doctor may ask you to wear an eye patch or shield. Your doctor may also recommend wearing an eye patch for a few days after surgery, and a shield while you fall asleep during recovery.
Your doctor may prescribe eye drops or other medicines to prevent infection, reduce inflammation, and control eye pressure. Sometimes these drugs are injected into the eye during surgery.
After a few days, most discomfort goes away. Usually, complete healing occurs within eight weeks.
Contact your doctor right away if you experience any of the following:
- vision loss
- Pain that persists despite over-the-counter pain relievers
- Increased redness of the eyes
- swelling of the eyelids
- Flashes of light or multiple new spots (floaters)
After cataract surgery, most people will need to use glasses, at least some of the time. Your doctor will let you know when your eyes have recovered enough to wear glasses. This usually happens one to three months after surgery.
If you have cataracts in both eyes, your doctor will usually schedule surgery on the other eye after the first has healed.
Cataract surgery is successful in restoring vision for most patients who undergo it.
Patients who have had cataract surgery may develop secondary cataracts. The medical term for this common complication is posterior capsular opacity ( PCO for short ). This happens when the back of the lens capsule (the part of the lens that was not removed during surgery and now supports the lens implant) becomes cloudy and damages your vision.
Posterior capsular opacities are treated with a painless five-minute outpatient procedure called yttrium aluminum garnet ( YAG ) laser capsulotomy. In YAG laser capsulotomy, a laser beam is used to make a small incision in the cloudy capsule to provide a clear path for light to travel through.
After surgery, you will usually stay in your doctor’s office for an hour or so to make sure your eye pressure doesn’t rise. Other complications may include increased intraocular pressure and retinal detachment, but are rare.
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