Ophthalmology (Eye Diseases)
Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear. A cataract causes the lens to become cloudy, which eventually affects your vision.
Cataract surgery is performed on an outpatient basis by an eye doctor called an ophthalmologist, which means you don't have to stay in the hospital after the surgery. Cataract surgery can be done traditionally using ultrasound energy to remove the cloudy lens or it can be removed with laser-assisted technology. Cataract surgery is common and generally a safe procedure.
Why cataract surgery is done
Cataract surgery is performed 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 normal activities, your doctor 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 medications?
- Do vision problems affect your level of independence?
- Do bright lights make it more difficult to see?
To prepare for your cataract surgery, you may be asked to:
- Undergo tests.
A week or so before your surgery, your doctor performs a painless ultrasound test to measure the size and shape of your eye. This helps determine the right type of lens implant.
- Stop taking certain medications.
Your doctor may advise you to temporarily stop taking any medication that could increase your risk of bleeding during the procedure. Let your doctor know if you take any medications for prostate problems, as some of these drugs can interfere with cataract surgery.
- Use eyedrops to reduce infection risk.
Antibiotic eyedrops may be prescribed for use one or two days before the surgery.
- Fast before surgery.
You may be instructed not to eat or drink anything 12 hours before the procedure.
- Prepare for your recovery.
Normally you can go home on the same day as your surgery, but you won't be able to drive, so arrange for a ride home. Also arrange for help around home, if necessary, because your doctor may limit activities, such as bending and lifting, for about a week after your surgery.
What you can expect with cataract surgery
Before cataract surgery
Nearly everyone who has cataract surgery will be given an artificial lens called an intraocular lens. 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 intraocular lens with different features are available. Before surgery, you and your eye doctor will discuss which type of intraocular lens might work best for you and your lifestyle. Cost may also be a factor, as insurance companies may not pay for all types of lenses.
Intraocular lens are made of plastic, acrylic or silicone. Some block ultraviolet light. Some are rigid plastic and implanted through an incision that requires several stitches (sutures) to close.
However, many are flexible, allowing 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 intraocular lens unfolds, filling the empty capsule.
Some of the types of lenses available include:
- Fixed-focus monofocal
This type of lens has a single focus strength for distance vision. Reading will generally require the use of reading glasses.
- Accommodating-focus monofocal
Although these lenses only have a single focusing strength, they can respond to eye muscle movements and shift focus on to near or distant objects.
These lenses are similar to glasses with bifocal or progressive lenses. Different areas of the lens have different focusing strengths, allowing for near, medium and far vision.
- Astigmatism correction (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 cataract surgery
Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. First, your doctor will place eyedrops in your eye to dilate your pupil. You'll receive local anesthetics to numb the area, and you may be given a sedative to help you relax. 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.
After cataract surgery
After cataract surgery, expect your vision to begin improving within a few days. Your vision may be blurry at first as your eye heals and adjusts. Colors may seem brighter after your surgery because you are looking through a new, clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting the look of colors.
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 doctor may ask you to wear an eye patch or protective shield the day of surgery. Your doctor may also recommend wearing the eye patch for a few days after your surgery and the protective shield when you sleep during the recovery period.
Your doctor may prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure. Sometimes, steroid medications can be injected into the eye at the time of surgery to keep inflammation at bay.
After a couple of days, most of the discomfort should disappear. Often, complete healing occurs within eight weeks.
Contact your doctor immediately if you experience any of these symptoms:
- Vision loss
- Pain that persists despite the use of over-the-counter pain medications
- Increased eye redness
- Light flashes or multiple new spots (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.