Cataract Surgery

How cataract problem occurs?

Cataract occurs when the natural clear lens inside the eye, located behind the iris, becomes cloudy over time and the clouding of this lens during cataract formation distorts our vision. Cataracts are usually a very gradual process of normal ageing.

Who is the candidate for cataract surgery?

An eye specialist may mention during a routine eye exam that you have early cataract development even if you are not yet experiencing visual symptoms. Although your doctor will be able to tell when you first begin to develop cataract, you will generally be the first person to notice changes in your vision that may require cataract surgery. Clouding of the lens may start to be seen at any age, but it is uncommon before the age of 40. However, a large majority of people will not begin to have symptoms from their cataract until many years after they begin to develop. Cataract can be safely observed without treatment until you notice changes in your vision.

Surgery is recommended for most individuals who have vision loss and are symptomatic from a cataract. If you have significant eye disease unrelated to cataract that limits your vision, your doctor may not recommend surgery. Sometimes after trauma to the eye or previous eye surgery, a cataract may make it difficult for your doctor to see the retina at the back of the eye; in these cases, it may still be appropriate to remove the cataract so that further retinal or optic nerve evaluation and treatment can occur. The mode of surgery can be tailored to individuals based on coexisting medical problems. Cataract surgery is generally performed with minimal sedation and generally takes less than 30 minutes. Therefore the surgery does not put significant strain on the heart or the lungs.

What are the different types of cataract surgery?

Phacoemulsification: With the use of an operating microscope, your surgeon will make a very small incision in the surface of the eye in or near the cornea. A thin ultrasound probe, which is often confused for a laser, is inserted into the eye and uses ultrasonic vibrations to dissolve the clouded lens. These tiny fragmented pieces are then suctioned out through the same ultrasound probe. Once the cataract is removed, an artificial lens is placed into the thin capsular bag that the cataract occupied. This lens is essential to help your eye focus after surgery. In this most modern method, cataract surgery can usually be performed in less than 30 minutes and usually requires only minimal sedation and numbing eye drops, no stitches to close the wound, and no eye patch after surgery

Extra capsular cataract surgery: This procedure is used mainly for very advanced cataracts where the lens is too dense to dissolve into fragments. This technique requires a larger incision so that the cataract can be removed in one piece without being fragmented inside the eye. An artificial lens is placed in the same capsular bag as with the phacoemulsification technique. This surgical technique requires a various number of sutures to close the larger wound, and visual recovery is often slower. It usually requires an injection of numbing medication around the eye and an eye patch after surgery.

Intra capsular cataract surgery: This surgical technique requires an even larger wound than extra capsular surgery, and the surgeon removes the entire lens and the surrounding capsule together. This technique requires the intraocular lens to be placed in a different location, in front of the iris. This method is rarely used today but can be still be useful in cases of significant trauma.

What should one expect prior to and on the day of cataract surgery?

Prior to the day of surgery, your eye specialist will discuss the steps that will occur during surgery. You should discuss with your ophthalmologist which, if any, of your routine medications you should avoid prior to surgery. Prior to surgery, several calculations will be made to determine the appropriate power of intraocular lens to implant. A specific artificial lens is chosen based on the length of the eye and corneal curvature (the clear portion of the front of the eye).

It is important to remember to follow all of your preoperative instructions, which will usually include not eating or drinking anything after midnight the day prior to your surgery. Mostly cataract surgery is done with only minimal anesthesia and numbing drops without having to put you to sleep. While cataract surgery does not involve a significant amount of pain, medications are used to minimize the amount of discomfort. The actual removal of the clouded lens will take approximately 20 minutes. You may notice the sensation of pressure from the various instruments used during the procedure. After leaving the operating room, you will be brought to a recovery room where your doctor will prescribe several eye drops that you will need to take for a few weeks postoperatively. While you may notice some discomfort, most patients do not experience significant pain following surgery.

What should one expect after the cataract surgery?

Following surgery, you will need to return for visits within the first few days and again within the first few weeks after surgery. During this time period, you will be using several eye drops which help protect against infection and inflammation. Within several days, most people notice that their vision is improving and that they are able to return to work. During the several office visits that follow, your doctor will monitor for complications, and once vision has stabilized, he will fit you with glasses if needed. The type of intraocular lens you have implanted will determine to some extent the type of glasses required for optimal vision.

What are the potential complications of cataract surgery?

While cataract surgery is one of the safest procedures available with a high rate of success, rare complications can arise. The most common difficulties arising after surgery are persistent inflammation, changes in eye pressure, infection, or swelling of the retina at the back of the eye, and retinal detachment. If the delicate bag the lens sits in is injured, then the artificial lens may need to be placed in a different location. In some cases, the intraocular lens moves or does not function properly and may need to be repositioned, exchanged, or removed. All of these complications are extremely rare but can lead to significant visual loss; thus, close follow-up is required after surgery.

In some cases, within months to years after surgery, the thin lens capsule may become cloudy, and you may have the sensation that the cataract is returning because your vision is becoming blurry again. This process is termed posterior capsule opacification, or a "secondary cataract." To restore vision, a laser is used in the hospital to painlessly create a hole in the cloudy bag. This procedure takes only a few minutes , and vision usually improves rapidly.