Cataract Removal Surgery

"Cataracts are a leading cause of blindness among adults in the United States, accounting for one out of every seven cases of blindness in people age 45 and older. Although most prevalent in adults, a cataract can occur in young people, and can sometimes be found in a baby's eyes at birth." - Prevent Blindness America

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Lasers are never used to remove the original cataract. The YAG laser is used to remove what is called a after-cataract that will blur vision much as the original cataract did. The YAG laser makes a small opening in the cloudy membrane behind the lens implant. This requires 2 minutes and usually results in immediate vision improvement.

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TYPES OF CATARACT TREATMENT

Cataracts cannot be removed with a laser, only through a surgical incision. There are laser devices for cataract removal under investigation, but none are approved by the Food and Drug Administration.

In cataract surgery, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.

Nearly all cataracts today are removed by extracapsular surgery, in which the posterior capsule of the natural lens is left in place to support the plastic replacement lens which is implanted at the time of surgery.

Both "one-stitch" and "no-stitch" surgery are just variants of phacoemulsification. The incision used in the surgery may be placed in one of several locations and the architecture of the incision may vary as well. The same incision may be "no-stitch" if the incision is watertight following surgery, or "one-stitch" if it is not, and requires a stitch to make it so.

Non-Surgical Cataract Treatment

There is no nonsurgical treatment for a cataract. Preventative measures include wearing good ultraviolet (UV) blocking sunglasses to protect your eyes from the sun. Anti-oxidant vitamins may retard cataract changes. Smoking accelerates cataract development and should be avoided. Some improvement with glasses is possible until the cataract becomes severe. Routine eye exams are important in watching for cataract formation that may be the result of medicines or general illnesses.

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Before surgery

A week or two before surgery, your eye care professional will do some tests. These may include tests to measure the curve of the cornea and the size and shape of the eye.

For patients who will receive an Interocular implant (IOL), this information helps your doctor choose the right type of IOL. Also, doctors may ask you not to eat or drink anything after midnight the morning of your surgery.

If surgery is recommended on both eyes, your surgeon may perform the procedure one day apart depending on your situation.

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During surgery

It's probably not absolutely necessary someone accompany you on the day of surgery, but advisable that you bring someone along to drive you home. It is not recommended that you drive yourself home. Although some patients who see well out of their other eye and have not had any medication may drive.

When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. Your surgeon most likely will use a topical anesthesia in the form of eye drops. The area around your eye will be washed and cleansed.

The operation usually lasts less than 1 hour and is almost painless. Many people choose to stay awake during surgery, while others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch will be placed over your eye and you will rest for a while. You will be watched by your medical team to see if there are any problems, such as bleeding. Most people who have cataract surgery can go home the same day. Since you will not be able to drive, make sure you make arrangements for a ride.

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Recovery

After surgery people usually go home and rest for the remainder of the day. The first day after surgery your doctor may perform a brief post-operative evaluation. Most patients' vision is quite blurred after the surgery from the dilating drops and the bright microscope lights.

Eye drops are used to promote healing and control the pressure in your eye. Remember to ask your surgeon how to use your medications, when to take them and what effects they can have. The eye must be kept clean and protected from injury. The eye drops often sting a little for most patients. You should continue to use your eye drops as prescribed.

However, if your discomfort seems to be worsening, or you experience a decrease in vision, call your doctor A burning sensation may actually be dry eyes, epiphora. (epiphora: The watery eye; a disease in which the tears accumulate in the eye, and trickle over the cheek.)

For one week a shield is worn over your eye at night to protect it. Avoid rubbing or pressing on your eye. You may usually resume normal activities including work, shopping, driving, hobbies, gardening, and most athletic activities immediately. Activities or athletics requiring excessive strain should be done with care.

Your vision may be quite good immediately or may require a week to clear. What glasses you may need are prescribed two weeks after surgery used for the original cataract surgery. It's normal to feel itching and mild discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch.

If you have discomfort, your eye care professional may suggest a pain reliever every 4-6 hours. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about 6 weeks. When you are home, try not to bend or lift heavy objects. Bending increases pressure in the eye. You can walk, climb stairs, and do light household chores.

Some patients do not need glasses at all after cataract surgery. The process of cataract removal and lens implantation is intended to restore your focus to normal, minimizing your dependence on glasses. Most people need some form of glasses, if only to read. Your ophthalmologist or referring optometrist will help you with these needs a month or more after surgery.

Success Rates

It is estimated that you have a 97-98% chance of an excellent surgical result and a 1% chance of achieving no improvement and/or worse vision.

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"LASIK" is an acronym for LASer In-situ Keratomileusis, which simply means, "to shape the cornea from within using a laser." Its "cool" or non-thermal light beam corrects vision by reshaping the cornea (outer window of the eye) so that light rays focus more precisely on the retina, thereby eliminating or reducing refractive errors and the need for glasses or contacts.

Since the LASIK procedure is performed on the surface of the cornea, (see diagram, below) and with cataract surgery, the lens implant is placed through the pupil, behind the colored iris, neither area is negatively affected by the other surgery.

In other words, should you have LASIK now to reshape the front of your cornea and have cataract surgery in, say 15+ years; the cataract will be removed and a new lens implant will be inserted behind the iris and won't adversely affect the positive results achieved with your prior LASIK surgery.

If you had cataract surgery, say 15 years ago, and you require LASIK to improve your myopia (nearsightedness), hyperopia (farsightedness) or astigmatism, the LASIK procedure would reshape the front of your cornea and would not adversely affect the positive results achieved with your prior cataract removal and lens implant surgery. Read more about LASIK.