Cataract Surgery

Overview

Cataract surgery is a procedure to take out a cataract from the eye (cloudy lens). The eye consists of a lens that focuses on the light, just like a camera. Usually, this lens is clear. A cataract thus occurs when the lens becomes hazy. In such cases, the ophthalmologist will recommend cataract surgery to remove and replace with a clear artificial lens, which restores your eyesight.

Light flows through the eye's clear lens during vision. The lens concentrates light to enable your brain and eye to convert the data into an image. If the lens becomes foggy, the eye loses its ability to concentrate light. Hence, you may have hazy vision or other symptoms such as glare and halos when exposed to bright lights.

What is a Cataract Surgery?

Cataract surgery is a surgical operation that removes your eye's lens and, in most circumstances, replaces it with an artificial lens. Normally, your eye's lens is clear. A cataract causes the lens to become clouded, affecting your vision. Cataract surgery is performed on an outpatient basis by an eye doctor (ophthalmologist), which means you do not need to stay in the hospital following the procedure. Cataract surgery is a routine and relatively safe treatment.

To correct cataracts, cataract surgery is performed. Cataracts can cause impaired vision and increase light glare. If a cataract interferes with your daily activities, your doctor may recommend cataract surgery. Cataract surgery may be suggested if a cataract interferes with the treatment of another eye disease. For example, if a cataract makes it difficult for your eye doctor to inspect the back of your eye to monitor or treat other visual disorders, such as age-related macular degeneration or diabetic retinopathy, doctors may prescribe cataract surgery.

In most circumstances, delaying cataract surgery will not hurt your eye, giving you more time to examine your alternatives. If you have good eyesight, you may not require cataract surgery for many years, if ever.

Why you need a Cataract Surgery?

The risks of developing eye cataracts increase as one ages and can slowly aggravate with time. The initial stages of changes in the lens do not usually lead to major visual impairment. Furthermore, they don’t need any surgical procedures.

If cataracts start to affect your eyesight, then the eye doctor will suggest a surgical procedure. Also, experiencing difficulties with daily activities, including reading, driving, and seeing under bright light, could indicate that you require surgery.

Examples of the common ways that cataracts might affect your vision are;

Night vision impairment
Blurry vision
Colors that look faded
Halos around the lights
Bright lights and glare sensitivity
Double vision

Sometimes, cataracts are present at birth (congenital). These congenital cataracts are usually the main cause of blindness among children. Fortunately, they have a positive result if the cataract surgery is done earlier before the child turns six weeks old.

Who might benefit from cataract surgery?

If you suffer vision loss that interferes with daily activities such as reading, driving, or watching TV, your doctor will most likely recommend cataract surgery. Even if cataracts aren't the primary cause of your visual issues, your doctor may propose cataract surgery. Cataracts, for example, may need to be removed so that your doctor can view the back of your eye. If you have another eye issue, such as diabetic retinopathy or age-related macular degeneration (AMD), your doctor will need to examine the back of your eye to assist you in managing it. Cataracts are not a medical emergency, and you do not need to have surgery to remove them right now. To determine whether cataract surgery is best for you, speak with your doctor about the risks and benefits.

Types of Cataract Surgery

The present types of cataract surgery include lens replacement with a transplant known as an intraocular lens. The most prevalent cataract surgical techniques that ophthalmologists often recommend include the following;

Phacoemulsification

This procedure involves the creation of incisions (2-3 millimeters long) at the front part of the eye for the ultrasonic probe. The probe uses vibration to break up the cataract and suction to eliminate the fragments. Through the incision, the physician will insert a foldable lens. This method leaves a tiny wound that normally heals without the need for stitches.

Manual extracapsular cataract surgery (MECS)

The doctor will remove the lens and replace it with a new IOL through a relatively big incision (about 9 and 13 millimeters long) during MECS. Because of the bigger incision, this method has a greater risk of problems than phacoemulsification.

Manual small incision cataract surgery (MSICS)

The MSICS method is a version of the MECS procedure. It entails a small V-shaped cut on the outer part of the eye and a broader incision on the inside. The external incision is around 6.5 mm to 7 mm in length, and the inside incision is up to 11 mm long.

Intracapsular cataract surgery

This type of cataract surgery is a more traditional approach in which the whole lens and lens capsule are removed from the eye via a big incision. Because of the considerable risk of complications, it is rarely recommended.

Femtosecond laser-assisted cataract surgery (FLACS)

Rather than a manual incision, the surgeon can use a laser to create an incision in the eye during the FLACS. In addition, because the laser divides and makes the cataract soft, less phacoemulsification energy is required to eliminate it. This can speed up the healing process.

Preparing for Cataract Surgery

A few days before the procedure for cataract surgery, the eye physician will conduct an ultrasound and eye measurements. The aim of this is to know the exact shape and size of the eye and determine the most suitable type of surgery.

The doctor will as well inquire about the medications you are currently using. Depending on your condition, they might recommend using medicated eye drops before undergoing the treatment. Your provider can also instruct you not to consume any solid meals at least six hours before the operation. Furthermore, you should not drink alcohol within 24 hours of surgery.

Generally, cataract surgery is a simple outpatient procedure that is mostly performed in a hospital or eye clinic. This means that you won’t have to spend the night in the hospital after treatment. Nonetheless, you should have someone to drive you back home after the procedure.

Before the Operation

Your doctor will do a painless ultrasound test to measure the size and shape of your eye about a week before surgery. This aids in determining the best type of lens implant (intraocular lens, or IOL). IOLs will be provided to nearly everyone who gets cataract surgery. By focusing light on the back of your eye, these glasses improve your eyesight. The lens will be invisible to you. It takes no maintenance and becomes an indelible part of your vision.

There are several IOLs with distinct characteristics available. You and your eye doctor will discuss which type of IOL is ideal for you and your lifestyle before surgery. Cost is another consideration, as insurance companies may not cover all types of lenses. Plastic, acrylic, or silicone are used to make IOLs. Some IOLs are designed to block UV light. Some IOLs are made of stiff plastic and are implanted through an incision that must be closed with multiple stitches (sutures). Many IOLs, on the other hand, are flexible, allowing for a smaller incision with few or no stitches. This sort of lens is folded and inserted into the empty capsule where the natural lens used to be. The folded IOL unfolds within the eye, filling the empty capsule.

Among the various types of lenses available are:

Monofocal with fixed focus. For distant vision, this lens offers a single focus strength. Reading glasses are usually required for reading.
Monofocal with accommodating focus. Despite having just one focusing strength, these lenses can adapt to eye muscle movements and alter focus to close or distant objects.
Multifocal. These lenses are similar to bifocal or progressive lenses in spectacles. The lens has varying focusing powers in different locations, allowing for close, mid, and distance vision.
Correction of astigmatism (toric). A toric lens might help correct your vision if you have substantial astigmatism.

Discuss the advantages and disadvantages of the various types of IOLs with your eye surgeon to determine which is best for you.

What Happens During Cataract Surgery?

To dilate the pupil, the eye doctor will first put eye drops in the eye. You will also be given local anesthetics to help numb the surgical area and prevent pain. Alternatively, you may receive a sedative to make you relax during the cataract surgery. Sedatives will make you awake but sleepy during surgery.

The clouded lens is removed during the procedure, while a clear prosthetic lens is normally put in its place. However, in certain circumstances, a cataract can be eliminated without the use of an artificial lens.

Cataract removal surgery procedures include:

Using an ultrasonic probe to break up the lens in preparation for removal. Your surgeon will create a tiny incision in the front of your eye (cornea) and introduce a needle-thin probe into the lens material where the cataract has developed during phacoemulsification . The probe, which transmits ultrasonic waves, is then used by the surgeon to break apart (emulsify) the cataract and suck away the fragments. The lens capsule (the very rear of your lens) is kept intact to serve as a resting place for the artificial lens. At the end of the process, stitches may be utilized to seal the small incision in your cornea.
Making an incision in the eye and removing the lens whole. Extracapsular cataract extraction, a less common treatment, necessitates a bigger incision than phacoemulsification. Through this wider incision, your surgeon will use surgical instruments to remove the front capsule of the lens as well as the hazy lens that is the cause of the cataract. The very rear capsule of your lens is left in situ to act as a resting spot for the artificial lens. If you have specific eye issues, this treatment may be performed. Stitches are necessary for the bigger incision.

The prosthetic lens is implanted into the empty lens capsule after the cataract has been removed through phacoemulsification or extracapsular extraction.

What to Expect After Cataract Surgery?

Your eye might feel sore or itch for a few days following cataract surgery. You may as well experience tearing and even find it difficult to see clearly under bright light during this recovery period.

To avoid infections, your eye doctor will prescribe eye drops. For the first few days, you will need to relax. Driving will be prohibited, and you should avoid bending over, lifting heavy objects, or applying any pressure to the eye.

The doctor will most likely recommend that you sleep with eye protection for the first week. This is to shield the surgical area, allowing your eye to recover. Let your doctor know right away if you feel any discomfort or think your eye is not healing properly.

Your eye should completely recover after eight weeks. Following cataract surgery, around 90 percent of individuals notice a significant improvement in their vision. However, do not expect that your vision will be flawless. You may still have to wear glasses or contacts.

Most of the soreness should go away within a few days. Typically, total recovery takes eight weeks. If you suffer any of the following symptoms, contact your doctor right away:

Loss of vision
Pain that continues after the use of over-the-counter pain relievers
increased redness of the eyes
puffiness of the eyelids
Flashes of light or the appearance of many new spots (floaters) in front of your eye

After cataract surgery, the majority of individuals use glasses at least a portion of the time. When your eyes have recovered sufficiently for you to receive a final prescription for eyeglasses, your doctor will notify you. This normally occurs one to three months following surgery.

If you have cataracts in both eyes, the second operation is normally scheduled after the first has healed.

Cataract Surgery Results

Most individuals who undergo cataract surgery usually have their vision restored effectively. However, a secondary cataract can develop in people who have already had cataract surgery. Posterior capsule opacification (PCO) is the medical term for this prevalent condition.

This condition occurs if the rear of the lens capsule, the lens region that was not taken out during surgery and now sustains the lens implant, gets hazy and causes visual problems. Five minutes of a painless outpatient technique known as yttrium-aluminum-garnet (YAG) laser capsulotomy is used to treat PCO. A laser beam is utilized in YAG laser capsulotomy to make a minute opening within the clouded capsule to give a clear channel for the light to pass through.

After the surgery, you should expect to spend around an hour in the physician's office to ensure that your eye pressure does not elevate. Other concerns are increased pressure of the eye and retinal detachment, both of which are uncommon.

Potential Risks and Complications of Cataract Surgery

While cataract surgery is usually safe, it does come with a few dangers, as with any other surgical procedure. These risks and complications might include the following;

Cloudiness in the eye after cataract surgery: A cloudy vision after cataract surgery (PCO) might occur at the back of the implant in about 5 to 50% of the cases. A YAG laser capsulotomy, which is performed in the office, can be used to treat this issue in about five minutes.
Blurry vision after cataract surgery: A short while after cataract surgery, some blurriness is likely to occur. It normally clears up in a few days, although it could take a little longer in certain cases.
Floaters in the eye after cataract surgery: Floaters are like dust grains that normally follow the vision line. Floaters after cataract surgery may not need any treatment in certain circumstances. However, they can be a symptom of a retinal tear.
Pain in the eye after cataract surgery: Severe discomfort could indicate an infection or any other problems. You should thus speak with your eye doctor to determine the best course of action.
Double vision following cataract surgery: Usually, double vision after cataract surgery can occur due to a variety of factors. However, it is most commonly because of the brain becoming accustomed to its new sight acuity. Double vision will most likely disappear within a few days.
Dryness of the eye after cataract surgery: You may experience gritty or dry eye after cataract surgery. Eye drops are frequently used to treat this.
Infection: Endophthalmitis is a common infection of the inner eye fluids. Only 0.05 to 0.30% of cataract procedures are thought to develop this condition.
Allergic reaction to anesthesia: There's a chance you'll develop an allergic reaction if you're given an anesthetic or sedative. Serious responses are quite uncommon.

Conclusion

Cataract surgery is a frequent eye operation that removes a cloudy lens causing visual problems. Cataracts are not a life-threatening medical issue; hence you can schedule the treatment whenever you like.

The procedure is quick and painless, and it has a high success rate. Cataract surgical complications are uncommon. Follow the doctor's recommendations for eye care after cataract surgery, which may include the use of special eye drops. The surgery might take about eight weeks to recover completely. You will notice that your eyesight is a lot clearer, and you'll be able to resume other fun activities.