Cataracts

A cataract occurs when the normally clear lens in your eye becomes cloudy, often impairing vision. Clouded vision may make it more difficult for you to read, drive a car or see as clearly as you once did.

For most people cataracts, which develop slowly over time, are a natural result of aging. About half of Americans between the ages of 65 and 75 have cataracts to some degree.

The key to living with cataracts is knowing when it’s time not to live with them anymore. Usually, this happens when your normal lifestyle — reading the morning paper, driving to the grocery store or seeing the expression on the face of a child or grandchild — is jeopardized by impaired vision. Fortunately, advanced surgical methods make cataract surgery one of the most successful surgical procedures performed today.

Signs and Symptoms

Signs and symptoms of cataracts may include:

  • Blurry or dim vision
  • Poor night vision
  • Halos around lights
  • Sensitivity to light and glare
  • Need for brighter light for reading and other activities
  • Frequent changes in eyeglass prescription

Treatment

Surgery is the most effective treatment for cataracts. More than 95 percent of the people who have cataract removal end up with better vision.

Using microsurgery and local anesthesia, an eye surgeon (ophthalmologist) removes the cataract, leaving much of your eye’s natural lens capsule in place. The capsule helps support the clear artificial lens that the surgeon inserts to replace the cloudy lens. The procedure is usually done on an outpatient basis and takes less than 20 minutes. If both eyes are affected, surgery is usually performed on one eye at a time, allowing the first eye to heal before surgery is done on the second one.

How long will the surgery take?

The procedures are typically performed in an outpatient surgical facility. You will arrive at the surgery center about an hour before the procedure. A number of topical drops will be placed in your eye and IV medications may be administered to help you relax. The eye drops anesthetize your eye and dilate your pupil.

Once in surgery, you will lie down, a microscope will be positioned over your eye and you will be asked to look up into the light of the microscope.

The actual surgery usually takes less than 20 minutes. Your surgeon will stabilize your eye with a device to keep your eyelids open. You will feel no pain, only slight pressure on your eye. Upon completion, additional drops will be placed in your eye to prevent infection, decrease inflammation, and keep your pupil dilated. A patch may be placed over your eye and someone will need to drive you home. When you are at home, you should rest for the remainder of the day. You should avoid any strenuous activities. We will see you the day after surgery to remove the eye patch and examine your eye. Do not rub your eye.

You will be given additional medications that you will need to put in your eye for the next week or two. These drugs help the eye heal leaving no residual effects.

What are the chances that something could go wrong with the surgery? What would they be?

The contemporary treatment for cataracts is to remove the crystalline lens and replace it with an artificial lens. 

The medical procedure to implant an intraocular lens is the same safe, proven cataract surgery performed annually on over 7 million eyes globally. Over 40 million procedures have been done in the last 25 years. It is important to note, like any surgery, it is not completely risk-free.

When will I be able to return to normal activities?

You will be able to return to normal activities within several days after implantation with some limitations. Your eye may be sensitive to touch and bright light, but you should be able to drive and return to work in two to three days.

Your doctor will provide you with medications to prevent infection and decrease inflammation, and may provide a protective shield to cover your eye while sleeping. A pair of plastic, disposable sunglasses will decrease your sensitivity to light as well as providing protection during the day.

It is important that you avoid heavy lifting or straining that would increase the pressure in your eye for several days after surgery. You also must avoid rubbing or pushing on your eye. You should refrain from activities that could increase your chances of getting hit in the eye. Wear your protective sunglasses when outdoors.

You can shower and wash your hair as long as you avoid getting soap or shampoo in your eye. Refrain from using eye makeup, lid liner and mascara for several weeks after implantation. You should avoid public swimming pools, hot tubs or other sources of bacterial contamination for several weeks.

Consult your surgeon on recommendations for specific activities.

How often do I need to have my eyes checked after surgery?

Typically, we will see you one day after surgery, after 2 to 4 weeks, and again around 3 to 6 months after surgery. Thereafter, an annual exam is usually sufficient unless you have a specific problem.

Will I have to have cataract surgery again?

Once your cataracts are removed and replaced with an artificial lens, you will never have to have cataract surgery again. Occasionally, several months after the lens has been placed in the eye, the vision may start to become cloudy once again. This is sometimes called a secondary cataract and refers to the clouding of the membrane that surrounds the implant.

This membrane (the capsular bag) originally surrounded the human lens. When the cataract was removed, all that remained was this membrane into which the artificial lens was implanted. The membrane healed around the artificial lens, securely holding it in place in the eye. Unfortunately, sometimes the same conditions that caused the original cataract will cause the build up of cells on the membrane behind the implant. These cells will block the vision and have to be removed.

A laser is used to make an opening in the membrane behind the implant, immediately improving vision. This is done painlessly without an anesthetic and takes just a few minutes. Once this is done no further surgery related to your cataracts will be required.

What happens if my eye is injured sometime in the future?

Eye injury can involve many different parts of the eye. The clear front part of the eye, the cornea, and the back part of the eye, the retina, are most often affected by injury.

The presence of an artificial lens does not make the eye any more vulnerable to trauma. Indeed, once the human lens has been replaced, eye trauma would not cause a cataract.

What about future eye surgery?

Since the implant is fixed in the same position as the original lens, any future eye surgery that could be performed in or around the normal eye can be performed in an eye with an intraocular lens.

I have dry eyes. Will lens implantation help this condition or will I still have to use artificial tears?

Implant surgery typically will have very little influence on chronic dry eyes. This condition is related to a variety of internal and external medical conditions and is sometime associated with aging. You should consult your surgeon on a therapy that is most suited to the cause and severity of your condition as well as your lifestyle.

Will cataract surgery influence chronic red and irritated eyes or headaches from eyestrain?

If eye irritation is a result of excessive contact lens wear, sensitivity to cleaning and storage solutions, or what is generally described as ‘eye strain’, implant surgery may reduce or eliminate these symptoms. Eye irritation can be caused by a wide variety of internal and external factors including allergies that have nothing to do with the lens implant.

The most common surgical method:

Phacoemulsification (FAY-co-ee-mul-sih-fih-CAY-shun). This method, often called “phaco,” is the most common cataract surgery in the United States. An eye surgeon uses a special instrument to break up the cataract with ultrasound waves and then vacuums out the emulsified pieces. Phacoemulsification requires only a small eye incision — about 1/8 inch (3 millimeters).

Once the cataract is out, an eye surgeon inserts an artificial lens implant that has been corrected to meet your eye’s specific needs. The surgeon folds the flexible implant lens to insert it, and once in place the lens opens to about 1/4 inch (6 millimeters). In most cases of cataract surgery, no sutures are necessary.

Initially, your eye may have mild inflammation and irritation and may feel a little scratchy for a couple of days. Return visits to the doctor usually are set up for the day after and then several times during the next 4 to 6 weeks.

Although cataract surgery is generally successful, complications such as bleeding, swelling, inflammation, infection or retinal detachment can occur. Contact your doctor immediately if you experience any of the following after cataract surgery:

  • Loss of vision
  • Pain that persists despite the use of over-the-counter pain medication
  • Significant increase in eye redness
  • Light flashes or multiple new spots before your eye
  • Nausea, vomiting or excessive coughing