Cataracts & Cataract Surgery

What is a Cataract?

The eye functions like a camera. There is a lens inside the eye. When we are young, the lens is clear and works to focus light on the retina. A clear lens lets light pass without degrading the image. This allows for clear, sharp vision.

As we get older, the lens slowly becomes cloudy. A cloudy natural lens is called a cataract. When images pass through this cloudy lens, the images are degraded and cause blurry vision or reversible vision loss.

In the clinic, we use the example of the headlights on a new car being clear, whereas the headlights on an older car becomes cloudy over time. Many patients ask if a cataract is a film over the eye. It is not a film over the eye.

There are different types of cataracts, including nuclear cataracts (the most common type), subcapsular, polar, and congenital. The type of cataract present can lead to varying symptoms. Some types present a higher risk during surgery.

What Are the Symptoms of Cataracts?

Blurry or Foggy Vision
Muted or Dull Color Perception
Glare from Sunlight or other sources of Light
Decreased Night Vision
Halos around Lights
Glasses no longer Work

Who Do Cataracts Affect?

The process of cataract formation begins in our 40’s, but in most cases, doesn’t significantly affect our vision until our 50’s, 60’s, or 70’s.

Cataracts are the leading cause of vision problems in individuals 55 years of age and over. Those with cataracts may have difficulty with:

Driving
Seeing at night
Reading
Viewing a computer screen, phone, or tablet
Seeing captions on TV

Unlike eye diseases like glaucoma or age-related macular degeneration, cataracts are a degeneration which means that 100% of us will develop cataracts if we live long enough. It’s a common eye health issue leading to a clouded lens that affects one’s visual acuity (near vision or distance vision).

Can I Prevent Cataracts?

There are no known ways to prevent cataracts at this time. Neither dietary changes, supplements, eye drops, or sunglasses will prevent the formation of cataracts.

An ophthalmologist at the University of California – San Diego, Dr. Kang Zhang, discovered an enzyme called lanosterol. This enzyme appears to clear cloudy lens cells in Petri dish studies. However, it is yet to be studied in humans. This research could lead to the development of an eye drop to slow or reverse the development of cataracts.

Is It Presbyopia or Cataracts?

In the early stages of cataract formation, the lens begins to stiffen. It is not yet cloudy. Stiffening of the lens, or presbyopia, can cause the loss of good near vision. This begins right around age 44-45. Similar to fully developed cataracts, an individual may have difficulty with near activities. Presbyopia does not require surgery as it can be corrected with glasses or contact lenses.

What Speeds Up the Formation of Cataracts?

Injuries to the eye, certain diseases, and some medications can speed up the formation of cataracts. A good example is the chronic use of corticosteroids. Even as a nasal spray, corticosteroids can cause cataracts to form much quicker.

However, the vast majority of cataracts are a consequence of the aging process.

How are cataracts treated?

Cataracts are treated with surgery. Cataract surgery is one of the safest surgeries in all of medicine. It can, in many cases, improve one’s quality of life in a short period of time. More than 3 million cataract surgeries, a day surgery, are performed each year in the United States.

Traditional cataract surgery involves putting the eye to sleep with local anesthesia. A small incision, approximately 2.4 mm in length, is made at the edge of the cornea. An instrument about the size of a small pencil is used to break up the cataract and remove the resultant fragments from the eye. An artificial lens, also called an intraocular lens (IOL), is placed in the same location as the original lens through the same incision.

In most cases, stitches are not required to close the incision. A technique using sterile water injected into the edge of the incision is used to seal the incision.

How Do I Know If I Need Cataract Surgery?

A refraction needs to be performed by your eye doctor. A refraction is a special test using a device called a phoropter. A phoropter has lenses to check your vision. If your vision improves with the refraction test, you simply need glasses or contact lenses to correct your vision.

However, if your vision cannot be improved with the refraction test, then you may be a candidate for cataract surgery. You must have difficulty with your activities of daily living to qualify for cataract surgery. This will be documented with a form at your final pre-surgical appointment.

Your overall eye health will need to be assessed to make sure that you don’t have other eye diseases, especially in the back of your eye.

In some cases, your ophthalmologist may need to remove your cataract so that the back of your eye can be clearly seen to manage other diseases. In some cases, a retina specialist will request that a cataract be removed so that they can better manage your retinal conditions. This ensures that the appropriate eye care can be provided.

$Refraction Performed With Phoropter Prior To Cataract Surgery$

How Long Does Cataract Surgery Take?

Like any surgery, the length of a cataract surgery can vary. It’s an outpatient procedure, and most cataract surgeries take 15-20 minutes. A dense cataract can take 30-40 minutes, especially if the pupil does not dilate fully.

Cases with poor dilating pupils or very dense, cloudy lenses is considered complex cataract surgery. Additional measures may need to be taken to open the pupil or stain the lens to make it more visible under the surgical microscope.

Even though surgery may take less than 30 minutes, you should be prepared to be at the surgery center for 2-3 hours as the entire process from start to finish takes can take that long.

Can You Walk Me Through Cataract Surgery?

In the beginning, you’ll register at the reception desk and wait to be called to the pre-operative area. Once in the pre-operative area, you’ll meet members of the nursing staff who will start preparing you for surgery. They’ll ask you a number of standard medical questions, place an IV in your arm for the anesthesiologist, and dilate your pupil for your surgeon. You’ll also meet the anesthesiologist in the pre-operative area.

Your pupil needs to be very dilated for cataract surgery, so you will receive 3 rounds of dilating drops. You’ll then wait until the pupil is maximally dilated. From the pre-operative area you’ll go to the operating suite in the rear of the surgery center. In the operating suite, you’ll meet another nurse and a surgical technician who will sterilely prepare your eye for surgery and place a drape over your face, exposing only the eye undergoing surgery.

Don’t worry, there is a rod that keeps the drape from sitting directly on your face so that you can easily breath. A nasal cannula will be placed in your nostrils providing you with fresh oxygen throughout the surgery.

You may hear your surgeon talking to the surgical assistant during the surgery. The assistant is there to hand instruments, medications, etc. to the surgeon. The eye surgeon is the only individual that will be operating on your eye. The anesthesiologist will be present throughout your surgery, in case you need additional pain control, sedation, or have any other medical emergencies.

You will not be asleep during the surgery. You will be relaxed by the IV sedative. Your eye will be put to sleep with lidocaine. You will not be able to see details while undergoing surgery. You may feel water dripping on your eye and mild pressure at times. You may see a kaleidoscope of bright lights and colored lights during the surgery.

An artificial lens, or intraocular lens (IOL), will be placed after the cataract is removed. You may have some options for the type of new lens you want to place in your eye. Many patients report that the experience of undergoing cataract surgery is psychedelic.

After this eye surgery, the eyelid speculum and drape will be removed and your eyelids will be cleaned. Drops will be placed on the eye and a clear plastic shield will be taped in place over the eye. You’ll then be taken to the post-operative recovery area.

What Happens After My Cataract Extraction is Completed?

In the post-operative area, you’ll meet another nurse who will review the post-operative instructions regarding your daily activities which state:

You should not bend, lift, or strain (do not lift anything heavier than 7 lbs. or a gallon of milk)
Keep your eye shield in place (you will remove it briefly to instill your eyedrops in the evening)
If you have any pain or discomfort , use Tylenol (if you are not allergic or have other issues)
You can continue your glaucoma drops (if you use glaucoma drops)
In the morning, you can remove your shield (don’t lose it, you’ll need it for 1 week)
Use your drops in the morning before arriving for your post-operarative visit
Do not use eye makeup for 1 week

The nurse will provide you with written directions. At the top of the paper, the time of your first post-operative visit, the day after surgery, will be provided. You will be given something to drink and a small snack like crackers. Your family member will then be called to the post-operative area to assist in getting you checked out.

Can I Drive Home After Cataract Surgery?

No, you cannot drive yourself home after cataract surgery. You must have a friend or family member pick you up and drive you home. The surgery center will not release you to a Uber or Lyft driver for safety reasons. You’ll need about 24 hours of recovery time before you can drive yourself.

Will My Vision Be Clear After Cataract Surgery?

Cataract surgery is a minimally-invasive surgery. The first day after surgery, your eye may still have some affects from anesthesia. Your pupil may still be dilated. Your eye may be minimally inflamed. For these reasons, we expect that your vision may still be blurry at the first post-operative visit.

We do not want to create the expectation that results are instantaneous after cataract surgery. Your vision will typically improve little by little, each passing day. It can take 1-2 weeks to see significant improvement. Patience if important during this time period. Continue your drops as directed by your surgeon. After your day-1 post-operative visit, you will be seen again to monitor your progress in approximately one week.

Some patient’s vision may be limited by more than one condition. For example, there may be other pre-existing conditions, like macular degeneration, diabetic retinopathy, or glaucoma, that will continue keep the vision from improving. In such situations, cataract surgery alone may not significantly improve the vision.

What Is the Risk of Complications in Cataract Surgery?

Cataract surgery is completed without complication in greater than 98% of cases. Innovation in techniques and equipment continue to make cataract surgery safer; however, that does not mean that cataract surgery is without risks, especially for patients with existing health problems. 2% or less of patients may experience a complication. Please keep in mind that it is impossible to list every possible side effect or complication. The most common side effects and complications are listed below:

Pain
Infection
Bleeding
High Eye Pressure
Retinal Detachment
Loss of Vision
Double Vision
Loss of the Eye
Need for further Surgery
Need for Glasses or Contacts
Droopy Eyelid
Death

We take precautions to avoid complications. If a complication occurs, we will take steps to manage the complication to achieve the best possible outcome and ensure you make a full recovery. Like any medical procedure, no guarantee can ever be made.

In some cases, the posterior capsule of the natural lens could be cloudy after surgery or it could become cloudy later (posterior capsule opacification). In those cases, a YAG laser could be used to remove the cloudy posterior capsule to maximize the vision. The is called YAG laser capsulotomy.

If you have any questions regarding your surgery, do not hesitate asking your doctor or the technicians. We are here to answer your questions and to provide you with the highest level of care available.

What’s the Difference Between Traditional and Laser Cataract Surgery?

Traditional cataract surgery is not the only way to perform the surgery. Traditional cataract surgery and laser cataract surgery differ primarily in how the procedure is performed:

Incisions: In traditional cataract surgery, the surgeon manually makes incisions in the cornea using a handheld blade. In laser cataract surgery, a femtosecond laser creates precise, computer-guided incisions, enhancing accuracy.
Lens Fragmentation: Traditional surgery uses ultrasound energy to break up the cataract for removal. In laser surgery, the laser softens and fragments the cataract before using ultrasound waves, requiring less energy and reducing potential damage to the eye.
Customization: Laser surgery allows for a more customized approach, using imaging technology like optical coherence tomography (OCT) to map the entire eye with a focus on the lens of the eye, which improves incision placement and outcomes. Traditional surgery relies more on the surgeon’s manual skill.
Refractive Outcomes: Laser cataract surgery can be tailored to correct astigmatism by making precise corneal incisions, which can lead to better vision outcomes without glasses. In traditional cataract surgery, astigmatism is typically not addressed.
Cost: Laser cataract removal typically costs more because of the advanced technology involved and may not be fully covered by insurance, while traditional surgery is generally more affordable and widely covered by insurance.

According to the American Academy of Ophthalmology, both methods are safe and effective surgical procedures, with the choice depending on the patient’s needs, surgeon’s recommendation, and budget. To learn more about the laser option, visit our webpage about Laser Cataract Surgery.