Cataract Surgery
Rutzen EYE SPECIALISTS & LASER CENTER
What is a cataract?
A cataract is a cloudy area in the lens of the eye. The lens helps focus light on the retina at the back of the eye. It is located inside the eye behind the iris (the colored part of the eye). As a cataract worsens over time, the cloudiness worsens and causes vision problems.
How does it occur?
Most cataracts occur naturally as people get older. What causes cataracts is not known, but many factors may contribute to their formation, such as:
- eye injury
- diabetes or other diseases
- exposure to radiation, especially X-rays
- long-term use of steroid medication
- exposure to toxic substances
- an inflammatory disorder of the eye (iritis)
- prolonged exposure to sunlight
- aging.
A child may be born with cataracts or develop them at an early age. These cataracts, called congenital cataracts, may be caused by a genetic disorder (such as Down syndrome) or by a condition the mother had during pregnancy (such as German measles). They also may be inherited.
Cataracts don’t spread from one eye to the other, but many people have cataracts in both eyes.
What are the symptoms?
The symptoms of a cataract include:
- blurred vision
- a need for frequent changes in your eyeglasses or contacts
- trouble driving at night
- sensitivity to bright light
- change in color vision (yellow, orange, and red appear brighter and blue appears dull).
Cataracts do not cause complete blindness. However, it is possible to lose enough vision to be declared legally blind.
How is it diagnosed?
The symptoms of a cataract develop slowly and are painless. The condition may go unnoticed and undiagnosed for a long time. It is often first diagnosed during a routine eye exam.
An eye doctor will thoroughly examine your eyes. He or she will evaluate your symptoms and determine the best course of treatment.
How is it treated?
If a cataract is not interfering with your lifestyle or work, your doctor may suggest changing your glasses or using brighter lights to help you read.
If the cataract is seriously affecting your vision and cannot be helped with glasses or contact lenses, a surgeon may need to remove the lens. This type of surgery is called cataract extraction surgery. The surgeon may first use sound waves (ultrasound) to break up the lens so the pieces can then be removed through a narrow hollow suction tube. This part of the procedure is called phacoemulsification. In some cases, the lens is removed in one piece through a larger incision (nuclear expression). After the lens is removed your surgeon may put a new plastic lens in your eye (intraocular lens implantation). If you do not have a new lens put in, you will need to wear contact lenses or cataract glasses.
Lasers are not used to remove cataracts. However, they may be used to open a cloudy membrane that may develop after cataract surgery.
How long will the effects last?
Decreased vision from cataracts is reversible and will last until it is corrected with glasses, contact lenses, or surgery. Surgery to remove cataracts is more than 90% successful in restoring vision. Ask your doctor about his or her success rate.
How can I take care of myself?
- Be sure to follow your doctor’s instructions.
- Call your eye doctor if your vision gets worse.
- Be careful when you drive at night. A cataract can make lights such as oncoming headlights seem very bright, causing a glare that makes it hard to see.
What can be done to help prevent cataracts?
You may reduce the risk of damaging your eyes and in turn reduce the risk of developing cataracts by wearing goggles or safety glasses at work or during activities where your eyes could be injured. Wearing glasses with a UV coating that protects your eyes from sunlight might prevent or delay some types of cataracts, but this is not proven.
If you are a woman and plan to have a baby, make sure you have had a German measles (rubella) shot at least 1 month before you try to become pregnant. If you have German measles while you are pregnant, your baby’s eyes should be checked by an eye care professional soon after birth. A baby can develop cataracts if you had German measles or other kinds of infections while you were pregnant.
What is a cataract extraction with intraocular lens implantation?
A cataract extraction with intraocular lens implantation is a procedure in which an eye surgeon removes a clouded lens (cataract) from the eye and replaces it with an artificial lens (lens implant).
When is it used?
Cataracts can cause vision problems by preventing clear images from reaching the retina (the light-sensitive tissue at the back of the eye). You may choose to have cataract surgery because you need to have better vision to continue your normal activities. In the early stages of cataracts, an alternative to surgery may be to change your glasses.
Alternatives to having an intraocular lens implanted in your eye after removal of a cataract are:
- wearing contact lenses
- wearing cataract glasses.
You should ask your eye doctor about these choices.
How do I prepare for the procedure?
Arrange for someone to take you home after your surgery. Plan for your care and recovery after the operation, especially if you are to have sedation or general anesthesia. Allow for time to rest and try to find people to help you with your day-to-day activities.
Follow your healthcare provider’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.
If you take aspirin, warfarin (Coumadin), or vitamin E, ask your provider if you need to stop taking this medicine before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This may help to avoid extra bleeding during surgery. Tell your doctor about any other medicines you are taking.
Eat a light meal, such as soup or salad, the night before the procedure. Your doctor will probably also recommend that you not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water.
Do not wear eye makeup on the day of the surgery. Follow any other instructions provided by your doctor.
What happens during the procedure?
You will be given a local or general anesthetic to prevent pain during the operation. A local anesthetic numbs your eye while you remain awake. The local anesthetic can be given to you with drops or ointment or with a shot of medicine behind the eye. A general anesthetic relaxes your muscles and puts you to sleep. Most surgery is done with local anesthesia only. Sometimes the doctor will give you a sedative to help you relax.
The surgeon will make a small incision (cut) in your eye and remove the cloudy lens. The surgeon will remove the lens through a process called phacoemulsification. This is a procedure in which sound waves (ultrasound) are used to break the lens into small pieces. The small pieces are then removed through a narrow hollow tube.
After the lens is removed, the surgeon will put an artificial lens in your eye. The surgeon may put one or more stitches in your eye to close the incision and then put a patch or shield over the eye.
What happens after the procedure?
You will be in the recovery area after surgery until you are ready to go home. Have someone take you home.
It’s normal to feel itching, sticky eyelids, and mild discomfort for a while after cataract surgery. Some fluid discharge is also common. If you have discomfort, your doctor may suggest a nonaspirin pain reliever every 4 to 6 hours (aspirin is not recommended because it can cause bleeding). After 1 to 2 days, the discomfort should stop.
You will have few limits on your activities after surgery. You can read and watch TV almost right away, but your vision may be blurry at first. You can do simple tasks such as ride in a car, get dressed, cook, and visit friends. Do not rub your eye or allow water or other substances to get into your eye. Avoid bumping or injuring the eye.
Your eye doctor will schedule exams to remove the patch and to check on your progress. You may need to use eyedrops to help healing or to prevent infection or inflammation. For a few days after surgery, you may also need to use eyedrops or take pills to control the pressure in your eye. Ask your doctor how and when to use the drops or pills and what effects they can have. Since you may have several different drops to use, be sure you have a written schedule to follow to avoid confusion.
In most cases, it takes about 6 weeks for the eye to heal. You will be ready for new glasses in about 1 month. It may take a few more weeks for the sharpest vision to return.
What are the benefits of this procedure?
You can regain nearly normal vision if the rest of your eye is normal.
What are the risks of this procedure?
The risks of this procedure include:
- infection
- bleeding
- inflammation (pain, redness, swelling)
- glaucoma (higher pressure inside your eye)
- retinal detachment
- need for additional surgery
- loss of vision (rare).
There are some risks when you have general anesthesia. Discuss these risks with your doctor.
A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases you may have an allergic reaction to the drug used in this type of anesthesia. Very rarely, bleeding may occur when the shot of anesthetic is given, affecting your vision and making it necessary to postpone the surgery. Local anesthesia is considered safer than general anesthesia and is used for most cataract surgeries.
You may develop an after-cataract. This is not a regrowth of the cataract that was removed. When it happens, the back part of the capsule that enclosed your lens becomes cloudy and blurs the image reaching the retina at the back of your eye. The after-cataract can be treated with a laser. In a procedure called YAG capsulotomy, your doctor uses a laser beam to make a hole in the clouded capsule so a clear image can reach the back of the eye. This is a painless outpatient procedure with low risk, but you will need to see your doctor for follow-up.
Ask your doctor how these risks apply to you.