Cataract Surgery

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as reading, driving, or watching television. Symptoms of an early cataract may be improved with a new eyeglasses prescription, brighter lighting, anti-glare sunglasses, or the use of magnifying lenses. If these measures do not help, it may be time for cataract surgery. A comprehensive eye exam with a trusted ophthalmologist is the only way to know for sure.

Sometimes a cataract needs to be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related diabetic retinopathy or macular degeneration.

Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most normal cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

A comprehensive eye examination is the first step. During your examination for cataract surgery, you will be evaluated for any special medical risks. Your eyes will be measured with the most up-to-date technology, including the Lenstar or IOLMaster, to determine the proper power of the intraocular lens that will be inserted during surgery. Be sure to inform your eye surgeon of all medications you are presently taking, and ask if you should continue your usual dosages. When your cataract surgery date is set, you will be given a simple list of preoperative instructions.

Cataract surgery today is quite comfortable. First, the procedure will begin with your eye being treated with an anesthetic so that you will feel little to no discomfort during the surgery.

Your eye surgeon operates while looking through a highly specialized microscope, designed exclusively for this purpose. A tiny, beveled incision, less than 1/8 of an inch, is made at the edge of the “clear cornea”. The clear cornea is the transparent covering of the front of the eye.

The incision is just large enough to allow a microscopic instrument the size of a pen tip to pass through it. Once the microscopic instrument is actually passed through the tiny incision, ultrasound from the tip of the microscopic instrument will be used to gently break the cataract into pieces small enough to be washed away, drawn through the instrument, and removed from the eye.

Through the tiny incision, a microsurgical, ultrasonic, oscillating probe is inserted, which gently fragments the cloudy lens, using high-frequency sound waves. Simultaneously, this same instrument suctions out the fragmented pieces. This process is known as “phacoemulsification.” The posterior capsule, an elastic bag-like membrane that holds the lens, is left in place.

The incision is commonly referred to as “self-sealing” because the eye’s natural internal pressure holds the incision tightly closed, allowing the eye to heal without the need for stitches. The chances of developing astigmatism (distorted vision) after surgery are significantly decreased by eliminating stitches, which tend to pull the eye’s surface slightly out of its natural shape.

Once all the minuscule bits of the cataract have been removed, a tiny new, clear implant lens is folded, inserted through the small incision, and allowed to open up inside the posterior capsule.

The surgery typically takes 20-30 minutes and is performed on an outpatient basis. This means that you will undergo the surgery and then go home, typically around 30 minutes afterward. Most of the time, only local anesthesia is used so that you will be awake for the entire process. After the surgery, you are taken to the recovery room and then released. You will need someone to drive you home.

It is perfectly normal to be a bit apprehensive before any unfamiliar experience. All this information about cataracts and surgery may seem odd or a little frightening to you. That’s okay because we will walk you through it and make your experience as smooth and straightforward as possible.

Our patients most often report that their surgery was remarkably pleasant, and that pain was not even a consideration. Some have even told us that they haven’t felt more relaxed in years!

At East Valley Ophthalmology, we promise to be attentive to your needs and well-being, and we will do everything possible to ensure you are entirely comfortable throughout the entire procedure. You will be given a relaxant to enhance calmness and will neither see nor feel any part of your eye surgery. After you are released, we will call you that evening to check that you are doing well. The next morning, you will visit with your physician for evaluation and to address any concerns you might have. We are always here for you.

You will need to avoid bending or lifting anything heavy for up to three weeks after the procedure, as well as refrain from rubbing or pressing the eye. But otherwise normal activities may be resumed the day after surgery. Some cataract patients experience immediate vision improvement following surgery, while others may notice a more gradual improvement over several months.

No — Cataract surgery is best performed on one eye at a time, to enable you to use one eye while the other is healing. They are typically scheduled two weeks apart.

Assuming your eye is normal and healthy, the intraocular lens implant should last your entire lifetime. Lens implants are not known ever to wear out.

Cataract surgery is one of the most successful surgeries of all, but just as crossing an empty street can be risky, so too are there risks involved with any surgery. The only way to avoid all risk is to do nothing.

Complications are possible during or after cataract surgery, even with the best care and treatment. The most commonly seen complications are associated with unusual eye anatomy (very long or very short eyes), certain inherited eye diseases, and prior trauma. Such complications include bleeding, infection, glaucoma, corneal clouding, swelling of the central retina, retinal detachment, decreased vision, or, in rare cases, loss of the eye itself. While it is impossible to predict in which patients these complications will occur, the risk of these complications is minimal.

There are times when a cataract can be removed successfully, but vision is not improved because of other conditions or diseases of the eye. One such disease is macular degeneration, where the central part of the retina — the area that is critical for “fine” seeing — is damaged. Occasionally, macular degeneration cannot be diagnosed before the cataract removal because the presence of the cataract itself may prevent seeing the macula in sufficient detail. It is sometimes only after the cataract is removed that macular degeneration is diagnosed.

Additionally, other pre-existing conditions of the eye, such as diabetic retinopathy or glaucoma, can also limit vision after cataract surgery. All such pre-existing conditions limit the eye’s ability to regain normal vision, even if the cataract surgery itself is a huge success.

All that said, remember that cataract surgery has a high success rate, higher than any other surgical procedure. Your vision will likely improve significantly, and your overall quality of life will also improve.

Not so long ago, cataract surgery involved making an incision large enough to remove the clouded lens in one piece. Patients often stayed at the hospital overnight or for several days. With the aid of new technologies, cataract surgery can be performed through a tiny incision and typically occurs on an outpatient basis, resulting in a significantly shorter recovery time.

The day following your surgery, you will have an office appointment to ensure that you are healing correctly. Your vision could be blurred from ointments associated with eye surgery, or you might see quite clearly. Every patient is an individual and heals in a unique way. Over the following weeks, visual clarity progressively improves, and after one month, the eye is typically healed and ready for refraction to determine the need for new glasses. Follow-up visits are usually scheduled for the next day, one week, and then one month after surgery. During this time, you will use eye drops to help the eye heal and prevent infection.

Your sight will usually improve within a few days, although complete healing may take several months. It is a good idea to have some help at home, if possible, especially if you find it challenging to put in your eye drops.

For the first four days following cataract surgery, we ask that you avoid any heavy lifting or bending that brings your head below the level of your heart. After that, and for the month following surgery, you can resume most of your everyday activities, but minimize lifting, bending, and straining. Carrying reasonably lightweight objects, such as a purse or a small bag of groceries, is usually fine.

You will also be asked to avoid getting water in the operated eye for one to two weeks. Avoid swimming. Water that is usually safe for showering and drinking contains bacteria, which can potentially cause an infection at the site of the incision in your eye. Just adjust your routine to wash your hair leaning backwards rather than forwards, for example. Or better yet, treat yourself and have someone else clean it for you!

You don’t need to stay indoors, but try to avoid being out in the wind, as something might blow in your eye. You’ll also need to keep your hands out of your eyes. Your surgeon may give you an eye shield to wear at bedtime to inhibit possible rubbing or pressing on the eye in your sleep. Avoid eye makeup for six weeks. As for returning to work or driving, this varies from one patient to another and depends on the type of work involved. Discuss your situation with your doctor, who is here to address all of your concerns.

Over 95% of cataract surgeries significantly improve a patient’s vision. If having a cataract is the only cause of your decreased vision, removing it will improve clarity. Suppose you have an additional problem (such as macular degeneration, prior uveitis, retinal detachment, diabetic retinopathy, or glaucoma). In that case, a determination will be made by your ophthalmologist as to which issue needs to be addressed, and when. Cataract surgery can be successfully carried out even in the setting of most of these other eye conditions.

Will I need glasses after cataract surgery?

Depending on your eyesight and refraction, as well as the type of lens implant chosen, you may or may not need to wear glasses for reading or distance.

Once a cataract has been removed, light can once again pass undistorted through the cornea and the newly implanted artificial lens to the retina in the back of the eye. However, you may still be required to wear glasses to see more clearly because the incoming light needs to be focused directly on the retina. If your eye cannot do so on its own, eyeglasses will be required to provide that focus.

In addition, the implanted artificial lens cannot change shape for close vision the way a natural, youthful lens does. A natural lens accommodates, or changes shape, to bring objects into focus at varying distances. The intraocular lens implant provides the clearest vision at a single focal distance, with the majority of implants used to correct distance vision. This means that an eye focused for distance will have the sharpest vision for activities such as driving. However, if you do not qualify for a multifocal lens implant, you will still require bifocal lenses or reading glasses to see clearly at close range.

No — Occasionally, the membrane that holds the lens implant in place becomes cloudy with a thin film of scar tissue that forms on the posterior capsule behind the new implant lens. This may be referred to as a secondary cataract, but is more accurately called capsular haze or posterior capsule clouding. Patients sometimes think their cataract has grown back, but it hasn’t. Once a cataract has been removed, it will not recur.

A special Nd:YAG laser is used to remove capsular haze, a painless procedure that takes approximately 15 minutes to complete at our office. The laser makes an opening in the scar tissue, allowing vision to be restored.

Capsular haze occurs in a small percentage of cataract surgeries and is harmless and painless. With modern intraocular lens implant designs and materials, the incidence of posterior capsule clouding has fallen to approximately one percent of patients.