Sarah Lewis, PharmD
What is cataract surgery?
Cataract surgery is the surgical removal of the lens of your eye when it has developed a cataract. Cataract surgery restores vision when cataracts cause vision loss.
A cataract is a clouding or loss of transparency in the lens of your eye. Cataracts interfere with vision and usually develop as a result of normal aging. In most cases, the diseased lens is replaced with an artificial lens implant called an intraocular lens (IOL). The IOL becomes a permanent part of your eye.
Cataract surgery is a common surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having cataract surgery.
Types of cataract surgery
The types of cataract surgery procedures include:
Phacoemulsification, also known as phaco, is short or small incision cataract surgery. In this procedure, your surgeon makes a small incision in the side of your cornea, the clear dome that covers the front of your eye. A tiny ultrasound probe is inserted through the incision. The ultrasound probe softens and breaks up your lens. Your doctor removes the lens with suction and replaces it with an IOL.
Extracapsular surgery requires a slightly longer incision in the side of your cornea. Your surgeon removes your entire lens in one piece through this incision. The IOL is inserted through this incision.
Types of intraocular lens (IOL) implants
The types of intraocular lens implants include:
Accommodative lens moves forward and backward in response to your eye muscles. It mimics the movement of your natural lens. This provides excellent near, intermediate and distance vision. An accommodative lens may reduce or eliminate the need for glasses.
Monofocal lens was the first lens developed for cataract surgery. It is considered the standard lens for cataract surgery. A monofocal lens is a single-focus lens. This means it can be set for near, intermediate or distance vision. Most people choose to set their monofocal lens for clear distance vision and use reading glasses for near vision.
Multifocal lens is designed to provide near, intermediate and distance vision in one implant. It accomplishes this through a series of rings set for each vision range. Think of it as a bull’s-eye target with each ring representing a different vision range. Your brain learns which ring to use to focus images. A multifocal lens also reduces or eliminates the need for glasses.
Toric lens is a type of monofocal lens that also corrects for astigmatism. Astigmatism is caused by abnormal curvature of the cornea. It can cause two focal points to fall in two different locations, making objects both up close and at a distance appear blurry. As with other monofocal lenses, you may need reading glasses to focus your near vision.
Other procedures that may be performed
Your doctor may perform one or more other procedures in addition to cataract surgery. These include:
LASIK, which stands for laser-assisted in situ keratomileusis. It is a minor but technical surgical procedure used to correct certain types of blurry vision (called refractive errors) including farsightedness, nearsightedness and astigmatism. Your doctor uses a laser to remove very thin layers of your cornea to change its shape and produce clearer vision.
Limbal relaxing incisions are a series of small incisions that help correct astigmatism. This procedure allows your cornea to take on a more round and symmetrical shape.
Why is cataract surgery performed?
Your doctor may recommend cataract surgery to treat advanced cataracts that are interfering with your vision. Cataracts are generally not treated until they begin to affect your vision noticeably. Some minor symptoms of cataracts, including dulling of vision or small changes in visual acuity, may be improved by nonsurgical approaches. These include improved lighting or changes in eyewear prescriptions. If both of your eyes require cataract surgery, they are usually done separately, at least four to eight weeks apart.
In most cases, cataract formation occurs as a result of aging. However, it may also be triggered by injury to the eye, eye surgery, exposure to radiation, or excess sun exposure. Cataracts may also be a birth defect.
Surgery is the not the only treatment for cataracts. Your doctor may only consider cataract surgery for you if nonsurgical options have not been effective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on cataract surgery.
Who performs cataract surgery?
An ophthalmologist will perform your cataract surgery. An ophthalmologist is a doctor with specialized training in diseases, conditions and surgery of the eye.
How is cataract surgery performed?
All cataract surgery involves an incision in the side of your cornea. Your cornea is the clear dome that covers the front of your eye. There are, however, different approaches to the surgery that your doctor may choose. Ophthalmologists perform cataract surgery in hospitals and outpatient surgery settings.
Surgical approaches to cataract surgery
Small incision cataract surgery, also known as phacoemulsification or phaco, is the most common form of cataract surgery. It uses a small incision in the side of your cornea and a tiny ultrasound probe to soften and break up your lens. Your doctor removes your lens with suction through the small incision. The intraocular lens (IOL) implant is inserted through the same small incision.
Extracapsular cataract surgery uses a slightly longer incision in the side of your cornea. Your doctor removes your lens in one piece and inserts your IOL through this incision.
Your doctor may or may not use stitches or sutures to close your incision. If your doctor uses sutures, they may need to be removed at a future visit.
Your doctor will determine which type of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different cataract surgery procedures and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used
Your doctor will perform cataract surgery using local or general anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Local anesthesia involves eye drops to numb the eye or injecting an anesthetic around nerves in your eye so you do not feel anything. You will likely have sedation to keep you relaxed and comfortable.
What to expect the day of your cataract
The day of your surgery, you can generally expect to:
Speak with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
A surgical team member will start an IV.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of cataract surgery?
As with all surgeries, cataract surgery involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgical procedures include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Potential complications of cataract surgery
Complications of cataract surgery are rare, but can be serious. Potential complications include:
Bleeding inside the eye
Capsular contraction, which occurs when the tissue that supports your IOL (called the capsule) scars and contracts during healing. This may cause vision changes and prevent accommodative lenses from functioning properly.
Dislocated or de-centered IOL
Glaucoma or increased pressure inside your eye
Inflammation or swelling
Night vision problems, such as seeing glare, halos or starbursts around lights at night. These effects are usually temporary.
Posterior capsule tear or a tear in the thin structure that holds your natural lens and will hold your IOL
Retinal tear or detachment, which is a medical emergency. Symptoms include a sudden appearance of flashes or floaters. Seek immediate medical care for symptoms of retinal detachment to prevent permanent vision loss.
Secondary cataracts, sometimes called posterior capsule opacification or PCO, which occur when the capsule or tissue that supports your IOL becomes cloudy. Secondary cataracts can develop months or even years after cataract surgery. They are typically treated with an outpatient laser procedure.
Reducing your risk of complications
You can reduce the risk of certain complications by following the treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my cataract surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for cataract surgery by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home after your cataract surgery. You will not be allowed to drive yourself home.
Getting preoperative testing as directed. Preoperative testing may include a complete eye exam, an ultrasound exam called an A-scan, keratometry (which measures the curve of your cornea), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. If you are having general anesthesia, your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during deep anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For cataract surgery, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need cataract surgery? Are there any other options for treating my condition?
Which type of cataract surgery procedure will I need?
How long will the surgery take? When will I be able to go home?
What kind of restrictions will I have