Cataract Surgery: Details

What is involved in cataract surgery?

Cataract surgery has evolved to become the safest and most successful procedure performed today. Most advanced surgeons use an outpatient “no shot, no stitch” technique that takes just minutes and requires only mild sedation.

We will use an anesthetic drop in your eye prior to the procedure so that you will feel little, if any, discomfort. We’ll then make a tiny incision in the clear part of the eye, known as the cornea, then use a small instrument (about the size of a pen tip) to vacuum away the inner cloudy component of the cataract, leaving behind a clear outer lens capsule. Finally, we’ll insert a new lens through the same tiny incision and place it into its permanent position within the capsule.

The whole process from check-in to discharge usually takes a couple of hours. Due to the mild sedation, you will need someone to drive you home following surgery. Most patients feel comfortable driving to the first post-operative exam the next day.

You will use prescription eye drops to guard against infection and assist with healing. Patients usually start using the drops several days before surgery and taper off of them over several weeks after surgery. We’ll give you specific written instructions for these drops that we will review with you before and after surgery.

You may need to wear a protective shield the first night to prevent you from accidentally rubbing your eye. Of course, everyone heals differently, but you will most likely be able to return to your routine activities the next day.

Will I be able to see right away?

Yes, you will be able to see right away. Also, vision typically continues to improves over the course of several days to several weeks. Many patients report excellent vision the first day. Others may experience moderate or even severe blurriness due to swelling in the cornea, the front clear part of the eye through which the incision is made. There may seem to be a “fogging of your windshield.” The degree of swelling depends such factors as the maturity of the cataract and the health of your cornea. Swelling typically goes down in a few days.

During the first few days after surgery, patients often report a shimmering sensation in their vision. This is normal and is due to tiny insignificant movements of the new lens implant. As the capsule “shrink-wraps” around the lens, this sensation typically goes away.

Finally, some patients report loss of peripheral vision and/or dim vision in dark surroundings during the first day or so. This is typically caused by a medication often used at the end of  surgery to reverse the dilation of your pupil and prevent elevated pressure in the eye. This usually resolves within 24 to 48 hours as the medicine wears off.

Does it hurt?

No, the surgery is typically very comfortable although each patient responds differently to sedation and pain. Many patients prefer to remain fairly alert during the procedure; others prefer to “remember nothing.” An anesthesiologist and/or a Certified Registered Nurse Anesthetist will be at your side to monitor your overall condition, safety, and comfort.

Immediately after surgery, some patients report a scratchy feeling or the sensation of a foreign body in their eye. This is normal and usually goes away within 24 hours. Some patients report these symptoms a week or so after surgery. This is typically due to a condition called “dry eye” often accompanied by blepharitis, an inflammation of the eyelid.

Cataract surgery does not cause either dry eye or blepharitis. The conditions were probably unsymptomatic at the time of previous exams but simply emerged during the course of post-operative drops. Artificial tears may help or, if symptoms are severe, other treatment for dry eye and blepharitis may be needed.

Could something go wrong?

Yes, cataract surgery, as with any surgical procedure, has risks. These include infection, bleeding, chronic inflammation, detachment of the retina, glaucoma, and other complications, which can be serious and lead to loss of vision or even blindness. Fortunately, complications are rare in an otherwise healthy patient who is in the hands of an experienced surgeon.

In addition, certain pre-existing conditions might limit your vision even after “perfect” cataract surgery. These include, but are not limited, to corneal conditions, such as Fuchs dystrophy, retinal conditions like macular degeneration or diabetic retinopathy, or epimacular membranes and conditions of the optic nerve, such as glaucoma.

We will discuss potential risks and benefits to help you decide whether cataract surgery is right for you.

Do cataracts come back?

No, your original cataract does not come back. However, your lens implant is held in place by a thin membrane known as the lens capsule. This capsule is the outermost lining of the original cataract, which can become cloudy over time. If it does, it is called a posterior capsule opacification, or PCO. Fortunately, PCO is easily remedied in the office by “polishing away” the central cloudiness with a laser, a procedure known as a “Yag capsulotomy” that is painless. Risks with this procedure are minimal and rare.

What’s the bottom line?

Cataract surgery, refractive lens exchange, and intraocular lens technologies have made giant strides forward recently. Combined with traditional refractive surgical procedures, such as corneal relaxing incisions and excimer laser treatments, these technologies can not only restore but can also truly enhance your vision.