Cataract Surgery: Details

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What Is Involved With Cataract Surgery?

To reassure you, cataract surgery has evolved to become the safest and most successful procedure performed today. Most advanced surgeons use a “no shot, no stitch” technique that is performed in minutes with only mild sedation as an outpatient surgery.

Your eye is treated with an anesthetic drop prior to the procedure so you will feel little, if any, discomfort. A tiny incision is made in the clear part of the eye known as the cornea. A small instrument about the size of a pen tip is then used to vacuum away the inner cloudy component of the cataract leaving behind a clear outer lens capsule. Finally, a new lens implant is inserted through the same tiny incision and placed into its permanent position within the capsule.

The whole process from check-in to check-out usually takes a couple of hours. You will need a family member or friend to drive you home following surgery due to the mild sedation. 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. These are typically begun several days prior to your surgery and are tapered over several weeks. You will receive specific written instructions regarding these drops that will be reviewed with you both before and after surgery.
You may need to wear a protective shield the first night to prevent you from inadvertently rubbing your eye. Of course, everyone heals somewhat 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. However, the vision typically improves over the course of several days to several weeks. While many patients report excellent vision the first day, others may experience moderate or even severe blurriness or cloudiness due to swelling in the cornea, the front clear part of the eye through which the surgical incision is made. This is analogous to “fogging of your windshield.” The degree of swelling is dependent on the maturity of the operated cataract and the health of your cornea among other things. Fortunately, the swelling typically clears over a few days.

In addition, patients often report a shimmering sensation in their vision the first few days. This is normal and is due to tiny insignificant movements of the new lens implant in its proper position within the capsule. This typically resolves quickly as the capsule “shrink-wraps” around the lens.

Lastly, some patients report loss of peripheral vision and/or dim vision in dark surroundings during the first day or so. This is typically due to a very small pupil created by a medication often used at the conclusion of your surgery to reverse your dilation and prevent pressure elevation 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. Of course, all patients are unique in their response to sedation and tolerance of pain. Many patients prefer to remain fairly alert during their procedure, while others prefer to “remember nothing.” You will have an anesthesiologist and/or their assigned CRNA by your side to monitor your overall status and insure your safety and comfort.

Immediately after surgery, some patients report a scratchy or foreign body sensation in their eye. This is normal and is typically due to the anesthetic drops used prior to surgery and/or the very small incision created during surgery. This usually resolves within 24 hours.

Lastly, some patients report the onset of these symptoms a week or so later. This is typically due to a condition known as dry eye often accompanied by inflammation of the eyelids known as blepharitis.

It is important you understand that cataract surgery does not cause either dry eye or blepharitis. Rather, they are pre-existing and if previously unnoticed, were just asymptomatic. They can become symptomatic when challenged with the routine course of post-operative drops. If this occurs, artificial tears may help. Depending on the severity, specific treatment for dry eye and blepharitis may be needed.

Is There A Chance Something Could Go “Wrong?”

Yes, cataract surgery is just that, surgery. As with any surgical procedure, there are inherent risks. These include but are not limited to infection, bleeding, chronic inflammation, detachment of the retina, and glaucoma to name a few. These complications can be serious leading to severe loss of vision or blindness. Fortunately, they are rare in an otherwise healthy patient in the hands of an experienced surgeon.

In addition, there are preexisting conditions which may limit your vision even after “perfect” cataract surgery. These include but are not limited to conditions of the cornea such as Fuchs dystrophy, retina known as macular degeneration, diabetic retinopathy, and epimacular membranes and conditions of the optic nerve such as glaucoma.

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