In the old days, people with cataracts just had to suffer from blurry vision and reduced enjoyment of life, but that is no longer the case. Today, thanks to ultrasound and laser technology, doctors are able to perform cataract surgery to remove the cloudy natural lens of the eye and replace it with a clear, durable artificial lens. In this article, we will present some common questions and concerns regarding cataract surgery and provide answers that will help you prepare for and recover from this miraculous treatment. Read on to learn more.
Before Cataract Surgery
How do I know I need cataract surgery?
If you have been experiencing blurry vision and/or glare from lights or the sun is unusually bothersome, you should talk with your doctor about the possibility of cataract surgery. This is especially true if these problems interfere with your ability to carry out your normal daily activities.
Sometimes cataracts may not be too bothersome for you, but your doctor may find that your cataracts interfere with his or her ability to treat another eye condition. If this is the case, your doctor may recommend that you have this simple and painless surgery.
Do I have to stay in the hospital?
Amazingly, cataract surgery is a safe and simple outpatient procedure that is performed by an ophthalmologist. It usually takes less than an hour to complete, and you can go home after a brief period of rest and observation.
Do I have to make a snap decision?
Having cataracts does not generally cause more harm to your eyes, so if you are unsure about having the surgery you will be happy to know that you can take your time to research the topic and make an informed decision.
How can I make up my mind about having cataract surgery?
If you are considering whether or not to have this surgery, ask yourself a few pertinent questions, such as:
- Am I able to see well enough to drive and work safely?
- Am I able to read and watch television easily?
- Do my cataracts make it hard for me to read labels and recipes, run errands, work in the yard and perform other activities of daily living?
- Could I be more independent if I could see better?
- Am I able to see my friends and relations (and others) clearly?
- Are bright lights more troublesome to me than they once were?
- If you answered “Yes” to any of these questions, you are a good candidate for cataract surgery.
Cataract Surgery Risks
Are there any risks?
There is risk involved in all types of surgery. When you decide to have cataract surgery, you will probably be asked to sign a release form indicating that you understand you are incurring a slight risk of:
- Increased eye pressure (aka: glaucoma)
- Bleeding inside the eye
- Potential vision loss
- Secondary cataract
- Retinal detachment
- Corneal swelling
- Retinal swelling
Are risks greater if I have other eye problems?
Naturally, if you have any serious medical condition or if you have other serious issues with your eyes, the risks you incur with this surgery will be somewhat greater. Additionally, if you have other eye problems cataract surgery may not resolve your vision problems. For this reason, your doctor may want to treat your other problems first if at all possible.
What if I have had LASIK surgery in the past?
This should not cause any problems, but you will want to be sure your doctor has a complete record of your vision. He or she will need to know the prescription strength of the lenses you used before LASIK. This will help in fitting you with a new IOL.
What do I need to do to prepare?
Once you have decided to look into cataract surgery, your doctor may order some tests for you. For example, you will need to have an ultrasound performed as a way of measuring your eye and determining the type and size of intraocular lens (IOL) that will be put in place. Your doctor will also measure the curve of your cornea through a procedure called keratometry.
Your doctor will review your medications with you. He or she may instruct you to stop taking any medicines that act as blood thinners because these may cause excessive bleeding during surgery. Be sure to tell your doctor if you are taking alpha-blockers to treat prostate problems. Also include information about all supplements you may be taking as some have very powerful blood thinning capabilities.
Your doctor may also prescribe some antibiotic eye-drops to help reduce your risk of contracting an infection. You will need to follow your doctor’s instructions closely when using these.
You may need to do without eating or drinking for approximately twelve hours before your surgery.
What happens during the surgery?
At the outset, your doctor will dilate your pupils with special eye-drops. After this, you will get local anesthetics in the area of your eye. Your doctor may also give you a sedative so that you can relax completely. You will not go to sleep (unless you are very tired) but you will feel a bit groggy during and immediately after your surgery.
The surgery is performed quickly and easily. Your doctor will carefully remove your clouded lens and replace it with a crystal clear artificial lens.
How is the natural lens removed?
Your doctor will use a very fine (needle-thin) probe inserted through a very tiny incision in the cornea of your eye. Ultrasound waves will be transmitted through the probe to emulsify (break up) the cataract. Following this, the fragments will be gently suctioned out.
Where is the IOL placed?
The IOL is usually placed behind the iris of your eye. When this is the case, it is also referred to as the “posterior chamber lens”. Occasionally, it must be placed in front of the iris. In this case it is referred to as the “anterior chamber lens”. Either way, once it is permanently in place, it lets light pass into the eye and focuses it correctly on the retina. Naturally, the lens capsule at the back of the eye will remain intact to support your new artificial lens.
Will the cataracts be removed from both my eyes at once?
Typically, you will have one eye done and then wait a month or two to have the other eye done.
Will I need stitches?
Most of the time stitches are unnecessary, but sometimes extremely small stitches are used to close the minute incision in the cornea. There is also another type of procedure known as extracapsular cataract extraction, which involves a slightly larger incision. This may require stitches; however, you needn’t worry too much about this. This type of procedure is rarely performed.
What lens do I need?
What is the artificial lens made of?
The IOL can be made of silicone, acrylic or plastic. It is absolutely carefree, and you will not be aware of its presence at all – other than the fact that you will be able to see much better!
Why are there differences in IOLs?
Your surgeon will choose the right type of IOL for you depending upon your condition and the type of procedure he or she wants to perform. For example, a plastic IOL is rather rigid and needs a larger incision, so it may be a good choice for an extracapsular cataract extraction.
Tiny, flexible silicone or acrylic IOLs can actually be folded to insert through a very small incision. They automatically unfold to fill the space recently vacated by your natural lens.
In addition to clearing up your vision, specialty IOLs can be put in place to block ultraviolet rays, act as bifocals or even provide long distance vision in one eye and close-up vision in the other.
How will I choose?
Your doctor is sure to have good recommendations for you. Be sure to discuss your hopes and expectations in advance of the surgery so that he or she can help you make a wise choice.
Recovery After Surgery
What immediate differences will I notice?
You may have pretty blurry vision for a few days. Your eye will need a bit of time to rest and recover.
Additionally, you may feel a bit of itchiness and discomfort at first. You should be very careful not to rub your eyes or scratch.
Let your doctor know if you think you would rub your eyes in your sleep. You may need to wear an eye-patch or bandage to protect your eyes if that is the case.
Is recovery difficult?
In most cases, recovery is a breeze. The procedure takes less than an hour and you can go home shortly thereafter.
You will need to arrange a ride home because you will not be able to see well enough to drive. Additionally, it’s a good idea to have someone help you out at home so that you can avoid stooping and bending and lifting heavy objects.
It is important to take it easy for at least a week after your surgery. Avoid bending over, straining or lifting anything heavier than 25 pounds. Take care to keep dust, dirt and water out of your eye as contamination can cause infection. Your doctor will probably also advise you to use wraparound sunglasses when you go outside in the bright sunshine.
Will I need to take any medicine?
Usually eye-drops are prescribed to help reduce inflammation, prevent infection and keep eye pressure under control.
How soon will my eye be completely healed?
Within a couple of months, you should be able to put the whole experience behind you and simply enjoy your new and improved vision.
Symptoms and Complications
What are post-operative warning signs of trouble?
If you experience any of the following symptoms, call your doctor right away!
- Coughing, nausea or vomiting
- Flashes of light
- Persistent pain
- Loss of vision
- New “floaters”
Are there any common complications?
For the most part, cataract surgery is simple and successful. Once in a while a patient will develop a secondary cataract. This is a condition that is also called posterior capsule opacification (PCO). When this happens, the back part of the lens capsule may become cloudy and cause your vision to be impaired.
If this happens, you can just pop into your doctors office for a quick (5-minute) procedure known as YAG or yttrium-aluminum-garnet laser capsulotomy. In this quick and painless procedure, your doctor will use a laser beam to create a small opening to let light in through the clouded capsule.
Although the procedure only takes five minutes, you will need to take it easy in the doctor’s office for about an hour. This will allow the doctor to monitor you for the very rare complications, retinal detachment and increased eye pressure.
Is cataract surgery expensive?
If you are eligible for Medicare benefits, your necessary cataract surgery will be covered. Most private prescription plans also cover this type of surgery.
Whether or not your surgery is covered usually depends upon the results of your vision tests. You should keep in mind that Medicare and insurance policies usually cover basic treatment. If you want any extras (e.g. special lenses) or if you choose to have your cataracts removed before they become intrusive, you may incur some out of pocket expense.
Be sure to discuss this thoroughly with your doctor and your Medicare or insurance provider to avoid unpleasant surprises.
If you are uninsured, talk with your doctor about payment plans or apply for established health care credit such as Care Credit. You may also wish to explore the possibility of a flexible health care spending account provided by your employer.
Will I be able to throw away my glasses?
You will probably need your glasses (or new glasses) for a while following your surgery. You will be following up with your doctor on a regular basis for a couple of months. You can rest assured that he or she will let you know when you can do without glasses or get a permanent set made to accommodate your new level of vision.
You may or may not need to wear glasses following your recovery. It is possible for your vision to be corrected, or at least improved, by this surgery; however, this is not always the case. One thing is certain, by following your doctor’s orders closely, you are sure to get the best results.