All About Cataract Surgery
A Patient’s Guide to Cataract Surgery
I wrote this guide for all patients considering cataract surgery, because I recognize that all of the different options can be confusing, and it may feel overwhelming. In general, I recommend that every patient think about the different options, to make a list of questions, and to consult with their doctor before making any final decisions.
-Jimmy Y. Hu, MD
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We generally perform cataract surgery when it has reached a point of “visually significance”: when a patient’s quality of vision becomes affected beyond the point that glasses/contacts are able to adequately improve. If the retina and optic nerve are functioning normally in the back of the eye, then you likely have the potential to see much better after cataract surgery.
Cataract surgery is the most commonly performed surgery in the United States, and is a “one-and-done” procedure; once removed, a cataract will never grow back. The benefits of cataract surgery are expected to last you for the rest of your life.
Modern cataract surgery is quick and relatively painless; the cataract is removed through a small incision, and a clear prosthetic lens implant is placed into the eye. This lens stays in the eye for the rest of your life.
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With the exception of a few medical conditions, cataract surgery is considered an elective surgery, and not urgent surgery. This means that no long-term damage will happen to the eye if you choose to postpone surgery for several months, but you won’t see better until cataract surgery is performed.
With few exceptions, we perform cataract surgery one eye at a time, a minimum of two weeks apart. This is to allow enough time for patient to recover from surgery in one eye and see well enough out of it to function, before we perform surgery on the other eye.
Which one is right for you?
At present, there are two surgical options for cataract surgery:
“Traditional” Phacoemulsification (ultrasound-driven) Cataract Surgery
Femtosecond Laser-Assisted Cataract Surgery (FLACS).
How do you decide which type of cataract surgery is right for you?
Here are some things you should understand about both kinds of cataract surgery. Talk with your ophthalmologist about which is best for you.
Femtosecond Laser-Assisted Cataract Surgery (FLACS)
Customized, laser-precise incisions that facilitate gentler removal of cataracts.
Able to correct for astigmatism at the time of surgery, allowing for better vision after surgery, with less dependence on glasses. Most patients after FLACS do not need glasses to drive or watch a movie, and only need to wear OTC reading glasses for close-up activities.
Improved precision and safety, as well as a quicker recovery.
Traditional Phacoemulsification Cataract Surgery
A small blade (keratome) is used to cut into the eye, and ultrasound energy vibrates and liquifies the cataract to allow for removal.
Does NOT correct for astigmatism at the time of surgery
Grants a patient excellent vision with glasses
Technical Details
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Cataract surgery is the most commonly performed surgery in the United States.
While there is no such thing as a “zero-risk” surgery, cataract surgery is considered very low risk. Surgery itself takes about 20 minutes, you go home that same day, and most patients are seeing better the next day.
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Fortunately, cataract surgery is a “one-and-done” kind of procedure; once performed, a cataract will never grow back.
Rarely, clouding behind the lens after cataract surgery may form, called a posterior capsular opacification (PCO). This may cause some patients to feel like their vision got worse after cataract surgery. This can be treated by a YAG Capsulotomy.
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Prior to surgery, a combination of machines are used to make a series of measurements of the eye. From these measurements, your doctor then calculates an appropriately sized “power” for a prosthetic, intraocular lens implant to be placed into your eye at the time of cataract surgery.
If your eyes are very dry, irritated, or have been indented by wearing contact lenses, they may have a small effect on these measurements. Rarely, your doctor may ask you to return for repeat measurements if the initial set of measurements are not satisfactory. This is to grant you the best possible vision.
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Standard, “traditional” cataract surgery, by phacoemulsification, is one of the most commonly performed surgeries in the world. It is recognized as safe and effective. Phacoemulsification cataract surgery involves using a small specialized scalpal blade (called a keratome) to make an incision in the eye; an ultrasound machine is then used to liquify the cataract; a vacuum probe then sucks out the liquefied cataract. The surgeon then places a prosthetic intraocular lens implant in the eye. The surgeon then closes the incision with a special liquid and the wound will self-seal. Stitches are commonly not needed.
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At present, the world’s most advanced method of performing cataract surgery is Femtosecond Laser-Assisted Cataract Surgery (FLACS).
FLACS surgery is blade-less; incisions are made using the femtosecond laser, allowing for micron-level precision cuts; more precise than any human hand ever could. The laser is computer-controlled, and your surgeon will customize the laser treatment for your eyes only. This custom laser treatment also automates some of the most difficult parts of cataract surgery, making surgery safer and more precise than what was previously humanly possible.
The femtosecond laser is used by the surgeon to create a perfectly circular, centered opening in the capsule containing the cataract. The surgeon also uses laser energy to soften the cataract. Vacuum energy is then used to remove those pieces out of the eye. The surgeon then places the IOL in the eye. Stitches are usually not required.
FLACS surgery is not covered by most insurance plans, and on average, costs approximately $1500 more per eye than traditional cataract surgery. In specific situations, it may provide some advantages.
How do I get rid of Cataracts?
Cataracts form as part of natural age-related changes to lens in the eye. These normal eye changes begin to happen around age 40, when many people start to need reading glasses or bifocals. Proteins in the lens start to break down, and as the lens become more cloudy, this is called a cataract. Cataracts are very common among adults 60 and older; though they may occur sooner with medical conditions like diabetes, autoimmune conditions, after using certain medications such as steroids, or a history of smoking. A history of head trauma may also cause a cataract to form years later.
The only way to fix a cataract is through cataract surgery.
Depending on the type of cataract, it may look different between eyes or people.
Further Reading at the American Academy of Ophthalmology
What is the best IOL (Intraocular Lens) with cataract surgery?
Every patient is different, which also means that every patient should be taken on a case-by-case basis. There is no single best or perfect lens with cataract surgery, and your surgeon will have a discussion with you regarding your individual needs.
Not all intraocular lenses are made the same, and each of these lenses have their respective advantages and disadvantages.
After cataract surgery, a custom-ordered intraocular lens implant is surgically placed inside the eye.
Some of these lens implants may have concentric rings or other patterns etched onto the surface of the lens, which will have different optical effects
How bright is the glare from an intraocular lens implant?
The eye's natural lens, cataracts, and all types of lens implants (IOLs) can cause a person to see starbursts, glare or halos, which are usually more noticeable in low-light or nighttime settings. The visibility of these effects varies by lens type.
Lenses with a greater range of focus often produce more glare, starbursts, and halos, especially in low-light or nighttime conditions. However, most patients do not find these effects troublesome.
