cataract

Top: Clear lens when born. Bottom: Brown lens in older eyes. Credit: AAO

Cataract surgery is the removal of the cloudy lens of the eye by surgery and replacement of the lens with an artificial lens implant.

The “history of cataract surgery” is found in this website.

Cataract surgery is arguably the most successful surgery throughout medicine today in terms of safety and outcome. It is the most commonly performed surgery worldwide.

Cataract surgery is most commonly performed when vision is not compatible with the person’s activities of daily living e.g work, hobbies, reading, driving etc.

Method of cataract surgery

The main method today remains extracapsular cataract extraction by means of

Cataract surgery

Cataract surgery by Phacoemulsification – handpiece inside the eye. Credits: AAO

phacoemulsification. The key elements of this gold standard technique are a small wound size, use of an ultrasound probe to break of the lens and use of foldable artificial lenses that can be put into the eye through the small wound size. The small wound size facilitates a faster recovery after the operation. Videos explaining modern cataract surgery can be found here.

Advances

New advances in surgical technique include the use of femtosecond laser assisted cataract surgery.  The technique however comes with additional surgical time  and cost to patient.   Additional resulting improvements in clinical outcome for the cost incurred are currently controversial.

The more important advance in cataract surgery is the widened range of artificial lenses to be put into the eye – Intraocular lenses.

There are now Toric lenses to correct astigmatism and Multifocal lenses to correct presbyopia and Toric multifocals to correct both astigmatism and presbyopia. Other advances include Aspheric lenses which reduce what are called higher order abberations of the eye.

These make cataract surgery much more then dealing with a cloudy lens. It can be a refractive surgery as well where short sightedness, long sightedness, astigmatism and presbyopia can all be corrected at the same time.

Preparing for cataract surgery

Before cataract surgery, your eye surgeon will take a full history and perform a comprehensive eye examination to make sure you are fit for surgery and determine if there are any other eye conditions  present apart from cataract.

Your surgeon will also look out for any eye conditions or general health conditions that will increase the risk of complications during cataract surgery.

Your surgeon will also discuss with you preferences regarding glasses wear after surgery. A full explanation is found in my post – “Before cataract surgery”

From your surgeon, you should understand the risks of cataract surgery, the benefits to be expected from undergoing the procedure and complications that can occur from surgery. Ask if there are any alternatives to surgery e.g. trying  glasses first. Make sure your questions are answered.

Determining the artificial lens choice

Your eye will be measured for its corneal curvature and axial length to determine the correct artificial lens to implant into your eye.  Good equipment such as IOL Master and Lenstar are used to measure the eye.

iol master

IOL Master

lenstar

Lenstar

Surgery Day

Refrain from eating and drinking as instructed. This is usually for 6 to 8 hours before the surgery time.

Take your other regular oral medications as specifically instructed by your surgeon.  Some medications e.g. blood thinners may be stopped before surgery day.

Put dilating eye drops and other eye drops as prescribed.

Arrange to have somebody take you home. Do not drive yourself home.

Recovering from Cataract Surgery

You will have to use antibiotic and steroid eye drops after cataract surgery. Follow the instructions given.  These are used for at least 1 month.

For at least 2 weeks

Use an eye shield while sleeping  to protect the eye.

Avoid strenuous exercise and swimming.

No dirty water or other contaminants should be allowed to enter the eye.

Avoid pressure or injury to your eye.

Use sunglasses should you experience glare from sunlight when going out of the house. Sunglasses can also serve as eye protection in crowded places.

1 month after surgery

New glasses will be prescribed if necessary.

If at any point after surgery you experience increasing eye pain, increasing redness of the eye or worsening of vision, you should seek medical help immediately. These may indicate serious infection or inflammation in the eye.

If you should run out of eye drops before you are due to stop them, get a refill of the eyedrops.