When cataracts cause cloudy vision to the point of interfering with a person’s daily activities, it’s time for cataract surgery, one of the most common operations in the world. This procedure results in improved vision for well over 90% of patients and has a very low complication rate. There is typically no rush to remove minor cataracts from the patient who is still functioning well, and the timing of surgery can be based on the patient’s calendar and needs.
Not so long ago, eye doctors removed the clouded-over lens(es) and the patient had to wear extremely thick eyeglasses for the rest of his or her life to make up for the loss. No more! Now many varieties of sterile, synthetic replacement lenses, called intra-ocular lenses (IOLs) are available.
There are two main types of cataract surgery now performed. One type is called phaco-emulsification. This involves inserting a tiny ultrasound probe through a very small incision at the side of the eye, and using it to emulsify the old lens. This means the water and non-water parts of the lens are mixed together like oil and vinegar in a salad dressing after shaking. The resulting emulsion is then siphoned off, leaving only the back of the lens capsule. The replacement IOL is then put into place atop this remnant. One or two stitches at most are sometimes needed.
The other surgical option is called extracapsular cataract extraction (ECCE), involving removal of the lens more or less intact and leaving the entire lens capsule behind to hold the IOL. This is in contrast to the older technique called intracapsular cataract extraction, which involved removing the lens and its capsule, with no lens replacement, and led to wearing thick glasses or contact lenses. ECCE involves a slightly larger incision at the side of the eye and a few more stitches. It may be necessary if the cataract has become too hardened to be emulsified or in a few other rare cases.
Both types of surgery are now done on an outpatient basis. In the best case scenario, surgery can be done in as few as 15 minutes, and rarely goes longer than a half hour. The patient typically will be at the surgical center for 90 minutes to two hours, for preparation and initial recovery. Patients typically wear a patch to keep the eye closed, and for this reason almost all cataract removals are done on one eye at a time with many weeks in between surgeries.
The main concern during recovery is protecting against infection or other causes of inflammation in the eye. Appropriate preventative medications, both oral and eyedrops, are always given. Recovering patients are also restricted from heavy lifting and other strenuous physical activities for the first week. As with most ‘day surgeries’, the cataract removal patient should have someone else present who can drive them home.
The most common complication after cataract surgery is developing an ‘after-cataract.’ This is a clouding of the back of the lens capsule, usually occurring within five years of surgery. This is almost never a serious problem and can be easily treated with a follow-up laser surgery.