Cataract Surgery
What is a cataract?
Cataract is a clouding of the natural lens of the eye, which is important for focusing light on the retina to help you to see. When the lens becomes opaque, the light entering the eye scatters and images can become out of focus. Cataracts often cause blurry vision and glare, which can impact your ability to see, read or drive a car. When cataracts interfere with your daily activities then it is likely time to consider cataract surgery, the only effective treatment.
What does cataract surgery involve?
In cataract surgery, an ophthalmologist removes the cataract and replaces it with a clear artificial implant, restoring your vision. Routine cataract surgery is a painless 20-minute outpatient day procedure. Anesthetic eye drops are used to make the eye comfortable and the surgery is performed under a microscope with the patient lying down on an operating table. Most patients are awake throughout the surgery but are given a mild sedative beforehand to help them stay calm.
Cataract surgery is performed through a self-sealing 2-3mm incision in the cornea, the clear cover to the eye. The cataract is carefully broken up into small fragments using an ultrasound machine called phacoemulsification and the cataract fragments are then removed with specialized fluid. An artificial lens, called an intraocular implant (IOL), is folded and inserted into the eye, where it opens up and is held in place by the eye’s natural support system.
What implant (IOL) should I choose in cataract surgery?
Patients are given options with cataract surgery to reduce their need for glasses by completing preoperative testing and/or selecting from a variety of special feature IOLs. Not all IOLs are suitable for all patients and you should discuss testing and implant choices with your eye surgeon.
What are the potential risks of cataract surgery?
Cataract surgery is a commonly performed safe procedure and less than 1% of patients experience serious complications.
Cataract surgery risks can be divided into two categories: things that can happen during the surgery (intraoperative), and those that can happen after surgery (postoperative).
Intraoperative risks:
- The cataract cannot be safely removed and further surgery may be required to remove the remaining fragments.
- The support system of the eye is compromised or weak and further surgery may be required to place an IOL implant.
- Intraoperative floppy iris syndrome (IFIS). Sometimes the iris can become unstable during surgery, making it challenging to remove the cataract. Intraoperative devices can be used to stabilize the iris and usually this can be safely managed. The risk of IFIS is greater for patients on bladder or prostate medications.
- Bleeding is a very rare risk.
Postoperative risks
- Dry eye disease. Patients often feel the eye is dry, scratchy, gritty, itchy, or irritated in the days and weeks after cataract surgery. This common problem is usually mild and stems from an underlying tendency to dry eye. Dry eye disease can be managed with artificial tears, omega 3 oral supplements, cleaning of the eyelashes, and warm compresses. Rarely dry eye disease can be more severe in the weeks and months after cataract surgery, causing blurry vision, sharp eye pain and tearing, and requiring more aggressive treatment.
- High eye pressure. You should be monitored in the weeks after cataract surgery to ensure that your eye pressure remains in a safe range. If left untreated, high eye pressure can cause glaucoma, damage to the nerve in the eye. Often high eye pressure is asymptomatic. Severe high eye pressure causes blurry vision, a headache above the eyebrow associated with nausea and vomiting.
- Corneal edema. Cataract surgery is a stress for the eye and the cornea usually clears over the first few days. In some patients, the cornea can struggle to recover form the surgery, and the vision remains cloudy. Your ophthalmologist will treat this with drops, and rarely it may require a cornea surgery. Some patients will have an increased risk of corneal edema after cataract surgery if they have a common underlying corneal disease called Fuch’s dystrophy.
- Macular edema. The center of the retina, the macula, can become irritated after cataract surgery and develop some cystic fluid spaces, called cystoid macular edema (CME). CME causes a painless smudge or a cloud over the central vision. This can happen to any patient after surgery and usually resolves with treatment with drops. Rarely CME can be a prolonged problem.
- Iritis. Inflammation in the eye, iritis, is expected in the days after cataract surgery and is treated routinely with steroid eye drops over the course of 4 weeks. Iritis usually causes light sensitivity, pain, eye redness, and mild blur to the vision. In some patients, the inflammation is more aggressive and can persist or recur, requiring drops over a longer course of time. Rarely iritis can be a prolonged problem.
- Retinal detachment. Cataract surgery can sometimes trigger the vitreous, the gel in the back of the eye, to shift. This is a normal event called a posterior vitreous detachment (PVD) that carries a 5% risk of developing a retinal tear. A PVD usually causes new floaters and flashes of light in the eye. Untreated retinal tears can lead to retinal detachment, a serious condition that carries a risk of permanent vision loss of blindness. Retinal detachment causes a painless curtain over the vision, or severe blurriness.
- Endophthalmitis, infection inside the eye, is an extremely rare but serious risk that can occur to any patient in the week after surgery. In endophthalmitis the vision gets very blurry over a few days and the eye becomes achy and red. It requires urgent treatment and carries a risk of permanent vision loss or blindness. The risk of endophthalmitis is between 1/1000 and 1/10,000.
What should I expect after cataract surgery?
It is common for vision to be cloudy or blurry on the day of surgery and it will significantly improve over the first week. Common side effects from surgery: GRITTINESS, WATERING, BLURRED VISION, REDNESS to the eye. Conservative management of dry eye may help improve these symptoms. These should subside slowly as the eye heals and are generally not worrisome. Usually you can return to normal activities in the days after surgery and you will have a drop schedule to follow for 4 weeks. You will be reassessed 1-2 weeks after the surgery to monitor your healing.
For information on cataracts and cataract surgery:
1. Cataracts
3. Optional non-insured testing and special feature IOL implants
