Before cataract surgery, a number of tests are carried out. Some of these tests are to rule out other causes of decreasing vision, while others are to measure the size and shape of the eye. This helps determine the right type of lens implant (intraocular lens, or IOL). In our practice, the most accurate equipment and up-to-date computer software is used to ensure the best results from surgery. Sometimes dry eye testing is required to ensure any underlying dry eye is corrected as this can compromise the success rate.
Nearly everyone who has cataract surgery will be given IOLs. These lenses improve your vision by focusing light on the back of your eye. You won't be able to see or feel the lens as it is implanted inside your eye. It requires no care and becomes a permanent part of your eye.
A variety of IOLs with different features are available. Before surgery, we will discuss which type of IOL might work best for you and your lifestyle.
IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires a few stitches (or sutures) to close.
However, many IOLs are flexible, allowing a smaller incision that requires no stitches. This type of lens is folded and inserted into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.
Some of the types of lenses available include:
Fixed-focus monofocal. This type of lens has a single focus strength for distance vision. Reading will generally require the use of reading glasses.
Multifocal. These lenses are similar to glasses with bifocal or progressive lenses. Different areas of the lens have different focusing strengths, allowing for near, medium and far vision.
Astigmatism correction (toric). If you have a significant astigmatism, a toric lens can help correct your vision.
We will discuss the benefits and risks of the different types of IOLs with you to help you determine what's best for you.
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Cataract surgery is one of the 'modern miracles' of surgery - it has one of the highest success rates of any surgery performed in the world. In the USA, the ASCRS (American Society of Cataract and Refractive Surgeons) found that, of more than 3 million people undergoing cataract surgery each year, the success rate is 98% or more.
Nevertheless, like all surgery, there are risks involved. Any surgery on the eye will carry a risk of damage to the eye and vision and this is also true of cataract surgery. However the level of risk is small and there are many daily activities which are also associated with this levelof risk, for example, the risk of a serious car accident while driving.
While the above may seem like a long list, the actual number of people experiencing complications is very low. Between 1994 and 2006, a study of over 200,000 USA Medicare recipients having cataract surgery found that 99.5% of patients had no severe postoperative complications, that is, the overall severe complication rate was less than 0.5% and even this has further decreased since this study, due to more modern and safe techniques and equipment. For example, with the use of antibiotics injected into the eye at the time of surgery, the infection rate is now less than 1 in 6000.
In summary, it is important to remember that cataract surgery is a major procedure on the eye that, like all surgery, carries some risks. However, cataract surgery remains one of the safest surgeries performed in the world, and the vast majority of people do well and are very happy with the vision resulting from their operation.
Preparing for surgery
Food and medications Do not to eat or drink anything from midnight before cataract surgery. You may also be advised to temporarily stop taking any medication that could increase your risk of bleeding during the procedure. Let us know if you take any medications for prostate problems, as some of these drugs can interfere with cataract surgery.
Other precautions Normally you can go home on the same day as your surgery, but you won't be able to drive, so arrange for a ride home.
Cataract surgery is usually an outpatient procedure and takes about 20 minutes.
First, eyedrops will be placed in your eye to dilate your pupil. You'll receive local anesthetics to numb the area, and you may be given a sedative to help you relax. If you're given a sedative, you may remain awake, but groggy, during surgery. Often, you may not remember what happened during the operation.
During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.
Surgical methods used to remove cataracts include:
Using an ultrasound probe to break up the lens for removal. During a procedure called phacoemulsification (fak-o-e-mul-sih-fih-KAY-shun), your surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed. Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The very back of your lens (the lens capsule) is left intact to serve as a place for the artificial lens to rest. Stitches may be used to close the tiny incision in your cornea at the completion of the procedure.
Making an incision in the eye and removing the lens in one piece. A much less frequently used procedure called extracapsular cataract extraction requires a larger incision than that used for phacoemulsification. Through this larger incision your surgeon uses surgical tools to remove the front capsule of the lens and the cloudy lens comprising the cataract. The very back capsule of your lens is left in place to serve as a place for the artificial lens to rest.
This procedure may be performed if you have certain eye complications. With the larger incision, stitches are required. Once the cataract has been removed by either phacoemulsification or extracapsular extraction, the artificial lens is implanted into the empty lens capsule.
After cataract surgery, expect your vision to begin improving within a few days. Your vision may be blurry at first as your eye heals and adjusts.
Colors may seem brighter after your surgery because you are looking through a new, clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting the look of colors. It is at this point that, if only one eye has had cataract surgery, you will notice the difference in clarity and colour perception between the newly operated eye and the one that has not yet had the surgery.
You'll usually be checked by clinical staff on the day of the surgery and will see your eye doctor a week or two after your surgery. If you have cataract surgery on both eyes, you will see your Optometrist at least 6 weeks after the second operation, to arrange glasses if required, or for a routine follow up if glasses are not required.
It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pushing on your eye.
After a day or two, most of the discomfort should disappear. Often, complete healing occurs within six weeks.
Contact your doctor immediately if you experience any of the following:
Pain that persists despite the use of over-the-counter pain medications
Increased eye redness
Light flashes or multiple new spots (floaters) in front of your eye
You will be given a protective shield the day of surgery to wear when you sleep during the recovery period, usually about a week, longer if required or if you consider it necessary due to personal sleep habits.
You will be prescribed eyedrops to prevent infection, reduce inflammation and sometimes, to control eye pressure. Sometimes, some of these medications can be injected into the eye at the time of surgery.
It is common to feel that lights are too bright after cataract surgery. This is partly due to inflammation in the eye. Anti-inflammatory eye drops go some way into relieving this problem, but if there is any difficulty, sunglasses can be worn. These can be obtained from any chemist or spectacle outlet
The rate of recovery of vision is usually fairly rapid. Expect that you will see well within a week or two (or sometimes earlier) following cataract surgery.
Most people need glasses, at least some of the time, after cataract surgery. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for eyeglasses. This is usually between 6 weeks and three months after surgery.
If you have cataracts in both eyes, your doctor usually schedules the second surgery after the first eye has healed. Often second eye surgery is booked a week or two after the first.
It is recommended that you rest after the operation as you will have been given a sedative that can make you drowsy the afternoon after surgery. If you have a quiet, non physical job you may get back to work a few days after surgery. You would be best advised to take a week or two off work to be safe. In the event that you have work that exposes your eyes to dust or dirty environments, you may need to refrain from going back to work for 2-4 weeks.
Cataract surgery successfully restores vision in the majority of people who have the procedure.
People who've had cataract surgery may develop a secondary cataract. The medical term for this common complication is known as posterior capsule opacification (PCO). This happens when the back of the lens capsule — the part of the lens that wasn't removed during surgery and that now supports the lens implant — becomes cloudy and impairs your vision.
PCO is treated with a painless, five-minute outpatient procedure called yttrium-aluminum-garnet (YAG) laser capsulotomy. In YAG laser capsulotomy, a laser beam is used to make a small opening in the clouded capsule to provide a clear path through which the light can pass. This is done in the clinic, no hospital admission being required and vision is often improved immediately, the full benefit becoming evident the next day