Cataract surgery is one of the most common surgeries performed in the United States each year, with over two million surgeries performed each year. It is also one of the safest surgeries, with over 95% of those surgeries having no complications. Despite these significant volumes, there tend to be many misconceptions about cataracts and cataract surgery.
The term ‘cataract’ describes the clouding of the natural lens in your eye. As you age, proteins in the lens deteriorate, leading to a loss of transparency in the lens. Cataracts are a natural part of aging; if everyone lived at least 80 years, more than 95% of the population would develop visually significant cataracts.
Since the aging process causes nearly all cataracts, researchers have found very few ways to prevent their development. Continued exposure to sunlight – a common hazard for farmers and lifeguards – does appear to speed the progression of certain types of cataracts, so eye doctors routinely recommend high-quality sunglasses and regular glasses with ultraviolet filters.
Long-term steroid (prednisone) use may also cause the early development of cataracts, and thus the many legitimate users of steroids – patients recovering from major illnesses and surgeries, patients using steroidal eye drops to treat inflammation, and even asthmatics using inhalers with steroids – have this slight risk. However, since most of the population will eventually develop cataracts, the health benefits of physician-monitored steroid use clearly outweigh the risks of early cataracts.
Most patients typically learn they have cataracts during an eye exam with their optometrist or ophthalmologist. Because cataracts generally develop slowly, the cataract may not be noticeable or bothersome for several years. When the cataract reduces a patient’s ability to perform normal functions like driving, reading, watching television or knitting, then the surgeon will recommend cataract surgery.
During cataract surgery, anesthetic is applied to the surface of the eye and a small incision is made in the eye. A machine called a phacoemulsifier is inserted into the incision and vibrates up to 50,000 times per minute, allowing the old lens to be painlessly broken into tiny pieces. The lens pieces are removed with suction and a new artificial lens (called an intraocular lens, or IOL) is placed in the capsule that once held the natural lens. The new lens has tiny wire-like arms on its sides that keep it from moving in the capsule.
Most patients have excellent distance vision within a few days of surgery, although some patients may require minor eyeglass correction to reach optimum distance vision. Virtually all patients will need glasses for near vision, since the new artificial lens placed in the eye is not designed for near and far vision. However, there are intraocular lenses, called ‘accommodative,’ ‘multifocal,’ or ‘premium’ lenses, that may allow you to see both near and far. However, they are more expensive than standard intraocular lenses, and Medicare will not cover the cost of the lenses. See the discussion on Premium IOLs below for more information.
One of the few post-operative restrictions is to avoid heavy lifting during the week after surgery, and most patients are back to their normal routines the day after surgery. Most patients are seen post-operatively on the day after surgery, 7 – 14 days later, and then approximately one month after surgery. Approximately 30 days after surgery, the surgeon or optometrist will prescribe new glasses.
Patients will be given prescriptions to fill for a steroid eye medication and an antibiotic eye medication that should be taken several times a day for the for the few weeks after cataract surgery. Your surgeon will provide you with a pre-printed medication schedule to help you remember how often and for how long you should instill each medicine.
For 20% to 30% of cataract patients, the capsule where the new lens was placed may begin to cloud. This cloudiness is removed by using a painless laser (a YAG laser) to break through the film in the capsule. Patients can resume their normal activities immediately after the YAG laser procedure.
The animation below provides an introduction to cataracts and the associated treatment options.
Please click on the topics below (or to the side) for more information on cataract symptoms, IOLs, and treatment options.