Things You Need to Know about Cataract Surgery

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At the age of 50 plus years, most of us are likely to hear the eye doctor tell us, "You have cataracts." As we age, proteins in the lens of our eyes may begin to break down, and the lens may become cloudy. What we see may appear blurred. This condition is known as a cataract.

Thus cataract is an eye disease - a clouding of the natural, crystalline lens inside the eye, causing partial or total blindness. It cannot be corrected with glasses, contact lenses or corneal refractive surgery like LASIK. As frightening as it might sound, cataract surgery is one of the safest and most effective surgical procedures performed today. In the vast majority of cases, this procedure produces excellent visual outcomes.

Cataract Surgery Basics

During cataract surgery, the natural lens inside your eye that has become cloudy is removed, and replaced with an artificial lens (called an intraocular lens, or IOL) to restore clear vision. The surgery is performed typically as an outpatient procedure. It does not require an overnight stay in the hospital.

Most modern cataract procedures involve the use of a high-frequency ultrasound device. It breaks up the cloudy lens in the eye into small pieces, which are then gently removed with suction. This procedure is medically called phacoemulsification or ‘phaco’ for short. It can be performed with smaller incisions of 2-3 mm, thus promoting faster healing and reducing the risk of surgical complications.

After all the remnants of the cloudy lens are removed from your eye, the cataract surgeon inserts a clear intraocular lens into the eye. It is positioned securely behind the iris and pupil, exactly in the same location occupied by your cloudy natural lens before the surgery.

Laser Cataract Surgery

Recently, a number of femtosecond lasers - similar to the lasers used to create the corneal flap in all-laser LASIK - are being used in cataract surgery.

These lasers have gained approval for the following steps in cataract surgery, reducing the need for surgical blades and other hand-held tools:

• Creating corneal incisions to allow the surgeon access to the lens
• Removing the anterior capsule of the lens
• Fragmenting the cataract (so, less phaco energy is required to break it up and remove it)
• Creating peripheral corneal incisions, when needed, to reduce astigmatism i.e., faulty vision resulting from defective curvature of the cornea or lens of the eye.

Preparing for Cataract Surgery and Choosing an IOL

Prior to cataract surgery, your eye doctor will perform a comprehensive eye exam to check: a) the overall health of your eyes; b) evaluate whether there are reasons why you should not have surgery; c) identify any risk factors you might have.

Also, a refraction (i.e., the ability of the eye to bend light so that an image is focused on the retina) test will be performed to accurately determine the amount of nearsightedness, farsightedness and/or astigmatism you have prior to surgery. Additional measurements of your eyes will be taken to determine the curvature of your cornea and the length of your eye.

These measurements are essential to help your cataract surgeon identify the proper power of the artificial intraocular lens that would give you the best vision possible after surgery.

Today you have many types of IOL to choose from for your cataract surgery, depending on your specific needs. In addition to IOLs that correct nearsightedness and farsightedness, there are now toric IOLs that correct astigmatism as well.

If you don't mind wearing glasses after cataract surgery, a monofocal lens is usually inserted surgically. Just part-time use of reading glasses is often needed after cataract surgery with monofocal IOLs.

May be you like the idea of being less dependent on glasses after cataract surgery. If so, one way to correct presbyopia (i.e., a reduced ability to focus on near objects caused by loss of elasticity of the crystalline lens after age 45) and reduce your need for reading glasses is to have your cataract surgeon adjust the power of one of your monofocal IOLs. This is done (assuming that you have cataract surgery performed in both eyes) to give you a monovision correction, similar to monovision correction with contact lenses.

Another option is to choose one of a variety of advanced presbyopia-correcting IOLs to improve your reading vision without sacrificing your distance vision. Presbyopia-correcting IOLs include accommodating IOLs and multifocal IOLs; both the types are designed to provide a greater range of vision after cataract surgery than that of conventional monofocal IOLs.

Beware using these premium IOLs for two reasons: a) you may not be a right candidate for this procedure; b) choosing a presbyopia-correcting IOL will increase the out-of-pocket cost of your cataract surgery, since its additional cost is not covered by insurance plans.

Discuss with your eye doctor all medications you are taking, including non-prescription ("over-the-counter") formulations and nutritional supplements. Some medications and supplements can increase your risk of cataract surgery complications and might need to be discontinued prior to surgery.

Article by Dr. B.S. Anil Chandra, MS (Ophthal)
Senior Consultant Phaco and Refractive Surgeon, Kauvery Hospital, Chennai

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