Cataracts are slow forming. They usually develop in people aged 55 years and older, though younger people can also develop cataracts.
There is no known way to prevent cataracts from forming but wearing sunglasses and quitting smoking can help slow down their development. Currently, surgery to remove the lens and replace it with a synthetic one is the only treatment option available.
This article outlines the two different types of cataract surgery available. We describe the procedures and provide information on what people can expect before, during, and after surgery. We also outline the potential risks and complications involved.
Who might need surgery and why?
Cataracts usually require surgery when a person’s vision loss interferes with their everyday activities.
Not everyone who has cataracts needs cataract surgery. In the early stages, cataracts may cause only minor issues, such as nearsightedness. An eye doctor may be able to correct these symptoms with glasses alone.
Cataracts tend to be slow forming, causing very gradual worsening of vision. Surgery is usually only necessary when a person’s vision loss interferes with their everyday activities, such as reading or driving.
A person who has cataracts should talk to their doctor to find out if and when they may need surgery.
According to the American Optometric Association, there are two types of cataract surgery: small incision cataract surgery and extracapsular surgery.
Small incision cataract surgery
Small incision cataract surgery (SICS) is the more common of the two procedures. SICS involves making a tiny incision into the cornea, which is the outermost layer of the eye. The cornea is the dome-shaped part of the eye that sits in front of the lens.
A surgeon then inserts a probe through the incision into the cornea. The probe uses ultrasound waves to break up the lens so that the surgeon can remove it in small pieces. Eye doctors call this process phacoemulsification.
The surgeon leaves the lens capsule, which is the thin outer membrane that covers the lens, in place and inserts a new, artificial lens into it. Typically, the incision in the cornea does not require any sutures.
In some cases, a person may be unable to receive an artificial lens due to other eye problems. In such cases, wearing contact lenses or eyeglasses may correct vision problems.
Extracapsular surgery involves making a large incision in the cornea. This allows the surgeon to remove the lens in one piece. As with SICS, they leave the lens capsule in place to support the new, artificial lens.
Typically, surgeons carry out this type of surgery when phacoemulsification cannot break up the cloudy spots.
Preparing for surgery
Before surgery, the doctor will ask the person about any medications they are taking. A person may need to stop taking certain medications on or before the day of the surgery. A doctor will outline which drugs a person should stop taking and may provide alternatives.
A doctor may also ask a person to avoid eating or drinking for up to 6 hours before the surgery.
Some people may also receive eye drops to use before the procedure.
Cataract surgery is a relatively quick procedure, and people can expect to be in and out of surgery in a very short time.
However, because the surgery directly affects vision, a person should arrange transport to get them to and from the clinic or surgery. They may also want to consider having someone stay with them to help out when they get home.
What to expect during and after surgery
Before surgery, the prep team will go over any final details about the person’s medical history and the surgery itself. Once they have prepared the person, the surgeon will begin the operation.
During the surgery, a person can expect the following:
- A doctor will usually give the person medication to help them relax.
- A doctor may use anesthetic eye drops or injections to numb the person’s eye.
- The person remains awake during the procedure and may see light and general movement. However, they will not be able to see what the surgeon is doing.
- The surgeon will make tiny incisions so they can reach the lens of the eye. They will then remove the lens and replace it with the synthetic one.
- Typically, there is no need for stitches since the wound heals on its own.
- The surgeon places a protective shield over the eye or eyes and sends the person to the recovery room.
The entire procedure usually takes around 15 minutes.
A person will usually wait in the recovery room for about an hour following the procedure. The surgeon may have bandaged their eyes to help aid their recovery.
Once at home, a person should focus on preventing their eyes from becoming infected. They should avoid getting water in their eyes and should apply any eye drops as prescribed by their surgeon or doctor.
A person can continue with most daily activities, such as reading and watching TV. However, they should avoid heavy lifting and activities that can jar the eyes, such as jogging or basketball.
A surgeon will usually ask the person to return for check ups following surgery. This is to ensure that the eye is recovering as expected. Check ups usually take place the day after surgery, a week later, and several weeks after the surgery.
Risks and complications
Cataract surgery is an outpatient procedure that uses local anesthesia. As such, experts generally consider the procedure to be safe.
However, as with any medical procedure, there are risks of complications. Before a person decides on having cataract surgery, they should talk to their doctor about any potential complications.
Some common complications include:
- swelling of the cornea and eye
- bleeding in the eye -vision loss
- accumulation of fluid in the retina
- detachment of the retina
- pressure behind the eyes
- drooping eyelid
- dislocation or movement of the implanted lens
People should be aware that certain medical conditions can increase the risk of complications from cataract surgery.
For example, a person with age-related macular degeneration (AMD) is at increased risk of developing blindness following cataract surgery. People with AMD should discuss the potential risks and benefits with their doctor, before deciding whether to go ahead with the surgery.
Also, certain underlying eye problems, such as damage to the retina, might become apparent after the surgery.
If a person experiences complications following cataract surgery, they should speak to their doctor.
Assuming no complications develop, a person can expect to have much clearer vision following cataract surgery. However, if a person notices any side effects or complications, they should let their doctor know as soon as possible.
Some people may develop a secondary cataract. When this occurs, the lens membrane that the surgeon did not remove during the procedure begins to cloud over. According to the American Optometric Association, up to 50% of people who undergo cataract surgery may develop this condition.
A secondary cataract is treatable. Typically, a doctor will use laser treatment to create an opening in the clouded areas.
Cataract surgery is a common outpatient procedure. It is currently the only treatment for removing cataracts.
However, not everyone with cataracts will need surgery to have them removed. Some people may never lose their functional vision. Others may be able to correct their vision problems with glasses.
A person who is considering cataract surgery should talk to their doctor or optician about the potential risks and complications involved.