Cataract Surgery

In cataract surgery, the cloudy natural lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens (IOL) implant.

The first treatment for cataracts is not surgery but glasses or contacts, this is based on how well you are able to see while engaging in routine activities. You might be able to drive, watch television and work at a computer for quite a few years, even after you are first diagnosed with cataracts.

However, if you have cataracts, you may eventually start to notice "ghost" images and declining visual clarity, which can not be corrected with glasses or contacts. Colors may also begin to look faded. If your functional vision is impaired significantly and it becomes difficult for you to visually perform your normal daily activities, it may be time for cataract surgery.

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Preparing for Cataract Surgery

Once you and our eye doctor have decided that you will have your cataract removed, our eye surgeons will examine you. . Your personal safety is very important to us. You will need to have seen your primary care physician for clearance within one month of your cataract surgery.

As an example, a common drug that treats men with enlarged prostates — Flomax and similar medications known as alpha-blockers — could cause problems associated with intraoperative floppy iris syndrome (IFIS) during cataract surgery. Patients on Flomax or similar medications should notify the eye surgeon before undergoing cataract surgery.

You may be given a choice of using a regular single-vision (monofocal) intraocular lens or a presbyopia-correcting intraocular lens for replacement of your eye's natural lens. Your eye will be thoroughly measured in a preliminary eye exam to determine the proper power of the intraocular lens that will be placed in your eye during surgery.

If you need cataracts removed from both eyes, surgery usually will be done on only one eye at a time. An uncomplicated surgical procedure lasts only about 30 minutes. Plan to arrive ½ hour before your scheduled surgery time and plan to be picked up ½ hour after your surgery is complete.  If you need transportation, please inquire at our office, as the surgery center will provide this service.  At least a few days to weeks typically will be needed between surgeries, so that your first eye has the chance to heal and be evaluated in a follow-up exam for any possible problems.

What Happens During Cataract Surgery?

Cataract surgery is usually done on an outpatient basis. You may be asked to skip breakfast and avoid drinking liquids, depending on the time of your surgery. Also, do not wear eye makeup on the day of surgery. Upon arrival for surgery, you will be given eye drops and perhaps medications to help you relax. In pre-op you will be given an injection around your eye to make the eye and the area around it numb; you will neither remember nor feel this part of the procedure.

Once in the operating room you will placed under a twilight anesthesia, you will be awake but completely comfortable.  An anesthesiologist will continuously monitor your heart rate and blood pressure.

The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your eye and head. Under an operating microscope, at least one small incision is made into the eye. The surgeon will mechanically remove your cloudy lens (i.e., the cataract).

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Clear Cornea Catarct surgery can be performed using an ultrasound-driven instrument that breaks up the cataract (phacoemulsification) as it is suctioned (aspirated) out of the eye.

AStasiorn Intraocular Lens IOL will be inserted inside the eye to replace the natural lens that was removed.

Most incisions used for cataract surgery are self-sealing. However, on occasion, incisions may need to be sutured. When stitches are used, they rarely need to be removed.

Up to 30% of the time following cataract surgery, some people may need a simple laser procedure to clear up cloudiness within a membrane (posterior capsule) that is the back surface of the eye's original natural lens. The intraocular lens is positioned on top of this membrane, which is purposely left in place during cataract surgery.

Up to 30% of this membrane becomes cloudy (called a posterior capsular opacity) and causes symptoms similar to those that were present with the original cataract. When a cloudy membrane causes compromised visual acuity, a high energy YAG laser is used to open up the membrane. This procedure is simple and painless and need be done only once in a lifetime if the membrane becomes cloudy following cataract surgery.

After Cataract Surgery

When the operation is over, our surgeon will place a protective shield over your eye that will remain on until the next morning. After a short stay in the outpatient recovery area, you will be ready to go home. Plan to have someone else drive you home.

You will need to administer eye drops, as prescribed by our surgeon, several times daily during the next few weeks after the procedure. You also will need to wear your protective eye shield while sleeping or napping, for a week after surgery. You will be given sun shades to help protect your eye in bright light.

How to care for your eye after Cataract Surgery

We care about your eyes and about attaining the best surgical result possible.  It is very normal for your eye to be somewhat swollen, red, itchy, watery or light sensitive.

You must help achieve the best surgical result possible by protecting your operative eye at all times during the healing process:

  • Do not rub your eye. Each year, there are numerous reports f of patients getting soap or water in their eyes, and/or rubbing their eyes and causing infection or displacement of their implant

  • While you are awake, wear your glasses (to protect your eye; they may not help you see any better). While in sunlight, wear your sunglasses

  • While sleeping, wear the plastic protective shield taped in place for one week after surgery.

  • Do not get soap or water into your eye. You may shower and wash your hair, but only with extreme caution. Wear the protective plastic shield, keep your eyes closed and face away from the stream of water. When rinsing your hair, make sure that all of the shampoo and water run backwards away from your face. The safest possible way to wash your hair is to have it done at a salon, with the plastic protective shield taped in place and your eyes closed.

  • You may clean your face and eyelids, but do so gently, with a moistened cotton ball or tissue. Keep your eyes closed and do not place any pressure on the eye.

  • Do not strain to lift or push any object heavier than 15lbs. for 10 days post-op.

  • Do not perform vigorous exercise for 4 weeks (please ask prior to returning to low impact or less vigorous exercise)

  • You may return to driving if the vision in your non-operated eye is good (please ask if you are unsure) please drive with caution, as your depth perception will be altered.

  • Remember to take all eye drops as prescribed.

  • If you have pain that Tylenol does not make better, any marked changes in your vision, or any concerns you may have regarding your eye, please phone our office at 518.220.1400. This phone line is answered 24 hours a day, 7 days a week.

Complications of Cataract Surgery

Glaucoma or a buildup of pressure within the eye (intraocular pressure) also sometimes occurs after cataract surgery. If your eye pressure remains high, you may need additional treatment such as eye drops, a laser procedure, pills or additional surgery.

Far more rarely, you might experience problems such as a decentered intraocular lens that might need to be repositioned or replaced in a second surgery. Various complications, ranging from minor to serious, also can take place as a direct result of the surgical procedure, including tearing of the posterior capsule holding the intraocular lens in place.

Retinal detachments also are possible in up to 3.6 percent of people following cataract surgery (Ophthalmology reference book, 2004), particularly if you have unusually long eyes associated with nearsightedness. Some eye surgeons dispute this direct association with cataract surgery (EyeWorld, November 2004), because highly nearsighted people already are at risk of retinal detachments with or without cataract surgery.

If you notice fading vision similar to a curtain moving across your field of view or flashes of light, immediately seek medical help for a possible retinal detachment. Retinas can frequently be reattached and vision restored, but only if action is taken promptly.

Endophthalmitis causing widespread inflammation or infection of the eye can be a serious side effect of cataract surgery that can lead to permanent vision loss and even blindness. Various studies indicate that endophthalmitis occurs in about one out of every thousand cataract surgeries. Endophthalmitis also is more likely to be seen in people with compromised immune systems associated with conditions such as diabetes (Ophthalmology Clinics of North America, December 2006).

However, even serious cataract surgery complications often can be resolved with appropriate follow-up treatments.

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Bruising or a black eye can result from cataract surgery if an injection is used to numb the eye.

Cataract Surgery Outcomes

A comprehensive study reported in Archives of Ophthalmology in 1994 noted that 95.5 percent of healthy eyes achieved 20/40 uncorrected vision (legally acceptable for driving) or better outcomes following cataract surgery. Of the more than 17,000 eyes evaluated, fewer than 2 percent had sight-threatening complications.

Remember that sight-threatening complications often are associated with individuals who already have poor underlying health affecting how their eyes heal. Also, some individuals have complications because their cataracts are far more advanced or "hardened" at the time of surgery, making them difficult to remove

Phacoemulsification in cataract surgery involves insertion of a tiny, hollowed tip that uses high frequency (ultrasonic) vibrations to "break up" the eye's cloudy lens (cataract). The same tip is used to suction out the lens.