Cataracts affect almost 22 million Americans who are over 40, and 90% of people over the age of 75 have cataracts, so this is not a rare condition. Cataracts develop very slowly and are most likely to be detected early on during a routine eye examination. As the natural lens of the eye becomes cloudier, sufferers may begin to see 'ghost images' which cannot be corrected with glasses or contact lenses. However, you may be able to drive, watch TV and see the computer screen for quite a few years after you have first been diagnosed with cataracts. Once your vision is significantly impaired and is affecting your daily activities, it is probably time for cataract surgery. The common guide line for surgery is when your vision is 20/30 or worse.
Preparing for Cataract Surgery
Once your eye doctor has decided you need cataract surgery, you will be examined by an eye surgeon. One of the most important parts of preparing for surgery is to stop taking any medications which may affect your recovery. The surgeon should tell you what you can and cannot take, including some vitamin supplements. Men taking Flomax and alpha blockers could have problems associated with intraoperative floppy iris syndrome (IFIS) during cataract surgery so be sure to discuss your medications fully in the preparatory appointment. Before surgery your eye will be thoroughly measured to determine the correct power of the new intraocular lens which will be inserted into the eye during surgery. Tests will also be made to ensure there are no other eye problems which may affect the new lens implant.
Choice of Intraocular lens (IOL)
You may be given a choice of lens implant. The choices are between a regular single-vision (monofocal) intraocular lens and a presbyopia-correcting intraocular lens to replace your eye's natural lens. Determining the right intraocular lens for you can be based on many factors, including your lifestyle and ability to pay. If you are interested in correcting presbyopia, which all people have beginning at around age 40, you potentially could restore your ability to see at all distances with a multifocal intraocular lens, although these are more expensive than standard lenses. However, opting for a multifocal lens may mean you no longer need glasses, so it is an important decision which depends upon your lifestyle and age.
An uncomplicated surgical procedure will only take about 10 minutes. However, you may be in the outpatient facility for 90 minutes or longer, because extra time will be needed for preparation and recovery. If you need cataracts removed from both eyes, surgery will usually only be done on one eye at a time so that everyday living can be maintained. At least a few days to weeks typically will be allowed 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 Does Cataract Surgery Involve?
On the day of surgery you may be asked not to eat or drink anything before surgery, depending upon the time your surgery is scheduled for. On arrival, you will be given eyedrops to dilate the pupil and a sedative if required to relax you. Rest assured, the local anesthetic will ensure that the procedure will be completely painless. The skin around the eye will be cleansed and your head will have a sterile covering. Beneath the operating microscope the surgeon will make one tiny incision and then remove the cloudy lens (the cataract). An ultra-sound instrument may be used to sonically break up the cataract so it can be easily removed in small pieces from the eye. This break up is called phacoemulsification. The surgeon will insert the new intraocular lens into the eye to replace the natural lens. The new IOL will be made of plastic or silicone. Most incisions do not require stitches and are self-healing. If stitches are used they do not usually need to be removed. A protective shield will be placed over the eye and after a short recuperation period, you will be allowed home. Obviously you will need to arrange transport as driving is out of the question.
Over the next days and weeks, you will need to apply the eyedrops prescribed for you. See our guide for how to apply eyedrops here. See 'Best Practices for the Application of Eyedrops' in the Glaucoma Treatment article for more information. You will also need to wear a protective eye patch when sleeping and dark glasses when going outside. During the first week after surgery you should avoid:
- Strenuous activity
- Heavy lifting
- Exercising and bending over
- Getting water in the eye area causing infection
- Any activities which may allow dust and grime to get into the eye
And remember to follow any other specific instructions which your surgeon may give you.
More than 95% of patients achieve 20/40 vision or better after cataract surgery which means they can drive without needing glasses. Fewer than 2% had any complications and most of these were minor such as infections or were caused by other eye problems present. Older patients with 'hardened' cataracts may not heal as quickly after surgery, but almost all cataract patients report a positive outcome.