In cataract surgery, the 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 procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility.
What is cataract surgery?
Cataract surgery is all about removing the faulty lens in your eye, and in majority of the scenarios, replacing it with an artificial lens. In fact, it is among one of the most frequently and successfully carried out eye surgeries right now, in the U.S as well as across the globe.
According to the American Society of Cataracts and Refractive Surgery (ASCRS), 3 million Americans undergo cataract surgery each year, with an overall success rate of 98 percent or higher.
So, why do you need a cataract surgery in the first place?
Well, if you want to get your cataracts problem treated, you need to undergo such a surgery. Since cataracts can inflict you with a blurry vision, also turning your eyesight sensitive to the glare from lights, turning your daily-life activities into a problem for you. This is when your doctor may advise you for cataract surgery.
Another possible scenario leading you to such a surgery can be the interference or hindrance of cataracts in treatment of other eye problems, such as age related macular degeneration, diabetic eye problems and other common eye diseases. With a clouded eye lens, optometrists fail to examine the back of the eye comprehensively.
When is the right time to have cataract surgery?
When dealing with cataract removal, you better ask yourself the following questions:
- Are cataracts making it difficult for you to carry out your daily or occupational activities?
- Is your ability to drive to work or at night being affected by cataracts?
- Is reading or watching television becoming cumbersome for you due to cataracts?
- Are you having issues in cooking, shopping, yard-work, taking medications or climbing stairs?
- Do you feel difficulty in seeing under bright lights?
- Is your level of independence getting disturbed after having cataracts?
- Is your cataracts problem manageable through alternative ways?
Types of cataract surgery
Also known as ‘Phaco’, it is the most common technique used for cataract removal nowadays. Usually, it takes no more than half an hour to remove cataract through phacoemulsification, and that too, requiring only minimal sedation, i.e. local anesthesia (injecting anesthesia around the eye) or topical anesthesia (administering numbing drops into the eye).
This cataract procedure requires a small surgical incision around the edge of the cornea, creating an opening through the membrane surrounding the lens. The next step involves inserting a small ultrasonic probe into the opening to break up the cloudy lens into tiny fragments using sound waves, which act as a microscopic jack hammer. An attachment on the probe tip is then used for suction of broken down cataract fragments.
Once the lens particles are removed, an intraocular lens implant, also referred commonly as an IOL, is implanted in the natural lens capsule. A hollowed out tube is used by the ophthalmologists to insert the IOL through a tiny corneal incision.
This is the cataract procedure used in case of highly advanced cataracts, which is too dense for phacoemulsification (the process of breaking down or dissolving the cataract into tiny fragments) or when phacoemulsification is not possible for various other reasons.
A slightly larger incision is required for this cataract removing technique, so that the cataract can be removed in one piece instead of being fragmented within the eye. Just like phacoemulsification, an artificial lens (IOL) is placed inside the same capsular bag.
A number of sutures are required to close the comparatively larger wound, which also results in slower recovery of the wound as well as visual function.
To initiate this cataract removal technique, the numbing medication is administered through an injection around the eye. An eye patch is also required after this kind of surgical process.
Though rarely used nowadays, this cataract removal technique may still be useful under certain circumstances. It requires an even larger incision as compared to extracapsular surgery, through which the entire lens with surrounding capsule is removed. Moreover, the IOL (intraocular lens) is placed in a different location, in front of the iris, in this surgical procedure.
Potential cataract surgery complications
Though more than 98% success rate of cataract surgery makes potential cataract surgery complications a rare incidence, the possibility of certain problems is still there; for example, bleeding or infection (endophthalmitis).
Since every single person with cataract can have varied health conditions, your ophthalmologist is supposed to discuss the specific potential complications of the type of cataract procedure most feasible for you, requiring your signatures on a consent form.
Some of the most common cataract surgery complications include persistent inflammation, ocular hypertension (also known as elevated intraocular pressure), cystoid macular edema (a condition where retina at the back of the eye is swollen) and retinal detachment. (You can find a detailed account of potential cataract surgery complications in this publication.)
Cataract Surgery Recovery
Cataract surgery recovery is also one of the most concerned aspects of cataract removal, especially the time required in restoration of functional vision after the procedure.
You’re expected to take first follow-up visit to your ophthalmologist within the first few days after the cataract surgery, followed by a subsequent visit within the first few weeks. In most of the cases, you’re prescribed with specific types of eye drops to reduce inflammation and protect against infection.
Most people observe an improvement in their visual function within several days of the surgery, enabling them to restart most of their daily activities including work. However, you need to have several visits to the doctor, who monitors and observe your eye(s) for any signs of complications.
Majority of people regain full activity after a few days of getting treated. Your doctor might fit you with a pair of glasses (if needed) once your vision is stabilized. This also depends upon the type of intraocular lens implanted in your eye.
There is also a possibility that you are unable to get cataract surgery, due to old age, for example. If so, you may consult your doctor for resorting to some of the contemporary low vision aids like IrisVision, which are designed to augment your visual capacity, returning you some of the independence that you once enjoyed before falling victim to this eye disease.
Types of IOL lens
Below are the major types of IOL Lens:
- Monofocal
Monofocal IOLs are one of the most traditional and widely used OL lens types. They offer a single focal point, which means that they provide clear vision for one specific distance – either near, intermediate, or far. Individuals who prefer a monofocal IOL often opt for clear distance vision and rely on reading glasses or other corrective measures for close-up tasks.
Advantages:
- Predictable Results: Monofocal IOLs are an excellent choice for patients who have straightforward vision needs.
- Cost-Effective: These IOLs tend to be more cost-effective compared to multifocal or premium lenses.
- Low Risk of Visual Disturbances: Monofocal IOLs have a lower risk of visual issues like halos and glare, making them suitable for night driving.
- Multifocal
As the name suggests, Multifocal lenses provide multiple focal points within a single lens. It allows individuals to see clearly at different distances, eliminating the need for glasses. These types of IOLs lenses can correct presbyopia, a condition that affects near vision as people age.
Advantages:
- Reduced Dependence on Glasses: Offer the convenience of clear vision at various distances.
- Enhanced Quality of Life: Improved quality of life due to their ability to perform a wide range of activities.
- Extended Depth-of-Focus Lens
Extended depth-of-focus IOLs are the most recent innovation in all Intraocular lens types that aim to provide continuous and seamless vision across various distances. Unlike multifocal IOLs, it does not have distinct focal points. Instead, it offers a continuous range of focus, helping patients easily achieve superb vision at varying distances.
Advantages:
- Continuous Range of Vision: Reduces the likelihood of visual disturbances associated with multifocal lenses.
- Improved Intermediate Vision: Excellent at providing clear vision for intermediate tasks, such as using a computer or reading a menu at a restaurant.
- Enhanced Night Vision: Offer better night vision compared to some multifocal options.
- Light-Adjustable Lens
The light-adjustable lens is the most innovative development in the field of Intraocular lens types. It can be customized and fine-tuned after cataract surgery to reshape the lens, optimizing the patient’s vision as required.
Advantages:
- Personalized Vision: It can be adjusted and personalized to meet each patient’s unique visual requirements.
- Reduced Need for Multiple Surgeries: It can be modified after the initial cataract surgery, eliminating the need for additional surgeries to address changing vision needs.
- High Precision: High level of precision in correcting vision, potentially leading to excellent outcomes.
4. Toric Intraocular Lens
Toric IOLs are specifically designed to address astigmatism. These type of IOLs lenses have a toric shape, which allows them to work effectively for the irregular curvature of the cornea in astigmatic eyes.
Advantages:
- Astigmatism Correction: Eliminates astigmatism, improving the overall quality of vision.
- Reduced Need for Glasses: Reduces dependence on glasses for distance vision.
- Improved Contrast Sensitivity: Enhances contrast sensitivity, leading to sharper and clearer vision, especially in low-light conditions.
- Accommodating IOL Lens
Accommodating IOLs are IOL lens options designed to enhance the natural flexibility of the eye’s crystalline lens. These lenses can adjust their shape in response to the eye’s focusing muscles, providing a range of clear vision at varying distances.
Advantages:
- Near-Natural Vision: Provides a more natural vision experience.
- Reduced Dependence on Glasses: Offer improved near and intermediate vision.
- Less Risk of Visual Disturbances: Lower risk of visual disturbances compared to multifocal IOLs.
- Custom and Enhanced Intraocular Lens
Custom and enhanced IOLs are designed to cater to patients with specific vision needs or unique anatomical considerations. These IOL lens types can be tailored to correct a wide range of refractive errors and can be combined with other advanced technologies.
Advantages:
- Individualized Solutions: It can be customized to address an array of visual imperfections.
- Comprehensive Correction: It addresses not only cataracts but also other refractive errors like myopia, hyperopia, and presbyopia.
- Enhanced Visual Outcomes: Offers excellent and often superior visual outcomes.