Definition and Overview

Cataract surgery is a procedure used to treat cataracts, a progressive condition characterised by the clouding of the lens inside the eye. It involves removing and replacing damaged lenses to improve vision. Thanks to modern developments in surgical technology, cataract eye surgery is one of the safest and most common eye surgeries performed today.

Who Should Undergo and Expected Results

Cataract surgery is the primary treatment option for patients with cataracts. Like glaucoma, most cases of cataracts are a result of the natural ageing process and develop gradually over a period of many years.

Other factors that may increase a person’s risk of developing cataracts are genetic diseases, severe trauma to the eye, previous eye surgery, and intraocular inflammation. Sometimes, cataracts also develop more rapidly and may affect younger individuals. Early onset cataracts are more common among diabetic patients, smokers, individuals exposed to excessive UV light or ionizing radiation, and those who use steroids in oral, topical, or inhaled forms. Certain medications, such as statins and phenothiazines, can also aggravate or trigger cataracts when used for prolonged periods.

Patients with cataracts may initially experience blurry or distorted vision and may find it difficult to read. They may also notice an unnatural glare. These are the earliest cataract symptoms. When left untreated, the cloudiness may affect the entire lens leading to vision loss.

Due to the ease with which the procedure can be performed, many patients with cataracts go on to undergo cataract surgery. The procedure can permanently remove the clouded lenses, improve patients’ vision, and reduce their dependence on eyeglasses and contact lenses.

Cataract surgery costs may differ depending on the specific technique used. Some of the newer techniques that employ laser technology tend to be more expensive.

How is the Procedure Performed?

A cataract surgery is an outpatient procedure and usually takes only around 15 minutes. However, it may take longer due to pre-surgical preparations, such as eye dilatation, and post-surgical evaluation.

Prior to the surgery, patients are advised not to eat solid foods at least 6 hours before the scheduled time. The procedure begins with the eye doctor applying numbing medication to the eye using eye drops or an eye injection. Since anaesthesia is not used, patients are awake during the procedure but are given medication to help them relax.

The cataract operation involves removing the damaged, clouded lens inside the eye and replacing it with an intraocular lens (IOL).

There are now many techniques used to remove the damaged lens.

Conventional cataract surgery uses tiny incisions near the edge of the cornea using a handheld blade. It involves accessing, breaking up, and removing the lens using small instruments.

With modern cataract removal surgery, the damaged lens is broken up using a high-frequency ultrasound device, and the smaller pieces are removed from the eye using suction. This surgical technique is called phacoemulsification, which requires smaller and fewer incisions. Due to this, patients heal and recover faster from the procedure. It also lowers the risk of retinal detachment, a common complication of cataract surgery. Once all small pieces of the damaged lens are suctioned out, the IOL is inserted where the natural lens used to be, which is just behind the iris and the pupil.

Another option is laser cataract surgery, which uses femtosecond lasers. These are the same type of lasers used in LASIK surgery. This procedure removes damaged lenses with minimal use of handheld surgical blades and tools. It is performed by first creating a corneal incision to remove the anterior capsule of the damaged lens. The laser technology then fragments the cataract making the damaged lens easier to break up and remove.

The cataract operation ends with the surgeon closing the incision. However, when modern techniques are used, the tiny incisions are usually self-sealing.

Aside from the different techniques for cataract removal, patients can also choose from different types of intraocular lenses as replacements for their natural lenses. The common type of IOL is called monofocal lens. However, some IOLs can also correct common eye problems such as nearsightedness and farsightedness, while some can also correct astigmatism; these are called toric IOLs. Other types include accommodating IOLs and multifocal IOLs, which can correct presbyopia and thus provide patients with a greater range of vision compared to monofocal lenses. Patients can discuss with their eye doctor which of these different types of lenses are most appropriate for them.

After the procedure, the patient is asked to rest in a recovery area for 15 to 30 minutes. The patient is then sent home with a protective shield, which has to be kept over the affected eye as it heals. The patient will also be given post-surgical eye drops and instructions on how to use them.

Possible Risks and Complications

To prevent complications after cataract surgery, patients are advised to refrain from strenuous activities and heavy lifting during the first week after the procedure. Bending and exercising are also not advised as these activities may place stress on the newly placed lenses.

It is important to note that while the eye is healing, it is very vulnerable to infections. Thus, patients must take care to keep the eye clean and dry, as water, especially those in hot tubs and swimming pools, may contain contaminants that may cause infections.

Other possible side effects and complications of cataract surgery include:

  • Bleeding

  • A feeling of pressure inside the eye

  • Fluid buildup

  • Drooping eyelids

  • After-cataract – This occurs when lens tissue that is meant to support the IOL is left behind during surgery and develops cataracts. New laser treatments, however, can permanently correct after-cataracts.

More serious complications include retinal detachment or the loosening of newly implanted lenses. Retinal detachment is a serious eye problem that occurs when the thin lining behind the retina pulls away from the blood vessels that provide it with oxygen. This condition requires emergency treatment.

References:

  • Boyd K. “What is Cataract Surgery?” American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/what-is-cataract-surgery

  • “Facts about Retinal Detachment.” National Eye Institute (NEI). https://nei.nih.gov/health/retinaldetach/retinaldetach

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