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Cataract surgery: Everything you need to know

cataract surgery

Sometime after age 50, most of us are likely to hear our optometrist say, "You have cataracts."

A cataract is a clouding of the lens inside the eye, causing vision loss that cannot be corrected with glasses, contact lenses or corneal refractive surgery like LASIK.

As frightening as cataracts might sound, modern cataract surgery usually can restore vision lost to cataracts — and often can reduce your need for glasses as well.

Most cataracts are associated with the aging process and are common among older Australians and New Zealanders. In fact, according to the Medibank Better Health Index around 700,000 Australians were living with cataracts in 2018. In the journal New Zealand Doctor estimates 370,000 Kiwis have cataracts in 2020.

The prevalence of cataracts in Australia is growing, with a 9.5% uplift between 2010 and 2017. There is also a difference between men and women with a 5% increase between 2010 and 2017 for women over 80 years of age, versus only 1.8% increase for men in the same age group.

Thankfully, modern cataract surgery is one of the safest and most effective surgical procedures performed today, with the vast majority of these procedures producing excellent visual outcomes.

Cataract surgery basics

In cataract surgery, the lens inside your eye that has become cloudy is removed and replaced with an artificial lens, called an intraocular lens (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.

Most modern cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction.

This procedure, called phacoemulsification or "phaco," can be performed with smaller incisions than previous surgical techniques for cataract removal, promoting faster healing and reducing the risk of cataract surgery complications, such as a retinal detachment.

After all remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear intraocular lens, positioning it securely behind the iris and pupil, in the same location your natural lens occupied. (In special cases, an IOL might be placed in front of the iris and pupil, but this is less common.)

The surgeon then completes the cataract removal and IOL implantation procedure by closing the incision in your eye (a stitch may or may not be needed), and a protective shield is placed over the eye to keep it safe in the early stages of your cataract surgery recovery.

Laser cataract surgery

Recently, a number of femtosecond lasers — similar to the lasers used to create the corneal flap in all-laser LASIK — have been approved for use in cataract surgery.

These lasers have gained approval for the following steps in cataract surgery, reducing the need for surgical blades and other hand-held tools:

  1. Creating corneal incisions to allow the surgeon access to the lens

  2. Removing the anterior capsule of the lens

  3. Fragmenting the cataract (so less phaco energy is required to break it up and remove it)

  4. Creating peripheral corneal incisions to reduce astigmatism (when needed)

Laser cataract surgery (or, more accurately, laser-assisted cataract surgery) is fairly new and significantly increases cataract surgery cost, primarily because the laser can cost from $300,000 to $500,000 for a surgeon to purchase and there are other significant costs associated with the use and maintenance of this technology.

While studies have shown that lasers can improve accuracy during certain steps of cataract surgery, they may not necessarily improve cataract surgery safety, recovery time or visual outcomes in every case.

For the latest information about laser cataract surgery, ask your optometrist during your preoperative eye examination and cataract surgery consultation.

Preparing for cataract surgery and choosing an IOL

Prior to cataract surgery, your optometrist and/or ophthalmologist will perform a comprehensive eye test to check the overall health of your eyes, evaluate whether there are reasons why you should not have surgery and identify any risk factors you might have.

A refraction also will be performed to accurately determine the amount of short-sightedness, long-sightedness, and/or astigmatism you have prior to surgery. Additional measurements of your eyes will be taken to determine the curvature of your cornea and the length of your eye.

These measurements are essential to help your cataract surgeon select the proper power of the intraocular lens and give you the best vision possible after surgery.

Today you have many types of IOLs to choose from for your cataract surgery, depending on your specific needs. In addition to IOLs that correct myopia and hyperopia, there are now toric IOLs that correct astigmatism as well.

If you don't mind wearing glasses after cataract surgery, a monofocal lens implant is usually used. Often, only part-time use of glasses is needed after cataract surgery with monofocal IOLs. However, if prescription glasses are needed (which often is the case if you only need cataract surgery in one eye), your optometrist typically will prescribe new glasses for you approximately one month after surgery.

If you like the idea of needing your glasses less after cataract surgery, one way to correct presbyopia and reduce your need for reading glasses is to have your cataract surgeon adjust the power of one of your monofocal IOLs (assuming you have cataract surgery performed in both eyes) to give you a monovision correction, similar to monovision with contact lenses.

Another option is to choose one of a variety of advanced presbyopia-correcting IOLs to improve your reading vision without sacrificing your distance vision. Presbyopia-correcting IOLs include accommodating IOLs and multifocal IOLs; both types are designed to provide a greater range of vision after cataract surgery than conventional monofocal IOLs.

Be aware that not everyone is a good candidate for these premium IOLs, and choosing a presbyopia-correcting IOL will increase the out-of-pocket cost of your cataract surgery, you will need to check what amount of cost of these advanced lens implants is covered by private health insurance.

Prior to cataract surgery, in addition to discussing the different types of IOLs, you will be advised about what to expect before, during and after your procedure. This information is meant to help you make an informed decision about whether to proceed with surgery.

If you have any questions or concerns about cataract surgery, be sure to discuss them with your optometrist and cataract surgeon prior to signing "informed consent" documents authorizing surgery.

Also, discuss with your optometrist all medications you are taking, including non-prescription ("over-the-counter") and nutritional supplements. Some medications and supplements can increase your risk of cataract surgery complications and might need to be discontinued prior to surgery. Ask your doctor for details.

Cataract surgery recovery

An uncomplicated cataract surgery typically lasts only about 15 minutes but expect to be at the day surgical unit for 90 minutes or longer, because extra time is needed to prepare you for surgery (dilating your pupil; administering preoperative medication) and for a brief post-operative evaluation and instructions about your cataract surgery recovery before you leave.

You must have someone drive you home after cataract surgery; do not attempt to drive until you have visited your optometrist the day after surgery and he or she tests your vision and confirms that you are safe to drive.

You will be prescribed medicated eye drops to use several times each day for a few weeks after the operation. You also must wear your protective eye shield while sleeping or napping for about a week after surgery. To protect your eyes from sunlight and other bright light as your eye recovers, you must wear sunglasses.

Also, many clinics require someone to be with you after cataract surgery if you received anesthesia. Be sure to ask about this requirement prior to your cataract procedure so you are prepared for surgery day.

While your eye heals, you might experience some eye redness and blurred vision during the first few days or even weeks following the procedure.

During at least the first week of your recovery, it is essential that you avoid:

  • Strenuous activity and heavy lifting (nothing over 10kgs).

  • Bending, exercising and similar activities that might stress your eye while it is healing.

  • Water that might splash into your eye and cause infection. Keep your eye closed while showering or bathing. Also, avoid swimming or spas for at least two weeks.

  • Any activity that would expose your healing eye to dust, grime or other infection-causing contaminants.

Your surgeon may give you other instructions and recommendations for your recovery, depending on your specific needs and the outcome of your procedure. If you have any questions at any time after your operation, call your optometrist for advice.

If you need surgery in both eyes, your surgeon typically will prefer that you wait one to three weeks between procedures, so your first eye has healed sufficiently and you have good vision in that eye before the second surgery is performed.

Glasses after cataract surgery

Unless you choose presbyopia-correcting IOLs, it's likely you will need glasses after the surgery to see near objects clearly. Even people who choose these premium IOLs often find glasses are helpful for certain near tasks and seeing very small print.

In the event you have some mild refractive errors present after surgery (this is common), you may want to wear glasses with progressive lenses full-time after your surgery to attain the best possible vision at all distances.

Even people who have an excellent visual outcome and can see well without glasses after cataract surgery often choose to wear glasses full-time after their procedure to protect their eyes and because they feel more like themselves wearing glasses after surgery if they have worn glasses most of their life.

If you choose to wear glasses after cataract surgery, lenses with anti-reflection coating and photochromic lenses are highly recommended for the best vision, comfort and appearance. Ask your eye care professional for details and to demonstrate these lenses.

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