Cataract surgery aims to treat cataracts. Cataracts are a clouding of your eye lens because of the clumping of proteins. As a result, your vision could worsen over time. They’re the world’s leading cause of blindness.
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The lens of your eye is behind your iris and pupil and helps you to focus on objects of varying distances away from you. Most types of cataract surgery involve switching the cloudy lens with an artificial transplant.
Cataract surgery is one of the most common and safest surgeries performed in the United States. As many as 95 percent of people who undergo the procedure experience an improvement in the sharpness of their vision.
Keep reading to learn everything you need to know about cataract surgery.
You become more likely to develop cataracts as you get older, and they tend to gradually get worse over time.
Early stages of lens changes don’t cause significant visual impairment and don’t require surgery. Usually, a doctor will recommend surgery when your cataracts begin noticeably affecting your vision. Having trouble with everyday activities — such as driving, reading, or seeing in bright light — is a sign that you may need cataract surgery.
Specific ways cataracts may impair your vision include:
- blurry vision
- impaired night vision
- colors appearing faded
- sensitivity to glare and bright lights
- halos around lights
- double vision
Cataracts can also be congenital, meaning they’re present at birth. Congenital cataracts are one of the leading causes of childhood blindness. However, they tend to have a good outcome if surgery is performed before a child is 6 weeks old.
Most modern types of cataract surgery involve replacing your lens with a transplant called an intraocular lens (IOL). Some of the most common cataract surgery techniques include:
During phacoemulsification, a surgeon will make a 2- to 3-millimeter-long incision in the front of your eye for an ultrasonic probe. The probe breaks up the cataract with vibration and removes the fragments with suction. A foldable lens is then inserted through the incision.
This technique leaves behind a small wound that doesn’t usually need sutures to heal.
Manual extracapsular cataract surgery (MECS)
During MECS, a surgeon makes a relatively large incision, between 9 to 13 millimeters long, and removes your lens and inserts the replacement IOL.
This technique has a higher risk of complications compared to phacoemulsification due to the larger incision. However, because of the low cost, it’s still performed in many parts of the world.
Manual small incision cataract surgery (MSICS)
MSICS is a variation of the MECS technique. It involves a smaller V-shaped incision that’s narrower on the outside of your eye and wider on the inside. The outer incision is about 6.5 mm to 7 mm and the internal incision is up to 11 mm.
A 2013 study found that phacoemulsification and MSICS have similar long-term outcomes and comparable complication risks. However, phacoemulsification may have better short-term results in the 3 months following surgery while MSIC is cheaper to perform.
Femtosecond laser-assisted cataract surgery (FLACS)
During FLACS, a surgeon may use a laser to make an incision in your eye instead of a manual incision. Also, the laser can divide and soften the cataract, requiring less phacoemulsification energy to remove it. This can lead to more rapid healing.
Finally, the laser can make an arcuate incision, which can correct astigmatism. Astigmatism is when the front of the eye has an irregular shape that often causes blurry vision. This can make it more likely that you can function without glasses. However, this technique is more expensive than other techniques. There’s still some debate about whether the marginal benefits outweigh the cost.
Intracapsular cataract surgery
Intracapsular cataract surgery is an older procedure that involves removing the entire lens and lens capsule from the eye through a large incision. It’s rarely performed now because it has a high risk of complications.
You have several options that can be used as a replacement for your natural lens. The type of lens you should choose depends on your lifestyle and price range.
Monofocal lenses are the most common type of lens replacement and are usually covered by insurance. Other lenses may be considered a premium by insurance providers and may not be covered.
Monofocal lenses are set to maximize your best vision at one particular distance. Often, people choose to set them for distance vision and use reading glasses for near vision.
Toric lenses help correct astigmatism.
Extended depth-of-focus lenses have one corrective zone stretched to maximize your distance and intermediate vision. This is helpful for using the computer and performing many types of work.
Accommodating monofocal lenses
Unlike traditional monofocal lenses, the focal distance of accommodating monofocal lenses can be adjusted based on the activity of your eye muscles.
These lenses help you to see objects both far and near by splitting the light that comes into the eye. The trade-off is that splitting the light can cause halos and starbursts in some peoples’ vision. Though most people can adapt, some cannot. You may want to discuss this with your doctor.
An eye doctor will likely give you an ultrasound and take measurements about a week before your procedure. This will help them determine the size and shape of your eye and decide what is best for your surgery.
They will also ask you if you’re taking any medications. They may give you medicated eye drops to begin using before the surgery.
Cataract surgery is usually done at an outpatient surgery center or hospital, so you won’t need to stay overnight. However, you’ll want to arrange a drive home once the procedure is complete.
Your provider may ask you to not eat any solid food 6 hours before your surgery. You should also avoid drinking alcohol at least 24 hours beforehand.
The exact procedure your surgeon performs will depend on which surgical technique they’re using. If you have cataracts in both eyes, your surgeries will likely be scheduled weeks apart.
What you can expect during the commonly used phacoemulsification technique:
- Your eye will be numbed with a local anaesthesia in the form of an injection or eye drops. You’ll stay awake during the surgery but won’t be able to see what your surgeon is doing. In some cases, you may be given a sedative to help you relax.
- Your surgeon will look through a microscope as they make a small incision to the front of your eye. They will then insert an ultrasonic probe into the incision to break up your lens and remove the cataract. The pieces will be removed with the probe using suction.
- A foldable lens implant will be inserted through the incision and positioned where your original lens was located. Usually, with this technique, stitches aren’t required.
- You’ll rest in a recovery area for about 30 minutes after your surgery and will then go home.
Cataract surgery is usually very quick. The procedure itself takes only about 20 to 30 minutes from start to finish.
Although you’ll likely be awake during the procedure, it’s generally not painful because you’ll be given a local anesthesia. You may experience slight discomfort, but intense pain is uncommon.
In most cases, you’ll begin experiencing significant improvement in the first several days, though it can take up to a month for you to fully heal. Your healthcare provider may give you special eye drops for pain and to prevent infections. Also, you may be instructed to wear a protective mask when you sleep.
While you’re recovering, you should wear sunglasses while outdoors to protect your eyes from sunlight. Also, try to avoid touching your eyes or getting anything in them.
Can you drive after cataract surgery?
You won’t be able to drive immediately after surgery and you will need to arrange a ride home ahead of time. You may be able to drive several days after the surgery. However, you should talk with your eye doctor for a timeline specific to you.
How much time will you miss from work?
Most people feel better a few days after surgery and are able to return to work 1 to 2 days later if they don’t develop any complications. However, you may need to avoid certain activities for a few weeks, such as lifting heavy objects or bending over.
Sleeping position after cataract surgery
It’s generally recommended that you try to sleep on your back or the opposite side of your healing eye to avoid direct pressure that may dislodge your lens.
When can you exercise after cataract surgery?
You should avoid strenuous activities directly after surgery. Your provider can give you a specific timeframe on how long you should avoid exercise. They’ll likely recommend taking at least 1 week off from strenuous activities.
Other restrictions after cataract surgery
Other recommendations to protect your eyes after surgery include avoiding:
- getting water and soap in your eyes
- touching your eyes
- wearing mascara for a week or two
- using face cream or lotion
- coloring or perming your hair for 1 to 2 weeks
- using hot tubs and saunas
- dusting and gardening
Although cataract surgery is generally safe, like all surgeries, it comes with risks. These may include:
Cloudiness in the eye after cataract surgery
In 5 to 50 percent of cases, a cloudy layer called posterior capsule opacification can form behind your implant. It can be treated in about 5 minutes with an office-based technique called a YAG laser capsulotomy.
Blurred vision after cataract surgery
Blurriness is normal shortly after cataract surgery. It usually clears up in a matter of days but may take longer in some cases.
Floaters after cataract surgery
Floaters look like specks of dust that follow your line of vision. In some cases, floaters don’t require any particular treatment, but they can be a sign of a retinal tear.
Dry eyes after cataract surgery
Dry or gritty eyes is a common symptom after your procedure. This is usually managed with eye drops.
Eye pain after cataract surgery
Serious pain may be a sign of an infection or other complications. You should contact your surgeon to find the best treatment.
Double vision after cataract surgery
Double vision can have many causes but is often a result of your brain getting used to its new visual acuity. It will likely go away in a few days.
Endophthalmitis is an infection of the fluids of your inner eye. It’s thought to occur in only 0.05 to 0.30 percent of cataract surgeries.
Anytime you’re administered anesthesia, it’s possible to have an allergic reaction. Severe reactions are relatively rare.
Insurance may cover the cost of your surgery if it’s deemed medically necessary. Prices for cataract surgery vary based on location and the surgical technique.
Out of pocket, the American Academy of Ophthalmology reported in 2014 that this procedure could cost roughly $2,500 for the surgeon fee, hospital fees, postoperative care, and anesthesiologist fees. This may mean it’s more expensive now. You can contact ophthalmologists in your area to get a more exact figure.
Does Medicare cover cataract surgery?
Medicare covers the cost of cataract surgery if the procedure is done with traditional surgical techniques or lasers.
Medicare part B covers 80 percent of the cost for a pair of corrective lenses or contacts needed after the surgery.
According to the National Eye Institute, about 9 out of 10 people can see better after cataract surgery. The procedure is considered safe and has the potential to return your vision to its pre-cataract sharpness.
About 5 to 50 percent of people will develop posterior capsule opacification and require a second surgery to treat it.
Cataracts are not considered a medical emergency and tend to develop slowly. How long you can safely delay your surgery depends on how fast your cataracts are progressing.
It’s generally best to have the surgery as soon as possible, but if you need to wait, you should talk with a doctor to determine a safe timeframe.
If left untreated, cataracts will continue to progress and may lead to complete blindness.
It’s important for children with congenital cataracts to have them identified and treated as early as possible
Cataract surgery is one of the most common and safest surgeries performed in the United States. The procedure is quick and doesn’t require an overnight stay in a hospital. Medicare and many insurance providers cover the cost.
If you experience vision impairment from cataracts, you may want to ask a doctor if you’re a good candidate for surgery.