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Will you use a laser to take out the cataract? What about possible complications? Capsular rupture/Vitreous loss Will you use laser to take out the cataract? NO! We get asked this all the time, and don't know where this misconception started. The cataract must actually be removed from the eye. This requires making an opening in the eye. Lasers can cut, burn and vaporize tissue, but they can't remove a cataract from the eye. A machine called a phacoemulsifier is most often used to remove the cataract. It is a hollow needle attached to a handpiece that delivers ultrasonic energy to the needle.
It breaks up the cataract and the pieces are sucked up and out of the eye through the bore of the needle. (However, just to confuse the issue, in 1998 an experimental laser cataract machine was invented. It still uses a needle in the eye to suck out the pieces, but rather then using ultrasound to break up the cataract, laser energy passes down the needle to break up the cataract. The technique of removing the cataract with this is quite similar to the phacoemulsifier. The possible advantages are technical and the patient's experience with both machines would be essentially the same. This machine will not be in common use for quite a while).
Will I need stitches with my surgery? That depends on your surgeon’s technique. More and more cataracts are removed through a small self sealing incision that does not require stitches. Will you take my "eye out" to remove the cataract? No. The eye is left in its natural location.
Will you put me asleep to take out the cataract? What kind of anesthetic will you use? This varies from surgeon to surgeon. Only because of extenuating circumstances is a general anesthetic used. A variety of methods are used to numb the eye. Numbing drops alone can be used, or in combination with some anesthetic under the skin of the eye, or inside the eye. A shot of anesthetic, a retrobulbar, can also be given behind the eye to anesthetize it.
What is the treatment for cataracts? Early on a change in glasses or the use of sunglasses may restore good vision. Eventually the cataracts tend to get worse and must be removed from the eye to allow clear vision. The cataract is replaced with an artificial lens called an intraocular lens, or IOL, (also called an implant) made of plexiglass, silicone or acrylic.
How well will I see after the surgery? That depends on the health of the rest of your eye. Provided you have no other problems your vision should correct with glasses to 20/20 or better. If you have problems with your retina (macular degeneration), cornea or other parts of your eye, these may limit how well you will see. Statistically, 98% of patients undergoing cataract surgery see better after their surgery than before.
No. Once removed from the eye, the lens does not grow back. However, a situation can arise that to the patient is quite similar to the cataract, it is called and opacified posterior capsule. When the cataract is removed from the eye, it is scooped out of its bag and the artificial lens is placed in the bag. Using the M&M analogy, the candy coating would be this bag and the chocolate in the M&M would be the cataract. During the cataract surgery a hole is made in the front candy coating and the chocolate (ie. Cataract) is removed with the phacoemulsifier needle. The artificial lens is then put in the candy coating - capsule or bag. Well, this capsule or bag, which after all is living tissue, can with time scar. This may happen 20% of the time. Then the vision becomes blurry. Well guess what - this is fixed with a laser! Since the capsule is very thin - like Saran Wrap - a laser can be used to cut a hole in it, removing the cloudiness.
Your doctor, depending on the technique he uses, and particulars affecting you may give different advise than below. It is always best to consult your own surgeon. The following are general guidelines. Bending over - With modern cataract surgery bending over is fine. Bend your knees and crouch down rather than bending at the waist. Lifting - Don't lift anything that would result in straining. Work - Depends on the nature of your work. Office workers should be able to return in a day or two. If work involves a dirty environment, risk of injuring the eye, or heavy activity your doctor should advise you. Sunlight - Bright light may be uncomfortable, and you may need to wear sunglasses while your eye recovers. Bathing, showering - Avoid immersing your eye in water while it is healing. Do not direct a shower at the eye, otherwise please bathe. Swimming - No swimming for a couple of weeks. Best to consult your doctor individually. Sex - Ok as long as there is no pressure on the eye or straining. Getting my hair done, permanents - No problem. Might be a good idea to wear an eye shield while getting your hair done for a couple of weeks after the surgery, just as a precaution so it doesn't get bumped. Sports - Consult your doctor. Make sure and wear eye protection while playing tennis, racket ball, hand ball, squash, hockey etc. Boxing is bad for your eyes in general, and should not be done for a long time after eye surgery if at all. Reading - As soon as it is comfortable you can read. You may need some temporary glasses until your permanent ones are ready. Computers - Same as for reading - see above. Capsular rupture/Vitreous loss During removal of the cataract, the substance of the lens is removed and the capsule (or bag enclosing the lens) is left to hold the artificial lens (IOL). This capsule also keeps the jelly in the back of the eye from coming forwards and escaping from the eye. This capsule is very thin and can be broken, it looks like Saran Wrap, but is not as strong. If it breaks the vitreous may come forward. The surgeon needs to attend to that, and carefully remove the vitreous. If the vitreous is disrupted and comes out of the eye it is called "vitreous loss." This complication increases the chances of getting retinal detachments, swelling of the retina, infections, and the IOL coming out of place, among other problems. When the capsule is broken, pieces of the cataract may fall into the back of the eye. There they may cause inflammation. If pieces are left in the eye it may be necessary to perform another surgery to remove them. Sometimes the pieces can be left and they will gradually absorb. How often the surgeon breaks the capsule during cataract surgery is a good measure of his or her skill as a surgeon. In an otherwise uncomplicated case a competent surgeon should have a broken capsule less than 5% of the time.
As with any surgery there is a risk of infection - an infection inside the eye is called endopthalmitis. It should happen no more than about 1 out of 1000 cases. It happens even in an otherwise perfect operation, but more commonly if there are other complications. It is a very serious medical emergency. There is usually increasing blurring, pain and redness if this happens. The physician needs to be contacted as an emergency and the eye examined by someone qualified to provide postoperative eye care (preferably your surgeon). Your family doctor is not qualified to diagnose or threat this condition. Depending on how much time passes from the beginning of the infection and what microorganism is infecting the eye, the eye may completely recover or the eye may be lost. Prompt treatment is extremely important. Treatment usually consists of an operation (vitrectomy) in which the inside of the eye is cleaned out and antibiotics are injected into the eye. Antibiotic drops, oral antibiotic and/or IV antibiotics may also be used - but they alone will not cure the infection. A vitrectomy and injection of antibiotic into the eye is necessary for a cure.
Redness of the eye and blood caught under the skin of the eye (a form of a bruise) is common after cataract surgery. It causes no problems and clears in a week. Occasionally there may be some blood in front of the pupil - this may come from the wound, even during the night after the surgery. This form of bleeding is called a hyphema. With modern small incision cataract surgery this is uncommon. If there is some blood it may obscure the vision. It usually clears on its own within a week. In severe cases the blood can cause other problems such as an increase in the pressure in the eye (glaucoma). The blood may then need to be removed. A very rare serious form of bleeding is an expulsive choroidal hemorrhage. In this a blood vessel in the back of the eye, underneath the retina, breaks resulting in severe damage to the eye, and possible loss of the eye. It happens more often in elderly patients with a combination of hardening of the arteries and high blood pressure, in surgeries that are longer than usual. The bleeding is not in the area of the surgery, but way back in the eye. It results from a fragile blood vessel breaking due to fluctuations of the pressure. A surgeon might have one of these in his or her career, it is so rare.
The eye is measured before the surgery to determine what size IOL to use. If the wrong IOL is used the eye will end up with an eyeglass prescription that was not desired - ie. nearsighted or farsighted. The vision should be correctable with glasses. If the resulting prescription is too strong it may not be possible to wear glasses. A contact lens is an option in some cases. If the problem is bad enough, the patient may want the IOL removed and a different one inserted, or other surgery to correct the refractive error. This problem may be due to human error (inaccurate measurement, error in calculation, clerical error, wrong lens handed to the surgeon, mislabeled lens, etc.), but sometimes it happens because an eye has an abnormal shape.
If the artificial lens moves off center, this may result in blurry vision, haloes or double vision. This is very uncommon in an uncomplicated case. It occurs more often if there are predisposing factors, such as a previous injury to the eye, or a condition called pseudoexfoliation, both of which cause a weakness of the support structures for the lens in the eye. Dislocation of the IOL is also more common when there have been other intraoperative complications, such as vitreous loss. A decision on operating to reposition or replace the lens depends for the most part on the patient's symptoms. Sometimes surgery may be recommended if the IOL is causing other problems because it is out of place.
If the inner layer of the cornea is damaged, the cornea may loose its clarity. It is common to have temporary swelling (edema) of the cornea after cataract surgery, and it clears within a few days. Permanent loss of clarity is extremely uncommon. Some corneas are weak to start with and the surgery may cause them to fail. The surgeon should be able to tell you before the surgery if your cornea is weak, that is it has a low endothelial cell count. Injury to the inner layer of the cornea, either chemically or by contact with instruments, can result in permanent damage to the cornea.
An increase in pressure of the fluids in the eye that damage the eye is termed glaucoma. Temporary increases in the eye pressure in the hours following surgery are common and self-limited. A very high elevation in the pressure is accompanied by pain, and may be dangerous. Therefore, if you experience pain (an aching pain) after the surgery you need to contact your surgeon. Complicated cataract surgery can result in scarring leading to a permanent glaucoma, which would need treatment. Of note is that an eye with glaucoma before the cataract surgery often has a beneficial permanent drop in the eye pressure after a cataract is removed.
If the retina comes out of place it is called a retinal detachment - a serious problem that can result in blindness if not fixed. The chances of getting a retinal detachment after small incision cataract surgery are no higher than if no surgery were done. However, if the surgery is complicated and there is vitreous loss the chances of getting a retinal detachment goes up significantly.
An eyeglass prescription that is different vertically than horizontally is called astigmatism. Modern small incision cataract surgery doesn't change the eyes astigmatism (except in the unusual case in which the astigmatism is in the cataract, where normally it is in the cornea). If a large incision is required, particularly if sutures are used, to remove the cataract, there may be a change in the eyes astigmatism.
Information currently being updated.
Cystoid Macular Edema (CME) is a condition in which the very center of the retina - the macula - develops swelling and cyst. This results in a fuzzy spot in the center of the vision reducing the vision. It is a reaction of the eye to inflammation. This may rarely occur in uncomplicated cases - in which case it usually goes away after a few weeks. It is more common in diabetics and in eyes that were prone to inflammation prior to the surgery. It is one of the complications that can result from vitreous loss.
If as a result of cataract surgery the two eyes have a large difference in their eyeglass prescription, double vision may result. If the person has a strong eyeglass prescription and both eyes are to have cataracts removed, this may be a temporary problem between the time the first and second eyes are operated on. The other cause would be a misalignment of the eyes. Rarely after cataract surgery the eyes may not track together. Correction of the problem may require special glasses or surgery to realign the eyes.
This was quite common in the past with large incisions and sutures. It is rare in uncomplicated surgery. If there are problems, particularly with a lot of inflammation, the eyelid may droop.
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