Cataract Surgery – What You Need to Know

Cataract Surgery - What You Need to Know

Being told that you have cataracts can be frightening. Even today, when we have straight forward procedures to treat this condition, there is still a lot of misinformation and anxiety about how to deal with this very natural ailment.

The truth is that cataracts are a normal part of ageing. Their formation is usually a gradual process that happens over many years, where the lenses of our eyes become less transparent, less resilient, and often thicker. While cataracts become more common after fifty, by the time we reach eighty years-old, approximately 50 percent of us will have developed some form of cataracts.

If you’ve noticed any changes in your vision, you need to make an appointment to discuss it with your eye doctor as soon as possible. 

While surgery is the only real way to treat cataracts, in the early stages, your doctor can provide options to counteract the symptoms. Adjusting your prescription and incorporating anti-glare lenses can neutralize some of the problems associated with early-stage cataracts. 

It is crucial, though, if you are developing cataracts that your doctor keeps an eye on them. Ordinarily, delaying the procedure won’t affect how well your vision recovers and many doctors even recommend holding off on surgery until the decrease in vision starts to affect the quality of your life negatively. However, the decision delay should be made with your doctor to ensure that no other complication would necessitate doing the procedure sooner. 

Once you and your doctor have decided it’s time to move forward with cataract surgery, there are a few things you should know about the procedure and what to expect after. 

About the Surgery

At a fundamental level, cataract surgery involves replacing your clouded lens with an artificial one, called an intraocular lens (IOL).

On rare occasions, as a result of other eye problems, it’s not possible to use an artificial lens. In these circumstances, once the cataract is removed, vision will be corrected through the use of prescription lenses. 

The surgery is most often an outpatient procedure and not performed in a hospital. So, provided there are no complications, patients can usually expect to go home shortly after. 

If cataracts exist in both eyes, doctors will start with one eye and only schedule the operation for the second after the first has fully healed.

Understanding the surgical process

During cataract surgery, your eye doctor uses a local anesthetic to numb the area around your eye and prevent blinking or eye movement during the operation. Having the patient awake throughout the procedure presents fewer complications and allows for the doctor to make simple requests of the patient if needed. Although, occasionally, people with extreme anxiety will need to undergo a general anesthetic to prevent them from causing complications.

In the developed world, the most common form of cataract surgery is called Phacoemulsification (small-incision surgery), and it takes only about 15 minutes to perform. 

The popularity of Phacoemulsification, called phaco-surgery, continues to increase because it has an excellent long-term prognosis, and approximately 98 percent of all cases performed by an experienced surgeon are completed complication-free.

The procedure begins by making two small incisions in the eye where the clear front covering (cornea) meets the white of the eye (sclera).

Next, the doctor makes a circular opening on the lens surface (capsule) and inserts a small surgical instrument, called a phaco probe, into the eye.

The phaco probe emits sound waves (ultrasound) to break the cataract into small pieces. Following this, suction is used to remove the cataract and lens pieces from the eye.

The doctor is then able to place a new intraocular lens implant (IOL) inside of the lens capsule.

When the process is complete, the incisions ordinarily seal themselves without requiring stitches.

A Laser-Assisted Alternative Cataract Surgery

In some cases, an Ophthalmologist will use a laser version of the procedure. The process is very much the same, except a laser is used to make the incisions and break up the cataract in place of the phaco probe. Both laser and phaco surgery are covered in Ontario, with the decision of which option to select usually requiring a consult with the patient and determined based on their particular medical situation. With the laser option, doctors are also able to correct astigmatism, although this has not been deemed medically necessary in Ontario. Your Ophthalmologist is required to inform you of anything that may be above what the provincial insurance will cover.  

Lens Selection

When it comes to choosing the new Intraocular Lens (IOL) Implants that will be placed in your eye, there are a few options to consider. 

Although, it’s worth mentioning again that OHIP and other provincial insurance programs will not pay for features that they deem not medically necessary. Very often, multi-focus lenses fall into that category. However, it’s worth discussing all the options with your doctor to understand what’s possible for you.

Mono-Vision IOLs

If you’re having cataract removal surgery on both eyes, your doctor will likely recommend that you consider mono-vision as an option. What this means is that the IOL in one eye provides for better near vision, and the other IOL is better suited to distance. Most people can adjust to mono-vision quite quickly, but it’s not for everyone. The challenge with mono-vision is that each eye must work more independently, which can cause problems with depth perception. You may also have to adjust your gaze more regularly to allow one eye or the other to see appropriately.

Monofocal IOLs

This option is putting either a near or distance lens into your eye. In the case of having cataract surgery on both eyes, it would mean using two of the same lenses. Having this type of IOL means you will probably need to wear glasses. The standard option is to have the lens provide better distance vision and then have reading glasses to bring nearer items into focus.

Multifocal (or accommodative) IOLs

This lens allows for both near and distant objects to be in focus at the same time. There is usually an adjustment period as your brain has to learn to select the relevant near or far visual information to form an image. These tend only to be recommended to people having the procedure for both eyes. 

After the procedure

Following the surgery, a short time is required for the local anesthetic to wear off. Next, the surgeon will conduct a post-operative assessment and clearly define the care instructions. Your doctor will explain symptoms of possible complications to watch for, eye protection strategies, exercises, medicines, and what follow-up visits are required to check on the healing process. They will also advise you what to do if emergency care is needed. Don’t be surprised if another health professional administers some portions of the follow-up. Often optometrists are better positioned to spend more time with patients ensuring they understand everything.

What to expect when you leave

The great news is that usually following the procedure, there no significant pain. Often, patients experience only slight discomfort as part of the healing process. 

When you get home, it’s critical to keep your eye from getting infected. Patients need to use eye drops several times a day and to generally prevent water from getting in their eyes. The newly cataract-free eye will need to be bandaged for the first night following surgery. After that, a protective shield will need to be worn at night for approximately a week.  

Before you leave, the patient care team will schedule your follow up appointments. These next visits will include a series of tests to see how the eye is responding, measurements of visual acuity and eye pressure, as well as a slit lamp examination, to check for lens clarity.

The first visit should be the following day, or two, after the surgery. The doctor will want to make sure there are no immediate complications. As with most medical procedures, it’s better if a problem is caught quickly.

The next visit will be a few weeks after the surgery. However, if there are any complications, appointments will need to be sooner and more frequent to ensure it’s looked after.

Patients are also free to return to their routine almost immediately. You do, though, want to avoid heavy lifting, or any physical activities can disturb the new lens.

The Payoff

No matter how quick and painless cataract surgery often is, no one looks forward to having the procedure. Although most patients are amazed, after the operation, how clear their vision has become. With cataracts removed, a new level of detail and vivid colour returns. For many patients, it’s like having new eyes!  

Usually, about six-weeks following the procedure, patients will need to schedule an eye exam to have their regular prescription glasses adjusted to their new and improved eyesight.