Thanks to advancements in technology, an improved understanding of the eye, and ground breaking surgical techniques, cataract removal is now safer than it has ever been!
How it works
To understand how cataract extraction benefits patients, it is important to understand what a cataract is. A cataract is a cloudy lens, which prevents patients from seeing clearly. Please check out the Cataract section under Quicklinks for a more detailed explanation and some interesting facts. Cataract extraction involves removing the cloudy part of the lens and (usually) replacing it with a clear lens which is developed specifically for your eye.
Process
Like any well designed procedure, Cataract extraction involves a series of steps that are performed one after the other. I will describe these steps below.
The first and most important step of cataract removal is making sure the patient is comfortable. Patients are laid on a bed with pillows and cushions which are positioned according to the desires of the patient and the doctor. Light medications are used to ensure the patient is relaxed and pain-free. Dilating drops are used to help dilate the pupil so the cataract can be taken out as easily as possible. Numbing eye drops are used until the patient’s eye is completely numb. This is supplemented with numbing medications during the procedure to make sure that the entire procedure is absolutely painless. To give you an idea of how effective this is, many patients are surprised to hear I’ve finished (or even started) the procedure since they could not feel us working on their eye.
Once the patient is comfortable, the patient’s eye is carefully cleaned and a drape is used to make sure it stays clean and the field is “sterile”, or free of any bacteria.
A microscope is brought into position and the remaining steps are performed under the magnified view which allows incredible visualization. The microscope also provides target lights for the patients to look at during the procedure.
The next steps of the procedure vary depending on whether you and your physician have decided on “laser” or “conventional” cataract surgery. Keep in mind that not all facilities offer “laser” cataract surgery and if you are interested in it, you may want to check with your doctor’s office before making an appointment.
I offer both “laser” and “conventional” cataract surgery. I will go into the specifics of each before getting back to the steps of the procedure that are common to both. As far as which one is right for you, I tailor my treatment plans for each individual patient as any doctor should. With that in mind, I recommend every patient discusses any questions they have with their eye care provider.
Conventional Cataract Surgery
A “microkeratome” is used to create a cataract incision. Other microscopic instruments are used to create a “capsulorhexis”, or circular opening in the lens capsule through which the cataract can be taken out and a new clear lens can be inserted. While some of these terms may sound unfamiliar, the take home message is that special instruments designed for micro-surgery are used to gain access to the cataract. You will see how this differs from Laser Cataract Surgery just below.
Laser Cataract Surgery
A femtosecond laser (an incredibly precise laser designed specifically for eye procedures) is used to create a cataract incision. At the same time, the laser creates a “capsulorhexis”, the circular opening through which the cataract is removed and new lens is inserted. The laser can also break up the cataract to make it easier to remove and create “limbal relaxing incisons” , which are a wonderful way to treat astigmatism. All of this is done in less than a couple minutes. It’s safe to say the laser is a great multi-tasker!
The remaining steps of the procedure are common to both conventional and laser cataract surgery. Now that there is clear access to the cataract, ultrasound energy is used to break up the cataract and take it out. This process is called phacoemulsification.
With the cataract out of the way, a carefully selected intraocular lens or IOL is inserted into the anatomical position that will provide the patient with the best visual and functional outcome. The idea of a lens inside your eye may seem unusual to some patients. However, intraocular lenses have been in used for decades, with the first one implanted in 1949. Over the years, the technology of IOLs have grown by leaps and bounds as the material used and designs have been perfected. Each lens is custom selected for the patient based on a variety of measurements and careful discussions at the time of your visit. In addition to restoring 20/20 vision or better, IOLs are also designed to reduce (or possibly eliminate) your need for glasses and treat astigmatism. There are many options to choose from, which is why I’ll write more about them in the Premium Lens section.
Getting back to the last steps of the Cataract procedure, once the lens is in the place, they eye is carefully flushed out and the eye is inspected to make sure it is in great condition. Additional drops are given to help the eye heal and protect it from infection. This concludes the procedure and the patient is then to the recovery area for check out. They can then spend the remainder of the day in the leisure of their own home.
Pros
The obvious benefit of this procedure is permanent relief from the symptoms induced by your cataract. Classic symptoms of cataracts include vision that is blurred or foggy vision, washed our color perception, and severe glare among other things. Cataract removal can improve clarity of vision, increase contrast sensitivity and color perception and reduce symptoms of glare. To help understand how one procedure can accomplish all this, imagine that you’ve been looking through a dirty, stained window for years. Now imagine that window is replaced with a brand new window that is completely stain resistant. This analogy might help you visualize how much of a difference cataract extraction can make.
An added benefit to cataract extraction is treatment of refractive errors (Myopia, hyperopia, and astigmatism). The surgeon can chose a specific lens to treat whatever refractive error your eye has. As a result, many patients no longer need distance glasses after cataract removal, even if they have worn them their entire life! Some lenses even allow for distance vision and near vision. These are especially helpful for patients that wish to say goodbye to reading glasses. Please consult the Premium Lens sections for more detailed information about specialty lenses.
Cons
As with any other procedure under the sun, it is important to fully understand the risks before deciding on cataract surgery. These include infection, inflammation, and (in the worst case) loss of vision. With that said, cataract removal is one of the safest procedures in the world and most complications can be effectively treated.
Another disadvantage for younger patients requiring cataract removal is the need for reading glasses after the procedure. However, there are many solutions to this problem including Monovision and Premium IOLs, which allow patient to see clearly far away and up-close.
Dr Vish 