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What is Cataract Surgery?

illustration of the four main steps in cataract surgery

Cataract surgery is a procedure used to restore cataract-related vision loss. During surgery, the clouded lens inside your eye will be replaced with a clear artificial lens. You won't feel any pain during the procedure, and it usually only takes about 15 minutes. It's typically an outpatient procedure and doesn't require an overnight stay in a hospital.

Cataract surgery might sound scary at first, but it's one of the safest and most effective vision surgeries available today. Millions of cataract surgeries are performed in the U.S. every year, and the vast majority have excellent outcomes.

The potential need for cataract eye surgery goes up as you age, when cataracts are most likely to develop or worsen.

According to the National Institutes of Health (NIH), cataracts affect:

  • About 1 in 20 of people aged 50-54

  • Roughly half of people aged 75-79

  • More than 2 in 3 people over age 80

SEE RELATED: Refractive cataract surgery

What happens during cataract surgery?

The cloudy lens inside your eye will be removed and replaced with a clear artificial lens during surgery. This device is called an intraocular lens, or IOL for short.

An IOL helps restore the clear vision you had before cataracts developed.

During any form of cataract removal, special precautions are taken to make sure you're completely relaxed and pain-free. At worst, patients can experience a slight sensation of pressure, but this feeling isn't painful.

A modern cataract surgery procedure will often follow these steps:

  1. A small incision is made along the side of the cornea.

  2. A high-frequency ultrasound device or laser is used to carefully break up the cloudy lens into small fragments.

  3. The lens fragments are gently removed from the eye using suction.

  4. After all fragments have been removed, the surgeon places the IOL behind the pupil and the colored part of the eye (iris) in the same spot your natural lens occupied.

  5. The incision heals on its own without any stitches.

  6. A protective shield is placed over the eye to keep it safe during the early stages of recovery.

If you need surgery in both eyes, your cataract surgeon will typically wait one to three weeks between procedures, to give the first eye a chance to heal.

SEE RELATED: Different ways cataracts can be treated

Two different options for cataract surgery

The most common type of cataract removal surgery is called phacoemulsification, or phaco for short. A phacoemulsification procedure uses high-frequency ultrasound waves to break up the cloudy lens.

The phaco operation is now performed with smaller incisions than ever before, so healing is faster with a much lower risk of complications.

Three main types of IOL can be implanted during cataract surgery:

  • Monofocal lenses – The standard options for most surgeries. These may still require the use of eyeglasses or reading glasses after surgery. If prescription glasses are needed, your eye doctor will prescribe them about a month after surgery. Optionally, presbyopia can be treated by adjusting the power of one of your monofocal IOLs to create a condition called monovision. [Read more about monovision cataract surgery.]

  • Accommodating lenses and multifocal lenses – Available for patients with presbyopia. These lenses can correct your reading vision without sacrificing your distance vision. Both of these IOLs provide a greater range of vision after cataract surgery than conventional monofocal lenses.

  • Extracapsular surgery – Instead of breaking up the cloudy lens with ultrasound, a surgeon will remove the core in one piece, then the rest with suction. Extracapsular surgery involves a longer incision and antibiotic eye drops before the operation. This type of cataract surgery procedure is typically only performed in complicated cases.

Watch this video about how cataract surgery works.

Laser cataract surgery, or Refractive Laser-Assisted Cataract Surgery (ReLACS), is a newer option that uses more recent technology.

Instead of ultrasound energy, a special laser is used to break up the existing cataract. The laser uses less energy than ultrasound, which can reduce the risk of complications even more.

In some cases, laser surgery can also improve visual outcomes.

Laser surgery is usually more expensive than standard phaco cataract surgery. During your cataract removal consultation, your surgeon can help you decide which procedure is best for your individual needs.

SEE RELATED: How much does cataract surgery cost?

Preparing for cataract surgery

Before you schedule cataract surgery, your eye doctor will perform a comprehensive eye exam to check the overall health of your eyes and decide if anything will prevent you from having surgery.

The doctor will also perform a refraction test to determine your nearsightedness, farsightedness and/or astigmatism measurements before surgery. Additional measurements of your eyes will be taken to determine the shape of your eye and which type of implantable lens you'll need.

Prior to eye surgery, you'll be informed about what to expect before, during and after your procedure. This information will help you make an informed decision about moving forward with surgery.

Your eye doctor will ask about any medications and supplements you're taking. Some of these can increase your risk of complications and may need to be discontinued for a little while.

If you have any questions or concerns about cataract surgery, be sure to discuss them with your eye doctor and cataract surgeon before signing the "informed consent" documents that authorize surgery.

READ NEXT: What is Peters anomaly (PA)?

Cataract surgery recovery

An uncomplicated cataract surgery procedure only takes about 15 minutes. You can expect to be at the surgical center for 90 minutes or longer, since extra time will be needed for preparation, along with a post-operative evaluation and recovery instructions.

You will need to have someone drive you home after cataract surgery. To protect your eye from sunlight and other bright light as it recovers, the facility will give you a special pair of post-operative sunglasses.

You will need to use special medicated eye drops for a few weeks. You'll also need to wear your protective eye shield while sleeping or napping for the first week or so.

You might experience some eye redness and blurred vision while your eye heals during the first few days or even weeks after surgery.

During at least the first week of your recovery, you will need to avoid:

  • Strenuous activity and any lifting over 25 pounds.

  • Bending, exercising and any other activities that can stress the eye.

  • Exposing your eye to water, since it can cause an infection. You'll need to keep your eye closed while showering or bathing. Avoid swimming or sitting in a hot tub for at least two weeks.

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

Your cataract surgeon may give you additional instructions, depending on your specific needs and the type of procedure performed.

READ NEXT: Floppy Iris Syndrome

Cataract tables. National Eye Institute. Accessed June 2021.

Cataract surgery. American Academy of Ophthalmology. September 2020.

Cataract surgery. Johns Hopkins Medicine. Accessed June 2021.

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