Cataract Surgery

Each year, roughly 15 million people undergo cataract surgery, and the success rate is very high. In fact, a study by the American Society of Cataract and Refractive Surgery (ASCRS) recently reported that more than 98 percent of cataract patients had their vision successfully improved following surgery. Studies indicate that patients have fewer falls and could maintain living independence longer with improved eyesight. Of course, the eye needs to otherwise be in good health for the best results from cataract surgery. Modern lens implants are of a very high quality but cannot yet mimic the clear normal lens in a young adult eye.

Once the cataract is repaired, it will not recur. The lens implants used today are meant to last a lifetime. Some patients may normally develop a thickening or haze in the natural membrane that holds the intraocular lens (IOL) in the eye (capsular opacity) and this is treated with a laser (YAG), if it should become an issue.

How is cataract surgery performed?

Cataract surgery is an outpatient surgery, so that patients return home that day. Medicine is used to numb the eye and to dilate the pupil, and an IV is established for light sedation. The skin around the eye is cleansed, and a sterile drape is positioned. The eyelids are gently helped open with a lid holder or “speculum” so that blinking is controlled. Using a high power operating microscope, the surgeon makes a small incision in the side of the clear cornea (about 1/8 inch long) and then inserts a thin ultrasound instrument (phacoemulsification) that breaks up the cataract into microscopic pieces. The tiny pieces are then rinsed from the eye. Once the cataract is removed, a personalized lens implant is placed into the eye, typically fitting where the cloudy cataract was once positioned. Most incisions for modern cataract surgery are self-sealing and do not require sutures, but one or more sutures may be placed for safety, or depending on patient activity requirements. A shield is typically placed over the eye and patients return home shortly after surgery.

Lens Implants

Once the cloudy lens is removed, a small artificial lens (intraocular lens or “IOL”) is placed inside the eye. The IOL both stabilizes the related structures in the eye and helps to reduce dependence on glasses after surgery (although it is rare to be entirely free of glasses even after perfect cataract surgery). These lenses are inert (usually made of an acrylic polymer) and are never “rejected”. Modern technology provides patients choices in deciding which intraocular lens might be the “best” for them. What IOL to use depends on the general health of the eye, other eye conditions that may be present, the testing results of eye measurements performed before surgery, and any patient desires to decrease dependency on glasses at certain distances. Insurance covers the high quality “monofocal” lens implants, but typically will not cover IOLs that correct astigmatism or reduce glasses needs at more than one distance (bifocal IOLs). Counseling is provided at the proper time in order to assist in the selection of the “best” IOL for a given eye and a given patient.