Cataract eye surgery involves the removal of the natural, clouded lens of the eye and its subsequent replacement with a clear, artificial lens. Patients typically undergo treatment when the symptoms become so great that they affect a person's quality of life. The cataract surgery procedure is usually performed under local anesthesia on an outpatient basis. The entire cataract surgery usually takes less than an hour. There are several variations in both the removal and the replacement portions of the surgery. The technique used depends on the patient's needs and the physician's diagnosis, as well as the type of cataract involved.
Types of Cataract Removal Surgery
There are two main types of cataract removal surgery that physicians perform: extracapsular and intracapsular.
The extracapsular cataract eye surgery procedure involves the removal of the lens, leaving the capsule in place. This provides added support and improves the healing ability of the eye. The most commonly performed type of extracapsular cataract surgery in the United States is phacoemulsification. Phacoemulsification softens and breaks apart the lens using ultrasound technology.
After phacoemulsification is achieved, the cataract surgery is completed with the removal of the lens, leaving the capsule in place.
Intracapsular cataract eye surgery involves the removal of the entire lens, including the capsule. This is a less frequently performed type of cataract surgery procedure due to increased complications associated with it, including heightened risks of retinal detachment and swelling.
Lens Replacement Surgery
During the first stage of cataract surgery, your surgeon will remove the clouded lens of your eye. At that point, a refractive replacement lens, such as an intraocular lens (IOL), glasses, or contact lenses, is used to restore vision. In the majority of cases, a single- or multi-focus IOL is implanted into the eye during cataract surgery.
Single-focus Intraocular Lenses
Intraocular lenses (IOLs) replace the natural lens within the lens capsule. They are inserted through a small incision and unfolded inside the eye. In the past, patients only had the choice of having single-focus lenses inserted during cataract surgery. Single-focus lenses allow patients to see clearly at one distance. They are unable to switch focus between near and far objects, so surgeons tend to implant a lens that allows patients to see objects at a distance. Patients that have single-focus lenses implanted will rely on glasses to see near objects.
Multi-focus Intraocular Lenses
Although most patients still have single-focus lenses implanted due to their cost, patients do have the option of having multi-focus intraocular lenses implanted during surgery. A growing number of cataract surgery patients are fitted with multi-focus IOL brands such as ReSTOR®, ReZoom™, and crystalens®. These IOLs have the ability to bring objects into focus at all distances.
After cataract surgery with multi-focus implantable lenses, glasses or contact lenses are needed in only about 10 percent of the cases. Cataract eye surgery patients who are extremely nearsighted may find that they still need to use glasses or contact lenses to improve their vision.
Cataract Surgery Results
According to the American Society of Cataract and Refractive Surgery (ASCRS), the procedure boasts an exceptionally high success rate, with 98% of patients experiencing positive results.
- Bring objects into focus
- Notice crisper, clearer eyesight
- Look at bright lights, such as streetlights or lamps, without glare
- See colors more vividly
- Enjoy reading, watching TV, and using the computer without straining the eyes
- Drive at night without dim or blurry vision
Some patients experience remarkably clearer vision within hours of their cataract surgery, although it may take several days for others to notice their sight improving. Either way, the majority of patients find that cataract surgery results in an improvement in visual acuity that increases their quality of life.
Results Achieved With Monofocal IOLs
The ASCRS reports that 95% of patients who are implanted with a monofocal IOL have their vision fully restored to its pre-cataract state. However, the majority of patients who choose this type of lens will need reading glasses in order to realize the full benefits of the procedure.
Results Achieved With Multifocal and Accommodating IOLs
Because these premier lenses maintain the eye's ability to focus naturally, and can be tailored to treat other conditions such as astigmatism and presbyopia, patients who choose multifocal or accommodating lenses may achieve clearer vision than they had prior to cataracts. Although the need for additional correction is reduced, some patients may require reading glasses until their eyes adjust to focusing with the new lenses.
Vision Correction after Cataract Surgery
Although the procedure is remarkably successful in restoring visual clarity, often cataract surgery results in the need for reading glasses while performing close tasks. According to the National Institute for Health and Clinical Excellence, 95% of patients who have a monofocal lens placed in both eyes will require additional vision correction, compared with 68% of patients placed with multifocal or accommodating lenses.
When monofocal IOLs are placed in both eyes, cataract surgery results in good distance vision; however, reading glasses are necessary to correct resulting nearsightedness. When multifocal or accommodating IOLs are used, the eye maintains the ability to naturally shift its focus from near to distant objects, which is why some patients who have been fitted with these lenses do not require additional vision correction.
Once the clouded lens of the eye has been replaced with an artificial IOL, cataracts cannot recur. However, the back of the eye's lens capsule, which is left intact during surgery to serve as an anchor for the IOL, may become clouded in a condition known as posterior lens opacification. Also referred to as secondary cataracts, clouded lens capsules are treated with a quick and painless outpatient procedure known as a YAG capsulotomy, which uses laser energy to create a hole in the clouded lens, allowing light to pass through.
Contact a Cataract Surgeon
If your cataracts are preventing you from driving, reading, and other activities, contact a cataract surgeon in your area to learn about your available treatment options. It may be time to undergo lens removal and replacement cataract surgery.