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Cataract Surgery

What is a cataract surgery?

Cataract surgery is a procedure in which an eye surgeon removes a clouded lens (cataract) from the eye and replaces it with an artificial lens.

When is it used?

Cataracts can cause vision problems by preventing clear images from reaching the retina (the light-sensitive tissue at the back of the eye). You may choose to have cataract surgery because you need to have better vision to continue your normal activities. In the early stages of cataracts, an alternative to surgery may be to get a stronger prescription in your glasses.

When the cataract is removed, your surgeon will replace the lens with a plastic lens. If an intraocular lens is not put in your eye after removal of a cataract, you would have to:

  • wear contact lenses
  • wear cataract glasses. Cataract glasses have a thick magnifying glass in the center of the lens. It makes things look about one-third larger than normal. If the vision in your other eye is good, you cannot wear cataract glasses because both eyes will not be able to work together properly.

Ask your eye care provider about these choices.

How do I prepare for the procedure?

Arrange for someone to take you home after your surgery. Plan for your care and recovery after the operation, especially if you are to have sedation or general anesthesia. Allow for time to rest and try to find people to help you with your day-to-day activities.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you take aspirin, warfarin (Coumadin), or vitamin E, ask your provider if you need to stop taking this medicine before your surgery. If you need a minor pain reliever in the week before surgery, take acetaminophen rather than aspirin, ibuprofen, or naproxen. This may help to avoid extra bleeding during surgery. If you cannot take acetaminophen (Tylenol) ask your provider what pain medicines you can take. Tell your provider about any other medicines you are taking.

Eat a light meal, such as soup or salad, the night before the procedure. Your provider will probably also recommend that you not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water. If you regularly take prescription medicines, your provider may ask you to take them on the day of surgery with a sip of water.

Do not wear eye makeup on the day of the surgery. Follow any other instructions provided by your provider.

What happens during the procedure?

You will be given a local or general anesthetic to prevent pain during the operation. A local anesthetic numbs your eye while you remain awake. The local anesthetic can be given to you with drops or ointment or with a shot of medicine behind the eye. A general anesthetic relaxes your muscles and puts you to sleep. Most surgery is done with local anesthesia only. Sometimes your provider will give you a sedative to help you relax.

The surgeon will make a small cut in your eye and remove the cloudy lens. There are 2 ways to remove the lens:

  • Phacoemulsification: Sound waves (ultrasound) are used to break the lens into small pieces. The small pieces are then removed through a tiny vacuum probe.
  • Nuclear expression: The lens is removed in one piece. This approach may be used if your cataract can't be broken up by phacoemulsification.

After the lens is removed, the surgeon will put an artificial lens in your eye. The surgeon may put one or more stitches in your eye to close the incision and then put a patch and shield over the eye.

What happens after the procedure?

You will be in the recovery area after surgery until you are ready to go home. Have someone take you home.

It's normal to feel itching, sticky eyelids, and mild discomfort for a while after cataract surgery. Some fluid discharge is also common. If you have discomfort, your provider may suggest that you take acetaminophen every 4 to 6 hours. Aspirin, ibuprofen, and naproxen are not recommended because they can cause bleeding. After 1 to 2 days, the discomfort should stop.

You can read and watch TV almost right away, but your vision may be blurry at first. You can do simple tasks such as ride in a car, get dressed, cook, and visit friends. You should not drive a car the day of surgery. Do not rub your eye or allow water or other substances to get into your eye. Avoid bumping your eye because it may cause injury.

Your eye care provider will schedule exams to remove the patch one day after surgery and to check on your progress. You may need to use eyedrops to help healing and to prevent infection or inflammation. For a few days after surgery, you may also need to use eyedrops or take pills to control the pressure in your eye. Ask your provider how and when to use the drops or pills and what effects they can have. Since you may have several different drops to use, be sure you have a written schedule to follow to avoid confusion.

In most cases, it takes about 6 weeks for the eye to heal. You will be ready for new glasses in about 1 month. It may take a few more weeks for the sharpest vision to return.

What are the benefits of this procedure?

You can regain nearly normal vision if the rest of your eye is normal.

What are the risks of this procedure?

The risks of this procedure include:

  • infection
  • bleeding
  • inflammation (pain, redness, swelling)
  • drooping eyelid
  • double vision
  • glaucoma (higher pressure inside your eye)
  • retinal tear or detachment
  • need for additional surgery
  • decreased or loss of vision (rare).

There are some risks when you have general anesthesia. Older adults may have mild to severe confusion after surgery. Temporary trouble with urinating is also common. Discuss these risks with your provider.

Despite the use of a local anesthetic, you may still feel some minor discomfort. Also, in rare cases you may have an allergic reaction to the drug used in this type of anesthesia. Very rarely, bleeding may happen when the shot of anesthetic is given, affecting your vision and making it necessary to postpone the surgery. Local anesthesia is considered safer than general anesthesia and is used for most cataract surgeries.

In some cases, you may notice cloudiness a few weeks to months after the surgery. This is called an after-cataract. This happens when a cloudy area forms on the membrane of the capsule behind the lens. This does not mean that the cataract grows back. This problem is easily fixed with a quick, painless procedure done in the office, in which your provider uses a laser to make a hole in the after-cataract. The procedure is called a YAG capsulotomy.

Ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call right away if:

  • You have severe or worsening pain.
  • Your eye gets very red.
  • You have a decrease or loss of vision.
  • You see flickers or flashes of light.
  • You see new floaters in your vision.
  • You have a lot of drainage from your eye.
  • You develop a fever.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File surg4201.htm Release 13/2010

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