Surgery for a
cataract involves removing the clouded lens of the eye
(the cataract). The lens can be replaced with an artificial lens called an
intraocular lens implant (IOL). Or, if an IOL cannot be used for any reason, it
will be left out and contact lenses or, rarely, eyeglasses can compensate for
its absence. Most people will get an IOL during surgery.
Before
surgery, review with your doctor the pros and cons of each type of IOL
available. Or, if you will not be getting an IOL, the pros and cons of contact
lenses or eyeglasses.
- Intraocular lens (IOL). A variety of IOL
types are available. Your doctor will choose the type of IOL that may work best
for you.
- Contact lens. A contact lens is placed
on the surface of the eye. A contact lens may not be a good choice for young
children or older adults who have a hard time properly placing the lens in the
eye.
- Cataract glasses. Cataract glasses were used for
decades when there were no other options for lens replacement. Because they are
thick and heavy, they are rarely used now.
For most adults, surgery is only needed when vision
loss caused by a cataract affects your quality of life. The goals of surgery in
adults with cataracts include:
- Improving vision.
- Helping you
return to work, leisure, and other daily activities.
Should I have cataract surgery?
The choices for
treating cataracts in children depend on how likely
the cataracts are to interfere with development of normal vision. Surgery for
cataracts in children may be necessary.
Before you have surgery
for cataracts, tell your doctor all of the medicines you are currently taking.
Your doctor may advise you to stop taking a medicine, such as an alpha-blocker
(for example, terazosin) before the surgery to prevent complications.
Second surgery
For adults who have cataracts in
both eyes, surgery is not normally done on both eyes at the same time. The
first eye needs to heal, and your doctor will determine how much eyesight has
improved before surgery is done on the second eye.
If you have both
glaucoma and cataracts, you may have
surgery for both conditions at the same time.
Depending on which condition caused the vision loss, vision may improve after
surgery.
Surgery Choices
There are two types of
cataract surgery. The decision about which one to use
depends on what kind of cataract you have and how much experience the surgeon
has with each type of surgery.
- Phacoemulsification. In this type of surgery, the
incisions are small, and sound waves (ultrasound) are used to break up the lens
into small pieces. Currently, this is the most common method of doing cataract
surgery.
- Extracapsular surgery. In this type of surgery,
the lens and the front portion of the lense capsule wrapped around the lens is
opened. The lens is then carefully removed in one piece. Some techniques use a
small incision and manually break up the lens into small pieces. Extracapsular
surgery is also called extracapsular cataract extraction (ECCE).
In the past, cataracts were removed by
intracapsular surgery, in which the entire lens and
lens capsule were removed. Intracapsular surgery is rarely, if ever, used
today. It is more difficult and has a higher rate of complications than
extracapsular procedures.
About 1 out of 4 people who have
cataract surgery develop clouding of the posterior lens capsule (called
aftercataract) within 5 years after surgery.4
But this clouding is usually not a serious problem, and it is easy to
treat with a laser surgery (Nd:YAG laser posterior capsulotomy) if
it develops. This type of surgery is done in an office setting.
What To Think About
For adults, cataract surgery is
almost always elective and can be done at your convenience. The surgeon, or
someone familiar with routine surgical practices, will usually be available for
any follow-up exams and treatment.
If you do not have another eye
condition, such as glaucoma or problems with your
retina, your chances of seeing better after cataract
surgery are very good. But you may still need reading glasses or glasses for
near vision.
Just because you have a cataract does not mean you
need to have it removed. Only you can decide whether cataracts are affecting
your vision and your life enough to have surgery. Learn
what you should ask about cataract surgery before deciding whether to have
the surgery.