Cataract removal

  • Definition
    • Cataract removal is surgery to remove a clouded lens (cataract) from the eye. Cataracts are removed to help you see better. The procedure almost always includes placing an artificial lens (IOL) in the eye.

  • Alternative Names
    • Cataract extraction; Cataract surgery

  • Description
    • Cataract surgery is an outpatient procedure. This means you likely do not have to stay overnight at a hospital. The surgery is performed by an ophthalmologist. This is a medical doctor who specializes in eye diseases and eye surgery.

      Adults are usually awake for the procedure. Numbing medicine (local anesthesia) is given using eyedrops or a shot. This blocks pain. You will also get medicine to help you relax. Children usually receive general anesthesia. This makes them unconscious and unable to feel pain.

      The doctor uses a special microscope to view the eye. A small cut (incision) is made in the eye.

      The lens is removed in one of the following ways, depending on the type of cataract:

      • Phacoemulsification: With this procedure, the doctor uses a tool that produces sound waves to break up the cataract into small pieces. The pieces are then suctioned out. This procedure uses a very small incision.
      • Extracapsular extraction: The doctor uses a small tool to remove the cataract in mostly one piece. This procedure uses a larger incision.
      • Laser surgery: The doctor guides a machine that uses laser energy to make the incisions and soften the cataract. The rest of the surgery is much like phacoemulsification. Using the laser instead of a knife (scalpel) may speed recovery and be more accurate.

      After the cataract is removed, a manmade lens, called an intraocular lens (IOL), is usually placed into the eye to restore the focusing power of the lens (cataract). It helps improve your vision.

      The doctor may close the incision with very small stitches. Usually, a self-sealing (sutureless) method is used. If you have stitches, they may need to be removed later.

      The surgery lasts less than half an hour. Most times, just one eye is done. If you have cataracts in both eyes, your doctor may suggest waiting at least 1 to 2 weeks between each surgery.

  • Why the Procedure Is Performed
    • The normal lens of the eye is clear (transparent). As a cataract develops, the lens becomes cloudy. This blocks light from entering your eye. Without enough light, you cannot see as clearly.

      Cataracts are painless. They are most often seen in older adults. Sometimes, children are born with them. Cataract surgery is usually done if you cannot see well enough because of cataracts. Cataracts usually do not damage your eye, so you and your eye doctor can decide when surgery is right for you.

  • Risks
    • In rare cases, the entire lens cannot be removed. If this happens, a procedure to remove all of the lens fragments will be done at a later time. Afterward, vision can still be improved.

      Very rare complications can include infection and bleeding. This can lead to permanent vision problems.

  • Before the Procedure
    • Before surgery, you will have a complete eye exam and eye tests by the ophthalmologist.

      The doctor will use ultrasound or a laser scanning device to measure your eye. These tests help determine the best IOL for you. Usually, the doctor will try to choose an IOL that can allow you to see without glasses or contact lenses after surgery. Be sure you understand what your vision will be like after the IOL is implanted.

      Your doctor may prescribe eyedrops before the surgery. Follow instructions exactly on how to use the drops.

  • After the Procedure
    • Before you go home, you may receive the following:

      • A patch to wear over your eye until the follow-up exam
      • Eyedrops to prevent infection, treat inflammation, and help with healing

      You will need to have someone drive you home after surgery.

      You will usually have a follow-up exam with your doctor the next day. If you had stitches, you will need to make an appointment to have them removed.

      Tips for recovering after cataract surgery:

      • Wear dark sunglasses outside after you remove the patch.
      • Wash your hands well before and after using eyedrops and touching your eye. Try not to get soap and water in your eye when you are bathing or showering for the first few days.
      • Light activities are best as you recover. Check with your doctor before doing any strenuous activity, resuming sexual activity, or driving.

      Recovery takes about 2 weeks. If you need new glasses or contact lenses, you can usually have them fitted at that time. Keep your follow-up visit with your doctor.

  • Outlook (Prognosis)
    • Most people do well and recover quickly after cataract surgery.

      If a person has other eye problems, such as glaucoma or macular degeneration, the surgery may be more difficult or the outcome may not be as good.

  • References
    • American Academy of Ophthalmology Preferred Practice Patterns Cataract and Anterior Segment Panel, Hoskins Center for Quality Eye Care. Cataract/anterior segment summary benchmark - 2016. Updated October 2016. Accessed November 17, 2016.

      Moorman C. Cataract surgery. In: Spaeth GL. Danensh-Meyer HV, Goldberg I, Kampik A, eds. Ophthalmic Surgery: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier; 2012:chap 4.

      Tipperman R. Cataracts. In: Gault JA, Vender JF. Ophthalmology Secrets in Color. 4th ed. Philadelphia, PA: Elsevier; 2015:chap 21.

      Wevill M. Epidemiology, pathophysiology, causes, morphology, and visual effects of cataract. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 5.17.