Cataract Eye Surgery: A Common & Important Procedure

Cataract eye surgery is one of the most common, safest eye surgeries in the world. Older adults are at higher risk of developing cataracts, but this procedure restores sight when the natural lens of the eye becomes so cloudy or dimmed that you can no longer perform daily tasks.

It takes about one to two hours total to perform. The full recovery time for most people is up to three months.

Cataracts Surgery Is a Safe, Effective Option

Many people associate cataracts with blindness, and without treatment like surgery, this could be the end result. However, this eye condition develops slowly, and most people do not know they have a cataract until their optometrist or ophthalmologist diagnoses it during a routine visit.

A cataract forms when proteins in the lens of the eye begin to break down and form cloudy, streaked, or dark clumps or spots. Though there are some genetic and environmental factors associated with cataracts forming, the most common cause of cataracts is aging.

Cataract risk increases in anyone over 40 years old. About half of people 80 and older either have cataracts or have had cataract surgery.

Since 1995, 500 million cataract surgeries have been performed around the world, with more than 60,000 cataract surgeries performed globally every day. About 4 million cataract surgeries are performed every year in the United States alone.

This is one of the most common eye surgeries. Since it has been performed for decades, the surgical and healing process is very well understood, making it one of the safest procedures.

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How Will I Know When I Need Cataract Surgery?

About 90 percent of people who have received cataract surgery report better vision after the procedure and overall satisfaction with the results.

Cataract surgery involves the surgeon making a small incision in your cornea, removing your natural lens, and replacing the lens with an artificial intraocular lens (IOL). This device, made from biocompatible plastics, gives you clear vision and can often improve refractive errors like nearsightedness, farsightedness, and astigmatism.

These steps are involved in cataract surgery:

• Have a consultation and eye exam with your surgeon a few weeks before the procedure.
• Schedule a ride from a loved one since you will not be able to drive yourself home after the procedure.
• Arrive at the surgery center or office and check in.
• Get numbing eye drops or an injection in your eyes. You will not receive general anesthesia, and you will be awake during the surgery.
• Your surgeon will use specialized tools during the procedure, but you will not see these. You may see some light and movement.
• When the surgery is complete, your surgeon will put a shield over your eyes and send you to the recovery room.
• You will wait between 15 and 30 minutes in the recovery room to ensure that the surgery went well. Then, you can go home.
• Rest for a few days after the procedure, follow aftercare instructions, and attend all post-surgery exams.

Only people whose vision is significantly impacted by cataracts will need surgery. If the cataract is not obscuring vision or causing personal limitations, like trouble reading or driving, your ophthalmologist will recommend monitoring the cataract at annual visits, but there is no other needed treatment.

As the cataract grows, it will impact how light is refracted to your retina, so your eye doctor will adjust your glasses prescription and recommend other lifestyle changes, like using brighter lights to see more clearly. Although cataract surgery is an important, safe, and well-studied procedure, it is still considered the last resort in cataract treatment and management.

Types of Cataract Surgery

Currently, there are three basic types of cataract surgery.

• Small-incision/phacoemulsification: This is the most common and recommended type of cataract surgery available.
  
  Your surgeon uses a tiny scalpel to make a small incision in your cornea. Then, they insert a probe that emits high-frequency sound waves in the ultrasound spectrum. These waves break up the natural lens of your eye, so it is easy to remove through the incision.
  
  Since the incision is so small, it is considered self-sealing, so you will not need stitches, which would add healing time to the recovery process. After the pieces of your natural lens have been gently removed, these are replaced with an IOL of your choice.
• Extracapsular: While this is an important and effective form of cataract surgery, it is not as recommended as phacoemulsification because the incision in the cornea is larger and might require stitches after the procedure. However, extracapsular cataract surgery is recommended for people who have larger cataracts that are harder to safely remove.
  
  Your surgeon will make a larger incision with a scalpel and remove the cataract itself before breaking up the rest of your natural lens and removing the organ. Like phaco, an IOL is implanted after your natural lens is removed.
• Laser-guided: This form of cataract surgery is typically applied to phaco but may also be part of extracapsular cataract removal. Rather than using a scalpel, your surgeon will use a guided laser to make the corneal incision.
  
  Surgeons are increasingly offering forms of LASIK while they remove the cataract, improving the patient’s vision in several ways during one procedure. Laser-guided cataract surgery is an especially good option for people with astigmatism.

More older adults are choosing premium or advanced IOLs rather than the standard monofocal IOL. In part, this is because aging adults are living longer and maintaining greater independence, so being able to focus on multiple fields of view with both eyes is more important for driving, working, and performing other daily tasks.

More cataract surgery patients are also opting for a form of LASIK after they undergo cataract surgery. This adjusts refractive errors further, so they can finally see clearly without glasses or contact lenses.

Recovering From Cataract Surgery

It takes about three months total for your eyes to heal after cataract surgery, but many people get clear vision after about one month. You will be scheduled for at least two follow-up appointments, so your surgeon or ophthalmologist can monitor how your eyes are healing and clear you for activities like exercise. You may need four appointments total, over two months. Most people who have cataracts in both eyes, who undergo cataract surgery, are receiving bilateral, same-day cataract surgery. In the past, the surgeon would typically remove the cataract from one eye, wait for the eye to heal enough, and then perform the surgery on the other eye. Now, however, technology has improved patient outcomes enough that surgeons are able to remove both natural lenses at the same time, so the patient does not have to spend extra weeks healing.

Risks & Side Effects From Cataract Surgery

Although this form of surgery has been safely and successfully performed on millions of people in the US for decades, there are still some risks associated with it. Some of these include the following:

• Eye infection
• Bleeding and pain that persists
• Ongoing swelling around the eye
• Swelling of the retina, at the back of the eye
• Detached retina
• Damage to other parts of the eye
• Blurry vision, haloes or glares around lights, and trouble seeing without lots of light
• Dislocated IOL
• Vision loss

These risks are minimal and very unlikely, but you should talk to your surgeon and eye doctor about your concerns. They can help you understand your individual risk level.

Since cataract surgery removes the natural lens of the eye, your cataracts will not come back. Your IOL is designed to maintain clear vision for years after it is implanted, and it is not subject to cataracts.

If you develop a cataract in one eye, you are likely to develop a cataract in the other eye. Even if you get surgery in just one eye, your chances of needing surgery to remove a cataract in the other eye at a later point are higher.

You may also develop posterior capsular opacification, which is sometimes called a second cataract but is actually scar tissue. This occurs when the membrane behind the lens becomes cloudy, making it difficult to see clearly. Often, this issue will heal on its own, but your surgeon may offer a laser procedure to remove this scar tissue if the problem persists.

Will My Insurance Cover Cataract Surgery?

Cataract surgery is considered a medically necessary procedure, so the cost will be covered by your health insurance and vision insurance, including Medicare or Medicaid.

Typically, your insurance will cover the cost of a monofocal IOL and, sometimes, a toric IOL, which is used to correct astigmatism. Currently, your insurance will not cover the cost of a multifocal or accommodative IOL since these are not considered medically necessary. You might be able to use a health savings account to pay for the cost of this lens, which will allow you to focus on near, middle, and far distances without glasses.

References

1. Cataract. American Optometric Association (AOA).

2. Future of Cataract Surgery Seems Promising. (February 2021). Healio Ophthalmology.

3. Cataract Surgery: Risks, Recovery, Costs. (September 2021). American Academy of Ophthalmology (AAO).

4. Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery. (April 2021). American Academy of Ophthalmology (AAO).