Types of Cataract Surgery: Phaco vs. Extracapsular

There are three types of cataract surgery, with phaco, or small incision, being the most recommended and performed. Laser-guided cataract surgery may become increasingly common in the future.

Types of Cataract Surgery

Cataract surgery is one of the most common and well-understood types of eye surgery. Many people undergo cataract surgery and receive an artificial lens to replace the cloudy or damaged natural lens.

Like all types of surgical procedures, medical studies and advancements have improved technology and techniques used in cataract surgery, which greatly improves patient outcomes. There are basically three different types of cataract surgery, with phacoemulsification (phaco) being the most common type.

Here is some more information on the different types of cataract surgery.

Phacoemulsification (phaco)

This type of cataract surgery involves the smallest possible incision into the cornea, which improves healing outcomes.

The surgeon will use a tiny scalpel, typically guided by a surgical machine, to make a minute incision in the cornea. Then, a special device that emits ultrasound waves will be used to break up the lens of the eye. Finally, suction will be used to remove the pieces of lens from this tiny corneal opening. Once the lens has been removed, the artificial lens will be implanted.

Since the opening in the cornea is so small, it is unlikely that your surgeon will use sutures to close it. You will need to take steps to protect your eyes afterward.

Phacoemulsification is the most common form of cataract surgery as it has faster healing times and is slightly less invasive. Because of the small scalpel incisions, this surgery is also called small incision cataract surgery.

Extracapsular surgery

While most people are good candidates for phaco, sometimes a patient’s cataract has progressed far enough that the lens must be removed in a different way. This requires a larger incision to remove the entire lens whole rather than breaking it up into smaller pieces. This is called extracapsular cataract extraction, or ECCE.

A larger corneal incision allows the surgeon to remove the cloudy part of the lens specifically and then safely remove the rest of the lens after breaking it up. They may also remove the entire lens in one piece, but this is rarer. Like phaco, a surgeon performing ECCE will replace the natural lens with an IOL.

This is a less common procedure and not preferred over phaco because the larger incision requires more healing time and is more likely to develop an infection.

Laser-assisted cataract surgery (LACS)

If your cataract surgery involves a guided laser, this device replaces the surgeon’s scalpel. Both small and extracapsular incision procedures can be performed using a laser rather than a scalpel.

Although there is still little medical research on its effectiveness, some scientific studies show that lasers can create much smaller and more precise incisions, which improves healing time for some people. For example, people with astigmatism are better candidates for LACS, as guided lasers can be used to correct this refractive error during cataract removal.

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IOL Options After Surgery

Intraocular lenses (IOLs) replace the natural lens of your eye after the organ has been removed due to cataracts. These lenses are silicone, acrylic, or a combination of biocompatible plastics. They are coated with a special material to keep the rest of your eye safe from ultraviolet (UV) radiation.

There are different types of IOLs available.

• Monofocal: This is the most common type of IOL and is most likely to be covered by your insurance after cataract surgery.
  
  The lens has one focusing distance that you can choose — either up close, far away, or medium distance. This depends on what type of distance vision you use the most. Often, people choose far-distance vision for driving and then wear reading glasses for up-close work.
• Multifocal: Like bifocals or trifocals, the multifocal IOL allows you a few ranges of visual distance, so you can focus on either near or far vision.
• Accommodative: These lenses will move and change shape inside your eye, working as close to the function and movement of your natural lens as possible. This allows you to focus clearly on several ranges of sight.
• Toric: People with astigmatism, which is a condition in which the shape of the eye is oblong rather than round, benefit from the toric lens, which can help reshape their eye, so light is refracted more clearly to the retina.

Typically, your vision insurance will only cover the monofocal IOL since there are solutions like glasses that can improve your sight at different ranges. However, your insurance might also cover toric IOLs if you have astigmatism. If you are interested in multifocal or accommodative IOLs, talk to your optometrist and eye surgeon about these options to determine which might work best for you, so you can begin saving for the lens.

References

1. Cataract Surgery. (September 2020). National Eye Institute (NEI).

2. Visual Acuity Improvement After Phacoemulsification Cataract Surgery in Patients Aged >90 Years. (October 2018). BMC Ophthalmology.

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