Cataract Surgery

Cataract surgery has evolved rapidly over the last two decades. The technological advancements as well as the skill of the surgeons has lead to a much higher rate of success with better visual results and fewer complications.

Phacoemulsification is the technique used most commonly to remove a cataract. This involves the use of an instrument that applies high energy sound waves to fragment the cataract into small pieces so that it can be removed through a small incision.

The incision size in cataract surgery continues to shrink. Cataracts can be removed now through 2.5 to 3.0 mm incisions. This small incision size allows the surgeon to have better control of the surgery, more rapid removal of the cataract, and a self sealing incision that does not require sutures. This "no stitch" incision heals rapidly and allows quick return of vision.

The advent of soft foldable lens implants allows the incision to remain small. Previously, the cataract could be removed through a small incision, but the incision had to be enlarged to place a lens implant within the eye. Since the cataract is a cloudiness of the natural lens of the eye, the natural lens is removed during the course of the surgery. This also removes some of the focusing power of the eye which must be restored by placing an artificial lens or intraocular lens implant within the eye. Prior to lens implants, thick "Coke bottle" glasses or contact lenses were required to restore this focusing power to the eye. With these new implants, the implant can be folded and placed through the small incision without enlarging it. This reduces recovery time and also prevents the surgery from inducing astigmatism, an irregular contour to the cornea.

Changes in anesthetic technique have also allowed patients to return to normal activities more quickly. General anesthesia is rarely used now. Local anesthetic using sedatives and injections around the eye to freeze the eye are also seldom used. Most frequently, our physicians are using newer techniques which involve the use of topical anesthesia or eye drops to "numb" the eye. No shots are used with this technique which allows for vision shortly after the surgery and less chance of bruising due to anesthetic injections. With this technique, most people are able to resume normal activities within 24 hours.

The future of cataract surgery involves further technological improvements. Implants are being developed to reduce the need for bifocals or trifocals for close work and also to reduce or eliminate astigmatism. New equipment to remove cataracts may include laser-assisted machines.

The final component to a successful surgery is a thorough discussion with your surgeon. It is important to understand the benefits and develop realistic expectations as well as to understand alternative treatments and possible complications.

The state of cataract surgery now is at a very high level. It is not necessary for a cataract to become "ripe" before it is removed. In past times, most surgeons would wait until visual function became extremely poor due to the high complication rate of surgery. Cataract surgery is so successful now, the main indication for removing a cataract is when the blurred vision from the cataract reaches a point that it interferes with the patient's daily activities such as reading, driving, or other hobbies such as golf and sewing.