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Cataract Surgery Overview

If you have a cataract, there are several treatments available to you.

A cataract is a clouding of the lens in the eye that typically will affect your vision. Most cataracts are related to aging. People who have cataracts often have other vision problems in one or both eyes that accompany the cataract, such as Nearsightedness (Myopia), Farsightedness (Hyperopia), Astigmatism (blurred vision), and/or Presbyopia (reading problems).

Both surgical and non-surgical treatments are available to treat patients
with cataract. One of the most exciting recent developments in the field is the femtosecond laser which has been adapted from LASIK surgery for use in cataract surgery.

In addition, there are several ways to treat vision after a cataract is removed. Our discussion of cataract surgery provides information about the cataract surgery procedure, including how the cataract lens is removed, as well as the available surgical and non-surgical options to treat your vision.

Below are visual simulations of:

  • Cataract Surgery
  • Laser Assisted Cataract Surgery
  • Multifocal Lens Implants
  • Accommodating Lens Implants
  • Toric Lens Implants
In order to view the content, you must install the Adobe Flash Player. Please click here to get started.

Using the Cataract Eye Surgery Video Player above click on: Micronincision Phaco, Toric Intraocular Lens Implants (IOL), Multifocal IOL - design, and Accomodative IOL. Click arrow for
video to start playing.

We hope you find our discussion helpful. Please scroll down to learn more about cataract surgery discussion or you can access a particular section by clicking on a link below:

Table of Contents for Cataract Eye Surgery


How Is a Cataract Treated?

Treatments to Correct Vision Problems Accompanying Cataracts

  • Non-Surgical Treatments
  • Surgical Options

How Is a Cataract Treated?


Early Treatment of Cataracts. The symptoms of an early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, cataract eye surgery is currently the only effective treatment. At present, there is no medical treatment for cataracts, only surgery. For example, there are no drops that will dissolve a cataract.


What Does Cataract Surgery Involve?
Cataract surgery involves removing the cloudy lens in your eye and replacing it with an artificial lens known as an Intraocular Lens Implant (also known as an IOL). The femtosecond lasers are now being used to assist with cataract surgery.

When Should I have Cataract Surgery? A Cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, participating in sports, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of cataract surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult, which is why many people decide to have the surgery only when it significantly interferes with their vision.

In other words, if you have a cataract and are a candidate for this procedure, you do not have to rush into surgery. We recommend taking the time to find a cataract surgeon with proven experience and expertise. You can find many highly qualified cataract surgery experts in our Trusted LASIK Surgeons Directory.

In some cases, a cataract should be removed from your eye even if it does not cause significant problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you are found to have cataracts during a refractive surgery consultation, your eye care professional may refer you to a vision correction surgeon with experience in cataract surgery to remove the cataract and treat any vision problems that accompany your cataract.

People who need cataract surgery may also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to a cataract, please talk with your eye doctor to learn about the risks, benefits, alternatives, and expected results of cataract surgery in your particular case.


What Are the Different Types of Cataract Surgery?

There are three types of cataract surgery to remove your cataract and replace with an intraocular lens (IOL) implant to help improve your vision. Your eye doctor can explain the differences and help determine which method better for you:

1. Phacoemulsification (or "phaco"): Almost all cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery." The Phaco procedure is by far the most common way to remove a cataract and is the procedure of choice for most cataracts. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. After the cataract is removed, an Intraocular Lens Implant (IOL) is placed inside the eye to refocus the light rays. An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. The IOL not only replaces the cloudy cataract but can also correct nearsightedness (myopia), farsightedness (hyperopia) and astigmatism (blurred vision). In most cases a suture is not required since the incision is generally very small (less than 3 mm). This is referred to as “No Stitch” Cataract Surgery. For more details on IOL's and how they can correct and improve your vision please visit our Intraocular Lens Implants discussion.

2. Femtosecond Laser-Assisted Cataract Surgery: While many consumers thought that lasers have been used in cataract surgery, it was not until 2010 that the femtosecond laser was introduced for use in cataract surgery in the United States. This exciting techonology was derived from the femtosecond laser used in LASIK surgery, which has been modified to perform important steps of the small incision cataract technique of phacoemulsification. In laser-assisted cataract surgery, the femtosecond laser is
used to make the incision on the eye, to open and soften the cataract lens for removal, and to make incisions on the cornea to correct
astigmatism (blurred vision).

To learn more about laser assisted cataract surgery, please visit our Laser Cataract Surgery discussion.

Laser Cataract Surgery Video. Please click on the Cataract Surgery Video above to view an animated video of showing how this laser performs critical aspects of the surgery that are performed by hand in standard surgery.

Since the femtosecond laser was approved by the FDA until 2010, it is not offered by all cataract surgeons and not all patients are candidates for its use. Also, use of this technology for your cataract surgery will probably not be covered by insurance so extra fees should apply. As with any surgery, please discuss with your eye surgeon to learn more about laser assisted cataract surgery and whether you are a good candidate.

3. Extracapsular Cataract Surgery: In Extracapsular Cataract Surgery, your eye surgeon makes a longer incision on the side of the cornea and removes the cloudy central core of the lens (nucleus) in one piece. The rest of the cataract lens is removed by suction. After the natural lens has been removed, it is replaced by an intraocular lens implant (IOL) just as in the phaco
procedure.

Patients who have another eye disease or have significant problems during cataract surgery cannot always have an IOL. For these rare complications, a soft contact lens or glasses that provide high magnification may be the best vision correction treatment available.

Complications: What Are the Risks of Cataract Surgery?

As with any surgery, cataract surgery poses general risks, such as infection and bleeding. If you are properly diagnosed and informed of those risks specific to you, your eye surgeon should recommend taking appropriate precautions. For example, before cataract surgery, your eye doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery or make the surgery more complicated. In men, the use of drugs such as Flomax to aid in urination, can make the surgery more complicated and special techniques are necessary to control the size of the pupil. As long as the surgeon is aware that you are taking the drug, the results are usually satisfactory. After any cataract surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection to your eyes. A serious infection can result in loss of vision.

Cataract eye surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters or a shadow or curtains in the peripheral vision. Floaters are little "cobwebs" or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes affecting your peripheral vision, please see an eye care professional immediately, preferably an experienced refractive surgeon. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. While a retinal detachment causes no pain, obtaining early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment for a detached retina, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.

Please discuss these and any risks of cataract eye surgery with an experienced refractive surgeon to make sure Cataract Surgery is right for you.

Is Cataract Surgery Effective?

Cataract removal is one of the most common eye surgery operations performed in the United States. With an experienced refractive surgeon, cataract surgery is also one of the safest and most effective types of surgery. In over 90% of cases of people with cataracts, those patients who have cataract eye surgery have better vision afterward since vision problems can be treated simultaneously with lens implants as further discussed in the section

What Tests Are Generally Performed Before Cataract Surgery?

A week or two before cataract surgery, your doctor will do some tests on your eyes. These tests may include measuring the curve of the cornea and the size and shape of each eye. The information from these tests and measurements helps your eye surgeon recommend the type of Intraocular Lens Implant that can best improve your vision problems. In the past, the IOL implant was designed to either correct your distance vision or it could be targeted to correct your reading vision (Monovision). In the past few years, other types of implants have been approved by the FDA including lenses to correct for astigmatism (Toric Implants) and presbyopia correcting implants lenses-- like multifocal implants or accommodating implants—that can help correct your vision for both near and far vision.

What To Expect Just Before Cataract Surgery

You will have a medical check-up by your regular doctor to make sure it
is safe to have cataract surgery. This check up will usually include
blood tests and an EKG.

You will be asked not to eat or drink anything 12 hours before your cataract surgery.

You may also be asked to apply eye drops on the day before surgery.


What Happens During Cataract Surgery?

To prepare your eye for cataract surgery, drops will be put into your eye to dilate the pupil and the area around your eye will be washed and cleansed.

Cataract surgery usually lasts less than one hour and is almost painless. Many patients choose to stay awake during surgery. Others may need to be put to sleep for a short period of time.

If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After cataract surgery, a patch may be placed over your eye. You will rest for a while. Your medical team will monitor your eye for any problems, such as bleeding. Most patients who have cataract surgery can go home within an hour of the procedure. You should always arrange for someone to drive you home.

What Happens After Cataract Surgery?

Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. After one or two days, moderate discomfort should disappear. If you have any discomfort that continues, contact your eye doctor to get this treated.

For a few days after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.

When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.

In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on how you are progressing.


What Problems Can Develop After Cataract Surgery?

Significant problems after cataract surgery are rare, but they can occur. These complications can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. If any of this occurs, please seek prompt medical attention since these problems can usually be treated successfully.

Problems that can follow traditional phacoemulsificaton, such as infection, retinal detachment, retinal swelling can also be seen with femtoscond assisted cataract surgery. It is hoped that the frequency of some complications will be reduced by the use of the laser but that has not yet been proven by published comparison studies.

In some cases, the eye tissue that is behind the IOL may become cloudy and blur your vision. This condition is called an after-cataract. An after-cataract may develop anywhere from a few months to years after you have your cataract surgery.

An after-cataract may be treated with a laser. An experience eye doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless. In rare cases, this procedure will result in increased eye pressure or other eye problems. As a precaution, your eye doctor may give you eye drops to lower your eye pressure before or after the procedure.

When Will My Vision Return To Normal?

You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with your other eye, especially if your other eye has a cataract. Be sure to ask your eye doctor when it is safe for you to resume driving.

If you received an IOL (lens implant), you may notice that colors have become brighter than before. This is because IOL is clear, unlike your natural lens which may have had a yellowish or brownish tint. Typically, you will become accustomed to the improved vision within a few months after receiving an IOL. Also, when your eye heals, you may need new glasses or contact lenses depending on the type of lens you had implanted and what vision correction was achieved.

What Can I Do If I Already Have Lost Some Vision From a Cataract?

If you have lost some sight from cataract or cataract surgery, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.


Treatments to Correct Vision Problems Accompanying Cataracts

Summary

If you have Cataract, you will likely have other vision problems in one or both eyes that accompany the Cataract, which can include Nearsightedness (Myopia), Farsightedness (Hyperopia), Astigmatism (blurred vision), and/or Presbyopia (reading problems).

Depending on your vision correction needs as well as the health and condition of your eyes, there are various vision correction surgical procedures that can be performed during the cataract surgery as well as some non-surgical treatments that may be available after your cataract surgery procedure. For example, different IOLs can be implanted during your cataract surgery to correct nearsightedness, farsightedness, astigmatism, and/or presbyopia. In addition, treatments that do not involve refractive eye surgery consist of glasses and contact lenses.

Monovision Correction. Monovision is where one eye is focused for distance vision and the other eye is focused for near vision. Some people have monovision naturally and others may have been corrected for monovision through glasses, contact lenses, or a refractive surgery procedure such as LASIK. For many cataract patients, monovision may be a viable course of treatment to improve your vision in conjunction with your cataract surgery.

Please consult an experienced cataract surgeon to help you determine what options and treatments are best for you when considering cataract surgery and correcting your vision. Laser assisted cataract surgery is very expensive technology and not available in all areas. Many expert cataract surgeons do not currently offer laser cataract surgery, which is why we believe you
should choose your cataract surgeon based on his or her experience and professional qualifications not by whether the surgeon offers this option. In addition, not all patients are candidates for laser cataract surgery so we strongly recommend consulting with an expert cataract surgeon if you are interested in laser assisted cataract surgery. The femtosecond laser option for cataract surgery is usually combined with premium IOLs (like multifocal or toric lenses). These options are not covered by Medicare or other insurance plans and will therefore cost extra.


Non-Surgical Treatments

Below are treatments that do not involve eye surgery than can correct the following vision problems that can accompany cataracts:

  • Nearsightedness (Myopia)
  • Farsightedness (Hyperopia)
  • Astigmatism (Blurry Vision)
  • Presbyopia (Reading Problems)

Glasses. If your vision cannot be corrected with an IOL (lens implant) or is not completely corrected with an IOL at the time of your cataract surgery, you typically can be fitted with glasses as you were before the surgery. You may also be corrected for Monovision, which may be an option where one eye is corrected for distance and the other eye is corrected for nearer or closer vision.

Contact Lenses. If you were comfortable with wearing contact lenses before you had your cataract removed, this is often an available option to improve and correct your vision. For some patients an available option may be Monovision, where one eye is corrected for distance and the other eye is corrected for closer vision.

Surgical Procedures

The available vision correction surgical procedures typically performed during cataract surgery involve various types of Intraocular Lens Implants (IOL's), which are inserted into the eye to replace the cataract lens. If you have a cataract, IOLs can be inserted during your Cataract Surgery procedure. If you do not have a cataract in your eye but have vision problems, lens implants are at times a better option than laser vision surgery.

Other refractive procedures that may be performed in connection with cataract surgery include Astigmatic Incisions, like limbal Relaxing Incisions and arcuate Incisions, the available vision correction surgical procedures.

Please discuss your options with an experienced refractive surgeon to determine the best course of treatment for your vision.

Below are refractive lens implant procedures that can help improve your vision.

Lens Implant Procedures
  • Toric Implants
  • Multifocal Implants
  • Accomodating Implants
  • Monofocal Lens Implants

The cost of monofocal lenses are typically covered by Medicare and other insurance plans for cataract surgery. For toric implants, multifocal lenses and accommodating lenses, there will be additional fees for any of these enhancements.

Astigmatic Incisions:

The following procedures can help correct astigmagtism , whether due to nearsightedness, farsightedness, or reading problems (presbyopia).

Astigmatic incisions made be made with a blade or using the femtosecond laser that is used for laser assisted cataract surgery and are used to help correct astigmatism (blurry vision). Incisions made near the limbus of the eye (toward the outside) are known as limbal relaxing incisions (or "LRI's") and incisions made in the clear cornea are called Arcuate Incisions.

As you can see, several vision problems can often accompany a cataract in one or both of your eyes - nearsightedness, farsightedness, astigmatism (blurred vision), and reading problems (presbyopia) in addition to several unique conditions that may affect your eyes.

Various and sometimes different vision correction treatments are available to treat problems for how you see. As each eye can have different conditions and may be better suited to different treatments, we recommend finding cataract eye surgeon with proven experience when it comes to selecting the best treatment for your cataract and vision needs.

How to Find a Highly Qualified and Experienced Surgeon for Cataract Surgery

Our Trusted LASIK Surgeons Directory features highly qualified LASIK and refractive surgery experts who have proven experience, are active in the field of refractive surgery, and have been professionally recognized for their research, accomplishments, and contributions to advancing vision correction care.

Most of the eye surgeons in our directory also perform cataract eye surgery and many of them are leading experts when it comes to lens implants and other refractive surgery procedures. In other words, most of the eye surgeons listed at Trusted LASIK Surgeons are not simply LASIK specialists, but vision correction experts who are accomplished cataract surgeons.

Please visit our directory of vision correction experts to find an experienced eye surgeon closest to you and review the profile of an expert surgeon to see if they offer cataract surgery. Even if the surgeon nearest to you in our directory does not offer cataract eye surgery, we believe that surgeon may be able to refer you to an experienced and qualified surgeon in your local area that can help diagnose and treat you for your cataract and other vision problems. If you do contact a surgeon in our directory, please let the surgeon know you found the doctor through Trusted LASIK Surgeons.

The National Eye Institute (NEI) conducts and supports research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness. The NEI is part of the National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services.

This online resource infomation provides information about cataracts. It answers questions about causes and symptoms, and discusses diagnosis and types of treatment. It was adapted from Don't Lose Sight of Cataract (NIH Publication No. 94-3463) and Cataract: What You Should Know (NIH Publication No. 03-201).

To find a vision correction expert surgeon who has qualified to be listed at Trusted LASIK surgeons in another area, please visit:

Find a Trusted LASIK Eye Surgeon

The screening process and standards used by Trusted LASIK Surgeons™ can be found at:

How Are Lasik Eye Surgeons Qualified at TLS