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By Mayo Clinic staff
During the procedure
Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. Eyedrops placed in your eye dilate your pupil. You'll have local anesthetics to numb the area, and you may be given a sedative to help you relax. If you're given a sedative, you may be awake but groggy during surgery. Rarely does anyone require general anesthesia for cataract surgery.
Typically, two things happen during cataract surgery — the clouded lens is removed, and a clear artificial lens is implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.
Surgical methods used to remove cataracts include:
- Phacoemulsification (fak-o-e-mul-sih-fih-KA-shun). In phacoemulsification, your surgeon removes the cataract but leaves most of the back layer of the lens (lens capsule) in place. To do this, your surgeon makes a small incision — about 1/8 inch, or 3 millimeters (mm), long — where the cornea meets the conjunctiva and inserts a needle-thin probe. Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The lens capsule remains in place to provide support for the lens implant.
- Extracapsular cataract extraction. If your cataract has advanced to the point where phacoemulsification can't break up the clouded lens, your surgeon may do an extracapsular cataract extraction. This procedure requires a larger incision, about 2/10 inch (10 mm), where the cornea and sclera meet. Through this incision your surgeon opens the lens capsule, removes the center (nucleus) of the lens in one piece and vacuums out the softer outer lens, leaving the capsule in place.
Once the cataract has been removed by either phacoemulsification or extracapsular extraction, a clear artificial lens is implanted into the empty lens capsule. This implant, known as an intraocular lens (IOL), is made of plastic, acrylic or silicone. You won't be able to see or feel the lens; it requires no care and becomes a permanent part of your eye.
Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once in place the lens unfolds to about 1/4 inch (6 mm) in diameter.
Recent advances in IOLs include blue-blocking lenses, which filter out ultraviolet light. Other types of IOLs provide multifocal vision — being able to see things both near and at a distance. Multifocal lenses offer reasonably good near and distance vision. However, vision at the intermediate range is sometimes less than satisfactory. Glare is reportedly a problem with multifocal lenses, but design improvements are ongoing.
After the procedure
With phacoemulsification and foldable lens implants, surgical incisions are very small, and sutures may not be necessary. If all goes well, you'll heal fast and your vision will start to improve within a few days.
You'll typically see your eye doctor the day after your surgery, the following week and then again after a month to monitor healing.
It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pressing on your eye. Clean your eyelids with tissue or cotton balls to remove any crusty discharge. You may wear an eye patch or protective shield the day of surgery. Your doctor may prescribe eyedrops or other medication to prevent infection and control eye pressure. After a couple of days, all discomfort should disappear. Often, complete healing occurs within eight weeks.
Contact your doctor immediately if you experience any of the following:
- Vision loss
- Pain that persists despite the use of over-the-counter pain medications
- Increased eye redness
- Light flashes or multiple spots (floaters) in front of your eye
- Nausea, vomiting or excessive coughing
You're likely to need glasses after cataract surgery, both for reading and to correct astigmatism, a focusing problem caused by uneven curving of the cornea. Although astigmatism is often unavoidable, it's not likely to be a significant problem if your surgeon is able to remove the cataract through a very small incision. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for eyeglasses.
If you have cataracts in both eyes, your doctor typically schedules a second surgery a month or two later to remove the cataract in your other eye. This allows time for the first eye to heal before the second eye surgery takes place.
