Cataract removal

Alternative names
Cataract extraction; Cataract surgery

Definition
Cataract removal is a procedure to remove a clouded lens (cataract) from the eye to improve vision, which almost always includes the implantation of an artificial lens.

Description

The normal lens of the eye is transparent. It focuses light onto the inner surface of the eye (the retina) to create an image. As a cataract develop, the lens becomes cloudy and blocks the normal path of light entering the eye. Vision becomes obscured.

The purpose of cataract surgery is to remove the clouded lens and replace it with an artificial lens, thereby restoring clear vision. Cataract removal surgery is for people who are not satisfied with their current vision or whose cataracts disrupt their life.

Cataracts are seen most commonly in the elderly. However, children may be born with clouded lenses (congenital cataracts) due to infections they acquire before birth.

Surgery is usually recommended for people who have loss of vision or visual abnormalities caused by cataracts.

PREPARATION:

An ophthalmologist will take several measurements to assess the type of surgery needed. These tests will include an ultrasound of the eye to measure length and a measurement of the curvature of the front surface of the eye. Together, these tests help the surgeon choose the power of the artificial lens to be implanted in the eye at the time of surgery.

Routine preoperative testing is often done to assess overall general health prior to cataract removal. Because cataract surgery is usually done with local anesthesia (numbing), most patients are able to undergo cataract extraction regardless of other illnesses they may have.

PROCEDURE:

The surgery is performed in a hospital or in an outpatient setting. Children are typically given general anesthesia to keep them deep asleep and pain-free; adults usually are awake but sedated and pain-free with local anesthesia.

With the help of a microscope, a small incision is made at the junction of the clear and white outer parts of the eye. The lens can be removed in several ways, depending upon the type of cataract:

     
  • With surgical instruments and suction  
  • With an instrument and machine that uses high frequency sound waves (ultrasonic energy) to break up the lens and suction it out (phacoemulsification)

An artificial intraocular lens (IOL) is usually inserted to help the eye focus in the absence of the removed lens. The incision may be closed with fine stitches (sutures) or may be self sealing (sutureless). If sutures are placed, they may need to be removed at a later date.

The surgery typically lasts less than an hour.

Generally the patient returns home the same day as the procedure and then returns the following day for examination. A patch is placed over the operated eye and worn until the follow-up examination the next day. Antibiotic and anti-inflammatory eye drops will be prescribed for use for several weeks to assist the healing process.

Expect complete healing in about 10 weeks. Glasses or contact lenses may then be fitted if the clarity of your vision needs to be refined. Close follow-up with the surgeon is essential.

Indications
Cataract surgery is usually recommended for people who have loss of vision or vision abnormalities caused by clouding of the lens.

Risks

Complications of cataract surgery are not common, and serious complications are rare. Most patients have better vision after cataract surgery.

FREQUENTLY ASKED QUESTIONS:

Q: Will a laser be used to remove my cataract?

A: No. Lasers are not used to remove cataracts, though they likely will be in the future. Several months after the surgery, a laser can be used to break apart remaining old lens fragments sitting behind the new artificial lens, if necessary.

Q: Will it harm my eye to wait to remove the cataract?

A: No. Cataracts do not harm the eye. You should have your cataract removed when it is convenient for you and only if you are unhappy with your vision.

Q: If I have a cataract in each eye, can I have them both done at the same time?

A: No. Usually one eye is allowed to heal before the operation is repeated on the other eye. Most surgeons recommend waiting 1 to 2 months between procedures.

Expectations after surgery
The outcome of cataract surgery is usually excellent. The operation has low risk, the pain is minimal and recovery time is short. Improvement in sight occurs in most cases. Ninety-five percent or more of all cataract surgeries result in improved vision.

Convalescence
Because this operation is usually performed on an outpatient basis, the patient returns home the same day. Expect complete healing in about 10 weeks.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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