Not Your Grandmother’s Cataract Surgery

By Deborah Jeanne Sergeant

Perhaps you’re not seeing as well at night. Or it’s harder to distinguish between objects similar in color. You notice you need more light to read, complete puzzles or sew. It could be time to talk with your eye care provider about the possibility of cataract surgery. 

A cataract isn’t a disease or a film that grows over the eye. Steve Park, ophthalmologist with Cornerstone Eye Associates in Rochester, said those are commonly held misconceptions among new patients.

“Cataract is a clouding of the natural lens,” Park said. “It happens to everyone as part of the aging process.”

An elective surgery, some patients choose to delay the surgery. Though cataracts worsen in time, they don’t damage the eyes or cause pain. 

“Some patients are anxious to recover their vision as fast as they can; others who are more sedentary are reasonably getting along and they wait,” Park said. “Others are nervous about any kind of surgery so they delay as long as they can.”

Patients may remember their parents’ surgery; however, cataract surgery has advanced much in recent decades. For one, it’s no longer a consideration to wait until the cataract is “ripe” or more advanced.

Park said that complications are so rare that physicians encourage patients to seek surgery once they feel that their vision interferes with activities, not to the point where they can hardly see anymore.

“It’s the most common surgery in the nation with 3 million done annually,” Park said.

His office performs 3,000 annually.

Instead of a hospital-based surgery, patients can select a surgical center for cataract surgery, now considered an out-patient procedure. Surgeons typically don’t use general anesthesia, but local anesthesia and IV sedation, so patients feel deeply relaxed, but remain to follow the surgeon’s instruction so their eyes remain in the right position for surgery. Patients may briefly feel mild eye irritation, but no pain. 

“Patients were being admitted to the hospital and staying for a week,” said Kenneth Dickerson, ophthalmologist and senior instructor of clinical ophthalmology department of ophthalmology with Flaum Eye Institute. “Now they show up on the day of surgery and are home a few hours later.”

The surgery itself takes about 10 minutes; however, the pre-operation procedures and recovery take longer. 

With early cataract surgeries, patients simply had the lenses removed and had to wear very thick glasses afterward to see well. 

Now, surgeons use ultrasonic technology that breaks up the lens into tiny pieces and it’s suctioned from the eye through tiny incisions. Surgeons use lasers and even robotics for improved precision. Patients receive artificial lens, some of which can actually improve vision over how well they could see before cataracts.

“We can get them closer to being glasses-free,” Dickerson said. “We can make marked improvements in far vision, intermediate vision and in some cases, near vision. We have lenses that correct for astigmatism and multi-focal lenses. It’s exciting to be living in these times where we can make these improvements.”

Usually, insurance covers only standard lenses, not the extra expense for lenses that correct vision.

For six weeks after surgery, patients use eye drops to prevent infection and inflammation. Then, they can be fitted for new glasses, as needed.

Dickerson said that about 90 percent of patients and doctors achieve the goal of the surgery. Rarely, the lens shifts, which changes its power and may require correction. 

“Nothing with any of this is 100 percent,” Dickerson said. “It is safe and effective. There’s low chance of complication, but it’s not zero.”

That’s why most offices still perform cataract surgery on one eye, wait a week to two weeks and then operate on the other eye. Patients can resume most activities the day of or the day after surgery and usually don’t need any care except for a ride home.

In the meantime, patients receive a day-after and a week-after follow-up examination. In about a month after the second surgery, the patient should be completely healed.

Dickerson said that since cataracts are a clouding of the lens that occurs over time, little can be done to prevent them except protecting the eyes from sun exposure, a step that’s more effective if begun early. Occupational hazards like working outside and welding can hasten the necessity of cataract surgery. 

“Afterward, sunglasses will be something you’ll be wearing because you had a yellow lens and now it’s removed,” Dickerson said. “Everything will look clearer, brighter. For anyone in a northern climate, if they’re out shoveling snow, they should be wearing sun protection.”