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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

A Patient's Guide to Cataract Removal Surgery

If you have cataracts and are considering having cataract removal surgery, then you probably do a lot of research. We acknowledge most of the materials online are too complex and scientific for the general public to fully grasp and comprehend. That's why, we are here to explain it in more simple terms.

In this publication, we will talk about what to expect, the recovery process, and everything else you need to know about cataract extraction surgery. Our goal is to clear up any confusion or doubts you might have about the cataract treatment, so you can enjoy life with clear vision again.

What is a Cataract? Simply Explained.

Before we dive deep into the topic of cataract removal surgery, we owe you a few lines to talk about cataracts in general.

parts of the eye

Imagine your eye as a camera. Just like a camera has a lens, your eye has a clear lens right behind the colored part (iris). It helps your eye focus on things clearly as a camera lens does. But sometimes, this clear lens can become cloudy and blurry. That's what we call a cataract.

A cataract is like having a tiny cloud inside your eye. It makes everything you see look foggy or hazy. Having this condition can make it hard to read, drive, or even recognize faces.

eye without cataract vs eye with cataract
On the left is a patient with a clear eye lens; and on the right is a patient with a cloudy lens (cataract)

Don't worry, though. Cataracts are common, especially in the elderly, and there is a way to remove them.

Diagnosing Cataracts

Detecting cataracts is the first step toward better vision. If you don't have the diagnosis yet, or you are not sure how your doctor knew you have the condition, this paragraph explains it as simply as possible.

When you feel like your vision is cloudy or not as sharp anymore, you go to an ophthalmologist for diagnosis. The eye doctor can figure out if you have cataracts during a simple eye exam.

  • Eye Test

  • Eye Drops

  • Lamp and Magnifying Lens

  • Other Tests

You sit down, and the doctor asks you to look at a chart with letters on it. You need to read the letters, and their job is to check if you are having trouble seeing them clearly. They also might put some special eye drops in your eyes to dilate your pupils. Don't worry; it doesn't hurt. This helps them evaluate the whole surface of the eye lens and to see inside your eye better.

Then, the eye doctor uses a bright lamp and a magnifying lens to look at your eye's lens. By doing this, they can assess different structures of the eye and see if they are working well, as well as tell if there's a cataract and how cloudy it is. Using the magnifying lens they evaluate the retina, and the optic nerve and look for changes.

In some cases, they might do more tests (for example OCT of the macula) to check if there are some changes in your central retina (where the light is focused) and test how well your eyes are working together.

Once the doctor confirms you have cataracts, they talk to you about the next steps. They might include discussing cataract removal surgery. Remember, having cataracts is normal as you get older, and there's a way to make your vision clearer and brighter.

How is a Cataract Removed?

To make your vision clear again, doctors can remove the cloudy lens (cataract) and replace it with a new, clear intraocular lens (IOL). That's why we call this procedure a "cataract removal surgery."

Here's a simple way to think about it: imagine you have a foggy window. You can't see through it clearly. What do you do? You clean the window or replace it with a new, clear one. Cataract removal is like giving your eye a brand-new, clear window!

It sounds scary, but this is a very common and relatively safe procedure, that will transform your life for the better. Also, having an artificial lens (intraocular lens) in your eye is not going to bring you any long-term discomfort. So here's one less thing to worry about.

Cataract Surgery

Types of Cataract Removal Surgery

The options for cataract extraction surgery are:

  1. Phacoemulsification (ultrasonic surgery)

  2. Femtosecond laser-assisted cataract surgery - FLACS (with a laser)

  3. Extracapsular cataract extraction - ECCE (traditional surgery with a larger incision)

  4. Small incision cataract surgery - SICS (traditional surgery with a smaller incision)

Your eye doctor will decide which type of surgery is best for you according to the type and density of your cataract, your overall health, and your preferences.

All methods are safe and effective in restoring clear vision, so you can trust your doctor's recommendation.

1. Phacoemulsification (Phaco)

Phacoemulsification is the most common method for cataract removal in modern days.

Here's how it works:

  1. The doctor makes a tiny incision in the front part of the eye.

  2. A special tool sends ultrasonic waves into the eye to break up the cloudy cataract into small pieces.

  3. The tiny pieces of the cataract are then gently suctioned out of the eye.

  4. The doctor places a new, clear artificial lens implant where the cloudy one used to be.

  5. In most cases, a patient won't need any stitches because the incision is so small, it heals by itself.

Phacoemulsification is a very precise and efficient cataract removal surgery, and it often allows for a faster recovery.

2. Femtosecond Laser-Assisted Cataract Surgery (FLACS)

FLACS is another advanced cataract removal surgery option. It uses a laser to make the procedure even more precise, as the surgeon can plan the incisions and cataract extraction with computer guidance. FLACS reduces the risk of complications during surgery because it's very accurate.

It works like this:

  1. A femtosecond laser creates precise incisions in the cornea and precisely opens up the lens capsule.

  2. The laser makes extremely fine cuts and breaks up the cataract into smaller pieces.

  3. The doctor removes the cataract pieces.

  4. A new artificial lens implant is placed into the eye.

  5. The corneal incisions are sealed without the need for stitches

3. Extracapsular Cataract Extraction (ECCE)

When the cataract is very dense or severe, the ECCE cataract extraction surgery is a viable option. It involves a larger incision and slightly different steps than FLACS and Phaco:

  1. The doctor makes a big incision at the edge of the clear front part of the eye (cornea).

  2. They remove the cataract in one piece through the incision. (Instead of breaking the cataract into tiny pieces, like with other methods.)

  3. A new artificial lens is inserted into the eye.

  4. The doctor makes stitches to close the incision and the patient should come back for stitches removal a few weeks after surgery.

The traditional cataract removal surgery is less common today but is still applicable in specific cases. It also has a longer recovery period of a few weeks.

4. Small incision cataract surgery - SICS

SICS is a widely used method for cataract removal in areas with limited access to advanced technology.

Here are the surgery steps:

  1. The doctor makes a small, self-sealing incision in the sclera or cornea

  2. A circular opening is made in the lens capsule to access the cataract

  3. The cataractous lens is manually fragmented into smaller pieces

  4. The tiny pieces of the cataract are then gently suctioned out of the eye

  5. The doctor places a new, clear artificial lens implant

In most cases, a patient won't need any stitches because the incision is small and self-sealing.

SICS uses a smaller, self-sealing incision for cataract removal, resulting in faster recovery and less postoperative discomfort compared to the larger incision required in ECCE.

Cataract Surgery Timeline

Before the Cataract Removal Surgery

Before the surgery, you need to visit your eye doctor for a consultation. They are going to check your eyes and discuss the most appropriate procedure for you, in detail.

The eye doctor will discuss the cataract surgery options for the type of lens that he can implant.

The doctor will ask about your medical history and any medications you're currently taking. Some medications may need to be adjusted before surgery.

The doctor may also ask you to stop eating and drinking for a few hours before the surgery. Fasting before cataract surgery is a common request, nothing unusual about it.

Feel free to ask anything; they'll give you all the information you need. Make sure to follow your doctor's advice thoroughly.

During the Cataract Eye Surgery

On the day of the surgery, you have to go to the eye clinic or hospital where the eye doctor scheduled the procedure.

Arrange for someone to drive you to and from the surgical center. You won't be able to drive immediately after cataract surgery.

You will be awake during the surgery. But your eye will be numb from the local anesthesia, so you won't feel any pain. The eye surgeon will gently remove the cloudy lens and replace it with a new artificial lens implant.

The cataract removal surgery doesn't take very long, around 10 - 30 minutes per eye. You can go back home the same day. There is no need for hospitalization.

This is what the patient sees during cataract surgery
This is what the patient sees during cataract surgery. The patient has to look at the bright light of the surgical microscope in order to keep the eye centered when the cataract is being removed.

After the Cataract Removal Surgery

Afterward, your eye(s) may be a bit sore or itchy, but this is normal.

Your eye doctor will give you special eye drops to help your eye heal and prevent infection. You might need to wear an eye patch or protective shield while you sleep to keep your eyes safe. Wearing sunglasses when going outside is also a tip to consider. Remember, take it easy and follow your ophthalmologist's instructions during the healing process.

Your vision will gradually improve over the course of the next few weeks.

Life After Cataract Removal

Once your eye heals, you are going to notice a big difference! After cataract treatment, your vision will be clearer, and colors will seem brighter. Depending on the type of implanted intraocular lens you might not even need glasses anymore. You can get back to doing the things you love, like reading, driving, and spending time with friends and family, without the cloudy cataract getting in the way!

Potential Side Effects

Cataract surgery is a very safe and effective procedure for most people. Like any surgical intervention, it carries potential risks and side effects. Even though complications are relatively rare, the surgeon will discuss them with you before the surgery.

Some rare potential side effects of the procedure that prompt medical attention are:

  • Long-term and excessive swelling

  • Vision changes (worst case includes permanent vision loss)

  • Infection (redness, pain, or eye discharge)

  • Retinal detachment (flashes of light or a curtain-like shadow)

  • Glaucoma (damage to the optic nerve due to persistent increased intraocular pressure)

  • Secondary cataract (cloudy membrane behind the new implant)

  • Persistent floaters or flashes (seeing specs or lightings)

Please don't reconsider getting the surgery just because of the risk of complications. They are rare and not likely to occur if you specifically follow your doctor's instructions post-operation.

Cataract removal surgery might sound a bit scary, but it's a common and safe procedure to improve your vision and quality of life. Your eye doctor will be there to guide you every step of the way, from diagnosis to recovery. So, keep calm, and get ready to see the world with crystal-clear eyes again!

Learn more about eye health in our ophthalmology blog. Resources:

  • Cataract Surgery, Mayo Clinic

  • American Academy of Ophthalmology Preferred Practice Pattern Cataract and Anterior Segment

Checked by Atanas Bogoev, MD.

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