Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Sammie Vasquez
Cataracts are a leading cause of reversible blindness in the world and many undergo surgery each day to have their cataracts removed and sight restored. What happens before, during and after cataract surgery? Here is an outline of what you can expect to go through.
Patients commonly check in to see an eye doctor for symptoms including progressive blurring of vision, glare, halos, sensitivity to light and even decreased night vision. A thorough ophthalmic history and eye examination including instilling dilating eye drops will be done to rule out other sight threatening causes of the above symptoms including infection, inflammation and high eye pressures. Once it is established that cataracts are the main cause of the symptoms, specific details including the type of cataract, density and severity of cataract and any associated complications are noted down including any high eye pressures and weakness in the bag holding the cataract. These specific details aid in surgical planning as specific techniques may be needed to be employed in certain scenarios. In some cases the cataracts are so dense, some special scans (ultrasound) need to be done to rule out any obvious problems with the retina like retinal detachment which can severely affect the visual outcomes after surgery if not detected before cataract surgery. A detailed discussion will also take place regarding the type of intraocular lens to be placed in the eye in place of the cataract, as well as the target visual outcomes desired after cataract surgery. This is a topic best elaborated upon in another post but in a line, the choice of intraocular lens would be tailored to help you achieve your vision goals, taking into account your lifestyle needs and eye health among other factors.
The day of surgery
As the day of your surgery arrives, many will feel a mix of hopeful anticipation as well as anxiety. Turn up at your appointed time slot in comfortable clothes and although the procedure itself is quick, you should set aside about 2 hours for the entire process. Remember to not eat any food or drink prior to the procedure. This should have been explained to you as part of the pre-operative assessment. It is also prudent to make arrangements for transport home after the procedure.
Before entering the operating theatre, your eyelids, eyelashes and surrounding skin will be cleaned thoroughly. You will then be introduced to your anesthetist who will also secure an intravenous access for use during the operation. Once on the operating table, your eyes are cleaned once again and sterile drapes applied to ensure your eyelashes do not get in the way of the surgery. Depending on the surgeons comfort level, an injection of local anesthetic may be given around the eye to numb the eye as well as reduce movement during the surgery. Numbing eye drops are also given to further ensure a painless process. Surgery will then commence, with small wounds created to allow access to the cataract. These wounds can be created with a sharp blade or by use of a laser. The cataract is then removed by means of an ultrasound machine. In some cases, a laser may also be used to soften the cataract and make removal even easier. Once the cataract is removed, an intraocular lens (IOL) is then placed into the bag where the cataract used to be. This allows correction of any short-sightedness, long-sightedness, astigmatism and even presbyopia.
The post surgical care
Some mild discomfort and a foreign body sensation is common in the early post-operative period so don’t be alarmed if you feel as if there is something in your eye. A combination of ant-biotic and steroid eye drops are given to reduce inflammation as well as the risk of infection. Commonly, patients are seen at 1 day post surgery, 1 week post surgery and 1 month after. In the early recovery period, it is important to be vigilant and not let any contaminated water into the eye. The vision takes about a month to stabilise so there is no need to rush into making a new pair of glasses immediately after surgery. In patients with a monofocal lens has been chosen to correct for distance vision, the loss in ability to read would be immediately apparent so don’t be surprised if you fall into this category.
Cataract surgery is a commonly done procedure to restore vision and with the appropriate steps taken to ensure safety, a successful outcome is very likely.