Cataract surgery is one of the most common operations performed in the U.S. During the surgery, the cloudy lens is removed and replaced by a clear, artificial lens implant called an intraocular lens or IOL. The procedure is generally outpatient and completed in less than an hour requiring no overnight stay in a hospital.
PRE-OPERATIVE TESTS FOR CATARACT SURGERY
A week or so before your surgery, your doctor will perform a painless ultrasound test (called an A-scan) to measure the length of your eye and the curve of the cornea. This will help determine the right type of lens implant (intraocular lens or IOL).
You can still have cataract surgery if you’ve had previous LASIK or other laser vision correction. If possible, provide your doctor with the vision correction prescription you had before LASIK. The information will help calculate the correct IOL prescription for you. Since previous refractive surgery can make determination of the correct IOL more difficult, your vision prescription prior to refractive surgery can help the surgeon calculate the correct IOL power.
MEDICATIONS AND CATARACT SURGERY
Be sure to tell your ophthalmologist about all medication and nutritional supplements you are taking, such as Flomax®, Hytrin®, Cadura® or Uroxatral®. These medications may prevent your pupil from dilating properly during surgery, leading to possible complications. If your surgeon is aware that you have had these drugs, he or she can adjust their surgical technique to adapt as needed, allowing for a successful cataract removal procedure. You should also tell your eye doctor about any other sedative medications you are taking.
Your doctor may also advise you to temporarily stop taking any medication that could increase your risk of bleeding during the procedure.
Antibiotic eye drops may be prescribed for one to two days before surgery to reduce the risk of infection.
The most common procedure used for removing cataracts is called phacoemulsification. A small incision is made in the side of the cornea (the front part of your eye), where your doctor inserts a tiny instrument that uses high-frequency ultrasound to break up the center of the cloudy lens and carefully suction it out.
After the lens is removed, the surgeon will replace it with an intraocular lens implant (IOL) made of plastic, silicone or acrylic. The new lens allows light to pass through and focus on the retina. Most of the time, the IOL is inserted behind the iris (the colored part of your eye). This is called a posterior chamber lens. At times, the IOL must be placed in front of the iris which is called an anterior chamber lens. Once the IOL is in place, the surgeon closes the incision. Stitches may or may not be required. The IOL becomes a permanent part of your eye, so there is no need for special treatment. Your doctor usually places a protective shield over your eye.
CATARACT SURGERY RECOVERY
You will spend a short time in the outpatient recovery area before you are ready to go home. You will need someone to drive you home. Following your surgery, it is imperative to follow your doctor’s instructions. You will be prescribed eye drops by your ophthalmologist to promote healing. It will be necessary to protect your eye by wearing the eye shield when you sleep and by wearing special wraparound sunglass in bright light. Do not rub your eyes.
For the first week, avoid strenuous activity such as exercise, bending and heavy lifting (anything over 25 pounds.) Avoid getting water, dirt or dust in your eye which could lead to infection.
CATARACT SURGERY RISKS AND COMPLICATIONS
As with any surgical procedure, there are risks associated with cataract surgery. Risk and complications can include:
- Bleeding inside the eye
- Increased pressure inside the eye (glaucoma)
- Swelling of the retina
- Swelling of the cornea
- Retinal detachment
- Loss of vision (partially or completely)
In some cases, the capsule (part of the lens covering that supports the IOL) can become cloudy several months or years after the cataract is removed. This is called a secondary cataract. Should this occur, your ophthalmologist will make an opening in the center of the cloudy capsule with a laser allowing light to pass through the lens properly again. This procedure is called a posterior capsulotomy and takes only about 5 minutes in the doctor’s office and requires no recovery.
Many people who wear bifocals or reading glasses for near vision may still need to wear glasses for reading after cataract surgery. If you choose to have multifocal or accommodative IOL, your dependence on glasses may be minimized or, in some cases, eliminated completely.
CATARACT SURGERY Costs
The cost of cataract surgery is generally covered by Medicare if you are Medicare eligible. Most private insurance plans will cover the surgery as well.
As long as your vision tests at a certain level of clarity, Medicare will cover the cost for your cataract surgery. Generally, private insurance plans have similar vision requirements that must be met for the procedure to be covered. Although Medicare or private insurance covers your surgery, there may be some costs you will be responsible for. These can include a special enhanced type of intraocular lens (IOL) instead of the standard IOL or choosing to have cataract surgery before your vision has deteriorated enough to be eligible through your insurance plan. In certain cases, there may be exceptions to getting the early surgery. Talk with your doctor if you are considering early cataract surgery.