Cataract surgery is a common procedure to treat one of the leading causes of vision loss in people over 45. A cataract is a condition that commonly develops as the eye ages, by the time we reach 80, more than half of us will have developed a cataract.
What is a cataract?
A cataract is a clouding of the lens in your eye which is normally transparent. The lens, located inside the eye, behind the iris and the pupil, focuses light onto the retina at the back of your eye, where it is converted to nerve signals that are passed to the brain, allowing you to see. When your lens becomes cloudy, the images projected onto your retina become blurry and unfocused. You can compare this to looking through a dirty or cloudy window. If the window is not clear, you can’t see well.
Usually cataracts develop slowly over time so your vision gradually worsens. While the majority of cataracts are a result of the aging process, there are also congenital cataracts that are present at birth, secondary cataracts that result from eye surgery or diseases such as glaucoma or diabetes and traumatic cataracts that result at any age from an injury to the eye.
Cataract surgery
While you may be able to live with mild or moderate cataracts, severe cataracts are treated with surgery. The procedure involves removing the clouded lens and replacing it with an intraocular lens (IOL) implant. Cataract surgery usually can restore vision lost to cataracts and often reduce your need for eyeglasses.
Modern cataract surgery is frequently done as an outpatient procedure. It is one of the safest and most effective surgical procedures performed today. Patients will have greatly improved vision the next day, and will continue to improve over the next few weeks. Surgery is often done in one eye first, and surgery on the second eye, if needed, may be done 2 weeks later.
Most modern cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction.
This procedure, called phacoemulsification or “phaco,” can be performed with smaller incisions than previous surgical techniques for cataract removal, promoting faster healing and reducing the risk of cataract surgery complications, such as a retinal detachment.
After all remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear intraocular lens, positioning it securely behind the iris and pupil, in the same location your natural lens occupied. (In special cases, an IOL might be placed in front of the iris and pupil, but this is less common.)
Do you need to have cataract surgery?
For the most part, the patient decides when to have cataract surgery. When your vision is bothering you enough that you can do your daily activities, whether that is driving a car, reading your mail or watching television, and your vision cannot be improved enough with eyeglasses, then it makes sense for you to have cataracts. Of course, the surgeon will have to agree that there is enough cataract for removal. But generally if you have the symptoms above, your cataracts are probably ready to be removed.
There are a few circumstances when cataract surgery when the cataract should be removed even if you are resisting the thought of surgery. This is usually when the cataracts get very dense or what doctors call a Morgagnian or hyper-mature cataract. As you can imagine, this type of cataract causes extremely blurred vision in the affected eye until it is treated. These very dense cataract can become a surgical challenge making a good outcome more difficult and increase risk of uveitis and a form of glaucoma.
LASIK patients may need cataract surgery sooner
Researchers in Japan discovered something interesting about people having cataract surgery after having had LASIK: they may need cataract surgery sooner.The mean age at cataract surgery for patients who previously had LASIK was 54.6 years — about 10 years younger than those in control group 1 (matched axial length) and about 15 years younger than those in control group 2 (unmatched for axial length).
Also, 70 percent of patients in the LASIK group were men, a significantly higher percentage than in the control groups. And the rate of corneal higher-order aberrations was significantly higher in the LASIK group than in the control groups.
The study authors concluded that patients with longer-than-average eyeball length (associated with higher myopia) and an increase in corneal higher-order aberrations might need to have cataract surgery performed earlier if they have previously undergone LASIK surgery.
Cataract Surgery Increases quality of life
In most cases, cataract surgery improves your vision greatly. As a bonus, patients notice that colors look more vibrant because the yellowing cataract was muting your color vision. While the decision to undergo any surgery should be taken seriously, cataract surgery is quick and has a relatively low risk for the significant improvement in your vision.