What do they do during cataract surgery

Cataracts usually get slowly worse over time. Surgery to replace the cloudy lens is the only way to improve your eyesight.

Surgery is usually offered on the NHS if your cataracts are affecting your eyesight and quality of life.

The decision to have surgery should not be based solely on your eye test (visual acuity) results.

You may have other personal reasons for deciding to have surgery, such as your daily activities, hobbies and interests.

You can choose to put off having surgery for a while and have regular check-ups to monitor the situation.

There are no medicines or eye drops that have been proven to improve cataracts or stop them getting worse.

Before the operation

Before surgery, you'll be referred to a specialist eye doctor for an assessment.

During the assessment different measurements will be taken of your eyes and your eyesight.

The assessment is an opportunity to discuss anything to do with your operation, including:

  • your lens preference, such as near sight or long sight
  • the risks and benefits of surgery
  • if you'll need glasses after surgery
  • how long you'll take to fully recover

If you're used to using 1 eye for distance and 1 for reading, which is called monovision, you can ask to stay that way.

This usually means you'll get a near-sight lens fitted in 1 eye and a long-sighted lens fitted in the other eye.

The operation

Cataract surgery is a straightforward procedure that usually takes 30 to 45 minutes.

It's often carried out as day surgery under local anaesthetic and you should be able to go home on the same day.

During the operation, the surgeon will make a tiny cut in your eye to remove the cloudy lens and replace it with a clear plastic one.

With the NHS, you'll usually be offered monofocal lenses, which have a single point of focus. This means the lens will be fixed for either near or distance vision, but not both.

If you go private, you may be able to choose either a multifocal or an accommodating lens, which allow the eye to focus on both near and distant objects.

Most people will need to wear glasses for some tasks, like reading, after surgery regardless of the type of lens they have fitted.

If you have cataracts in both eyes it may be recommended that both eyes are treated on the same day. This procedure is known as immediate sequential bilateral cataract surgery (ISBCS). ISBCS is usually only recommended for people thought to have a low risk of complications. The surgeon will discuss this with you if this is an option.

Otherwise, surgery is done 6 to 12 weeks apart to allow the recovery one eye at a time.

Find out more about recovering from cataract surgery

Benefits of surgery

After cataract surgery you should be able to:

  • see things in focus
  • look into bright lights and not see as much glare
  • tell the difference between colours

If you have another condition affecting your eyes, such as diabetes or glaucoma, you may still have limited vision, even after successful surgery.

Risks of surgery

The risk of serious complications developing as a result of cataract surgery is estimated at around 1 in 50 cases.

These can include:

  • blurred vision
  • some loss of vision
  • detached retina – where the the thin layer at the back of your eye (retina) becomes loose

Most of these serious complications can be treated with medicines or further surgery.

There is a very small risk – around 1 in 1,000 – of permanent sight loss in the treated eye as a direct result of the operation.

Cataract surgery is a procedure used to restore cataract-related vision loss. During surgery, the clouded lens inside your eye will be replaced with a clear artificial lens. You won't feel any pain during the procedure, and it usually only takes about 15 minutes. It's typically an outpatient procedure and doesn't require an overnight stay in a hospital.

Cataract surgery might sound scary at first, but it's one of the safest and most effective vision surgeries available today. Millions of cataract surgeries are performed in the U.S. every year, and the vast majority have excellent outcomes.

What do they do during cataract surgery

The potential need for cataract eye surgery goes up as you age, when cataracts are most likely to develop or worsen.

According to the National Institutes of Health (NIH), cataracts affect:

  • About 1 in 20 of people aged 50-54

  • Roughly half of people aged 75-79

  • More than 2 in 3 people over age 80

SEE RELATED: Refractive cataract surgery

What happens during cataract surgery?

The cloudy lens inside your eye will be removed and replaced with a clear artificial lens during surgery. This device is called an intraocular lens, or IOL for short.

An IOL helps restore the clear vision you had before cataracts developed.

During any form of cataract removal, special precautions are taken to make sure you're completely relaxed and pain-free. At worst, patients can experience a slight sensation of pressure, but this feeling isn't painful.

A modern cataract surgery procedure will often follow these steps:

  1. A small incision is made along the side of the cornea.

  2. A high-frequency ultrasound device or laser is used to carefully break up the cloudy lens into small fragments.

  3. The lens fragments are gently removed from the eye using suction.

  4. After all fragments have been removed, the surgeon places the IOL behind the pupil and the colored part of the eye (iris) in the same spot your natural lens occupied.

  5. The incision heals on its own without any stitches.

  6. A protective shield is placed over the eye to keep it safe during the early stages of recovery.

If you need surgery in both eyes, your cataract surgeon will typically wait one to three weeks between procedures, to give the first eye a chance to heal.

SEE RELATED: Different ways cataracts can be treated

Two different options for cataract surgery

The most common type of cataract removal surgery is called phacoemulsification, or phaco for short. A phacoemulsification procedure uses high-frequency ultrasound waves to break up the cloudy lens.

The phaco operation is now performed with smaller incisions than ever before, so healing is faster with a much lower risk of complications.

Three main types of IOL can be implanted during cataract surgery:

  • Monofocal lenses – The standard options for most surgeries. These may still require the use of eyeglasses or reading glasses after surgery. If prescription glasses are needed, your eye doctor will prescribe them about a month after surgery. Optionally, presbyopia can be treated by adjusting the power of one of your monofocal IOLs to create a condition called monovision. [Read more about monovision cataract surgery.]

  • Accommodating lenses and multifocal lenses – Available for patients with presbyopia. These lenses can correct your reading vision without sacrificing your distance vision. Both of these IOLs provide a greater range of vision after cataract surgery than conventional monofocal lenses.

  • Extracapsular surgery – Instead of breaking up the cloudy lens with ultrasound, a surgeon will remove the core in one piece, then the rest with suction. Extracapsular surgery involves a longer incision and antibiotic eye drops before the operation. This type of cataract surgery procedure is typically only performed in complicated cases.

Watch this video about how cataract surgery works.

Laser cataract surgery, or Refractive Laser-Assisted Cataract Surgery (ReLACS), is a newer option that uses more recent technology.

Instead of ultrasound energy, a special laser is used to break up the existing cataract. The laser uses less energy than ultrasound, which can reduce the risk of complications even more.

In some cases, laser surgery can also improve visual outcomes.

Laser surgery is usually more expensive than standard phaco cataract surgery. During your cataract removal consultation, your surgeon can help you decide which procedure is best for your individual needs.

SEE RELATED: How much does cataract surgery cost?

Preparing for cataract surgery

Before you schedule cataract surgery, your eye doctor will perform a comprehensive eye exam to check the overall health of your eyes and decide if anything will prevent you from having surgery.

The doctor will also perform a refraction test to determine your nearsightedness, farsightedness and/or astigmatism measurements before surgery. Additional measurements of your eyes will be taken to determine the shape of your eye and which type of implantable lens you'll need.

Prior to eye surgery, you'll be informed about what to expect before, during and after your procedure. This information will help you make an informed decision about moving forward with surgery.

Your eye doctor will ask about any medications and supplements you're taking. Some of these can increase your risk of complications and may need to be discontinued for a little while.

If you have any questions or concerns about cataract surgery, be sure to discuss them with your eye doctor and cataract surgeon before signing the "informed consent" documents that authorize surgery.

READ NEXT: What is Peters anomaly (PA)?

Cataract surgery recovery

An uncomplicated cataract surgery procedure only takes about 15 minutes. You can expect to be at the surgical center for 90 minutes or longer, since extra time will be needed for preparation, along with a post-operative evaluation and recovery instructions.

You will need to have someone drive you home after cataract surgery. To protect your eye from sunlight and other bright light as it recovers, the facility will give you a special pair of post-operative sunglasses.

You will need to use special medicated eye drops for a few weeks. You'll also need to wear your protective eye shield while sleeping or napping for the first week or so.

You might experience some eye redness and blurred vision while your eye heals during the first few days or even weeks after surgery.

During at least the first week of your recovery, you will need to avoid:

  • Strenuous activity and any lifting over 25 pounds.

  • Bending, exercising and any other activities that can stress the eye.

  • Exposing your eye to water, since it can cause an infection. You'll need to keep your eye closed while showering or bathing. Avoid swimming or sitting in a hot tub for at least two weeks.

  • Any activity that would expose your healing eye to dust, grime or other infection-causing contaminants.

Your cataract surgeon may give you additional instructions, depending on your specific needs and the type of procedure performed.

Can you see what they are doing during cataract surgery?

During cataract surgery You'll be awake during surgery, but you won't be able to see what's happening in your eye. Our ophthalmologists at Beverly Hills Institute of Ophthalmology perform cataract surgery using a state-of-the-art femtosecond laser.

How painful is cataract surgery?

Cataract surgery is not painful. While patients are awake during surgery, there is little or no discomfort involved. A mild sedative may be administered before the surgery, which calms the nerves, and eye drops are used to numb the eye.

How do they perform cataract surgery?

Cataract removal: Your provider uses a special microscope to see your eye. They create tiny incisions to reach the lens. Then they use ultrasound waves to break up the lens and remove it. Finally, they place the new lens.

How do they keep your head still during cataract surgery?

Tape the patient's head to the operating room table before starting the surgery. I use paper tape to gently hold the patient's head in place during the procedure. Place it over the forehead and use a tape that is gentle and will not damage delicate skin.