Cataract surgery-the only option for patients whose cataracts interfere with vision to the extent that their daily activities are affected-is the most frequently performed surgery in the United States. It generally improves vision in more than 90% of patients. Most cataracts are removed before the lens is completely opaque or mature. This is done to minimize the impact of the cataract on the patient’s daily life and also to decrease the risk of other eye complications. Sometimes cataracts need to be removed so the surgeon can examine the back of the eye more carefully. This is important in patients with diseases that may affect the eye. If cataracts are present in both eyes, surgery is performed on one eye at a time. The first eye heals before the second cataract is removed, sometimes as soon as the following week. A final eyeglass prescription is usually given about four to six weeks after surgery. Patients will still need reading glasses. The overall health of the patient must be considered in making the decision to have undergo cataract surgery. However, age alone need not preclude effective surgical treatment of cataracts, and people in their 90s can have successful return of vision after cataract surgery.

Surgery to remove cataracts is generally an outpatient procedure. A local anesthetic is used, and some newer techniques take only minutes to complete. Removal of the cloudy lens can be accomplished with one of the three types of cataract surgery available:

Extracapsular cataract extraction. In this type of cataract extraction, the lens and the front portion of the capsule are removed. The back part of the capsule remains in place.

Extracapsular cataract extraction by phacoemulsification. This type of extracapsular extraction requires only a very small incision, resulting in faster healing. Ultrasonic vibration is applied to the lens to break it up into very small pieces, and the ophthalmologist then aspirates the pieces out of the eye with suction. As of 2001, this is the most commonly performed type of cataract surgery.

Intracapsular cataract extraction. The lens and the entire capsule are removed. This method carries an increased risk for detachment of the retina and swelling after surgery, and, as a result, it is rarely used.

A replacement lens is inserted at the time of the surgery. A plastic artificial lens called an intraocular lens (IOL) is placed in the remaining posterior lens capsule of the eye. When the intracapsular extraction method is used, an IOL may be clipped onto the iris. Contact lenses and cataract glasses (aphakic lenses) are prescribed if an IOL cannot be inserted due to complications. A folding IOL is used with the phacoemulsification procedure to allow it to pass through the small incision.

Antibiotic drops to prevent infection and steroids to reduce inflammation are prescribed after surgery. An eye shield or glasses protect the eye from injury while it heals. During the night, an eye shield is worn. The patient returns to the doctor the day after surgery for assessment, with several follow-up visits over the next two months to monitor the healing process. Return visits at three and six months are optional.

The cataract extraction success rate is very high with a good prognosis. A visual acuity of 20/40 or better is expected as a result of cataract extraction. If an extracapsular cataract extraction was performed, a secondary cataract may develop in the remaining back portion of the capsule. This can occur one to two years after surgery. YAG capsulotomy is most often used for this type of cataract. YAG stands for yttrium aluminum garnet, the name of the laser used for this procedure. This is a painless outpatient procedure and requires no incision. The laser beam makes a small opening in the remaining back part of the capsule, allowing light through.

Complications occur in a very small percentage (3-5%) of surgical cataract extractions. Possible complications include infections, corneal edema (swelling), diplopia, bleeding, retinal detachment, iris prolapse or vitreous in the wound, intraocular lens dislocation, and the onset of glaucoma. Some problems may occur one to two days, or even several weeks, after surgery. Follow-up examinations should check the patient for haziness or redness in the eye, decrease in vision, nausea, and pain.

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