Actual Cataracts Surgical Process and Procedure
Who can get surgery?
A patient is deemed a good candidate for cataracts surgery if the cataract has reached a stage where the resulting impaired vision is decreasing the individual's quality of life. Many patients believe that their cataracts must be "ripe" before surgery can be undertaken. This is not true. Any cataracts can be removed during surgery. In the past, it was preferred that patients wait until the last possible moment in case any problems arose during surgery that might later impede their vision. However, today, where cataracts surgery is done on a routine basis and is one of the most common outpatient surgeries performed; there is no need to wait until the cataracts reaches a particular condition. If the cataracts is impairing vision, it can be removed.
Which power of lens should be used?
Before the actual surgical procedure takes place, the doctor and patient must decide which power of lens will be most beneficial for the patient. With over 65 different powers, there will surely be one that fits best for each individual. The final power will be chosen based on several factors, one of the most important being the type of lifestyle the person leads. Do they need to read up close on a regular basis or is far vision more important? In some cases a patient may opt to have a different power lens placed in each eye.
A computer generated print out, based on the criteria that is input by the doctor and patient, will calculate the proper power of lens for each patient. Unlike trying on glasses or contact lenses, there is no way to determine if the power that is chosen is the correct one, as IOL's can not be tried on before surgery. Therefore it is crucial that the doctor and patient both understand exactly what the desired outcome is so that the best choice can be made.
Most surgeons do not require patients to stop or decrease their currently prescribed medication. However, this topic should be addressed and discussed well in advance of surgery.
Patients are given special eye drops when they arrive for surgery, some may be given a few days before the procedure while others are administered only a few hours prior to surgery. There are various types of eye drops used.
The first eye drop, an antibiotic, is applied to decrease the risk of infection by killing off certain strains of bacteria in the eyeball which are known to cause problems in this area.
A second eye drop is used to reduce inflammation during and after the surgery.
And, finally, a special eye drop is given which dilates the pupil allowing the surgeon to view the working field more clearly.
Different forms of anesthesia, local, topical or regional are available for cataracts surgery. The specific type given to the patient will be based on multiple variables; however, all forms of anesthesia work in such a manner that no pain is felt by the patient.
One study published in 2001 studied patients that underwent cataracts surgery in both eyes. One eye was anesthetized using a local anesthesia while the other was given a topical anesthesia. In 78% of patients, the topical anesthesia was favored over the local. Most patients cited the fact that after surgery had concluded, the eye which was given topical anesthesia returned to normal more quickly than the one that had been given the local anesthesia. 16
Moreover, a 2005 study noted that after the use of topical anesthesia, there were less cases of diplopia (or double vision) reported than when regional anesthesia was used. 17
If a topical anesthesia is chosen for surgery it is administered through the use of eye drops. No injection is needed, adding to the benefit of using a topical anesthesia over a local anesthesia where the medication is injected via a small needle. The injection used in a local anesthesia has the potential to have minor side effects such as slight discomfort, swelling or bruising. This is another reason why many patients and doctors now prefer the topical eye drops.
Regional anesthesia is almost never given unless the patient needs for some reason to be unconscious during the surgery. Examples include children or patients with mental/nervous disorders who cannot sit still or deal with the mental stress of surgery.
Nevertheless, the surgeon and patient should discuss which anesthesia will be most advantageous to the patient, as each type provides both benefits and drawbacks, keeping in mind though that all forms serve the purpose of blocking out pain during the surgery and are extremely efficient in this regard. One note however, is that under normal circumstances, topical anesthesia can only be used with small-incision surgery (please see An In-Depth Look at the Cataracts Surgery Procedure for description of small-incision surgery).
Surgery is Safe, Fast and Easy
Routinely, cataracts surgery is performed as an outpatient procedure. The patient usually arrives one to two hours before the scheduled surgery time. This period is used to prepare the patient for surgery; the required eye drops are administered, the patient is given a verbal explanation of what will occur, patient questions are answered, and the patient is then settled into a comfortable position ready for the surgery.
The actual surgery only takes 20-30 minutes. The patient normally remains awake, although in some cases if there is need for sedation such as being overly anxious or fearful, a mild sedative can be given. The patient is asked to remain as still as possible and to inform the physician if any movement, such as an itch or a cough, is to be made.
Typically, after surgery several post-op exams are performed to ensure that the lens was placed correctly and that the vision has returned to the eye. The patient is then given instructions for recovery and most often discharged from the facility within an hour or two post-op.