Thinking about cataract surgery? We have answers to your most frequently asked questions.
Cataracts are a common cause of vision loss in older Americans with over 4 million undergoing sight-saving surgery each year. Modern cataract surgery replaces the aging, clouded lens of the eye with a state-of-the-art intraocular lens that lasts a lifetime.
Today’s cataract surgery has many options; from traditional or laser-assisted procedures to multi-focal and astigmatism correcting replacement lenses.
Talk to your ophthalmologist about your expectations after cataract surgery in order to choose the most effective options for your lifestyle.
What is a cataract?
Cataracts occur when the clear lens of the eye becomes cloudy and dense, causing light to refract abnormally when entering the eye, resulting in blurry vision, glare and halos. Cataracts develop naturally with aging, typically affecting people over age 60. Occasionally cataracts develop prematurely from an eye injury or steroid medication use.
Surgery is the only way to permanently correct cataracts and prevent continued vision loss.
How do I know if I have cataracts?
If you are over age 60, you most likely have signs of cataract development. A dilated, comprehensive eye exam is the best way to know if cataracts are adversely impacting your vision.
Answering ‘yes’ to any of the following questions may show the beginning signs of cataract.
- Do you see starbursts or halos around lights?
- Are you bothered by glare or bright lights?
- Is it more difficult to recognize faces at a distance?
- Do colors appear not as bright as you remember?
- Do you need more light for reading or cooking?
What are common symptoms of cataracts?
Early symptoms of cataract include blurred vision, decreased color perception, sensitivity to light/glare, and the appearance of ghost images and halos.
- Blurred vision: Especially noticeable when driving, watching TV, or looking at details across a room.
- Sensitivity to glare: Squinting and discomfort from bright sunlight and oncoming headlights. It may be harder to follow golf or tennis balls in bright daylight.
- Needing more light: Less light gets into the back of the eye making it more difficult to see in low light conditions, especially when driving at night.
When should I have cataract surgery?
It’s a common question – Do I need cataract surgery now, or wait until they’re ‘ripe’?
As most cataracts mature slowly, the decision to have cataract surgery is based on patient preference and quality of vision. In short, if you have a cataract resulting in blurred vision that makes it difficult to perform normal activities, it is time to consider cataract surgery.
In years past, it was not uncommon for physicians to delay discussion of cataracts until they were quite advanced and required surgery. Today, physicians mention the first observations of cataract for several reasons.
- First, to alert patients that changes to their vision due to cataract development are normal (blurry, cloudy, halos, glare).
- Second, to make sure these changes do not adversely impact daily activities or patient safety as current studies show a correlation between risk of falls and car accident for patients with untreated cataracts.
- Third, to educate patients about their options.
Can I delay having cataract surgery?
The main risk of not having timely cataract removal is that you will continue to have compromised vision. Without surgery, you can expect increased vision loss as the cataract continues to become cloudy and stiff. New glasses will not be able to correct for these changes happening within the eye.
Additionally, it is possible to wait too long for cataract surgery, making the operation more difficult if the cataract is dense and mature.
When considering cataract surgery, keep these questions in mind:
- Can you see to safely do your job and to drive?
- Do you have problems reading or watching television?
- Is it difficult to cook, shop, do yardwork, climb stairs or take medications?
- Do vision problems affect your level of independence?
- Do bright lights make it more difficult to see?
Is cataract surgery risky?
All surgery involves some degree of risk. However, cataract surgery is the safest and most commonly performed outpatient surgery in the US with over 4 million successful procedures performed annually.
Many steps are taken before surgery to ensure patient safety and outcome.
- A comprehensive eye exam to detect other eye conditions that may impact the results of cataract surgery, glaucoma, macular degeneration, diabetes, dry eye and corneal disease.
- Accurate pre-op testing with Zeiss IOL Master to determine your best lens replacement.
- Detailed pre- and post-operative instructions about eye drops to prevent infection and reduce inflammation.
- Surgical clearance from your primary care provider to prepare you for outpatient surgery and sedation.
How is cataract surgery done?
At St Lucie Eye, two methods are used to perform cataract surgery – traditional and laser assisted.
- Traditional cataract surgery uses hand-held instruments and blade.
- Laser assisted cataract surgery uses computer assisted blade-free laser technology.
What is the difference between traditional and laser-assisted cataract surgery?
- Traditional cataract surgery, your surgeon makes a small incision on the side of the cornea with a surgical blade to remove the clouded cataract lens. Commonly referred to as ‘no stitch’, the miniscule incision heals itself without sutures. After the incision, a small probe is inserted into the eye, releasing gentle ultrasonic waves that break up the cataract to be suctioned out. This process is called phacoemulsification. Finally, a new replacement lens is inserted into the capsule, replacing the cloudy cataract lens.
- Laser assisted cataract surgery offers a new level of customization to cataract surgery. Computerized measurements guide key steps in the procedure without a blade ever touching the eye. A femto-second laser, operating at a quadrillionth of a second, makes the corneal incisions instead of a hand-held surgical blade. The highly customized digital measurements also benefit the placement of multifocal and toric IOLs, which require meticulous measurement for accurate placement. Not all patients are candidates for laser-assisted surgery or specialty lenses. Talk to your ophthalmologist about your expectations and need for reading or distance glasses after surgery.
Will I need glasses after cataract surgery?
This is a very important question. The answer is dependent on several individual factors:
- The quality of your vision before surgery
- The choices you make about the type of surgery (traditional or laser-assisted)
- The type of replacement lens (IOL) you select.
If reducing or eliminating glasses for most activities is important, choosing the right lens and method of procedure is critical. Cataract surgery is a once-in-a-lifetime opportunity to improve your vision for many situations and distances.
But not all procedures and lenses are appropriate for every eye. Your ophthalmology team will provide detailed guidance based on your lifestyle preferences and the results of your diagnostic testing.
For most patients – YES – you will need glasses for at least some activities like reading or driving after cataract surgery.
Questions to prepare yourself for life after cataract surgery
- Do I mind wearing glasses, either for specific activities like reading or driving, or all the time?
- What activities are most important for me to see well – driving, playing sports, watching TV/movies, using a computer or smart phone, reading books, reading labels or tags, cooking, needle work, writing.
- Am I nearsighted, farsighted, or have an astigmatism?
- Do I want to greatly reduce dependency on glasses or contact lenses?
- Do I have other eye concerns – glaucoma, diabetes, dry eye or macular degeneration?
- Am I willing to pay the additional fees for specialized lenses and laser assisted surgery to reduce dependance on glasses?
What is an IOL?
An IOL is an intraocular lens. During cataract surgery, your surgeon will replace the eye’s clouded natural lens with a clear artificial lens. This is where your choice of IOL becomes important.
Much like prescription glasses or contact lenses, different IOL implants have different focusing strengths and benefits.
There is no IOL that is “best” for everyone. Your needs are best determined by your daily activities and which type of vision is important to complete those activities. The ophthalmology team at St Lucie Eye will work very closely with you to determine your goals to help you be as satisfied as possible with your vision after surgery.
There are several variations of IOLs, each with unique properties.
- Monofocal – single focus lens
- Toric – specialty lens to correct astigmatism
- Multifocal – specialty lens with fixed ranges of focus (near, intermediate, far)
- Multifocal toric – specialty lens with multiple ranges that corrects astigmatism
- Extended range – specialty lens with extended range of focus intermediate and far
What is the difference between specialty cataract lenses?
Each lens has its own set of benefits and limitations. Be sure to talk with your doctor at St Lucie Eye to understand the differences in IOLs and what it means for your vision after cataract surgery.
Is your distance vision very important because you like to spend your time traveling or want the best distance possible for a round of golf? Do you not mind having to wear reading glasses or bifocals for the tradeoff of having the best distance vision possible?
- Monofocal Intraocular Lens – Monofocal lenses are used to restore vision for one area of focus. Usually patients opt to restore clear, crisp distance vision with this lens. Reading glasses or contact lenses will be needed for near and intermediate distances after surgery. Patients with astigmatism will not receive the full benefit of distance clarity with this lens and still need glasses to correct blurriness caused by an irregular shaped cornea.
- Multifocal Intraocular Lens – Multifocal lenses provide high-quality vision at pre-set distances. Multifocal allows you to see distance, up close, and in-between. Multifocal IOL’s are a good choice if you value having improved distance and reading vision and do not mind some compromise in your distance vision. Most people greatly reduce their need for glasses in many situations. Although, under certain conditions, you might still prefer to wear glasses like when driving at night.
- Toric Intraocular Lens – Toric lenses are specialty monofocal lenses that correct astigmatism. They allow better vision for distance or reading, but not both. The majority of patients choose toric to restore crisp, clear distance vision and rely on glasses for reading.
Does insurance cover cataract surgery?
Medicare and most insurance plans cover the costs for traditional cataract surgery with single-focus lens. There are out-of-pocket fees for specialty multifocal and toric lenses as well as laser-assisted surgery.
It is always best to check your insurance plan for a full understanding of cost estimates including co-pays and deductibles. Your surgical scheduler at St Lucie Eye will assist in the breakdown of expenses that include physician and surgical center.
Are there other costs for cataract surgery?
You can receive cost estimates from St Lucie Eye and One Day Surgery Center to find out insurance reimbursement and your co-payments. Specialty lens and laser-assisted options are out-of-pocket expenses and not covered by insurance.
Ask your surgery scheduler for a complete list of potential expenses:
- Surgery center
- Eye Drops
- Surgical clearance
Is cataract surgery permanent?
Cataract surgery is considered permanent because your new replacement lens is extremely durable and lasts a lifetime.
Therefore, it’s important to carefully consider all your options before surgery. It’s a once-in-a-lifetime opportunity to improve your vision.
Why do some people have another procedure after cataract surgery?
A common condition called posterior capsular opacification may occur months or years after cataract surgery. This happens when a cloudy layer of scar tissue forms behind the lens implant causing blurred vision.
A simple in-office procedure called a YAG laser capsulotomy corrects this “secondary cataract” and typically only needs to be performed once.
Does cataract surgery hurt?
In general, patients do not complain of pain during or after cataract surgery. Only a slight sensation of ‘tugging’ if they are awake during the procedure, or a feeling of ‘grittiness’ immediately following. During surgery, local anesthesia keeps the eye numb, and the entire procedure takes only about 10 minutes. Pre-operative evaluation and postoperative observation accounts for most of the time with cataract surgery.
What happens after cataract surgery?
Because there are no needles or injections, stitches are not required. In most cases, the incision is so small that the eye heals rapidly, with little or no discomfort. Sometimes an eyepatch is used to prevent inadvertent rubbing as the eye heals.
Most patient’s experience a quick visual recovery and can return to normal activities within a week or so. However, observe precautions like no swimming or heavy lifting in the first weeks to avoid any complications.
You will use antibiotic eye drops and anti-inflammatory eye drops for 1-2 weeks after surgery. Be sure to follow all directions from your ophthalmology team and maintain any follow-up appointments.