Cataracts occur when proteins in the lens of the eye begin to break down, so vision can become blurry, doubled, or turn yellow in tint. You may lose color vision, peripheral vision, or have a spot or two in the middle of your vision. (Learn More) This can lead to loss of vision, which can make it harder for you to enjoy your life. In some instances, it may become dangerous. (Learn More)
This means you may qualify for cataract surgery, a procedure that removes the diseased lens of the eye and replaces it with an artificial lens. (Learn More) There are two types of cataract surgery, and several different lenses you can opt for; however, some of these may not be covered by insurance. (Learn More)
Learn more about this outpatient procedure that can dramatically improve your vision if you qualify, how quickly you can expect to recover, and whether you will need ongoing vision correction from glasses or contacts. (Learn More)
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What Are Cataracts, and When Do They Require Surgery?
Cataracts are the leading cause of blindness in the world as well as the leading cause of vision loss in the United States. In fact, 20.5 million Americans ages 40 and older have a cataract in one or both eyes, representing about 17 percent of the middle aged and older population.
This condition involves clouding of the eye’s lens, and it can occur at any age, although it is more often associated with older adults than young people. Treatment and removal of cataracts are widely available, although there may be some barriers, including cost, insurance coverage, access to vision care, and understanding of the seriousness of the condition, which can impact when and how cataracts are treated.
Signs of Cataracts and Why You Developed Them
When cataracts form in the lens of your eye, you will experience changes in your vision that can reduce how well you see. The cloudiness may form in a small area of your lens and barely affect your vision, if it does all, or the spot could be prominent and grow quickly. As the cataract grows larger, you will experience increased vision loss, including blurriness, changes to colors, and trouble in low light because the cataract will change how your lens refracts light in your eye.
If you have cataracts, you may experience the following symptoms:
- Cloudiness in your vision, like looking through a foggy or dusty windshield
- Blurry or hazy vision
- Double vision (diplopia)
- Less colorful vision, particularly a yellow tint to the world
- Increased light sensitivity
- Trouble seeing well at night
- Needing more light to read
- Seeing halos around lights
The most common cause of cataracts is normal changes to the eye that begin around age 40 for many people. Proteins in the lens begin to break down, either due to genetic or pre-existing conditions or with age; this protein breakdown leads to clouding in the lens. People older than 60 typically start to experience some clouding in their lenses. Even though clouding may start with protein breakdown, actual vision degradation or loss may not begin until years later.
There are various reasons you may start to develop cataracts.
- Family history of, or close family members with, cataracts
- Diabetes, high blood pressure, or other medical conditions
- Previous eye injury, eye surgery, or upper body radiation treatments
- Spending a lot of time in the sun, especially without sunglasses that protect against ultraviolet (UV) radiation
- Medications like corticosteroids
- Drinking too much alcohol
- Previous eye inflammation
It is difficult to determine how rapidly cataracts may develop, but if you have any of the above risk factors, speak with your doctor if you begin to experience any of the symptoms listed above.
There are different types of cataracts.
- Nuclear cataracts: These affect the center of the lens. They may start by causing more nearsightedness or a rare, temporary improvement in reading vision. However, the lens will gradually turn more yellow and cloudy, so vision loss begins. The lens may even turn brown if nuclear cataracts are left untreated.
- Cortical cataracts: These begin as wedge-shaped, whitish opaque areas or streaks along the outer edge of the lens. Progression of this type of cataract means that the streaks or opaque areas extend toward the center of the lens to interfere with light passing through the organ.
- Posterior subcapsular cataracts: This type of cataract forms in the back of the lens as a small, opaque area, often directly in the path of sight. Your reading vision may change, you will have trouble with dim light and poor vision in bright light, and you may see glares or halos around lights at night. This type tends to progress faster than other types of cataracts.
- Congenital cataracts: These are formed in utero, so a baby will be born with them or quickly develop them in childhood. They can be genetic, or they may be due to a head trauma or intrauterine infection impacting eye growth. There are other diseases that may trigger these cataracts in young children. These are often removed soon after detection to prevent them from impacting vision.
- Traumatic cataract: These can develop after an injury to the eye that damages the lens. Sometimes, this type of cataract can develop years after the original injury.
- Secondary cataract: This may form after a different eye surgery to treat a vision complication like glaucoma. This is sometimes called posterior capsular opacification, and it is essentially scar tissue from the procedure.
- Radiation cataract: Exposure to some types of radiation may damage the lens and lead to cataracts.
If you develop cataracts, you may qualify for cataract surgery. While the foundation of cataract surgery involves removing the affected lens, there are two different types: traditional and laser-assisted. It is important to understand more about these approaches.
Types of Cataract Surgery
At its core, either traditional or laser-assisted cataract surgery involves removing the lens with the cataract and replacing it with a device called an intraocular lens (IOL). This false lens will be shaped to refract light properly to your retina, so you can clearly see the world.
Traditional cataract surgery is one of the most common procedures performed anywhere, and it is safe and effective. Laser-assisted cataract surgery uses newer technology to improve certain parts of cataract surgery in some situations, although it may not be covered by insurance.
- Traditional cataract surgery: Also called phacoemulsification, this approach to treating cataracts begins with your eye surgeon creating a small incision in the side of your cornea with a scalpel. Then, a precision tool is inserted through the opening behind the pupil, where the lens of the eye sits. Another tool creates a circular opening in the lens, and then, a probe uses sound waves to break up the lens, which is then suctioned out. An artificial lens is inserted to replace the natural lens. Typically, the cornea is filled with self-sealing liquid instead of using stitches to seal the opening.
- Laser-assisted cataract surgery: In comparison to traditional cataract surgery, laser-assisted surgery maps out the entire eye with an ultrasound device. Guided lasers, instead of a scalpel, create the openings in the cornea and lens, and they are sometimes used to break up the lens instead of the probe.
While many people benefit from traditional cataract surgery, your ophthalmologist may specifically recommend laser-assisted surgery if you have astigmatism along with cataracts because the lasers can also correct this refractive error by reshaping the cornea with lasers. Additionally, if you have a premium lens implanted, like one that corrects astigmatism or is a multifocal IOL, you may qualify for laser-assisted cataract surgery.
There are also different names for different incision sizes required by either type of surgery.
- Small-incision cataract surgery: This is the most common type of cataract surgery, and it involves the smallest incision possible to remove the lens.
- Extracapsular surgery: This procedure requires a slightly larger incision, so the lens core can be removed in one piece.
Both traditional and laser-assisted cataract surgeries have similar healing times, so current Medicare guidelines say that a surgeon cannot offer the laser-assisted procedure unless one of the two conditions listed above is met. There is a great additional cost for the laser-assisted surgery, so there is currently no reason to pursue it unless you also have astigmatism to correct. Studies have not shown that there is any added benefit for those with cataracts who do not have astigmatism to pursue laser-assisted surgery. Your surgeon’s skill has more impact on healing and vision improvement than the technology used in the procedure.
Typically, either procedure takes about three months for full recovery. Some people may experience vision improvements immediately, and others begin to experience vision improvements within a few weeks. As the eye heals, vision will gradually get better. Check in with your ophthalmologist if this does not occur or if progress stops.
How Do You Know When to Get Cataract Surgery?
If you are diagnosed with cataracts, this does not mean that you will be scheduled for surgery immediately. In many cases, your doctor may recommend waiting unless the cataract has caused severe vision loss, which could put you in danger. Your eye doctor may also set you up for surgery if cataracts may prevent them from treating a different eye condition, like diabetic retinopathy or macular degeneration.
Reasons you may need cataract surgery include:
- Your job requires a lot of driving.
- You have trouble reading or seeing a television, even with corrective wear.
- Vision problems affect your level of independence, including safely walking, preparing food, and performing other routine, daily tasks.
Often, your doctor will ask you to wait and to come for regular visits to follow the progress of your cataract. You may still have clear enough vision for a long time after being diagnosed with a cataract, but it is important to keep up with visits to your eye doctor, so you can know how the cataract is progressing.
The Risks of Cataract Surgery
Though not common, there are many risks associated with cataract surgery.
- Drooping eyelid
- Retinal detachment
- Dislocation of the artificial lens
- Secondary cataract
- Other loss of vision
These are rare complications, although the risk goes up if you have another eye disease or a serious medical condition like diabetes. Sometimes, underlying eye conditions like macular degeneration or glaucoma can prevent improvements in vision from happening, but your doctor will better be able to treat these conditions after the procedure.
Typically, about 1 percent of people who undergo cataract surgery experience temporary vision loss due to macular edema, or swelling in the eye; less than 1 percent develop an eye infection. About 10 percent of older adults who undergo this surgery develop drooping eyelids, but this typically returns to normal on its own after about six months.
The Cataract Surgery Procedure
Once you and your eye doctor have determined that cataract surgery is the right step for your eyes, there are some ways to prepare for surgery. This is an outpatient procedure, so you will not spend the night in the hospital; instead, your recovery will be at home. You should speak with your eye doctor about how much time you need to take off work to recover from the procedure.
First, after you have been diagnosed with cataracts that are determined to need surgery, you will be asked to:
- Undergo some tests to measure the size and shape of your eye.
- Stop taking some medications, especially those that increase the risk of bleeding.
- Use medicated eye drops to reduce the risk of infection.
- Fast for 12 hours before surgery (no eating or drinking).
- Set up your first days of recovery, including getting a ride home with someone you trust and securing help around the house.
You may also discuss which type of IOL you want with your doctor. Options include:
- Fixed-focus monofocal, which has a single focus strength to improve distance vision. This means you may require reading glasses after surgery.
- Accommodating-focus monofocal, which also have a single strength. They can change from near to far vision with muscle twitches in your eye that normally focus your natural lens.
- Multifocal lens, which is like having glasses with bifocals or progressive lenses, allowing for near, medium, and far vision.
- Astigmatism correction, or toric lenses, which can help reshape the eye while also improving vision.
Like some other vision surgeries, cataract surgery is quick, taking about 30 minutes on average. During the procedure, you will receive a sedative to numb the eye, but it is very unlikely that you will be put under general anesthesia.
After the surgery, your doctor will prescribe medicated eye drops for you to use and give you with a list of things to avoid for the first few days and weeks. This may include wearing a protective eye shield when you sleep and wearing glasses during the day to stop you from rubbing your eye. You may also need to avoid exercise, driving, and work that leads to eye strain for a few days. Your ophthalmologist will tell you when it is safe to do these things again.
You may experience itching, mild discomfort, or a small amount of discharge for the first days after the procedure. This is normal, but if it does not go away or gets worse, speak with your eye doctor.
If you have cataracts in both eyes, it is likely that your doctor will recommend removing one, waiting one to two weeks, and then removing the other. The majority of people who undergo cataract surgery recover well from the procedure.
How Do You Pay for Cataract Surgery & What Does it Cost?
The average cost of cataract surgery is likely covered at least partially by insurance, especially if you undergo traditional cataract surgery and receive monofocal lenses. Toric lenses will run about $1,500 each, and even more specialty lenses may cost up to $3,000 each. These may not be covered by insurance, so speak with your doctor before deciding on these lenses.
Medicare will cover this procedure for older adults when it is considered medically necessary. Other insurance companies will also cover the procedure, at least in part, because being able to see impacts safety and quality of life.
You may not realize how much having cataracts impacts your life until after you have surgery to correct the problem. About 62 percent of people who undergo cataract surgery report that they see better and consequently enjoy life more. As technology improves, recovery time after cataract surgery shortens, so you can return to activities you enjoy sooner.
Cataract Extraction: Removing the Lens to Improve Vision
There are several ways to remove the lens from the eye during cataract surgery, but one of the most common ways to approach this surgery is extracapsular cataract extraction. This involves removing the entire lens through an incision. This removes the cataract while the natural capsule holding the lens remains in place.
Rather than breaking up the lens to remove the damaged area, a slice is made in the outer part of the lens. Then, the internal portion, including the cataract, is removed. Typically, this is followed by replacing the natural lens with an intraocular lens (IOL), an artificial device that refracts light onto the retina.
History of Extracapsular Cataract Extraction
The original extracapsular cataract extraction is believed to date back to 600 BC, when a surgeon in India, named Sushruta, removed a cataract by making an incision in the eye. However, the first fully recorded extracapsular cataract extraction occurred in 1747, performed by the Parisian surgeon Jacques Daviel.
The procedure was reportedly more effective at managing cataracts than another type of surgery, called couching, which had about a 50 percent success rate. There were still several complications associated with this procedure, as the incision in the lens capsule was quite large. Without antibiotics, infections were common, and the surgical incision often struggled to heal properly.
This procedure was still the most accepted version for more than a century until the invention of intracapsular cataract extraction, which became the preferred method to remove cataracts for the next several decades. This procedure involved removing the entire lens, including the capsule. It was much more effective than attempting to leave some tissue in place until technology advancements made microscopic incisions possible.
By the 1970s, surgical tools had improved enough that extracapsular cataract extraction was revived.
Cataract Extraction Today
There are several versions of modern extracapsular cataract extraction now, with the most popular being manual small incision cataract surgery (MSICS), which is the leading form of cataract removal in the United States.
Once the cataract is removed from your eye, it is typically replaced with an IOL. The most common type of IOL is a monofocal IOL, which allows your eye to focus on a single distance (near or far). You can choose, depending on which one you need more. Your other eye should be able to compensate for the lack of distance vision from the artificial lens.
Your health insurance is most likely to cover monofocal IOLs. If you are interested in a multifocal IOL, you may pay more for this device, as it is not considered medically necessary. Accommodative IOLs can change shape inside your eye. Toric IOLs help people with astigmatism change the shape of their eyes. You can ask about these options, but again, they may not be covered by your insurance.
There are other types of cataract removal, which may be better for your vision. Variations on extracapsular cataract surgery are the most likely procedures if you need to have a cataract removed.
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IOL Implants: Lens Replacement After Cataracts. (October 2019). American Academy of Ophthalmology (AAO).