When a patient has cataracts, the removal process is simple, safe, and effective.(Learn More)

An ophthalmologist makes microscopic incisions in the cornea, through which the cataracts are broken up by ultrasound and removed by suction. The natural lens is then switched with an artificial lens, over which the inactive proteins of cataracts cannot grow.(Learn More)

There are different types of artificial (intraocular) lenses that can be used for the procedure.(Learn More) There are also different surgical options, depending on the patient’s eligibility.(Learn More)

What Are Cataracts

Cataracts are clumps of inactive proteins that form on the lens of the eye. The formation of cataracts on the lens creates a foggy blur over vision. This makes vision-intensive tasks, like reading or driving (especially at night), difficult or even dangerous.

To a point, cataracts can be addressed with eyeglasses, and people might be able to see despite the growing impairments to their vision. However, there will come a point when the cataracts render day-to-day or important activities all but impossible. This is when the cataracts need to be removed to improve overall quality of life.

At present, the only option to treat cataracts is by surgery. The need for surgery increases as a person ages. By the age of 75 to 70, as many as 50 percent of adults require surgery to remove their cataracts. For an overwhelming majority of patients, cataract surgery is straightforward, easy, and effective.

How Cataracts Are Removed

During cataract surgery, the clouded lens in the eye is removed and replaced with an artificial, clear lens, known as an intraocular lens.

Cataract surgery is very safe and painless. A normal operation can be as quick as 30 minutes, and it can be conducted in an outpatient setting.

Patients are awake during cataract surgery. Their eyes will be numbed with medicine, so they will not feel any pain, though they may be aware of some pressure on the surface of their eye. To ensure the patient does not blink, their eyelids will be kept open with an eye holder. If possible, a doctor may also administer a medication to help the patient relax.

The new, artificial lens is typically made of acrylic, silicone, or plastic. Regardless of the material, it is durable and meant to last for years. Cataracts will not grow on the artificial lens, so cataract surgery needs to be performed just once in a patient’s lifetime.

A Step-by-Step Guide to Cataract Removal

As it is a commonly practiced procedure, the steps of cataract removal surgery are well established.

  • Step 1: Incisions are made.

    The ophthalmologist will make two tiny incisions. The smaller one is approximately 1 millimeter, and the larger one is approximately 3 millimeters. These are made in the cornea, the transparent dome of tissue that covers the front of the eye.

    A thick, viscous solution, made up of substances that the body naturally produces on its own (like sodium hyaluronate) is injected into the cornea to help it keep its shape during the surgery. The thickness of the solution means it will not leak out of the incisions.

    The doctor cuts an opening in the lens capsule, which is like a bag that keeps the lens in place. Slowly, the lens is separated from the capsule by the use of a balanced salt solution.

  • Step 2: The cataract is broken up and removed.

    A laser, or a high-frequency ultrasound device, carefully breaks up the protein clumps that cause the foggy vision into smaller fragments. Suction is used to gently remove the fragments.

  • Step 3: The artificial lens is placed.

    After the lens has been removed, the doctor will inject more of the viscous solution (sodium hyaluronate) into the lens capsule. This keeps it open and makes room for the replacement lens.

    The artificial lens is injected into the capsule behind the pupil and the iris in a folded state. Once inside, it is allowed to unfold.

  • Step 4: The procedure is completed.

    The sodium hyaluronate that maintained the shape of the eye during the surgery is removed since it is no longer needed.

    The incision heals by itself. Stitches are not needed.

    Usually, a protective shield is used to cover the eye, to keep it safe and allow for normal healing.

If a patient needs surgery in both eyes, it is normal procedure to wait up to three weeks to allow the first eye to fully heal.

Types of Intraocular Lenses for Cataracts

There are three different kinds of intraocular lenses that can be placed during cataract surgery.

    • Monofocal lenses: These are the most typically used lenses for cataract surgery. Patients might still need to use glasses after receiving monofocal lenses, for reading or other vision-intensive tasks. If prescription glasses are needed, an optometrist will wait a month after the surgery to prescribe them.
    • Toric lenses: These are designed with more power in one specific axis in the lens. This is to offer correction for astigmatism (an imperfection in the curvature of the cornea or the lens of the eye, resulting in blurry vision at all distances) as well as to improve distance vision. Because a toric lens has different power in different areas, the patient will still need eyeglasses or contact lenses for near-sighted tasks, like reading or writing.
    • Multifocal lenses: These can be given to patients who have presbyopia, offering improvements in reading vision without a loss of distance vision. Multifocal lenses offer a greater scope of improvement to vision after cataract surgery than standard monofocal lenses.

Types of Surgical Options for Cataracts

There are two different surgical options to remove cataracts.

The first, and most common, is known as phaco, short for phacoemulsification. This surgery uses high-frequency ultrasound to break up the protein clumps that have formed on the lens.

Technological advancements in the field now allow the phaco operation to be done by incisions that are no more than millimeters in size. This means the healing process is much faster and the risk of post-surgery complications is greatly reduced.

Another way that cataracts are removed is through extracapsular surgery. In this method, the protein clumps on the lens are not broken up by ultrasound. Instead, the surgeon removes the biggest clump of proteins in a single piece and then removes the rest of the fragments by suction. The incision in extracapsular surgery is longer, and patients are given antibiotic eye drops prior to the surgery.

Extracapsular surgery is only carried out in cases where there are possible complications with the cataract removal or recovery.

Laser Cataract Surgery

A newer option for removing cataracts is laser cataract surgery, also known as refractive laser-assisted cataract surgery. This method uses lasers, instead of ultrasound, to break up the existing protein clumps on the lens.

Lasers use less energy than ultrasounds, so this can reduce any complications that might arise. Because of this, laser cataract surgery can aid outcomes in some patients to a greater degree than using only ultrasound to remove the cataracts, but this depends on many factors. Not every patient might see this benefit.

It is important to distinguish that the laser does not replace standard cataract surgery. As the name suggests, the laser assists in the removal of cataracts. The cataracts themselves are still removed through suction.

Thanks to the technology involved, lasers offer incredible precision for breaking up the protein clumps and the placement of the new lens. Because of this, laser cataract surgery is more expensive than the standard phacoemulsification cataract surgery. Not all patients will be eligible to receive laser surgery.

Cataract Surgery Follow-Up Care

If you undergo cataract surgery, it’s important that you follow post-surgery aftercare instructions.

While cataract surgery can be done in an outpatient setting, you will need someone to drive you home after the procedure. It is advisable that you rest your eyes and avoid any vision-intensive work for a few days.

It is normal to feel some itching or soreness in the treated eye. Some patients experience tearing, and vision might be reduced in bright light. Everyone will be sent home with some eye drops to prevent infection, and it’s important to use these as prescribed.

For the first week after surgery, you should wear an eye shield while you sleep, protecting the eye so that it can heal without interruption. If pain persists, tell your ophthalmologist immediately.

It should take about eight weeks for the eye to be completely healed. As many as 90 percent of patients have significantly improved vision after their cataract surgery. Still, cataract surgery does not guarantee perfect vision, and many patients might still need to wear prescription glasses or contact lenses following the procedure.

References

What Are Cataracts? (September 2020). American Academy of Ophthalmology.

Cataract Surgical Rates. (2017). Community Eye Health Journal.

Considering Cataract Surgery? What You Should Know. (July 2018). Harvard Medical School.

Cataract Surgery. (December 2019). MedicineNet.

Clear Corneal Incision in Cataract Surgery. (Jan-Mar 2014). Middle East African Journal of Ophthalmology.

Visual and Refractive Outcomes of Laser Cataract Surgery. (January 2014). Current Opinion in Ophthalmology.

Emerging Technology in Refractive Cataract Surgery. (January 2016). Journal of Ophthalmology.

Use of Viscoelastic Substance in Ophthalmic Surgery – Focus on Sodium Hyaluronate. (March 2008). Clinical Ophthalmology.

Phacoemulsification. (May 2020). Verywell Mind.

Effectiveness of Multifocal and Monofocal Intraocular Lenses for Cataract Surgery and Lens Replacement: A Systematic Review and Meta-analysis. (May 2019). Graefe's Archive For Clinical And Experimental Ophthalmology.

Subjective Quality of Vision Before and After Cataract Surgery. (November 2012). JAMA Ophthalmology.

Comparison of Toric Intraocular Lenses and Peripheral Corneal Relaxing Incisions to Treat Astigmatism During Cataract Surgery. (October 2010). Journal of Cataract & Refractive Surgery.

Visual Acuity Outcomes of Toric Lens Implantation in Patients Undergoing Cataract Surgery at a Residency Training Program. (Jan-Feb 2016). Missouri Medicine.

Extracapsular Cataract Extraction Compared With Small Incision Surgery by Phacoemulsification: A Randomised Trial. (July 2001). British Journal of Ophthalmology.

A Review of Laser-Assisted Versus Traditional Phacoemulsification Cataract Surgery. (June 2017). Ophthalmology and Therapy.

What to Know About Cataract Surgery. (September 2019). Medical News Today.