Understanding Cataract Surgery

Article Written By: Kathryn Dawson

The practice of cataract surgery started out in the 6th century by Sushruta, an Indian physicist who used a bent needle to push the lens until it reached the back of the eye. This procedure was called coaching and was adapted by other Asian, Middle Eastern, and Western countries.

To start off, an ophthalmologist or eye doctor will make a thorough examination of the eye. Cataracts may involve one or both eyes and do not require an immediate operation. In fact, some patients with cataracts have slight visual impairment and the use of corrective glasses or contact lenses can help improve vision. With this adaptation it would take a few years before an operation will be needed.

As the cataract progresses, the lens becomes cloudy and opaque so not even strong glasses can help to correct vision. At this point, an operation is unavoidable.

Most cataract surgeries are on an outpatient basis. Before the operation, the eye or eyes are anesthetized and properly sterilised. Depending on the procedure, patients are wide awake or mildly sedated during the whole operation.

There are three types of cataract surgery:

1. Phacoemulsification (Phaco). This is the most commonly practiced and modern cataract removal to date. First, the eyes are anesthetized using only aesthetic ophthalmic drops. With the aid of an operating microscope, a tiny incision in made just outside the margin of the cornea. Then a small hollow probe is inserted to the incision and placed directly over the cataract-filled lens. This probe then emits ultrasonic vibrations that break up and dissolve the lens which is suctioned out at the same time. This procedure usually lasts less than 30 minutes and requires no stitches or eye patches.

2. Extracapuslar cataract surgery (ECCS). There are times when the lens is too dense or hard for the Phaco procedure to dissolve. In this case, the lens should be removed as a whole, thus requiring a larger incision. Before the procedure, anaesthesia is delivered through injection around the eye. This also requires a number of stitches after surgery due to a fairly large incision. Recovery is slower and patients will need to patch their eye for several days until the stitches are healed.

3. Intracapsular cataract surgery (ICCS). This involves an even larger incision where the whole lens and the capsule are removed. This procedure has a high degree of complications due to a significantly large incision made and trauma that the eye has to endure during operation. For this reason, this procedure is now rarely done.

All of the surgical procedures mentioned above involve insertion of an intraocular lens (IOL) right after the natural lens has been extracted. The lens is placed inside the capsule where the natural lens is found. In ICCS, wherein the capsule is also extracted, the lens is usually placed between the cornea and iris. These lenses do not need replacement or any maintenance provided that the eyes do not get hit or traumatized, displacing the lens.

There are different types of IOL implants and the most popular is the monofocal lens. This lens provides excellent distant vision but is very poor in near vision especially when reading. For this, corrective glasses or contact lenses are used for near vision. Monofocal lens does not correct astigmatism.

In contrast, multifocal lens has different regions of magnification that allow the patient to see in different distances. Near vision is much clearer than with the monofocal lens allowing the patient to read and write, but the multifocal lens does not correct astigmatism. For this reason, corrective glasses or contacts are needed by some patients.

Toric lenses are used to address the problems with astigmatism. These implants are inserted at a specific region of the eye to correct astigmatism. Like monofocal lenses, near vision is also poor. Again, corrective glasses are needed for this.

A cataract surgery is inevitable especially when advanced clouding of the lens occurs. Depending on the status of the affected lens, the ophthalmologist will decide which cataract operation is best for the patient to attain optimum vision.

About the Author

Kathryn Dawson - cataract surgery. Only an ophthalmologist can decide which cataract operation is best for a patient.

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