So you have a cataract, now what?

So you have a cataract, now what?

Everyone gets a cataract, but not everyone needs it removed. A cataract is the hardening and opacification of the natural lens of the eye. You may have already noticed this in your 50s when you started to need reading glasses, that’s because the lens could no longer accommodate like it used to. Now you may have noticed glare, halos, trouble with street signs at night, or maybe the vision just isn’t as sharp as it used to be despite a new pair of glasses. Cataract surgery is best thought of as lens transplant surgery, removing the old hard lens and replacing it with a new synthetic lens.

So, when is it time to take out a cataract?

We look for three things when deciding whether the time is right for cataract surgery.

Number 1: what is your visual acuity? How well you can see the eye chart can also determine whether it is safe to drive. Remember, at least one eye needs to see at least 20/40.

Number 2: What does the cataract look like? Does it look like it could be the reason your vision is decreased? Not all decreased vision is due to cataract. Dry eye, macular disease, and glaucoma can also play a role. And finally;

Number 3: Are the symptoms bothersome to you? Have you had to change your daily routines (no longer driving at night), or can you just not see as well as you used to? When all three of these factors come together then we can decide as a team (physician and patient) if you are ready for cataract surgery.

What do you need to do to prepare for cataract surgery?

The old carpenter’s adage is to measure twice and cut once. We hold ourselves to a higher standard. To pick out the perfect lens for your eye, we need to get accurate measurements of your eye. No two eyes are the same. This includes measuring the corneal curvature and the length of the eye. Only once we know the measurements are stable and accurate can we pick the right power of lens for your eye. After all, changing your surgically implanted lens is much more difficult than changing your glasses prescription. This means you will have to return, perhaps multiple times, to get an accurate measurement of your eye. 

What kind of lens should you pick?

Cataract surgery has advanced to the point where we can help you reduce your dependence on reading glasses, correct your astigmatism, and give you good functional vision without the need for glasses. Not everyone is a candidate for all intraocular lenses, so we will have an in-depth conversation about how to choose the lens that is best for you. Refractive cataract surgery involves not only removal of the cloudy lens but correcting any astigmatism and presbyopia that you naturally developed. Novel advances in intraocular lenses technology now give us the choice of using lenses that greatly reduce daily dependence on spectacles.

What is surgery like?

Cataract surgery is the most performed surgery in the United States. It is done on an outpatient basis, meaning you won’t be admitted to a hospital afterwards. We operate out of Hoag Surgery Center in Irvine.

Plan on having someone drive you to the surgery center in the morning and after check-in and meeting with the anesthesiologist, you will go to the OR. Cataract surgery can be performed with the assist of a femtosecond laser to aid in astigmatism management, wound creation, and can initiate cataract breakdown, all of which can lead to more predictable outcomes. The amount of time in the OR can be upwards of one hour, though it is usually less.

After surgery, you will need someone to drive you home. Plan on taking it easy that day and the day afterwards. You will leave the surgery center with a shield on the eye to prevent you from rubbing your eye. We will also give you a drop schedule so you know when you should place the drops in your eyes. Plan on coming back to the clinic the day after surgery, 1 week post op, and 2 weeks post op. This will ensure that everything is healing smoothly.

Most people can go back to work 2-3 days after cataract surgery as long as they can follow the recommended post-operative regimen.

What am I allowed to do or not do after cataract surgery?

The most important restriction is to avoid rubbing the eye after surgery. The wounds are still healing and rubbing could lead to a wound leak. We also advise not bending over or lifting heavy objects while the wound heals. Most people can get back to walking, cycling, and light exercise after the first few days and by 1 month after surgery you can get back to all your normal activities.

What about the second eye?

Some people develop cataracts quickly, over the course of a few months. Some people develop cataracts more slowly. Usually cataracts are symmetric between eyes, other times one eye is affected much more severely than the other eye. Each case is different.

We do not perform cataract surgery on both eyes at the same time for two reasons: Number one, if something unexpected were to occur or the eye were to develop an infection or retinal detachment, we would like that eye to heal and regain vision prior to operating again. Fortunately, these are very rare occurrences. The second reason is that, like the preoperative measurements we took for before surgery on the first eye, we like to get postoperative measurements to see how well our mathematic models fit for the first eye. We can then use these models and refine them to make sure we hit the target right on the second eye. Finally, some people may not need cataract surgery immediately after the first eye and can wait years between operations.

Anything else?

No two eyes are alike, and we pride ourselves on the care and precision that we take with each of your eyes. We respect the trust given to us to treat your eye conditions and hope that you will have the best visual outcome possible. Please feel free to bring up any questions and discuss with us any concerns you have. We can be reached at 949-645-2250 and a physician is on call 24 hours a day.

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Author

Judd M. Cahoon, MD, PhD Dr. Cahoon completed the combined MD/PhD program at the University of Utah School of Medicine. He earned his PhD in Neuroscience studying the underlying mechanisms of and developing a novel treatment for diabetic eye disease.