Cataract Surgery

​​​​Overview

The lens of the eye is made of water and protein fibers. As the eye ages, proteins can clump together transforming a transparent lens to a cloudy or opaque lens. This can block light from hitting the retina, in the back of the eye, creating distorted, dim or fuzzy vision. Cataracts can be either fast acting or can take many years to develop. Cataracts can occur in one or both eyes and occur to some degree for everyone older than 65.

Majority of cataracts are developed from normal aging changes. Other factors include systemic conditions, such as diabetes, ultraviolet radiation, specific medicines (steroids use) and blunt trauma.

Cataract surgery is the removal of a hazy lens with ultrasound and replacing it with a new clear artificial lens implant. Patients are often awake for surgery and only local anesthesia is used on the eye. Surgery is performed on one eye at a time, with three to four weeks between each eye.

There are different lens options, and it’s important to find the type that meets your visual demands for your particular lifestyle. We offer various lens options. They include a standard intraocular lens (IOL), the IOL with special surface modifications and multifocal IOL.
With a standard lens, you can either have your distance vision corrected (always wear over-the-counter reading glasses) or you can have the option of monovision (creating less reliance on spectacles). The standard lens is typically covered by insurance, making this lens the most affordable.

The IOL with modified optic is designed to increase one’s contrast sensitivity. This is optimal for people that do a lot of night driving. It can be designed to correct distance only, or you can have the option of monovision correction.  The multifocal IOLs are not covered by insurance. It is an accommodating lens that it is designed to make both distance and intermediate vision clear, reducing the dependence on glasses. The multifocal IOL is good for people who are trying to rely less on glasses.

Procedural Details

The procedure typically takes about 25 minutes for one eye. You will be awake during the surgery. Eye drops will numb the surface of your eye and general anesthesia will numb the surrounding tissues of your eye.
You will be able to go home on the day of surgery, but will need a driver. You will receive a follow-up exam the next day, at one week, at one month and at three months post-surgery. If glasses are needed, you will be given a prescription at the three-month follow-up. You will be sent home with written instructions for the care of your eye, including how to take each of the eye drop medications.
Cataract surgery is performed with a process called phacoemulsification. This is where a small probe is used with a vibrating tip to break up the cataract and gently remove it from the eye. Then a soft, flexible, folded intraocular lens is carefully injected and unfolded in the eye.

Pre-surgery Checklist

  • Schedule a comprehensive pre-operative exam. Plan on a being here for three hours and to have your eyes dilated.
  • Bring your updated glasses and a list of your current medications that includes the dosages and the name of the provider that prescribed each medicine to you.
  • Discuss distance vision versus monovision with a contact lens trial to decide visual correction.
  • Schedule an appointment for a physical exam. All patients are required to have a current history and physical within 30 days before surgery. This may be scheduled with your own primary care physician, or we can help provide you with one.
  • We highly recommend you contact your insurance company directly to ask about the need for a second opinion and about pre-existing condition clauses. You are responsible for making sure that your coverage is currently in effect.
  • Schedule an appointment for an A-Scan. This is an important measurement that is taken to decide the appropriate lens. This appointment is usually no longer than 30 minutes.
  • Start Zymar and Acular four times a day in the eye that will have surgery one week before surgery date.
  • A patient care coordinator from the Pre-Anesthesia Clinic will call you between 2 and 6 p.m. on the last working day prior to your surgery to confirm your check-in time. If you do not hear from the clinic by 5:30 p.m., it is very important that you call the clinic before 6 p.m. at 206.744.5432 to confirm your arrival time and pre-surgery instructions. Please be sure that the Eye Institute has an accurate phone number so you can be contacted or receive a message.
  • Avoid eating or drinking after midnight before your surgery, unless otherwise instructed by the Pre-Anesthesia Clinic.
  • Wear comfortable clothing the day of surgery, preferably shirts that button up the front.
  • Avoid wearing make-up.
  • On the day of surgery, please bring something to read or work on while you are waiting, in the event that delays occur.
  • Arrive two hours before scheduled cataract surgery.
  • You will need someone to drive you home after surgery. You may also require someone ​to bring you back to the eye center if you have an appointment.
  • Parking is located underground in the Ninth and Jefferson building. Patients should enter the building from the parking elevators at the Ground level and follow the signs to the Ambulatory Surgery Check-In.
  • You will have a one-day, one-week, one-month and three-month follow-up. Your doctor will let you know if additional follow-up is required.
  • You will be given written and oral instructions for eye drop medications that you will be taking for the first month after surgery.

Medications

Patients will take eye drop medications for the first month after surgery.

Considerations

With today’s advanced technology, cataracts no longer have to cause severe vision loss. Medicare requirements include best corrected vision of 20/50 or worse or brightness acuity testing with best corrected vision of 20/40.

The doctor will spend some time with you to decide the best option for your visual outcome. There is the option to aim for sharp distance vision but rely on over-the-counter reading glasses. Another option is monovision. This is where the dominant eye is corrected fully for the distance and the non-dominant eye is corrected for near vision. Because both eyes are not working together for the same distance, this makes vision functional but not crisp.

Usually, we will recommend trying a contact lens trial of monovision to see if this option works for you. The last option is the accommodating lens, which corrects both distance and intermediate distances. This is a good option for people who use computers, but may still require occasional reading glasses. Because this is one of the newest lenses on the market, it has specific guidelines for which patients can successfully use this lens. Your doctor will let you know if you are a good candidate for this option.

Effectiveness

Your original cataract will not return. Occasionally patients can experience a secondary cataract that is caused by the cells that grow across the capsular bag that holds the lens implant. This can create a cloudiness, which decreases overall vision. If this occurs, then a simple procedure with a YAG laser can remove the cloudy capsule to restore clear vision again.

Over-the-counter reading glasses will be needed for everything arms length and closer for patients who elect to have their distance vision corrected. Patients that choose monovision or the accommodating lens will rely less on spectacles and may only need them occasionally, pending on your specific visual demands.

What are the risks involved with this procedure?

The most common difficulties arising after surgery are persistent inflammation, changes in eye pressure, infection, or swelling of the retina at the back of the eye and retinal detachment. If the delicate bag the lens sits in is injured, then the artificial lens may need to be placed in a different location. In very rare cases, the intraocular lens moves or does not function properly and may need to be repositioned, exchanged, or removed. All of these complications are extremely rare but can lead to significant visual loss if left untreated; thus, close follow-up with your Eye Institute ophthalmologist is required after surgery.

What are the risks of not having this procedure?

While cataract surgery is one of the safest procedures available with a high rate of success, rare complications can arise. Your Eye Institute ophthalmologist will discuss the specific potential complications of the procedure that are unique to your eye.

Urgency

Since cataract development rarely causes any long-term damage to the eye, cataract surgery should be considered only when visual symptoms begin to develop. Whenever significant vision problems are noted, you should schedule an exam by an eye-care professional. Typical symptoms may include blurry vision, difficulty with glare or night vision, poor color vision or frequent changes in eyeglass prescription.