Cataract & Cataract Surgery

Inside our eyes, there is a lens that focuses light so that our vision is clear.  Over time, the lens becomes cloudy and the lens is called a cataract.  Often in the early stages of cataract, the vision remains clear, but you may need to change your glasses more frequently to keep your vision clear.

Once the lens becomes more clouded, changing your glasses prescription will not further improve your vision.  At this stage, patients often describe blurred vision, glare, haloes, or decreased vision at night.  Your ophthalmologist will decide to perform cataract surgery when the blurred vision is impacting your daily activities.

Please see the American Academy of Ophthalmology website or https://www.seethepossibilities.ca/eye-health/cataracts/ for further details and information.

CATARACT SURGERY:

Once your vision becomes significantly impacted by cataracts, your ophthalmologist may suggest cataract surgery to improve the clarity of your vision.

Cataract surgery is typically performed in a non-hospital surgical centre as a day procedure.  The cataract surgery is performed and you go home the same day.  You will be required to start an antibiotic eye drop 3 days prior to surgery.  Following the surgery, you will take antibiotic eye drops and anti-inflammatory eye drops to ensure the eye heals well.  You will ensure that no water enters the eye for 2 weeks and you wear a shield at night to prevent accidental rubbing or injury.  You will be limited to no bending and lifting more than 10 pounds for 2 weeks.

Cataract surgery is typically performed with the patient awake and focusing on a bright light.  The eye is numbed with topical eye drops, but occasionally an additional procedure of numbing is placed behind the eye.    Sometimes, patients require sedation if you are claustrophobic or nervous of medical procedures.   The pupil is dilated with eye drops.  You look at a bright light on the microscope while laying flat on your back for the surgery.  Small incisions are made at the junction of where the sclera (the white of the eye) meets the cornea (clear part of the eye).  A small opening is created in the top of the lens and ultrasound energy is used to break up and then vacuum the cloudy lens out of the eye.  A clear plastic lens is then implanted and the small incisions are closed.  For a standard cataract surgery, it takes 15-20 minutes to complete.  If there are complications or a difficult cataract, it can take 30 minutes or more.

WHAT ARE THE RISKS OF CATARACT SURGERY?

Mild complications are common.  These include high intraocular pressure, corneal swelling, damage to the iris or macular swelling.  These typically improve with eye drops and time.  Rarely, another procedure would need to be performed if it didn’t resolve.

Moderate complications include a break in the shell of the lens and pieces of the cataract falling into the back of the eye.  This occurs 1 in 1000 procedures.  You will require a second surgery by a retina specialist if this occurs.  A lens may or may not be able to be placed in the eye if this occurs.

Severe complications include a large bleed in the eye, retinal detachment or infection.  This occurs 1 in 250 000.  These all cause permanent vision loss that is difficult to reverse.  This may leave your vision with only seeing shapes or movement and unable to read the eyechart.

Please see the American Academy of Ophthalmology website for further details and information.

LENS IMPLANTATION OPTIONS:

After your lens is removed, a plastic lens is put in place in order to focus your vision.  Without the lens, your vision would be very blurred and you would need very strong glasses.

There are 3 intraocular lens choices:

1. Standard (Monofocal) lens – no cost

2. TORIC lens (for astigmatism) – additional cost

3. Multi-focal lens – additional cost

STANDARD (MONOFOCAL) LENS:

The standard lens is a good quality lens that provides clear vision at one distance.  You will need glasses for either distance or near after surgery.

If you have astigmatism (oval shaped eye), you will need glasses for distance and near after surgery.

TORIC LENS:

This lens is for people with astigmatism (oval shaped eye).  This lens will correct for astigmatism.  This will improve your vision without glasses at one distance (either distance or near).  You will still require glasses for the other distance.

i.e.  If you choose to have better uncorrected distance vision, you will still need glasses at near.

MULTI-FOCAL LENSES:

This lens helps patients see at near and distance without glasses.  This is for people who do not want to wear glasses at all after surgery.  YOU NEED TO HAVE HEALTHY EYES FOR THIS LENS TO WORK PROPERLY.  This lens has side effects of glare and haloes and decreases contrast of your vision.

Please see the American Academy of Ophthalmology website for further details and information.

TARGET DISTANCE OF LENSES (STANDARD AND TORIC):

Your lens can be focused for either distance or near. This choice will decide where your vision is clearest without glasses after surgery.

1. Most people choose a DISTANCE TARGET => better distance vision without glasses after surgery, need to wear reading glasses for near

2. Some people choose a NEAR TARGET => better near vision without glasses after surgery, need to wear distance glasses for driving, TV, distance activities (golf, etc.)