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Cataract Removal/Surgery

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How is a cataract removed?

There are several procedures for removing the cloudy lens. In each, a small incision is made in the front of the eye and an instrument is inserted into the eye to remove the lens. Your eye remains in its normal position during the operation. It is never removed from its socket.

With the intracapsular method, which is rarely used today, the entire lens is taken out in one piece, along with its capsule (the membrane enclosing the lens). With the extracapsular method, the front part of the capsule is opened and the lens taken out, leaving the back part of the capsule in its normal position.

The newest extracapsular techniques are referred to as "small incision" surgery. One of these involves phacoemulsification (FAKE-oh-ee-mull-sih-fuh-KAY-shun), in which a needle-like ultrasonic instrument is introduced into the eye. It delivers high-frequency sound waves to break up the opaque lens into tiny fragments that are then gently suctioned out through the instrument's hollow tubing.

Will I be awake during the operation?

The type of anesthesia you have will depend on your general health. If you have a "local" so you can stay awake, you will be given sedatives, and novocaine-like medication will be injected under the eye to paralyze the eye muscles and numb the nerves for pain. The injection is not especially painful, although it produces a little discomfort and will cause vision to be quite dim for a few hours. The lids may also be injected with an anesthetic to keep you from squeezing them during surgery.

General anesthesia may be recommended if you would otherwise be uncomfortable or are frightened to stay awake during the procedure or if there is a chance you could not hold still. Children always need to have general anesthesia.

How soon after cataract surgery can I resume normal activity?

Most patients can be up and around on the day of surgery, and in a short time can return to most activities that do not require heavy lifting or straining. It is safe to use your eyes for reading, office work, or watching TV almost immediately. Depending on the procedure used and the size of the incision, you will be able to resume full, normal activity in a few days to a month or so.

What will my vision be like after surgery?

Cataract surgery removes the crystalline lens, a major focusing element of the eye. Without a lens, your vision would be very poor. Good vision, however, depends on many factors, such as how your vision will be corrected after surgery, as well as your vision before surgery and the eye's overall condition;

If you are having an intraocular lens (IOL) implanted during surgery, your focusing power and your vision will be restored. You will see images that are normal in size and shape, and your depth perception and side vision will be very natural. You are still likely to require an eyeglass correction for reading and for sharp distance vision.

It may take several weeks before the operated eye is fully healed and vision is stabilized. If you have a special need for very sharp vision before then, you may have eyeglasses prescribed early, so long as you understand that they may need to be changed soon afterward.

If you are not having an IOL, your vision will need to be restored by contact lenses or special cataract glasses. Neither of those options is ideal. Contact lenses must be handled, cared for, and tolerated, and not everyone can wear them or even handle them easily. Cataract glasses used to be the most common way to restore vision after cataract removal, but they are thick and heavy, and they magnify and distort vision and create difficulty with side vision.

How do I care for an IOL?

An IOL is a permanent replacement for your natural lens. After it has been placed inside your eye during surgery, it requires no care. You cannot feel or see it, and it is not noticed by others. Today, almost all patients having cataract surgery safely choose an IOL as part of the procedure.

Are the risks of surgery greater with an IOL?

There is a very slightly increased risk of surgical complications, such as displacement of the IOL, but most people feel that the benefits far outweigh the risk. Though no surgical results can ever be guaranteed, the odds are excellent that everything will be fine and you will see just about as well after the operation as you did before the cataract developed.

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