Guide to Cataract Surgery

According to the Prevent Blindness report, Future of Vision, more than 29 million Americans age 40 and older have cataract. By age 80, more than half of all Americans will have cataract. In 2017, 3.8 million cataract surgeries were performed in the United States. Cataract surgeries are performed without complication in 98% of cases.

What is a cataract? A cataract is when your eye’s natural lens becomes cloudy Macula leading to blurry vision. At first, 225 West Wacker Drive you may not notice that you have a Cornea Suite 400 Chicago, Illinois 60606 cataract. But over time, cataracts Lens 800.331.2020 can make your vision blurry, hazy, Optic Nerve PreventBlindness.org or colors may appear to be faded. You may have trouble reading or Retina doing other everyday activities. Cataracts can occur in one eye or both eyes.

Who will get a cataract? • Various diseases, such Most people experience cataracts as diabetes, arthritis, as a part of aging. There are other or metabolic disorders risk factors to develop a cataract: • Smoking • Eye infections • Family history of cataract • Some medicines (such • Nearsightedness (also as long-term steroid use, called myopia) cancer medication) • Infection or inflammation • Eye injuries during pregnancy (such as • Exposure to intense heat measles or rubella) or radiation • Too much exposure to What are the types of cataract? non-visible sunlight (called Age-related – 95% of cataract are UV or ultraviolet light) age-related, usually after age 40.

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Congenital – These are present at as bright as they used to be. Or you birth, usually caused by infection may have to change your eyeglass or inflammation during pregnancy; prescription often. possibly inherited. To find out if you have cataract, Traumatic – Lens damage from a your eye doctor will want to: hard blow, cut, puncture, intense • ask about your general heat or chemical burn may cause medical history Normal Vision cataract. • ask about your specific eye Secondary – Some medicines, history, including problems eye disease, eye infection, or and symptoms diseases such as diabetes cause this cataract. • test your vision (visual acuity) Cataracts are also named by the • test your side vision location in the lens: (peripheral vision) • Nuclear cataract: This cataract • test your eye movement is located in the center of the • test you for glaucoma (by Cataract Simulation lens. It can darken with age, measuring the eye’s changing from clear to yellow internal pressure) and sometimes brown. • do a microscopic exam of the • Cortical cataract: This front of the eye (using a device cataract affects the layer of called a slit lamp) to assess the lens around the nucleus. It the thickness of the cataract looks like a wedge or a spoke. and how it interferes with light • Posterior capsular cataract: passing through the lens This cataract is found in the • widen (dilate) the pupils of your back of the lens. This type often eyes to examine the retina, develops more rapidly. the optic nerve (which carries visual messages from the retina to the brain) and the macula How can the eye doctor tell if (responsible for the best part I have cataract? of central vision) Everyone who gets cataract • test you to see how glare experiences it differently. But a affects your vision person with cataract commonly experiences cloudy or blurry vision. Lights may cause a glare, seem too Should I have cataract surgery? dim or seem too bright. It may be You must decide whether to have hard to read or drive, especially at cataract surgery. Cataracts will night. If you have cataract, you may not cause large vision changes see halos around lights, such as for some people. A cataract at car headlights, that make it hard to the outer edge of your lens, for focus clearly. Colors may not seem example, may hardly affect your

Prevent Blindness 2 Guide to Cataract Surgery (continued)

vision. A cataract at the center of What kind of lens will replace my your lens, however, may greatly cataract lens? affect your sight. Only you can When the eye surgeon removes decide if a change in your vision the lens with the cataract, you will keeps you from doing all the things need something to replace it, so you want or need to do. A cataract that you can focus and see clearly. may also impede your eye doctor Intraocular lenses (IOLs) replace from treating you for other vision your cataract, or cloudy lens. IOLs diseases. If a cataract keeps have become the most popular your eye doctor from viewing choice for replacing lenses with the inside of your eye, he or cataract. The eye surgeon implants she may suggest surgery. the IOL in about the same place as your natural lens, so that it results When should I wait to have in the most natural vision. The eye cataract surgery? surgeon can decide to correct your vision with an IOL to be able to An eye care professional may not see at a distance for driving a car recommend cataract surgery if: or playing golf. However, you may • cataract has not affected your need glasses for near vision. lifestyle or kept you from doing all the things you want and Types of IOLs need to do • your vision will not improve • Monofocal IOL: This IOL is with surgery because of other most commonly used. It is eye problems usually used to correct for distance vision. Using this IOL • your glasses or contact lenses option means that you will likely can provide satisfactory vision still use glasses for close vision. • you are not well enough/fit • Multifocal IOL: These IOLs enough for the surgery provide both distance and near • you do not want surgery correction at the same time. • Accommodative IOL: These What if I have cataracts in lenses move or change shape both eyes? inside your eye, allowing correct vision at different If you have cataracts in both eyes, distances. your eye surgeon will suggest having your cataract removed in • Toric IOL: This lens is used if one eye first and the second eye you have astigmatism. at a later date. IOLs are the best option to replace your own lenses. However, if you have certain eye diseases or problems, you may not be able to

Prevent Blindness 3 Guide to Cataract Surgery (continued)

have lens implants. You and your Here are some points you eye doctor will need to discuss may want to bring up with whether any restrictions apply. your doctor. Check the questions you’d like your Choosing an eye surgeon eye doctor to answer during your next appointment or conversation. Once you decide to have cataract ❏ surgery, you’ll need to choose Do I really need surgery? an eye surgeon to perform What will I gain by having it? the operation. Some things to ❏ What are the risks? keep in mind are the surgeon’s ❏ What is surgery like? Will it experience and skill, how easy it hurt? What will I see? is to talk to him or her and have ❏ your questions answered, and Will any other health issues I your previous experience with may have-such as glaucoma or this eye doctor, if any. If you have diabetes- affect my cataract or insurance coverage, you will want my surgery? to find out if the surgeon accepts ❏ How long will I need to recover it. Referrals including from your from the surgery? optometrist may help you choose ❏ Will I need glasses after an eye surgeon. Ask friends who surgery? If I wear contacts, have had cataract surgery or can I wear them again after contact a university with a medical surgery? school or a hospital for names and ❏ references. Are there some things I won’t be able to do after surgery? If If an eye doctor has recommended so, for how long? surgery, you may want to get ❏ a second opinion. Make an Will someone have to take appointment to see an eye doctor care of me after surgery? If so, who does not work with, and was for how long? not referred by, your regular doctor. ❏ Will the medicines I take for You do not have to tell this doctor other illnesses interfere with that someone else has already surgery or my recovery? recommended surgery—let this ❏ How experienced is the doctor come to his or her own doctor? Is he or she board conclusions about whether you certified? need cataract surgery. ❏ Does the doctor’s office accept my insurance coverage? Will I have a co-pay amount? ❏ Is a payment plan available?

Prevent Blindness 4 Guide to Cataract Surgery (continued)

Cost of surgery surgery. If you take medicines or Basic charges you can expect for have diabetes, ask your doctor cataract surgery include fees for whether different guidelines apply. the hospital/surgical center, the Removing the cataract and inserting doctor, the anesthesiologist, basic an intraocular lens usually takes the tests before surgery, medicine surgeon ten to fifteen minutes. The after surgery and follow-up visits entire process, from arriving at the with your doctor. Ask your doctor’s hospital or surgical center to going office and your insurance company home, takes about half a day. Less to estimate each of the costs. You than 1% of surgeries require an will likely need new glasses (or less overnight hospital stay. likely contact lenses) after surgery. On the day of your surgery, you will If you have private health insurance be given some eye drops to widen or Medicare, it will usually pay for a (dilate) your pupils. You may also part of or most of the surgery cost. be given a mild sedative to help Try to find out what your health you relax. A healthcare worker will insurance will cover before the take you into the operating room surgery. Ask your doctor about his where an anesthesiologist or nurse or her billing and payment methods. anesthetist will give you a local or Newer “trifocal,” “multifocal,” or an intravenous anesthetic. He or “astigmatism-correcting (toric)” she will monitor your condition. IOLs are not usually covered by You will not feel the surgery insurance, requiring you to pay out- because the topical or local of-pocket if you wish to choose one anesthetic numbs your eye during of these options. the operation. You may see some Some hospitals and surgical lights or vague shapes, but that is centers may be able to help all. Your surgeon will use a special you with financial planning. This microscope, which magnifies may include putting together a and illuminates the area of the payment plan or filing claims to procedure as he or she removes your insurance company. Filling out your cataract. insurance forms can be hard and You may not remember much about take a lot of time—so be sure to ask the operation after it is over. You questions ahead of time. may feel a little drowsy afterward, but as the sedative wears off, you Getting ready for surgery will be encouraged to walk around a bit. Your doctor will monitor your Because you will be given some condition for a while, explain how form of anesthesia during the to care for your eye at home and surgery, your doctor will probably schedule a follow-up appointment. ask you not to eat or drink anything Have a family member, friend, after midnight the day before your or caregiver help you on the day

Prevent Blindness 5 Guide to Cataract Surgery (continued) of the surgery and to assist in surgeon uses sound waves (an or she may then implant the IOL remembering the after-surgery ultrasonic device) to break the lens in front of the iris where its loops instructions. into small pieces, and then suctions hold it in place. Another option is Once you’re fully recovered, you the tiny pieces out through the to suture the IOL to the wall of the will be allowed to go home. It is a same incision. Next, the doctor will eye. This latter option enables the good idea to have a friend, relative, insert the lens into the capsular IOL to be placed behind the iris. or caregiver drive you, and some bag, which is the original location of the lens. Most IOLs are foldable, surgery centers will require that Possible complications so they can be inserted through the you have a ride and someone from surgery accompany you. You may feel tired same small incision. after surgery, so try to relax the rest The lens usually unfolds slowly Less than 2% of patients of the day. once it is placed into the capsular experience complications from bag. The incision can be closed cataract surgery, but you should At home, you should not discuss possible problems with experience much discomfort. with either one stitch, or usually none at all. your doctor. Here are three areas Some people describe the feeling of complications: as having an eyelash in their eye— Phacoemulsification, with slightly uncomfortable and itchy its smaller incision, offers the Problems during surgery, called but not painful. You will apply eye fastest healing and recovery time, operative complications, such as drops or ointment as your doctor produces little discomfort, and severe bleeding, happen to less prescribes, and you will learn to reduces the chance of uneven than 1% of patients. Up to 2% of rely on your untreated eye during focus (astigmatism) or distorted patients lose the gel-like substance this time. vision. that fills the inside of the eye (vitreous humor) during surgery. Extracapsular and Intracapsular Complication rates may be higher Three kinds of cataract removal Much less common in the U.S. are if you have certain medical or the extracapsular and intracapsular ocular diseases. During the cataract operation, procedures. An extracapsular your surgeon will first remove the cataract extraction may be needed Problems soon after surgery, clouded lens. (If you are able to if your lens is too hard to break called early post-operative have a lens implant, your doctor will apart. The extracapsular procedure complications, can include leaking perform this procedure right after removes only the inside of the lens from the wound, bleeding or removing your cataract lens.) There but leaves the capsular bag that infections. are three methods for removing the holds the lens in place. Leaving the Problems after healing, called clouded lens: capsular bag adds to the structural late post-operative complications, • Phacoemulsification strength of the eye and promotes include retinal detachment (this (fei·kuh·uh·muhl·suh·fuh·kei·shn) easier healing. requires surgery to correct), • Extracapsular (ex·tra·cap·su·lar) During the intracapsular procedure, swelling of the cornea, or swelling of the retina (called cystoid • Intracapsular (in·tra·cap·su·lar) your eye surgeon removes the lens and the entire capsular bag that macular edema). Infection is a rare Phacoemulsification By far holds it. Your doctor will make an complication, but it may cause the most common procedure, incision in the sclera, use a special severe vision loss. Remember, phacoemulsification requires a tool to freeze the lens, and then the risk of severe problems or smaller incision in the cornea or, remove it through the incision. He blindness from cataract surgery less commonly, the sclera. The is very low. Still, it may ease your

Prevent Blindness 6 Guide to Cataract Surgery (continued)

iris mind to talk about your concerns with your doctor before surgery. sclera Sometimes after the extracapsular or phacoemulsification procedure, the capsular bag that remains in your eye can become cloudy. This is called an after cataract or posterior capsular opacification. If this happens, your doctor may lens suggest laser surgery to make capsular bag a small hole through the cloudy capsule. This hole will let you see clearly again. • Do have someone else drive holds the drops or ointment. Put in while your eye is healing. the prescribed amount of medicine and close your eye to distribute it Your recovery • Do wear sunglasses in bright light. evenly. If you have trouble doing After surgery, most of the healing this, ask a friend or relative for • Do keep follow-up takes place in the first few days. help. Start with a fresh bottle of appointments with your doctor. But it may take up to 1 month for medicine after surgery so germs your eye to fully heal. For the first • Do keep moderately active. don’t get transferred. Do not touch week or two, or as your doctor • Don’t rub or press your eye. the tip of the medicine bottle to recommends, you should minimize your eye. • Don’t bend over to pick things vigorous physical activity. You up; kneel instead. Eye shields should avoid any lifting or deep Your doctor may want you to use bending, which causes increased • Don’t get cosmetics, soap, an eye shield at night to protect eye pressure. If you experience shampoo, or other irritants your eye while you sleep. severe pain, loss of vision, or a in your eye. sudden increase in redness or Follow-up care swelling of your operated eye, Take care of your eye Your doctor will suggest a call your eye doctor right away. schedule for follow-up visits. The Here are some pointers that can first one will be the day after your help you recover more quickly: Other DO’s and DON’Ts surgery. It is important to keep Applying eye medications these appointments to find out • Do use your medication as Use the eye drops or ointment whether your eye is healing well. directed. exactly as prescribed by your These visits will also let you ask • Do sit down and lift your feet to doctor to help your eye heal. This your doctor any questions you put on your shoes. medicine protects against infection have about medicine or your • Do try to sleep on your back or and helps decrease swelling. activities (such as heavy lifting or exercising). on the unoperated side. How to apply eye drops • Do wear a shield to protect the or ointment eye while sleeping for the first Tilt your head back. Pull your lower week after surgery. eyelid down to create a “cup” that

Prevent Blindness 7 Guide to Cataract Surgery (continued)

Resources for cataract surgery Vision Care Financial Assistance Information: This resource provides a list of organizations and services that provide financial assistance for vision care. https://preventblindness.org/vision-care-financial-assistance-information/

Medicare: Learn about cataract surgery benefits. https://preventblindness.org/medicare-benefits-your- eyes/#1587953897065-8df2ee06-1e30

Medicaid: Consult your state-specific Medicaid agency to confirm which vision services are covered. https://www.medicaid.gov/about-us/contact-us/index.html

Mission Cataract USA: This organization offers free cataract surgery to people of all ages who have no means to pay. http://missioncataractusa.org/

Transportation Services Directory: Search for transportation assistance by city and state. https://lowvision.preventblindness.org/transportation-services-directory/

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