If you’re one of the thousands of Australians who are booked in to undergo cataract surgery every year, your ophthalmologist or optometrist has probably already answered your question about “how is cataract surgery done”. Even if you’ve not yet reached that point where you need to think about cataract surgery for yourself, you most likely know someone who does or who has already had it done. If you’d like to know how is cataract surgery done in greater detail, keep reading.
Is it Time for Cataract Surgery?
One of the most common questions preceding how is cataract surgery done is whether you even need to have cataract surgery right now.
Your optometrist or ophthalmologist will be the best person to discuss this with, as each individual’s case is a little different and it’s important to know your eye history and the current state of your vision when deciding. There are some factors to take into consideration but ultimately, you are the one who decides whether you’re ready to undergo an eye operation or not.
The main factor to think about is whether your current vision is adequate for your needs. Different people will have different expectations and demands of their vision. This can depend on your work and your hobbies. For example, if you’re a truck driver who often does long journeys overnight, you may feel the effects of a developing cataract much earlier than someone who works on a computer during the day, even if objectively your cataracts are similar. Vocation and hobbies aside, some people are also simply more sensitive to changes to their vision, or less tolerant of blur compared to others. This can mean an individual with only a mild cataract may still be significantly bothered by the deterioration of their vision, enough to want to seek cataract surgery at this stage.
Another factor your eye care professional will take into account is the overall health of your eyes. There are few circumstances where delaying cataract surgery may result in more serious damage to your eye health, however, one such situation is if the drainage of fluid from your eye is compromised. Angle-closure glaucoma results in increased eye pressure, which can cause permanent vision loss.
If you are at risk of this eye condition, your eye care provider may recommend you have cataract surgery sooner rather than later to ameliorate this risk, even if you’re still happy with your overall vision.
How is Cataract Surgery Done?
It is comforting to know that cataract surgery is one of the most commonly performed surgical procedures in the developed world. Although the ultimate success of your operation depends on the skill of your eye surgeon, cataract surgery is generally associated with low rates of complications and high levels of success.
After your pre-operation examination and consult, if you and your ophthalmologist have decided it’s time to remove your cataracts, you will be organised an appointment in the operating theatre. On the day, you will need to bring someone to drive you home.
Cataract surgery is a day procedure performed under local anaesthetic. Your eye will be numbed with either an injection around the eye or with topical eye drops. Typically, eye surgeons prefer to operate on one eye at a time, but in special circumstances, you may have both cataracts removed at the same time.
Once you’re comfortable, the surgeon will ask you to fixate on a target overhead to help keep your eye steady. There will be an instrument known as a speculum to help keep your eyelids open during the procedure as you may reflexively feel like blinking even though the eyeball itself is anaesthetised. You will also be given some dilating eye drops to widen the pupil so the cataract behind it is more easily accessed.
There are two techniques of cataract surgery. Your eye surgeon may prefer one over the other for all patients or may switch between the two depending on the specific case. Conventional cataract surgery is known as phacoemulsification while a newer method utilises laser technology, called femtosecond laser-assisted cataract surgery (FLACS). During FLACS, almost all steps of the cataract extraction procedure may be performed with the femtosecond laser rather than a handheld tool as in conventional phacoemulsification.
The first step is to create an incision in the cornea, the clear front surface of the eye. This makes an opening for other tools to get to the cataract further inside the eyeball. From here, the membrane capsule that holds the cataract must be gently torn open, a step known as capsulorhexis. Before the cataract can be removed from the eye, it must be broken into fragments small enough to be suctioned out. In FLACS, the femtosecond laser is used to soften the cataract before an ultrasound probe breaks it into pieces; in conventional cataract surgery, only the probe is used for this step. Once the cataract is entirely removed, the surgeon will insert an intraocular lens implant into the membrane capsule and the corneal incision allowed to self-seal.
Your eye will continue healing over the following 4 to 6 weeks. During that time, you will have a few review appointments with your eye care professional to ensure your vision is stabilising as expected.
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Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.