Procedure for Cataract Surgery — All You Need to Know

Every year, over a quarter of a million people undergo cataract surgery in Australia. Considering that the development of cataract is closely linked to older age, it’s no surprise that your local cataract surgeon is kept busy with our ageing population. As preparing for upcoming cataract surgery can be a nerve-wracking experience, it may help you to read about what you should expect from the procedure for cataract surgery.

The Procedure for Cataract Surgery

The procedure for cataract surgery is actually relatively simple. That being said, your cataract surgeon would have gone through about a decade of medical and specialist training to perfect their technique. The aim of the surgery is to remove the hazy, cloudy crystalline lens from your eye and replace it with a clear implant. By removing the opaque lens, light can enter the eye correctly, allowing you to see with better clarity.

Cataract surgery is a day procedure performed either through the public or the private system. The calibre of the surgeon is the same no matter which system you choose, as many surgeons operate in both.  

Before your cataract surgery, your surgeon and clinical team will have gone through a few pre-operative necessities. These include:

• Assessing your cataracts and your vision to ensure cataract surgery is an appropriate course of action at this time for you. 
• Examining your eye for other conditions or abnormalities that may pose a risk during your operation or during the post-operative recovery. 
• Discussing your visual needs with you and what sort of intraocular lens implant you would like to replace your natural lens once it’s been removed. 
• Taking a complete medical history, including any medications or other health conditions that have the potential to affect the outcome of your cataract operation. 
• Taking precise biometric measurements of your eye to calculate the power of the intraocular lens. 
• Recommending pre-operative preparation as necessary, such as avoiding contact lens wear or using certain prescribed eyedrops leading up to your surgery. 

On the day of your cataract surgery, you will be asked to ensure you’ve organised transport home as you won’t be able to drive after your operation. Your cataract surgeon may offer you a light sedative if you’re feeling particularly uncomfortable or anxious, but general anaesthesia is usually avoided as it increases the risks of the surgery. Your eye area will be numbed with either a topical anaesthetic or a local nerve block injection, and your pupil will have been dilated with pharmaceutical eye drops. If the eye drops aren’t sufficient to widen the pupil, the surgeon can also use other tools to achieve this. 

Once you’re comfortable, your surgeon will ask you to fixate on an overhead light to help keep your eye steady. A small incision is made in the cornea, the eye’s front surface. The surgeon can insert the other tools necessary to extract the cataract through this incision. This includes gently opening the membrane bag that holds the cataract, fragmenting the cataract into smaller pieces, and then suctioning these pieces out of the eye. The intraocular lens is also inserted through this corneal incision. Your surgeon places the implant into the membrane bag and gently manipulates it into place. The procedure for cataract surgery takes, on average, 10-20 minutes per eye. 

There are two popular methods of cataract surgery – conventional phacoemulsification and femtosecond laser-assisted cataract surgery. Femtosecond laser-assisted surgery replaces most steps performed manually in conventional surgery, with a laser tool. Advocates for femtosecond laser-assisted cataract surgery find that the steps of the operation are more precise and predictable than during phacoemulsification cataract surgery. However, the cost of the femtosecond laser equipment is significantly higher, and this method is not available through the public healthcare system. Ultimately, research tends to find that the visual outcomes between femtosecond laser-assisted surgery and conventional cataract surgery are not significantly different. The final result is often largely dependent on the skill of the surgeon. 

Cataract Surgery Post-Op

After your cataracts have been removed, your surgeon will provide you with a prescription for various eyedrop medications and some post-operative guidelines. You will have a protective shield placed over your eye and a few review appointments booked, typically for a day or two after your operation, a week later, and a month later. 

Your specific post-op instructions may vary slightly, but in general, they will include recommendations to:

• Get enough rest to allow your body to heal.
• Avoid any heavy lifting.
• Use your eye drops as instructed, even if the eye feels better before the end of the prescribed course. 
• Avoid swimming pools, the beach, jacuzzis, spas, and saunas.
• Keep the eye protected from dirt, dust, soaps, and other foreign substances. 
• Take a break from high-risk activities that have the potential to result in an eye injury. 

Most people can return to driving within a few days once they’ve had their eyesight assessed and cleared as passing the local road authority’s vision requirements. Depending on your vocation, you may return to work after a week. Alternatively, high-risk occupations may be recommended to take a more extended leave period. 

If you think you may be developing a cataract that requires an operation, see your local optometrist or ophthalmologist for an assessment by calling on (03) 9070 5753. 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. 

References

New standard to improve care for Australians with cataract.
https://www.safetyandquality.gov.au/about-us/latest-news/media-releases/new-standard-improve-care-australians-cataract#:~:text=Each%20year%20more%20than%20250%2C000,in%20private%20hospitals%5Biii%5D.

Cataract surgery and nonsteroidal anti-inflammatory drugs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531861/#:~:text=This%20has%20been%20widely%20accepted,an%20increased%20risk%20for%20complications.&text=Another%20and%20arguably%20the%20most,is%20for%20prevention%20of%20CME.

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