Successful cataract surgery starts in the clinic with a comprehensive eye examination and measurements of your eye’s shape, length, and curvature. These values help determine the power of the intraocular lens (IOL) implant that will be placed into your eye at the time of cataract surgery.
The Surgical Process
After you arrive at the surgery center, you will be admitted to the preoperative suite. An IV will be started in your arm so that relaxing medication can be administered as needed. After meeting with your anesthesiologist, you will be taken into the operating room for your surgery.
During cataract surgery, the eye is sterilized with a disinfecting solution, and then a sterile surgical drape and eyelid speculum (holds the lids open) are placed. Cataract surgery takes about 10-15 minutes to complete.
A small incision is made in the cornea. The lens sits in a bag, called the capsule. A small hole is peeled in the capsular bag, called a capsulorhexis. Utilizing high-frequency ultrasound energy, the cataract is broken up and removed. After ensuring all portions of the cataract are removed, the chosen IOL is inserted into the bag and checked for stability. The incisions are then evaluated to ensure they are water-tight.
You are typically seen the day after surgery to ensure the healing process is progressing well. Typically, you may wear a shield at bedtime and have moderate limitations for the first few weeks, but discuss this with your doctor for specific instructions. You may need an updated glasses prescription 1-2 months after your cataract surgery.
Once cataract surgery is completed, you will not develop another cataract; however, you may develop a film behind the back surface of the lens implant. This film, also known as posterior capsule opacification, commonly occurs in up to 50% of patients and presents with symptoms very similar to the original symptoms of cataract — blurriness of vision and glare. Fortunately, this problem is easily addressed with a laser surgery called a YAG capsulotomy.
Laser Cataract Surgery
We are pleased to offer Alcon’s LenSx laser, a computer-controlled laser that allows the surgeon to plan and perform your surgery to exacting, individualized specifications not attainable with other surgical methods.
The LenSx laser can help treat a condition known as astigmatism by creating precise incisions in the cornea. Astigmatism is a condition in which the surface of the eye has a more oval shape rather than a round shape. The LenSx® laser also softens the core of a cataract, and this helps reduce the amount of ultrasonic energy required to complete the surgery. During surgery, the clouded lenses are removed and, in most instances, replaced with an intraocular lens, referred to as IOLs.
Today, we are able to offer patients, a variety of options for IOLs to accommodate individual needs.
Advantages of Laser-Assisted Cataract Surgery
- Correcting Astigmatism with extremely precise laser incisions
- Using less energy in the eye to remove the cataract
- Provides extremely efficient and safe treatment for very hard or mature cataracts
- Protects the lens capsule during surgery and provides consistent implant placement
Catering Cataract Surgery to your visual needs
During cataract surgery, your natural lens is replaced with an intraocular lens (IOL). This IOL determines the focusing ability of your eye. The single vision lenses do not have the ability to change their focusing point, and therefore are “aimed” for a certain distance; near, intermediate or distance.
When we choose the IOL for your eye, we determine the necessary power based on the anatomy of your eye. The IOL is placed in the eye at the time of surgery and based upon your healing process, you may or may not need glasses after surgery.
- A near aim is best for patients who are near-sighted and do a significant amount of reading or fine work. In this case, you would wear glasses for distance and intermediate vision.
- An intermediate aim is for patients who do a significant amount of computer work. In this case, you would wear glasses for distance and near.
- A distance aim is for patients who wish to be “glasses-free” for distance. You would wear glasses for intermediate and near activities.
Another option includes something called MONOVISION, where the dominant eye (which we will test for) is set for distance and the other eye is set for near. While this does compromise some depth perception, it does offer the opportunity to be “glasses-free” without the added investment of the premium lenses. Monovision is best for patients who have had the same type of vision in contact lenses or glasses before, as there is an adaptation period associated with monovision.
If you have astigmatism or are interested in our premium lenses, please read about the Premium IOL’s. As with any other issue regarding your eye health, if you have any questions or comments, we would be happy to discuss them in detail with you during your appointment.
During cataract surgery, after removing your cataract, we will insert an intraocular lens (IOL). Single vision IOL’s are the most commonly implanted lenses, but do not correct astigmatism or provide independence from glasses. New lenses, called premium IOL’s, offer astigmatism correction and multifocal correction. While these IOLs are not covered by medical insurance, they provided enhanced vision in patients whose eyes are healthy other than having cataracts.
Astigmatism-correcting IOL’s (Toric IOL’s)
Astigmatism is most commonly from the shape of the cornea or the cataract itself. Astigmatism that is from the cataract will be corrected with cataract surgery. Corneal astigmatism will be identified through our preoperative measurements with optical biometry. In an optical system, such as the eye, the curvature of the cornea works with the lens to focus light on the retina. If the cornea is shaped more like a football than a basketball, the image that is focused on the retina will not be completely sharp. The shape of the cornea can be altered with refractive surgery. Alternatively, during cataract surgery, a toric IOL may be implanted to counteract the astigmatism that exists in the cornea.
If based on our measurements, you qualify for a toric IOL, your eye physician will discuss this option with you. In addition to the routine surgical procedure, the IOL has to be placed at the correct axis (or degree) to ensure the lens correctly addresses the corneal astigmatism. With successful surgery, patients often see “better than they ever have” after cataract surgery.
Multifocal IOL’s (Restor, Tecnis Multifocal)
Standard cataract surgery includes the implantation of an IOL that clears your view for a single distance (based on the power of the lens chosen). However, since it is a single vision lens, you will use glasses for other tasks. For example, if the power of the IOL is chosen to give you the best distance vision, then you will wear glasses for intermediate (computer) and near (reading) distances.
Multifocal IOL’s utilize something called diffractive optics. These lenses have concentric rings that have different focal lengths, alternating between near and far distances. These lenses give the greatest chance for independence from glasses but have side effects that include glare and halos at night from the edges of the concentric rings. It does take some time to get accustomed to the multifocal IOL’s, and the best outcomes are in patients who have had the multifocal lenses implanted in both eyes.
There is typically no additional recovery period or preparation for the multifocal IOL implantation. There are three types of multifocal IOL’s currently being used; the Restor lens and the Tecnis MultiFocal lens.
Extended Depth of Focus IOLs
These lenses are similar to multifocal IOLs but tend to give patients better intermediate vision for tasks such as sports and computer work.