Cataract Surgery Overview

Pre-Operative Evaluation for Cataract Surgery

It is important to know that not all cataracts need to be treated. Dr. Callahan firmly believes that in the vast majority of cases, the decision to have cataract surgery must be made based on each individual patient’s needs and wants.

Cataracts very rarely cause any damage to the eye. They simply cause a decrease in vision over time. It is a common myth that cataracts need to be “ripe” to be removed. The ideal time to have cataract surgery is when the vision change from the cataract is interfering with your day-to-day activities such as reading, driving, working or hobbies.

For this reason, the timing of cataract surgery is different for different patients. After a complete dilated eye exam, Dr. Callahan will discuss any medical problems in your eyes. If you have a cataract or cataracts that are affecting your vision, she will explain the risks, benefits, and alternatives to cataract surgery. Sometimes it is necessary to remove a cataract in order to treat or evaluate another disease in the eye. You may elect to discuss your options with your family or friends prior to scheduling surgery.

When you schedule your surgery, an appointment will be made to see Dr. Callahan in the week prior to your surgery. At this appointment, Dr. Callahan will measure the length of your eye and the curvature of your cornea. These measurements are then used to calculate the power of the intraocular lens or IOL and to help select the proper type of lens implant for your eye. Based on this information, Dr. Callahan will discuss the various lens options available to you and explain what to expect on the day of your surgery. You will have plenty of time to ask questions.

If you have had previous LASIK or other refractive surgery, you can still have cataract surgery. Previous refractive surgery can make determination of the correct IOL more difficult. Your eye doctor records from both before and after your refractive procedure are very helpful in calculating the correct IOL power.

Video: Cataracts Overview

This video explain cataracts, how they affect vision, and how vision is restored with an IOL implant.

The Day of Surgery

With very few exceptions, cataract surgery is done with the patient awake but mildly sedated. This is generally the safest approach and also allows for faster recovery. Most patients leave the surgery center within an hour of completion and are able to resume some normal activities that same day. The anesthesia staff will monitor you throughout the procedure to make sure you are comfortable and relaxed.

Once in the operating room, you will be very relaxed. In fact, many patients do not remember much about actually being in the operating room. You should not experience any pain. It is important that you remain still and quiet throughout the surgery. The procedure usually takes about 15 minutes.

The Cataract Surgery Procedure

Dr. Callahan uses phacoemulsification, the most common state-of-the-art procedure for removing cataracts. A small incision, approximately 2.4 mm, is made in the front part of your eye (the cornea). The cataract is removed through this incision using a tiny high frequency ultrasound instrument. The ultrasound energy liquefies or emulsifies the cataract that is then suctioned out of the eye. The intraocular lens is then injected into the eye and in most cases is held in place by the same structure that held the natural lens in place (the capsular bag). This is called a posterior chamber IOL. Sometimes it is necessary to place the IOL in front of the pupil and iris. This is called an anterior chamber IOL.

Most IOLs are made of silicone or acrylic. The IOL becomes a permanent part of the eye, allowing light to pass through and focus on the retina. Because the incision is very small and created to be self-sealing, the majority of patients do not need stitches. After the surgery is completed, an antibiotic/steroid ointment is applied and a shield is placed over the eye. The shield is to be used during the first 24 hours following surgery.

Video: Cataract Surgery

This video explains how cataracts are removed with the phacoemulsification procedure and how intraocular lenses (IOLs) are implanted to restore vision.

No Stitch/No Needle Surgery

The incision through which the cataract is removed is approximately 2.4mm. It is constructed in such a way that it is generally self-sealing, avoiding the need for stitches. Dr. Callahan does the majority of cataract surgery without putting an injection behind the eye. She uses topical anesthetic gel to numb the eye. This decreases the risk of bleeding and is generally well tolerated. Patients should not experience pain during cataract surgery. Patients are not required to stop blood thinners such as aspirin and Coumadin prior to routine cataract surgery. While not every patient is a candidate for no-needle/no-stitch surgery, Dr. Callahan will discuss your specific needs and formulate the best surgical plan for you.

Cataract Surgery Recovery

You will spend a short period of time resting in the outpatient recovery area before you are ready to go home. You will need to have someone drive you home.

After surgery, it is very important to put in the eye drops exactly as explained in your instructions and to wear the eye shield until you wake up the next morning. You will likely experience light sensitivity immediately after your procedure. Patients are generally more comfortable wearing sunglasses for the first few days. You may shower or bathe as usual but you must take special care to avoid getting anything in your eye.

Depending on the severity of your cataract your vision may be blurry for a few days or weeks after surgery. However if you experience any pain or loss of vision, be sure to call Dr. Callahan’s office immediately. You may resume your normal activities as you feel comfortable, although you cannot drive the day of your surgery. Most patients feel comfortable driving themselves to their one-day postoperative visit with Dr. Callahan.

Cataract Surgery Risks and Complications

Cataract surgery is very safe. It is one of the most commonly performed surgical procedures in the United States today. As with any other surgery, it is important to understand and evaluate the risks and benefits of surgery before proceeding.

The risks and complications of cataract surgery include:

  • Infection
  • Bleeding inside the eye
  • Increased pressure inside the eye (glaucoma)
  • Inflammation in the eye
  • Swelling of the retina
  • Swelling of the cornea
  • Damage to other structures within the eye including the retina
  • Loss of vision (partially or completely)
  • Secondary cataract

In some cases, the part of the lens covering that supports the IOL (called the posterior capsule) can become cloudy several months or years after the first cataract was removed. While this is not a recurrence of the cataract, it is sometimes referred to as a secondary cataract. If this causes a significant decrease in your vision, it can be treated with a YAG Capsulotomy.

Cataract Surgery Costs

Cataract surgery costs are generally covered by Medicare (if you are Medicare eligible) as well as by most private insurance plans provided the surgery is medically necessary. Costs for which you may be responsible will vary depending on your insurance provider and your choice of IOL. The following are some of the criteria for medical necessity:

  • Your vision tests at a certain level of acuity or clarity
  • The vision change is affecting some part of your daily life such as work, reading, driving and hobbies
  • The cataract is interfering with the ability to evaluate and/or treat coexisting pathology in the eye