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Cataract Surgery

Capt. Joseph Pasternak, an ophthalmology surgeon at National Naval Medical Center Bethesda, lines up the laser on Marine Corps Lt. Col. Lawrence Ryder’s eye before beginning LASIK VISX surgery. The actual procedure can take only seconds, while most of the patient’s time is spent preparing for the procedure.  Photo credit: U.S. Navy photo by Mass Communication Specialist 1st Class Brien Aho; Public Domain, Wikipedia

 

 

A cataract is an opacification or cloudiness of the eye’s crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the 1) ___. If visual loss is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic intraocular lens (IOL). Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended. The clouding of the lens leads to a decrease in 2) ___. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry vision, halos around light, trouble with bright lights, and trouble seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause half of all cases of blindness and 33% of visual impairment worldwide. Cataracts are most commonly due to 3) ___ but may also occur due to trauma or radiation exposure, be present from birth, or occur following eye surgery for other problems. Risk factors include diabetes, smoking tobacco, prolonged exposure to sunlight, and alcohol. Either clumps of protein or yellow-brown pigment may be deposited in the lens reducing the transmission of light to the retina at the back of the eye. Diagnosis is by an eye examination. The genetic component is strong in the development of cataracts, most commonly through mechanisms that protect and maintain the lens.

 

Prevention includes wearing sunglasses and not smoking. Early on the symptoms may be improved with 4) ___. If this does not help, surgery to remove the cloudy lens and replace it with an artificial lens is the only effective treatment. Surgery is needed only if the cataracts are causing problems and generally results in an improved quality of life. Cataract surgery is not readily available in many countries, which is especially true for women, those living in rural areas, and those who do not know how to read. About 20 million people are blind due to cataracts. It is the cause of approximately 5% of blindness in the United States and nearly 60% of blindness in parts of Africa and South America. 5) ___ from cataracts occurs in about 10 to 40 per 100,000 children in the developing world, and 1 to 4 per 100,000 children in the developed world. Cataracts become more common with age. More than half the people in the United States had cataracts by the age of 80.

 

Blunt trauma causes swelling, thickening, and whitening of the lens fibers. While the swelling normally resolves with time, the white color may remain. In severe blunt trauma, or in injuries that penetrate the eye, the capsule in which the lens sits can be damaged. This damage allows fluid from other parts of the eye to rapidly enter the lens leading to swelling and then whitening, obstructing light from reaching the retina at the back of the eye. Cataracts may develop in 0.7 to 8.0% of cases following electrical injuries. Blunt trauma can also result in star- or petal-shaped cataracts.

 

Femtosecond laser-assisted cataract surgery (FLACS) has gained popularity in recent years with the new technology suggesting potential improvements in clinical and safety outcomes over conventional phacoemulsification cataract surgery (PCS). A decade since the advent of FLACS has given time and experience for laser technology to develop in maturity, and better quality evidence to become available.

 

Just behind the iris and pupil lies the lens, which helps focus light on the back of your eye. Most of the eye is filled with a clear gel called the vitreous. Light projects through your pupil and lens to the back of the eye. The inside lining of the eye is covered by special light-sensing cells that are collectively called the retina. It converts light into electrical impulses. Behind the eye, your optic 6) ___ carries these impulses to the brain. The macula is a small extra-sensitive area in the retina that gives you central vision.

 

In most cases, waiting to have cataract surgery won’t harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever. Complications after cataract surgery are uncommon, and most can be treated successfully.

 

Undergoing Tests: A week or so before your surgery, a painless ultrasound test is performed to measure the size and shape of the eye. This helps determine the right type of lens implant (intraocular lens, or IOL). The eye surgeon advises the patient to temporarily stop taking any medication that could increase risk of 7) ___ during the procedure. Use eyedrops to reduce infection risk. Antibiotic eyedrops may be prescribed for use one or two days before the surgery.

 

Fast before surgery. You may be instructed not to eat or drink anything 12 hours before the procedure.

 

Prepare for your recovery. Normally you can go home on the same day as your surgery, but you won’t be able to drive, so arrange for a ride home. Also arrange for help around home, if necessary, because your doctor may limit activities, such as bending and lifting, for about a week after your surgery.

 

Nearly everyone who has cataract surgery will be given an 8) ___ lens called an intraocular lens (IOL). These lenses improve your vision by focusing light on the back of your eye. You won’t be able to see or feel the lens. It requires no care and becomes a permanent part of your eye. A variety of IOLs with different features are available. Before surgery, you and your eye doctor will discuss which type of intraocular lens (IOL) might work best for you and your lifestyle. Cost may also be a factor, as insurance companies may not pay for all types of lenses. IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires few or no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.

 

Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. First, your doctor will place eyedrops in your eye to dilate your pupil. You’ll receive local anesthetics to numb the area, and you may be given a sedative to help you relax. If you’re given a sedative, you may remain awake, but groggy, during surgery. During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens. A laser or an ultrasound probe, will be used to break up the lens for removal. During a procedure called phacoemulsification, your surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed, to suction out the fragments of the lens. Using an advanced laser technique to remove the cloudy lens. In laser-assisted cataract surgery, the surgeon uses a laser to make all incisions and soften the cataract for removal. Once the cataract pieces have been removed the artificial lens is implanted into the empty lens capsule. After surgery, expect your vision to begin improving within a few days. Your vision may be blurry at first as your eye heals and adjusts. Colors may seem brighter after your surgery because you are looking through a new, clear lens. A cataract is usually yellow- or brown-tinted before surgery, muting the look of colors. You’ll usually see your eye doctor a day or two after your surgery, the following week, and then again after about a month to monitor healing. It’s normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pushing on your eye. The surgeon will cover the healing eye with an eye patch or protective shield the day of surgery; and may also recommend wearing the eye patch for a few days after surgery along with the protective shield when you sleep during the recovery period. Doctor usually prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure. Sometimes, steroid medications can be injected into the eye at the time of surgery to keep inflammation at bay. After a couple of days, most of the discomfort should disappear. Often, complete healing occurs within eight weeks. Most people need glasses, at least some of the time, after cataract surgery. The doctor will inform whether the eye has healed enough to get a final prescription for eyeglasses. This is usually between one and three months after surgery.

 

Ophthalmology surgeons prefer to use the laser because it is simpler and quicker. While the laser avoids certain sources of human error and automates multiple steps of cataract surgery, users must still pay careful attention to what the laser will be doing. The precision benefits of the laser make surgeons very trusting of its performance. However, surgeons must be mindful to not flash quickly through all of the screens, assuming that the OCT pick-up of the lens capsule position is always correct. Results of a randomized controlled, real-world study in which the ophthalmologists-in-training were doing the surgery showed that FLACS significantly reduced the average total time spent in the OR compared with conventional phacoemulsifcation. The FS laser pretreatment reduces the duration of the operation. Most eye surgeons see the potential for laser surgery, offering a huge change in a world where cataract surgery will become even more automated and performed by a dedicated subspecialty group of surgeons. After the procedure, you usually stay in the doctor’s office for about an hour to make sure your eye pressure doesn’t rise. Other complications are rare but can include increased eye pressure and retinal detachment. The Johns Hopkins Medicine website reports that cataract surgery is among the 9) ___ (and pain free) surgeries performed today. For most people, cataract surgery is an outpatient procedure. After 10) ___, you’ll probably spend one or two hours in the post-op room with a protective eye covering. You should arrange for someone to drive you home and pick up any prescriptions, as you may not be able to drive right away

 

According to an AARP telephone survey of 250 people who had cataract surgery, 2 out of 3 said they were less dependent on glasses for distance vision after surgery. Additionally, two-thirds said they could read better (with or without glasses) after surgery, and 82% said cataract surgery made it easier to drive.

 

Sources: Mayo ClinicOphthalmology Times ; Wikipedia;

 

Click to see a short video describing cataract surgery.

 

ANSWERS: 1) retina; 2) vision; 3) aging; 4) glasses; 5) Blindness; 6) nerve; 7) bleeding; 8) artificial; 9) safest; 10) surgery

 

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