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Understanding the Steps of Cataract Surgery: From Prepping to Recovery

steps of cataract surgery
CONTENTS

Cataract surgery is the most common procedure in medicine with an estimated 3.7 million cases per year in the USA alone. Cataract surgery can significantly improve your vision and quality of life. However, like any surgical procedure, it requires some understanding and preparation. This article will provide a comprehensive guide to help you understand the steps of cataract surgery.

What is Cataract Surgery?

Cataract surgery is a procedure to remove the lens of your eye when it has become cloudy, a condition known as a cataract. The cloudy lens is replaced with an artificial lens implant, known as an intraocular lens implant (IOL), to restore clear vision. The surgery is typically performed on an outpatient basis, which means you can go home the same day.

How Long Does Cataract Surgery Take?

Typically, cataract surgery is a quick procedure that doesn’t take much time. The actual surgery usually takes about 10 to 20 minutes, but you should expect to be at the surgical center for about 2 to 3 hours in total. This time includes pre-operative preparation, the surgery itself, and the initial recovery period. It’s important to note that the exact duration can vary depending on individual circumstances and the specific surgical technique used.

Pre-Surgery Examination

Before your cataract surgery, your eye surgeon will conduct a thorough eye examination. This examination will assess your eye health and determine the extent of the cataract. Expect to be dilated during this visit to ensure complete evaluation of other parts of the eye, including cornea, retina, and optic nerve.

cataract - the eye surgeon typically sees a yellow/brown lens when examining a patient with a cataract

If your eye surgeon proceeds to recommend cataract surgery, you will then have pre-operative measurements of the size and shape of your eye. This pre-surgery examination is crucial to plan the surgery and to choose the right type of IOL for you.

pre-operative measurements for cataract surgery

Types of Cataract Surgery

There are several types of cataract surgery, and the best option for you depends on your specific condition and your doctor’s expertise.

The most common type is phacoemulsification, which uses ultrasound to break up the cataract before it’s removed. The incision is small and no stitches are necessary. Phacoemulsification is standard in the United States.

Extracapsular and intracapsular cataract extractions are less common and involve removing the entire lens of the eye, either leaving the outer shell (extracapsular) or removing the entire lens including the capsule (intracapsular). These involves larger incisions and stitches and have longer recovery times.

Laser-assisted cataract surgery is a newer approach that uses a femtosecond laser to create incisions and soften the cataract prior to phacoemulsification. The laser increases the precision of these steps. However, not all patients are candidates for laser surgery, and it may have higher costs.

Currently, there isn’t sufficient evidence to suggest that laser-assisted cataract surgery provides better outcomes or lowers risks compared to traditional cataract surgery methods.

Your doctor will discuss these options with you and recommend the best type of cataract surgery based on your individual needs and circumstances.

Sterile Preparation Prior to Cataract Surgery

Before the surgery begins, a crucial step is the sterile preparation. This involves cleaning the area around your eye with an antiseptic solution, usually a compound called betadine (Povidone-Iodine). This has been shown to reduce the risk of infection. You will also receive eye drops or other medication to dilate your pupil and numb your eye.

A sterile drape is placed over your face, leaving only your eye exposed for the surgery. This sterile environment is maintained throughout the procedure to ensure the safety and success of the surgery.

Steps of Cataract Surgery

Understanding the steps involved in cataract removal can help alleviate any anxiety you may have about the procedure. Here’s a detailed, step-by-step guide to what you can expect during cataract surgery:

Step 1: Anesthesia

The first step in cataract surgery is the administration of anesthesia to ensure you’re comfortable during the procedure. Most cataract surgeries are performed under local anesthesia, which means you’ll be awake but won’t feel any pain. You will receive numbing eye drops. In most cases, you may also receive a sedative through an intravenous line to help you relax. When the light of the operating microscope turns on, most patients notice lots of different colors and moving shadows.

Step 2: Corneal Incision

Once your eye is numb, the surgeon will place an eyelid support to prevent blinking. Then a small incision in the cornea is made, which is the clear and reflection, dome-shaped surface that covers the front of your eye.

steps of cataract surgery

In traditional cataract surgery, the surgeon uses a handheld instrument to make the incision. In laser-assisted cataract surgery, a laser is used to make the incision with precise accuracy.

Step 3: Capsulorrhexis

The next step is capsulorrhexis, a process where the surgeon creates a circular opening in the capsule (the thin membrane surrounding the natural lens) to access the cataract. This is a delicate procedure that requires a high degree of skill and precision.

Step 4: Phacoemulsification

The surgeon then proceeds to phacoemulsification, which is the process of breaking up and removing the cloudy lens. The surgeon inserts a tiny probe through the cornea incision. This probe emits ultrasound waves that break up the cataract into small pieces and removes these pieces using vacuum.

Step 5: Capsular Cleanup

After the cataract has been removed, the surgeon will clean up the remaining pieces of the cataract and polish the lens capsule. This is an important step to ensure that the artificial lens can be properly placed and to reduce the risk of complications.

Step 6: Lens Insertion

The surgeon will then insert the intraocular lens (IOL) into the empty lens capsule in your eye. The IOL is a clear, artificial lens that will focus light onto your retina, allowing you to see clearly. The IOL is folded up for insertion and unfolds once it’s in place.

Intraocular lens implant before insertion into the capsule

Step 7: Eye Protection

Finally, the surgeon will test to make sure the incision is water tight (stitches are usually not needed) and place a protective shield over your eye. This shield protects your eye as it heals and prevents you from accidentally rubbing it. The protective shield is usually clear or perforated to allow for vision. Eye patching is rarely necessary.

Step 8: Post-Surgery Care

After the surgery, you’ll rest in a recovery area for a short while before going home. You’ll need someone to drive you home because of the anesthesia and blurry vision. You will be given specific instructions for post-surgery care, which typically includes using prescription eye drops to prevent infection and inflammation, wearing the eye shield while sleeping, and avoiding strenuous activities for a few weeks.

Remember, each person’s experience with cataract surgery may vary slightly, and your doctor will provide the most accurate information based on your individual circumstances.

For a more visual understanding of the cataract surgery process, I highly recommend watching this animated video of a cataract surgery. It provides a clear, step-by-step depiction of the procedure, which can help you better grasp what to expect during your own surgery.

Time Between Eyes

If you have cataracts in both eyes, your doctor will likely recommend treating one eye at a time, starting with the eye that has the more advanced cataract. There’s typically a waiting period of a 1-2 weeks between surgeries. This allows the first eye to heal and your vision to stabilize before the second surgery is performed. It also gives you a chance to adjust to the intraocular lens and provides an opportunity for your doctor to make any necessary adjustments to the treatment plan for your second eye based on the results of the first surgery.

FAQs About Cataract Surgery

  • How long does cataract surgery take from start to finish?

    Cataract surgery is a quick procedure that typically takes 10 – 20 minutes from start to finish.

  • How do they keep your eye open for cataract surgery?

    During cataract surgery, a device called a lid speculum is used to keep your eye open. This prevents blinking during the procedure.

  • What is the most common procedure for cataract surgery?

    The most common procedure for cataract surgery is phacoemulsification. This involves using ultrasound waves to break up the cataract, which is then removed through suction.

  • How long between cataract surgery on each eye?

    The most common duration is 1-2 weeks between eyes. This allows for adequate recovery in the first eye. One week is also enough time to allow the infection possibility window to pass from the first procedure before performing surgery on the second eye.

Conclusion

Cataract surgery is a common, safe, and effective procedure that can significantly improve your vision and quality of life. Understanding the steps involved in cataract surgery can help you feel more prepared and less anxious about the procedure. Always remember to follow your doctor’s specific instructions before and after surgery to ensure a successful procedure and a smooth recovery.