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Cataract Surgery

Surgery Overview

Cataracts are cloudy areas in the lens of your eye. In some people, cataracts prevent light from reaching the back of the eye. This can cause vision problems.

Cataract surgery helps you see better. It replaces your natural lens, which has become cloudy, with a clear artificial one.

Phacoemulsification (say "fack-oh-ee-mul-suh-fuh-KAY-shun") is the most common type of surgery. The doctor makes a small cut in your eye and uses an ultrasound tool to break your cloudy lens apart. The small pieces of the lens are removed and replaced with an artificial lens.

In extracapsular extraction, the doctor makes a larger incision and removes the whole lens. Recovery from this type of surgery takes longer.

Before either surgery, the doctor will use medicine to relax you. You probably won't feel much pain. After surgery, you may have a bandage or shield on your eye.

Most people will see better in 1 to 3 days.

How It Is Done

How a cataract looks

A normal lens compared to a lens clouded by a cataract
slide 1 of 8
    
slide 1 of 8, How a cataract looks,

In a normal eye, the lens—which lies behind the pupil—is clear (transparent), so the pupil appears black. In an eye with a severe cataract, the cataract clouds the lens. So the pupil may look gray or cloudy.

Close-up of a cataract

An eye lens clouded by a cataract (close-up)
slide 2 of 8
    
slide 2 of 8, Close-up of a cataract,

The cornea is the clear layer that covers the front of the eye. The lens is contained inside the eye's lens capsule. A cataract is a partial or complete cloudiness in the lens.

Incision for surgical instrument is made

Incisions and opening created to begin cataract surgery
slide 3 of 8
    
slide 3 of 8, Incision for surgical instrument is made,

Two small cuts (incisions) are made in the eye where the clear front covering of the eye (cornea) meets the white of the eye (sclera). Next, a small, circular opening is made in the front of the lens capsule to allow access to the cataract. A small surgical instrument (phaco probe) is inserted into the eye.

Lens is broken up and removed

Cataract being broken up using ultrasound and removed using suction
slide 4 of 8
    
slide 4 of 8, Lens is broken up and removed,

The probe uses sound waves (ultrasound) to break the cataract into small pieces. Then the surgeon uses suction to remove the cataract and lens pieces from the eye. The surgeon may use a laser during parts of the surgery.

Intraocular lens (IOL)

An intraocular lens (IOL)
slide 5 of 8
    
slide 5 of 8, Intraocular lens (IOL),

A variety of IOL types are available to replace your natural lens. Your doctor can help you choose the type that may work best for you.

A lens replacement (IOL) is inserted

An intraocular lens being placed during cataract surgery
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slide 6 of 8, A lens replacement (IOL) is inserted,

After the cataract is removed, an intraocular lens (IOL) may be placed inside the lens capsule. The back of the lens capsule (posterior capsule) is left inside the eye to keep the clear gel in the back of the eye (vitreous gel), as well as the IOL, in place.

Intraocular lens in place

An intraocular lens in place after cataract surgery
slide 7 of 8
    
slide 7 of 8, Intraocular lens in place,

The intraocular lens (IOL) takes the place of the eye's natural lens. The incision does not usually require stitches, unless the surgeon decides they are needed.

Before and after cataract surgery

How the eye looks before and after cataract surgery
slide 8 of 8
    
slide 8 of 8, Before and after cataract surgery,

Before cataract surgery, the cloudy lens can be seen through the pupil. After cataract surgery, the pupil appears black because the intraocular lens is clear.

Learn more

What To Expect

Before you leave the outpatient center, you will get the immediate eye care that you need after surgery. The surgeon will review the symptoms of possible complications, eye protection, activities, medicines, and required visits. They will also tell you what to do for emergency care if you need it.

The eye that was operated on may be bandaged for 1 night after surgery. You will wear a protective shield over the eye at night for about a week. There is normally no significant pain after surgery.

You most likely will need to see the doctor for checkups 1 or 2 days after surgery, and again within a few weeks after surgery. If you have any complications, you should visit sooner and more often.

Most people get a new eyeglass prescription about 6 weeks after surgery.

Why It Is Done

The decision to have this surgery is based on whether:

  • Your work or lifestyle is affected by vision problems caused by the cataract. For example, you may want surgery if you need to drive, especially at night.
  • Glare caused by bright lights is a problem.
  • You can't pass a vision test required for a driver's license.
  • You have double vision.
  • You notice a big difference in vision when you compare one eye to the other.
  • You have another vision-threatening eye disease, such as diabetic retinopathy or macular degeneration.

How Well It Works

Cataract surgery is successful for 85 to 92 out of 100 adults. Surgery may also improve vision in infants who have cataracts.

In one large study, 95 out of 100 adults were satisfied with the results of their surgery. The people who were not satisfied were older adults who had other eye problems along with cataracts.footnote 1

People who have surgery for cataracts usually have:

  • Improved vision.
  • Increased mobility and independence.
  • Relief from the fear of going blind.

Studies done with adults 1 year after surgery show that phacoemulsification works better than standard extracapsular cataract extraction (ECCE) to improve vision.footnote 2 Also, recovery of sight occurs sooner after surgery with phacoemulsification. And it is less likely that you will need glasses for distance vision after phacoemulsification surgery.

Risks

Fewer than 10 out of 100 people have complications from cataract surgery that could threaten their sight or require further surgery.footnote 3 The rate of complications increases in people who have other eye diseases in addition to the cataract.

Although the risk is low, surgery for cataracts does involve the risk of partial to total vision loss if the surgery is not successful or if there are complications. Some complications can be treated and vision loss reversed, but others cannot. Complications that may occur with cataract surgery include:

  • Infection in the eye (endophthalmitis).
  • Swelling and fluid in the center of the nerve layer (cystoid macular edema).
  • Swelling of the clear covering of the eye (corneal edema).
  • Bleeding in the front of the eye (hyphema).
  • Detachment of the nerve layer at the back of the eye (retinal detachment).

Complications that may occur some time after surgery include:

  • Problems with glare.
  • Dislocated intraocular lens.
  • Clouding of the portion of the lens covering (capsule) that remains after surgery, often called aftercataract (posterior capsular opacification). This is usually not a big problem and can be treated with laser surgery, if needed. The type of IOL may affect how likely it is to have clouding after surgery.
  • Retinal detachment.
  • Glaucoma.
  • Astigmatism or strabismus.
  • Sagging of the upper eyelid (ptosis).

References

Citations

  1. American Academy of Ophthalmology (2011). Cataract in the Adult Eye (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online: http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=a80a87ce-9042-4677-85d7-4b876deed276.
  2. Allen D (2011). Cataract, search date May 2010. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  3. Harper RA, Shock JP (2011). Lens. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 18th ed., pp. 174–182. New York: McGraw-Hill.

Credits

Current as of: August 31, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine

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400 West 16th Street, Pueblo, CO 81003

719.584.4000