Cataract treatment has made great strides since the early 20th century. Back then, artist Mary Cassatt was forced to stop painting after two failed cataract surgeries that left her with low vision in both eyes. Impressionist Claude Monet also had cataracts, and he postponed surgery for years, fearing the same result.
Options for Care and Treatment
Today, the news about cataract treatment is good. In the first place, many people don’t need surgery at all. With the help of their vision care provider, they can simply monitor the progression of the condition and related changes in their vision. Surgery, the only definitive treatment for cataracts, is required only if their activities of daily living are curtailed by low vision. Second, the complication rate of cataract surgery - the most frequently performed surgery in the United States - is among the lowest of any type of surgery performed in the country today.
If a cataract is interfering with daily activities or hampering visualization of the back of the eye in a person with another ocular disease, surgery is in order; provided that the person can tolerate it, improvement in visual function can be expected, and appropriate postoperative care is available. In deciding whether someone is in good enough physical condition for surgery, the only consideration is the person’s health - not his or her age.
The goals of cataract surgery include better vision, physical function, and emotional well-being, including improvements in the following specific areas:
- Corrected and uncorrected vision (both with and without glasses or contact lenses)
- Color and depth perception
- Ability to tolerate glare
- Night vision
- Ability of the eyes to work together
- Mobility, such as walking and climbing stairs
- Ability to perform the normal activities of daily living, such as working, driving, and cooking
Types of surgery
Surgery is usually an outpatient procedure performed under local anesthetic. If you have cataracts in both eyes, the first eye will be given time to heal before the second eye is operated on. However, there can be as little as one week between surgeries. One of two general surgical approaches is used:
- Extracapsular extraction (usually with phacoemulsification). In this procedure, the front (anterior) of the lens capsule and cortex are removed and the back (posterior) of the capsule is left intact. This is often done with the aid of a technique called phacoemulsification. A tiny incision is made and ultrasonic vibration is used to break the lens into minuscule pieces, which are then aspirated (suctioned) out of the eye. (Your surgeon may use a different technique that is more appropriate for the type, location, and stage of your cataract; be sure to ask if you have questions about the specific procedure that will be used.)
A collapsible intraocular lens (IOL) inserted through the incision unfolds once in place and remains permanently in the eye. This artificial acrylic or silicone lens replaces the crystalline lens of the eye. New, multifocal IOLs give good postoperative results for both near vision and distance vision.
- Intracapsular extraction. This approach relies on cryoextraction of the lens using a metal probe. The intact lens and capsule stick to the cold probe, allowing quick extraction. However, this method is rarely used because it has two serious disadvantages. First, it carries a high risk of retinal detachment. Second, an IOL (artificial lens) can’t be placed and the person must wear aphakic glasses or contact lenses for vision correction. The glasses tend to cause magnification, distortion, and loss of peripheral vision. Contact lenses may be a good alternative, but elderly people sometimes have difficulty inserting, removing, and caring for them.
Three percent to five percent of cataract surgeries are complicated by infection, bleeding, corneal edema (swelling), retinal detachment, secondary glaucoma, or other problems. You should report to your surgeon any discharge, redness, swelling, pain, nausea, or deterioration in vision.
If you had an extracapsular extraction, an extracapsular cataract may form, usually within two years of surgery. It can be removed using a laser in a procedure called a capsulotomy.
Your surgeon will prescribe antibiotics to control infection and steroid drops to reduce inflammation. An eye patch is applied immediately after surgery. Sometimes a collagen shield similar to a contact lens is used in place of the eye patch, and it dissolves by itself in 24 hours. You’ll be asked to wear a rigid eye shield day and night for a week or so to protect the eye from injury during the healing process.
Four to six weeks after surgery, when refraction becomes stable (see How the Eye Works), a final prescription for reading glasses (or contact lenses, if you prefer) will be written.