Cataract Care

Cataract Surgery

There are numerous benefits of cataract surgery to patients and society in general for those who elect to address their cataracts. Improved eyesight decreases risk for falls and accidents including motor vehicle accidents. Read more below how cataract surgery affects vision and lifestyle.

How will removing the cataract affect your vision?

The goal of cataract surgery is to correct the decreased vision that was caused by the cataract. During the surgery, the ophthalmologist (eye surgeon) removes the cataract and may place in a new artificial lens called an intraocular lens or IOL. Cataract surgery will not correct other causes of decreased vision, such as glaucoma, optic nerve or retinal problems, diabetes, age-related macular degeneration, or dry eye. In order to obtain the best possible vision, many people still need to wear glasses or contact lenses after cataract surgery for either near and/or distance vision, for some activities, or in low light.

What are the types of Intra-ocular lenses (IOL) that are available for me?

Dr. Sheets will help you decide on the type of IOL that will replace your cloudy lens. There are IOLs available to treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. IOLs usually provide either near or distance vision– these single focus lenses are called monofocal IOLs. Some more recently developed IOLs may provide for near, intermediate, and distance vision– these multiple focus lenses are called multifocal IOLs. Lenses that have some focusing power are called accommodative IOLs. IOLs that treat astigmatism are called toric IOLs.

You can also have one eye corrected for near vision, and the other for distance vision, a choice called monovision. With monovision, the implanted IOLs have two different powers, one for near vision in one eye, and one for distance vision in the other eye. Monovision allows for near and distance vision but can decrease depth perception. Although many patients adjust well to monovision, some may find it uncomfortable, which may require compensating glasses, contact lenses or another operation to change the IOL. No IOL is perfect, and often glasses or contact lenses are needed for certain activities even if you have chosen a special IOL lens. Dr. Sheets carefully walks you through these decisions and explains details every step of the way.

Do I have astigmatism in addition to my cataract? Are there treatments for it?

Patients with nearsightedness and farsightedness may also have astigmatism. Astigmatism is caused by an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like an American style football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by eyeglasses, contact lenses, and refractive surgery which includes Laser Assisted In Situ Keratomileusis [LASIK] or Photorefractive Keratectomy [PRK].

There is also a procedure called a Limbal Relaxing Incision (LRI), which can be done at the same time as the cataract operation, or as a separate procedure. An LRI is a small cut or incision the ophthalmologist makes into your cornea to make its shape more round. Astigmatic Keratotomy (AK) is a similar procedure that involves a smaller, more central incision in the cornea than the LRI.  Any attempt at astigmatism reduction could result in over- or under-correction, in which case eyeglasses, contact lenses, or another procedure may be needed. None of the methods of reducing astigmatism are perfect or completely predictable, but all are designed to help reduce the amount of astigmatism present.

What are the recognized risks of cataract surgery?

On average, cataract surgery is the most common procedure performed by an ophthalmologist each year. Most operations are performed easily and successfully without complications. All operations and surgical procedures have risks and can have unsuccessful results or associated complications that can injure the patient, or even cause death in some instances. The recognized, specific risks of cataract surgery include problems that can lead to loss of vision, blindness or loss of your eye. Those risks include: bleeding; infection; high eye pressure; a swollen or detached retina; a droopy eyelid; double vision; displacement of the lens or portion (fragments) of the lens; injury to the cornea, iris, sclera, conjunctivae, pupil function, or other parts of the eye and nearby structures, from the operation or the anesthesia.

Sometimes pieces of the lens cannot be completely removed and the vitreous can become displaced. The specific, recognized, risks of a Limbal Relaxing Incision (LRI) or Astigmatic Keratectomy (AK), if performed in conjunction with cataract surgery are similar to those for cataract surgery, but also include perforation to the cornea, damage to the iris, increased astigmatism, and scarring, which could cause loss of vision. Furthermore, the LRI or AK may not fully correct the astigmatism and an under- or over-correction could occur, and eyeglasses, contacts, or another surgical procedure may be needed to correct the vision.

Depending upon your eye and the type of IOL that is used, the most serious, recognized side effects include: increased night glare or halos, double vision, ghost images, impaired depth perception, decreased contrast, blurry vision, and decreased night vision. At the time of your cataract surgery, your ophthalmologist may make the decision not to implant an IOL even though you may have given prior permission to do so, or your ophthalmologist may make the decision to implant an IOL different from the one that you initially preferred once the surgery underway and more information is acquired about your unique case. The goal is to provide you with the best, personalized ophthalmology solution for you. In some cases, the IOL may later need to be repositioned, replaced, or removed by way of a subsequent surgical procedure. No intraocular lens or power calculation is perfect. You may likely still need eyeglasses. Calculating IOL power is difficult in patients who are highly nearsighted or farsighted, as well as in patients that have had previous eye surgeries such as cornea surgery, glaucoma surgery, refractive surgery or retina surgery. This difficulty in calculating IOL power may result in your post-operative prescription being different from what you and the doctor thought it would be. This may require you to wear eyeglasses, contact lenses, need refractive surgery, or have an IOL exchange or piggyback lens placed. Because only one eye is operated on at a time, you may experience a feeling of imbalance between the two eyes that may require correction.

There is no guarantee that cataract surgery or astigmatism reduction will improve your vision, even with eyeglasses or contacts. You may need eyeglasses or contacts for best vision. In some cases, complications may occur weeks, months or even years later.

Do I have astigmatism in addition to my cataract? Are there treatments for it?

Patients with nearsightedness and farsightedness may also have astigmatism. Astigmatism is caused by an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like an American style football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by eyeglasses, contact lenses, and refractive surgery which includes Laser Assisted In Situ keratomileusis [LASIK] or Photorefractive Keratectomy [PRK].

There is also a procedure called a Limbal Relaxing Incision (LRI), which can be done at the same time as the cataract operation, or as a separate procedure. An LRI is a small cut or incision the ophthalmologist makes into your cornea to make its shape more round. Astigmatic Keratotomy (AK) is a similar procedure that involves a smaller, more central incision in the cornea than the LRI.  Any attempt at astigmatism reduction could result in over- or under-correction, in which case eyeglasses, contact lenses, or another procedure may be needed. None of the methods of reducing astigmatism are perfect or completely predictable, but all are designed to help reduce the amount of astigmatism present.

What are the recognized risks of cataract surgery?

On average, cataract surgery is the most common procedure performed by an ophthalmologist each year. Most operations are performed easily and successfully without complications. All operations and surgical procedures have risks and can have unsuccessful results or associated complications that can injure the patient, or even cause death in some instances. The recognized, specific risks of cataract surgery include problems that can lead to loss of vision, blindness or loss of your eye. Those risks include: bleeding; infection; high eye pressure; a swollen or detached retina; a droopy eyelid; double vision; displacement of the lens or portion (fragments) of the lens; injury to the cornea, iris, sclera, conjunctivae, pupil function, or other parts of the eye and nearby structures, from the operation or the anesthesia.

Sometimes pieces of the lens cannot be completely removed and the vitreous can become displaced. The specific, recognized, risks of a Limbal Relaxing Incision (LRI) or Astigmatic Keratectomy (AK), if performed in conjunction with cataract surgery are similar to those for cataract surgery, but also include perforation to the cornea, damage to the iris, increased astigmatism, and scarring, which could cause loss of vision. Furthermore, the LRI or AK may not fully correct the astigmatism and an under- or over-correction could occur, and eyeglasses, contacts, or another surgical procedure may be needed to correct the vision.

Depending upon your eye and the type of IOL that is used, the most serious, recognized side effects include: increased night glare or halos, double vision, ghost images, impaired depth perception, decreased contrast, blurry vision, and decreased night vision. At the time of your cataract surgery, your ophthalmologist may make the decision not to implant an IOL even though you may have given prior permission to do so, or your ophthalmologist may make the decision to implant an IOL different from the one that you initially preferred once the surgery underway and more information is acquired about your unique case. The goal is to provide you with the best, personalized ophthalmology solution for you. In some cases, the IOL may later need to be repositioned, replaced, or removed by way of a subsequent surgical procedure. No intraocular lens or power calculation is perfect. You may likely still need eyeglasses. Calculating IOL power is difficult in patients who are highly nearsighted or farsighted, as well as in patients that have had previous eye surgeries such as cornea surgery, glaucoma surgery, refractive surgery or retina surgery. This difficulty in calculating IOL power may result in your post-operative prescription being different from what you and the doctor thought it would be. This may require you to wear eyeglasses, contact lenses, need refractive surgery, or have an IOL exchange or piggyback lens placed. Because only one eye is operated on at a time, you may experience a feeling of imbalance between the two eyes that may require correction.

There is no guarantee that cataract surgery or astigmatism reduction will improve your vision, even with eyeglasses or contacts. You may need eyeglasses or contacts for best vision. In some cases, complications may occur weeks, months or even years later.

Per the American Academy of Ophthalmology, there are numerous benefits to patients  society in general for those who elect to have cataract surgery.

  • 40% lower mortality risk for patients who had cataract surgery
  • 16% decrease in odds of hip fracture after cataract surgery
  • 13% decrease in odds of car crashes after cataract surgery
  • 21% Gain in quality of life after cataract surgery in one eye
  • 36% Gain in quality of life after cataract surgery in two eyes
  • $123.4 billion cost benefit to society over a 13 year period
  • 2 million cataract surgeries per year in U.S.
  • 50 million projected to have cataracts U.S. by 2050
  • Age 50-59 – under 10%
  • Age 60-69 – 20+%
  • Age 70-79 – Almost 40%
  • Age 80-89 – Between 20 and 30%

Cost of cataract surgery has declined 85% between 1985 and 2012, adjusted for inflation.

Information provided courtesy of the American Academy of Ophthalmology (AAO).

Infographic provided by AAO.

Information adapted from:  Florida Board of Medicine and Florida Board of Osteopathic medicine approved informed consent form for cataract operation with or without implantation of intraocular lens.

American Board of Ophthalmology Logo_See Word Doc