Cataract surgery is the most commonly performed operation in the world. In the United States alone, in 2021, 4 million cataract surgeries were performed. Major improvements in technology and technique have allowed for vast improvements in results and safety over the last three decades.
What is a cataract?
A cataract is a normal change in the protein make up of the natural lens in the eye. When we are young the proteins are arranged in a perfect crystalline structure so that the lens is transparent. With age the crystalline structure degrades and the lens becomes cloudy and finally opaque. Cataracts developed very slowly, typically over the course of years. In some cases, especially in younger patients, cataracts may progress over the course of months.
How do you treat cataracts?
Surgery is the only treatment for cataracts. There are no eyedrops, medications, or nutritional supplements that will make a cloudy lens clear again. Some lifestyle changes can be modified to slow the pace of cataracts over years. For example, smoking, excessive alcohol, uncontrolled diabetes, and significant UV-sunlight exposure may speed up cataracts over time. Once a cataract is causing symptoms such as blurry vision or glare, some non-surgical aids may diminish cataract symptoms. Making sure the glasses prescription strength is fine tuned, as well as anti-reflective spectacle coating, is helpful. Increasing overhead light for reading is also useful.
When should you have cataract surgery?
There is no absolute, hard-and-fast, indication or reason to have cataract surgery. The term “ripe” is used, but there is no medical definition of “ripe'. A useful way to think about when to have cataract surgery is “when the benefits outweigh the risks”. Your doctor can tell you how dense the cataract is when he or she examines it. You may learn your visual visual acuity is decreasing in the exam room, or that bright light is diminishing your tested “glare vision”. These are important factors. The most important factor is how cataract symptoms are impacting day-to-day function. Is, for example, blurry vision or glare causing significant difficulty with driving or reading? If so, you and your surgeon may decide that the benefits of cataract surgery outweigh the risks.
Importantly, worse vision from cataracts happens so slowly that some changes may not be immediately apparent to the patient. A frank discussion with your surgeon can help determine functional vision changes.
Improvements in technology and technique continue to make cataract surgery a safer operation. As modern cataract surgery gets better, and rare risks become even more rare, the benefits of cataract surgery begin to outweigh the risks sooner during the progression of cataract.
What are the risks of cataract surgery?
Risks of cataract surgery include very rare risk of infection. Infection occurs in modern cataract surgery about one in every 5000 or 10,000 operations. Other risks include incomplete wound closure, cataract remnants remaining in the eye, or swelling in the retina after surgery. In unusual circumstances, complications can result in vision loss. In most cases conditions can be treated with eyedrops or a second surgery, and vision is not affected.
What can you expect after cataract surgery?
Most patients will have some normal blurry vision and scratchiness as the eye heals from cataract surgery. Other symptoms include tearing, redness, and light sensitivity. Everyone heals at a different rate after surgery, depending on the anatomy of an individual's eye, how dense the cataract was, and many other factors. While many patients see very clearly one day after cataract surgery, some patients may take weeks for the vision to improve as part of normal healing.
Some patients have other reasons for blurry vision that cataract surgery will not improve. For example, a patient with macular degeneration may get a partial improvement in their vision after cataract surgery, but blurry vision from macular degeneration in the retina will persist.
Protecting the healing eye after surgery is vital. Patients should avoid rubbing or pressing on the eye, especially for the first week after surgery. Some surgeons recommend patients wear a shield at night to protect the eye when they are sleeping. Heavy exercise and swimming should be avoided while the eye is healing, as should excessive bending and lifting. Generally speaking, patients may use the eyes as they normally would in the post-operative period, and reading and driving as vision allows.
Patients will use eyedrops, generally an antibiotic and anti-inflammatory drops, during the healing process.
Cataracts are an unavoidable change with aging. Cataract surgery is the treatment for when glasses or contact lenses do not meet a patient's vision needs, and cataracts are the reason. Cataract surgery in Nashua is extremetly safe and effective.