There have been huge advances made in cataract surgery in the past few years. Now one of the most common operations performed in the United States, it is also one of the safest and most effective. Considered a simple outpatient procedure, cataract surgery takes less than an hour to perform and can free the patient from a life of blurriness, allowing him or her to read and even drive again. However, like any procedure, there are some risks and possible side effects associated with cataract surgery, so you should discuss both the pros and cons with your doctor before making a decision.
Whether phacoemulsification or extracapsular cataract extraction has been performed, follow up care is identical after surgery and healing generally proceeds with no complications. With any cataract procedure, the surgical incisions are very small indeed. Stitches are often unnecessary. Healing within the eye generally should be fast and although vision at first may be blurry, it should begin to improve just a few days after the surgery.
Follow-up exams with the eye doctor normally begin the day after surgery. They will then be scheduled as necessary to ensure all is healing correctly. Driving may not be possible until healing has progressed sufficiently. During the recovery period, you should also avoid strenuous exercise, bending over, heavy lifting and any activities that would expose your eye to water, dust or other contaminants. You should also wear an eye shield or protective cover over the eye on the day of surgery and use dark glasses to protect the eye as it heals. An eye patch is also a good idea at night initially, so that the eye does not get rubbed accidentally as you sleep.
If cataract surgery is required in both eyes, the doctor will normally leave a few weeks to a month between surgeries. This allows the first eye to heal before the second cataract removal.
Normal side effects after surgery
Be prepared for some minor itching and scratchiness in the eye after cataract surgery. Eyedrops and medication will be prescribed which should minimize feelings of discomfort and prevent infection. Sensible precautions should be taken, including avoiding rubbing or pressing on the eye as it heals. Keep the eye clean and wash your hands before applying any eyedrops or medication to the eye. If the eyes have any type of discharge, carefully bathe the eyelids with clean water on cotton balls.
All side effects and discomfort should disappear after a week, although eye drops should be continued as prescribed by your eye doctor. Complete healing takes around eight weeks.
Abnormal side effects
Any of the following symptoms should be reported to your doctor immediately:
Pain which persists and is not improved by pain medications
Blurry vision or Vision loss
An increase in the redness of the eye
Flashes of light or floating spots in your vision
Nausea, vomiting or excessive coughing
Minor complications after cataract surgery
After cataract surgery, approximately 95% of patients end up with clear vision once again. However, there are some minor complications that can be fairly common and should resolve in a few weeks' time. These include:
Swelling of the cornea or the retina
Increased pressure in the eye
Posterior Capsule Opacity
While most cataract surgeries are successful, in some cases there might be a problem with cloudy or blurry vision after surgery. Sometimes referred to as a “secondary cataract,” “aftercataract” or “secondary membrane,” Posterior Capsule Opacity results when some epithelial cells are left behind during cataract removal. These cells then grow on the capsule (the membrane which the artificial lens is implanted in front of), creating a film which causes blurry vision.
To treat PCO, the surgeon will perform a YAG laser capsulotomy. This procedure is painless, performed in the doctor's office and takes only minutes. It's usually done with the patient fully alert, but people who are unable to keep still during the procedure, such as children and mentally disabled patients may need to be sedated.
The surgeon typically starts by dilating your pupils with eye drops, then, a YAG (yttrium-aluminum-garnet) laser is used to create a small hole in the capsule, allowing light to pass through. You may be asked to remain in the office for 1-2 hours, so that your intraocular pressure can be monitored, and you will likely be prescribed anti-inflammatory eye drops.
You should notice an improvement in your vision within a day of the procedure. There is usually no discomfort afterwards, though you may notice some floaters in your field of vision for the next few weeks.
There is a slightly increased risk of detached retina following this procedure; after standard cataract surgery, the risk of this serious complication is 1%, YAG laser capsulotomy raises that risk to 2%.
Dislocated or malplaced lenses In most cases, cataract surgery will restore vision and you'll barely even remember having had the procedure once the recovery period is complete. However, in some cases, the intraocular lens will become malpositioned or dislodged, causing you to see the edges of the lens or develop double vision in that eye.
During cataract surgery., the artificial lens is inserted into a structure in the eye called the capsular bag. This membrane is extremely thin and, even in the hands of the most skilled surgeon, may tear or rupture, making it difficult for the lens to be positioned properly. Also, it is possible for the bag itself to become dislocated, causing the lens to be dislocated as well. This is particularly likely if the fibers that hold the capsular bag in place are broken, a condition called zonular dialysis.
If dislocation does occur, a second surgery can be performed to reposition the lens. If the lens cannot simply be readjusted, it may need to be sewn in place, or a different type of lens may be required. This procedure is best done as soon as possible after the original surgery. By approximately 3 months after cataract surgery, the lens will be healed into place, and will be much more difficult for the surgeon to adjust or remove. If action is taken swiftly, the prognosis is very good.
Complications from medications and supplements
If you are taking the prescription drug Flomax, which is often prescribed for prostate problems, it is essential that you mention this to your cataract surgeon. This drug causes permanent changes in the muscle tone of the iris, which can lead to a complication during surgery called Floppy Iris Syndrome. The surgeon must be made aware of this possibility beforehand so that he or she can plan accordingly and take special precautions to avoid eye damage. In addition, patients who have taken Flomax face an increased risk of detached retina.
If you are planning to have cataract surgery in the future and are prescribed Flomax, you should discuss other options with your urologist (or primary care physician) and your eye doctor before you begin taking it.
Other drugs which can potentially cause Floppy Iris Syndrome are Uroxatrol, Hytrin, Cardura, Proscar and even the over the counter herbal supplement Saw Palmetto. It is critical that you discuss any and all medications and supplements you have taken with your surgeon prior to the procedure.
The use of eye glasses after cataract surgery
Depending on what type of intraocular lens you chose, you may need glasses after having had cataract surgery. Some people need them just for reading and close work, others to correct astigmatism, which may be caused by an uneven surface on the cornea. Astigmatism is a common problem after the removal of cataracts. The smaller the surgical, the less significant this problem is likely to be.
Obviously the eye must be completely healed before glasses are prescribed, when the sight has stabilized. Your doctor will tell you how long to wait before being measured for glasses. Typically between 2-4 weeks after surgery.