En español | Cataract surgery is widely viewed as a silver bullet. Those who've had it will gush about how it eliminates bothersome visual fog and night-time driving glare; adds crispness to their reading, and restores their vision to 100 percent of what it was before their cataracts developed — or even better.
And that is almost 100 percent true.
Some 4 million cataract procedures are done in this country each year and they are “overwhelmingly successful,” explains Christopher Starr, M.D., clinical spokesperson for the American Academy of Ophthalmology (AAO) and associate professor at Weill Cornell Medicine. One study showed that of 221,000 cataract surgery patients, 99.5 percent had no serious complications after their surgery. But, Starr warns, “It's real surgery...and with any surgery there are always potential risks.”
Patients should be aware of the common after-surgery side effects, as well as the rare complications that can occur. Early treatment can eliminate most of the problems.
Getting ready for surgery
Be sure to have a “preoperative evaluation” done, says Ravi Goel, M.D., clinical spokesperson for the AAO and ophthalmologist at Regional Eye Associates in Cherry Hill, New Jersey. Any pre-existing conditions you have, he says, such as diabetes, retinopathy, macular degeneration, glaucoma, are an important part of your pre-surgery evaluation and discussion. Also, Goel adds, if you are very near sighted, or have high myopia, or pathological myopia, these factors should be discussed.
Follow your physician's pre-surgery instructions meticulously, so you are fully prepared. That may include obtaining any medications you may need post-surgery.
The actual cataract surgery takes only about 20 minutes, is done under local anesthesia, and is painless. Typically, a prophylactic antibiotic and perhaps pressure-lowering drops or ointment will be put on your eye to help the healing start immediately, Goel says; and a patch or a shield will be placed over the eye.
After surgery, have the person who will drive you home listen to any additional instructions you're given, just in case you're a bit groggy, and don't catch everything.
Normal side effects
There will be some normal side effects related to the surgery itself, Starr explains. They will disappear within a day or two. You may experience one or more of these mild temporary symptoms:
- Discomfort in the eye
- Anesthesia residual effects, like grogginess, dizziness, or nausea
- Blurred vision
- Itchiness in the eye
- Redness in the white of the eye
- Dryness, irritation, or a feeling of grittiness in the eye
- Swelling in or around the eye
- Light sensitivity
- Visual halo effect
Rehydrate, eat and rest when you get home. The day after surgery you'll visit your doctor to have the patch or shield removed from the eye and be evaluated for any problems.
Symptoms that cause concern
"The sooner we get to any of the potential postoperative complications,” says Starr, “the better the outcome will be.” Early treatment, experts agree, can eliminate almost every problem.
If you have one of these symptoms, which are very rare, call your doctor immediately:
- A sudden decrease in vision
- Redness in or around the eye that persists after two days
- Continued sensitivity to light
- Discharge from the eye
- Pain that continues
- Fever, nausea or vomiting
- Sudden increase in floaters, or flashing lights
- A shadow in your peripheral vision; a shade appearing in your field of vision; or dark spots
It's important to note that when complications do occur, most can be immediately and successfully treated with medication, or an additional procedure.
Potential (and, again, rare) complications include:
Eye inflammation. This usually occurs if you had large or dense cataracts. Your vision continues to be foggy or blurred. This is easily treated with anti-inflammatory eye drops, which will reduce the swelling within a few days or a week.
Light sensitivity. When it continues, it can be due to dryness or inflammation; extreme light sensitivity can be a sign of infection, or a condition called iritis (inflammation of the iris), which can be treated with steroid eye drops. For some people, wearing sunglasses for a few months is helpful.
Photopsia. Photopsia, or seeing flashes of light or floaters, is caused when the gel inside the eye separates from the retina. This is a natural process, and symptoms usually disappear within a few months. In extreme cases, a surgery that replaces the gel, a vitrectomy, can remove these floating cells.
Macular edema. This is caused by a buildup of fluid in the macula, the center part of the retina at the back of the eye. It can be successfully treated with medication and diet, but may take a few months to resolve. It must be closely monitored by your doctor.
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Ptosis. Otherwise known as droopy eyelid, ptosis can be the result of the trauma of surgery, and disappears within a few days or weeks. Very rarely, the condition requires surgery.
Intraocular lens dislocation. This occurs if the new (intraocular) lens implant isn't correctly seated in the capsular bag of the eye, which holds it in place; or it becomes dislocated. Symptoms can be double vision, or even seeing the edge of the lens. This rarely happens, but immediate surgery to correct it is necessary for a good outcome. (Studies conclude that this occurs in only 0.1 percent of patients.)
Post-operative interocular Infection. Endophthalmitis, as it's known, can develop, Starr says, even though every precaution has been taken to make your surgery completely sterile. This infection is very serious, and needs to be treated with antibiotics as soon as it is detected.
Posterior capsule opacification (PCO). PCO occurs when the back of the lens capsular bag becomes cloudy. Although sometimes referred to as a second cataract, it is not. Once your cataract is removed, it does not regrow. In some cases, a PCO may occur because a few of the old cataract cells are not removed during the surgery. (Studies show that this occurs in 11.8 percent of patients at one year after surgery; 20.7 percent at three years; and 28.4 percent at five years.) A simple YAG laser procedure, which takes minutes in your doctor's office, can remove this haze. A prescription of anti-inflammatory eye drops should then be used.
Torn or detached retina. This is more likely to occur in younger patients, and is the result of the retina pulling away from the back of the eye. Symptoms of this condition can be a curtain or shade over your vision, new floaters appearing, or flashes of light. Immediate surgery to repair the tear, or reattach the retina, is necessary to restore vision.
Botton line: There's low risk and high rewards with cataract surgery, but avoiding even the slightest chance of a problem by carefully selecting a qualified eye surgeon, following instructions, and reporting any symptoms of a potential problem will ensure that you have the best outcome possible.
Sandra Lamb is a freelance journalist and author of books on writing, including How to Write It: A Complete Guide to Everything You'll Ever Write.