Cataract Surgery

The basic operation to remove a cataract is a process called phacoemulsification/extracapsular cataract extraction. This technique involves making a small incision where the cornea, the clear layer covering the lens, and the sclera, the white of the eye, meet. Through this incision, two of the three structures of the lens -- the hard nucleus and the soft cortex -- are removed. The last structure, the lens capsule, is left in the eye to support the intraocular lens implant.

A relatively recent modification of the extracapsular cataract extraction technique is phacoemulsification. An ultrasonic probe is inserted into the incision and used to break up the nucleus and cortex tissue, where it is suctioned out by the probe. The major advantage to phacoemulsification is it allows the surgeon to remove the tissue through a smaller incision.

After the clouded lens tissue has been removed, the surgeon usually places a synthetic implanted lens, known as an intraocular lens (IOL), into the eye. The same incision where the lens tissue was removed is used to place the IOL in the eye. Lenses have been developed that can fold, so small incisions such as those used in the phacoemulsification process do not necessarily need to be enlarged. Implanted lenses are often preferred over cataract glasses or contacts, two other ways to replace the function of the removed lens, as they provide superior vision results and have less maintenance concerns.

Cataract surgery is a highly successful treatment, with outcome eyesight between 20/20 and 20/40 for 90% of the procedures. In about 50% of all treated patients, several months to a year after the procedure the capsule of the lens will become clouded also know as "secondary cataracts". A recent study suggested that the type of material used in the intraocular lens may be associated with more or less development of this complication, and this is something that should be discussed with your ophthalmologist.

If the "secondary cataract" develops can be treated using a procedure called a YAG capsulotomy. This procedure involves using a laser to clear a hole through the damaged capsule tissue for light to enter the eye. This post-operative treatment is the only current use for a laser in cataract surgery, although research into the use of a laser to remove the lens tissue is ongoing.

The following complications can result from cataract surgery: high pressure in the eye (glaucoma); blood collection inside the eye; infection inside the eye; artificial lens damage or dislocation; drooping eyelid; retinal detachment; severe bleeding inside the eye; swelling or clouding of the cornea; blindness; and loss of the eye. Note that these risks are sorted from most common to least common and most have medicinal or surgical treatments.

Cataract extraction is most successful if the damaged lens is the sole vision problem in the eye. If other damage is present, particularly if due to a continuing condition, such as diabetes, vision can remain compromised even after the cataract is removed. However, if the vision quality is improved, it may make sense to undergo the procedure despite the knowledge that the resulting vision will not be perfect.

The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

Surgery charges for an outpatient procedure can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charge for the operating room, 4) the medications, and 5) additional charges.

• Surgeon's fee: variable
• Anesthesiologist's fee: averages $350 to $400 per hour
• Hospital charges: variable
• Medication charges: $200 to $400
• Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.

1. Do I need surgery right away?
2. If not, how long can I wait?
3. What are my personal risks?
4. What benefits can I expect?
5. If I choose surgery, which type is best for me?
6. Which type of lens replacement is best for me?
7. What are the chances of developing cloudiness in the lens capsule after cataract surgery?
8. What are the benefits and risks of YAG capsulotomy?
9. Do you offer patient financing?

• Tell your doctor about any medical conditions you have and any medications that you are taking. Include any self-prescribed medications that your are taking, such as herbs or other natural remedies.
• Carefully follow the doctor's instructions regarding the use of eye drops and shields after the surgery.
• Arrange for someone to drive you home after the surgery.

The information on this web site is intended only as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

• The art of Choosing an Eye Care Specialist

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