How are cataracts evaluated preoperatively?

Evaluation of cataracts includes a discussion of symptoms, visual needs, and a complete eye exam. Once the need for surgery has been established, the eyes are measured with an ultrasonic (sound wave) or optical device to determine the strength of the intraocular lens needed to restore good uncorrected vision. If both eyes need cataract surgery, the procedures are scheduled on separate days as a safety precaution.

What is the procedure for cataract surgery?

Cataract surgery is performed as an outpatient procedure (you come in and go home the same day) in an ambulatory surgical center. The procedure takes about~15-20 minutes.

The surgical eye is dilated with eye drops. In most cases, eye drops alone will be used to numb the eye. Local anesthesia, supplemented with intravenous sedation, may also be used. An anesthesiologist or anesthetist is present during the surgery to monitor vital signs and administer any medications needed to make you comfortable. A feeling of pressure may be noted, but there is no pain during the procedure.

A microscope is positioned and an eyelid holder is placed between the eyelids to prevent blinking during the surgical procedure. Two small incisions are made on the edge of the cornea. The central, front portion of the lens capsule is removed and saline solution is used to separate the cataract layers. A probe is inserted, which bathes the eye with cooling fluid, applies high frequency ultrasound energy to emulsify (liquiefy) the cataract, and provides gentle suction to remove the emulsified particles. This process is known as phacoemulsification.

An intra-ocular lens (IOL) is then folded, inserted through one of the incisions, and unfolded into its permanent position. The normal pressure of the eye seals the small incisions, which usually require no stitches. Because of the small size and shape of the incisions, healing and stabilization occur very quickly. A mild foreign-body sensation may be perceived when the anesthetic drops wear off. This may last for several days.

Laser cataract surgery is also an option, and is a standard procedure used with premium lens cataract surgery. To learn more about laser cataract surgery, click here.

What are the lens options for cataract surgery?

Many different types of intraocular lenses (‘implants’ or ‘IOL’s) are available now, with new implant types in development. The choice of implant depends on factors such as astigmatism, pupil size, anatomical considerations, presence of retinal disease, and your desires. Your doctor will discuss the implant recommended for you at your visit. 

A brief overview of different IOL options is listed below:

  • Monofocal implants: provide a clear image at a single focal point. Most patients elect to use a monofocal lens to achieve the best distance vision possible, and use glasses to correct any remaining astigmatism, and for reading. These intraocular lenses are included in the procedure and therefore are covered by insurance.
  • Premium Lenses: These optional upgrades involve additional cost, but can provide greater freedom from glasses for many activities.
    • Toric (astigmatism correcting) implants: provide clear distance vision (without the need for glasses) and correct astigmatism. Reading glasses are needed. 
    • Multifocal implants: provide a range of vision including distance, intermediate, and near while also correcting astigmatism, so you no longer need to wear prescription eyeglasses for day-to-day tasks.

Does cataract surgery ever have to be repeated?

Generally, cataract surgery is only performed once. Despite careful measurements and techniques, sometimes the desired outcome is not achieved and additional procedures may be required. Options include replacing the IOL with a different power, replacing the IOL with a different IOL style, and refractive surgery to fine-tune the focus.

How is the recovery after cataract surgery?

Eye drops are used for several weeks to help prevent infection and control inflammation. Post-operative examinations are usually scheduled within 1 day, at 1 week, and at 1 month. It is important not to rub or bump the eye and to use protective eyewear when engaged in any activity which may cause eye injury. Swimming or diving underwater should be avoided for at two weeks.

Most patients return to their normal routine immediately. While everyone heals at a different rate, many patients note significant improvement in their vision right away. Depending on the rate of healing and visual needs, corrective lenses may be prescribed from between one and six weeks after surgery.

Why Dr. Fuerst?

Dr. David Fuerst and Dr. Nicole Fuerst have extensive experience performing cataract and refractive surgery. Our doctors are certified to use all of the currently FDA-approved multifocal IOLs, so they can use the lens that makes the most sense for each individual patient. They are also experienced in the performance of astigmatic corneal surgery. Our doctors utilize the latest diagnostic and treatment technology to optimize surgical outcomes.

What are the risks of cataract surgery?

Cataract surgery is highly successful. Significant, sight-threatening complications are rare. These include intraocular infection (endophthalmitis), retinal detachment, corneal edema (swelling), retinal edema (swelling), and hemorrhage. Additional surgery may be necessary to correct implant power miscalculations, reposition a displaced implant, or remove retained cataract particles. Symptoms of glare, haloes, double vision, and ghost images may occur. Abnormalities of pupil size, shape, or function may rarely result from cataract surgery.

What does cataract surgery cost?

Medicare and private insurance companies cover cataract surgery. An additional charge is made for a premium IOL. This charge includes the cost of the lens itself and the additional testing and follow-up which this new technology requires. It also includes most costs associated with additional procedures required to optimize the results of the surgery (replacement of the lens, astigmatism adjustments, LASIK touch-ups) if required.

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