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Cataract removal

Cataract extraction; Cataract surgery

Cataract removal is surgery to remove a clouded lens (cataract) from the eye. Cataracts are removed to help you see better. The procedure almost always includes placing an artificial lens in the eye.

Description

Cataract surgery is an outpatient procedure. This means you likely do not have to stay overnight at a hospital. The surgery is performed by an ophthalmologist. This is a medical doctor who specializes in eye diseases and eye surgery.

Adults are usually awake for the procedure. Numbing medicine (local anesthesia) is given using eyedrops or a shot to block pain. You will also get medicine to help you relax. Children usually receive general anesthesia. This is medicine that puts them into a deep sleep so that they are unable to feel pain.

Your doctor uses a special microscope to view the eye. A small cut (incision) is made in the eye.

The lens is removed in one of the following ways, depending on the type of cataract:

  • Phacoemulsification: With this procedure, your doctor uses a tool that produces sound waves to break up the cataract into small pieces. The pieces are then suctioned out. This procedure uses a very small incision.
  • Extracapsular extraction: Your doctor uses a small tool to remove the cataract in mostly one piece. This procedure uses a larger incision.
  • Laser surgery: Your doctor guides a machine that uses laser energy to make the incisions and soften the cataract. The rest of the surgery is much like phacoemulsification. Using the laser instead of a knife (scalpel) may speed recovery and be more accurate.

After the cataract is removed, a manmade lens, called an intraocular lens (IOL), is usually placed into the eye to restore the focusing power of the old lens (cataract). It helps improve your vision. Depending on the power of the IOL and the type implanted, glasses may not be needed after surgery.

Your doctor may close the incision with very small stitches. Usually, a self-sealing (sutureless) method is used. If you have stitches, they may need to be removed later.

The surgery lasts less than half an hour. Most times, just one eye is done. If you have cataracts in both eyes, your doctor may suggest waiting at least 1 to 2 weeks between each surgery. Recently, some health systems have performed surgery in both eyes, just minutes apart.

Why the Procedure Is Performed

The normal lens of the eye is clear (transparent). As a cataract develops, the lens becomes cloudy. This blocks light from entering your eye. Without enough light, you cannot see as clearly.

Cataracts are painless. They are most often seen in older adults. Sometimes, children are born with them. Cataract surgery is usually done if you cannot see well enough because of cataracts. Cataracts usually do not permanently damage your eye, so you and your eye doctor can decide when surgery is right for you.

Risks

In rare cases, the entire lens cannot be removed. If this happens, a procedure to remove all of the lens fragments will be done at a later time. Afterward, vision can still be improved.

Very rare complications can include infection and bleeding. This can lead to permanent vision problems.

Before the Procedure

Before surgery, you will have a complete eye exam and eye tests by the ophthalmologist.

Your doctor will use ultrasound or a laser scanning device to measure your eye. These tests help determine the best IOL for you. Usually, your doctor will try to choose an IOL that can allow you to see without glasses or contact lenses after surgery. Some IOLs give you both distance and near vision, but they are not for everyone. Ask your doctor which one is best for you. Be sure you understand what your vision will be like after the IOL is implanted. Also, be sure to ask questions so that you will know what to expect of the surgery.

Your doctor may prescribe eyedrops before the surgery. Follow instructions exactly on how to use the drops.

After the Procedure

Before you go home, you may receive the following:

  • A patch to wear over your eye until the follow-up exam
  • Eyedrops to prevent infection, treat inflammation, and help with healing

Sometimes, your doctor will give an injection at the end of the surgery so you won't need to put drops in.

You will need to have someone drive you home after surgery.

You will usually have a follow-up exam with your doctor the next day. If you had stitches, you will need to make an appointment to have them removed.

Tips for recovering after cataract surgery:

  • Wear dark sunglasses outside after you remove the patch.
  • Wash your hands well before and after using eyedrops and touching your eye. Try not to get soap and water in your eye when you are bathing or showering for the first few days.
  • Light activities are best as you recover. Check with your doctor before doing any strenuous activity, resuming sexual activity, or driving.

Recovery takes about 2 weeks. If you need new glasses or contact lenses, you can usually have them fitted at that time. Keep your follow-up visit with your doctor.

Outlook (Prognosis)

Most people do well and recover quickly after cataract surgery.

If a person has other eye problems, such as glaucoma or macular degeneration, the surgery may be more difficult or the outcome may not be as good.

Open References

References

American Academy of Ophthalmology website. Cataract /Anterior Segment Summary Benchmark - 2022, AAO PPP Cataract and Anterior Segment Panel, Hoskins Center for Quality Eye Care. www.aao.org/summary-benchmark-detail/cataract-anterior-segment-summary-benchmark-2020. Updated December 2022. Accessed August 3, 2023.

American Academy of Ophthalmology website. Preferred Practice Patterns. AAO PPP Cataract and Anterior Segment Panel, Hoskins Center for Quality Eye Care. Cataract in the adult eye PPP - 2021. www.aao.org/preferred-practice-pattern/cataract-in-adult-eye-ppp-2021-in-press. Updated November 2021. Accessed August 7, 2023.

Lacy M, Kung TPH, Owen JP, et al. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the Intelligent Research in Sight (IRIS) Registry Data. Ophthalmology. 2022;129(2):129-138. PMID: 34265315 pubmed.ncbi.nlm.nih.gov/34265315/.

Salmon JF. Lens. In: Salmon JF, ed. Kanski's Clinical Ophthalmology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 10.

Shorstein NH, Liu L, Carolan JA, Herrinton L. Endophthalmitis prophylaxis failures in patients injected with intracameral antibiotic during cataract surgery. Am J Ophthalmol. 2021;227:166-172. PMID: 33571472 pubmed.ncbi.nlm.nih.gov/33571472/.

  • Cataracts

    Cataracts

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    •  

    Cataracts - Animation

    Many of us take for granted that, when we open our eyes each morning, we'll have a pretty clear view of the world. But as we get older, we often have trouble seeing as well as we used to. By the time you're 75, there's a pretty good chance you'll develop cataracts. Having cataracts is kind of like seeing through a blurry, hazy cloud. Let's talk today about cataracts. Normally the lens of your eye is clear. It works much like the lens on a camera. When light hits the lens, it focuses an image on the back of your eye. Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away. As we age, proteins in the lens begin to break down and the lens then becomes cloudy. A cataract is like having a cloud pass over your lens. Only, that cloud never moves on. Cataracts are common after the age of 60. But some people are more likely than others to get them than others; including those with diabetes, and people who smoke or who had surgery for another eye problem. You're also more likely to get cataracts if you don't wear sunglasses outside and your eyes are exposed to a lot of damaging ultraviolet light from the sun. People with a family history of cataracts are also at greater risk. And, sometimes, doctors can't even find any cause for them. When you have a cataract, the world looks blurry or fuzzy. You have trouble making out shapes, and colors aren't as rich as usual. You may not notice much of a change in your vision at first. For minor vision loss, you can compensate by changing your eyeglass prescription and using brighter lights to read or work. But eventually, the cataract will block more and more of your sight. And then you'll need surgery to have it removed and replaced your lens with a nice new artificial one. Often cataract surgery can restore 20/20 vision, especially in people who don't have other eye diseases. You may be able to live with your cataracts; at least, for a while. Even if your vision isn't bothering you however, keep in touch with your eye doctor. Letting a cataract go for too long can lead to other problems, including a certain type of glaucoma. If you can't see as well as you used to, get an eye exam. To protect your eyes, treat diseases like diabetes, which can cause cataracts. And always wear a good pair of sunglasses outside to shield your eyes from the ultraviolet damage from the sun.

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    Slit-lamp exam

    illustration

  • Cataract - close-up of the eye

    Cataract - close-up of the eye - illustration

    This photograph shows a cloudy white lens (cataract) as seen through the pupil. Cataracts are a leading cause of decreased vision in older adults, but children may have congenital cataracts. With surgery, the cataract can be removed, a new lens implanted, and the person can usually return home the same day.

    Cataract - close-up of the eye

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  • Cataract

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    The lens of an eye is normally clear. If the lens becomes cloudy (opacified) it is called a cataract.

    Cataract

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    Cataract surgery - series - Normal anatomy Indications Procedure, part 1 Procedure, part 2 Aftercare
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    Eye shield

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  • Cataracts

    Cataracts

    Animation

    •  

    Cataracts - Animation

    Many of us take for granted that, when we open our eyes each morning, we'll have a pretty clear view of the world. But as we get older, we often have trouble seeing as well as we used to. By the time you're 75, there's a pretty good chance you'll develop cataracts. Having cataracts is kind of like seeing through a blurry, hazy cloud. Let's talk today about cataracts. Normally the lens of your eye is clear. It works much like the lens on a camera. When light hits the lens, it focuses an image on the back of your eye. Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away. As we age, proteins in the lens begin to break down and the lens then becomes cloudy. A cataract is like having a cloud pass over your lens. Only, that cloud never moves on. Cataracts are common after the age of 60. But some people are more likely than others to get them than others; including those with diabetes, and people who smoke or who had surgery for another eye problem. You're also more likely to get cataracts if you don't wear sunglasses outside and your eyes are exposed to a lot of damaging ultraviolet light from the sun. People with a family history of cataracts are also at greater risk. And, sometimes, doctors can't even find any cause for them. When you have a cataract, the world looks blurry or fuzzy. You have trouble making out shapes, and colors aren't as rich as usual. You may not notice much of a change in your vision at first. For minor vision loss, you can compensate by changing your eyeglass prescription and using brighter lights to read or work. But eventually, the cataract will block more and more of your sight. And then you'll need surgery to have it removed and replaced your lens with a nice new artificial one. Often cataract surgery can restore 20/20 vision, especially in people who don't have other eye diseases. You may be able to live with your cataracts; at least, for a while. Even if your vision isn't bothering you however, keep in touch with your eye doctor. Letting a cataract go for too long can lead to other problems, including a certain type of glaucoma. If you can't see as well as you used to, get an eye exam. To protect your eyes, treat diseases like diabetes, which can cause cataracts. And always wear a good pair of sunglasses outside to shield your eyes from the ultraviolet damage from the sun.

  • Eye

    Eye - illustration

    The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer (sclera, or white of the eye, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (retina) is sensory nerve tissue that is light sensitive. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

    Eye

    illustration

  • Slit-lamp exam

    Slit-lamp exam - illustration

    A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.

    Slit-lamp exam

    illustration

  • Cataract - close-up of the eye

    Cataract - close-up of the eye - illustration

    This photograph shows a cloudy white lens (cataract) as seen through the pupil. Cataracts are a leading cause of decreased vision in older adults, but children may have congenital cataracts. With surgery, the cataract can be removed, a new lens implanted, and the person can usually return home the same day.

    Cataract - close-up of the eye

    illustration

  • Cataract

    Cataract - illustration

    The lens of an eye is normally clear. If the lens becomes cloudy (opacified) it is called a cataract.

    Cataract

    illustration

  •   right hand presentation - Cataract surgery - series - Normal anatomy

    Cataract surgery - series - Normal anatomy

    Presentation

    •  
    Cataract surgery - series - Normal anatomy Indications Procedure, part 1 Procedure, part 2 Aftercare
  • Eye shield

    Eye shield - illustration

    An eye shield helps prevent rubbing or pressure on the eye until it has healed. Eye shields are commonly used after surgical procedures on the eye, including LASIK and cataract surgery.

    Eye shield

    illustration

 

Review Date: 8/4/2023

Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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