Cataract Surgery Procedures – Step-by-step – Risks and Costs
Guidelines for patients interested in cataract surgery
Surgery is the only effective method to treat cataracts nowadays. It is widely regarded as safe and reliable. In fact, it is the most frequently performed surgical procedure in the world. During the operation, the natural clouded lens is permanently replaced with a very small artificial lens – a so-called intraocular lens (IOL). This procedure is well-established and constantly evolving with new technology: for example, new types of intraocular lenses, and more precise devices for diagnosis and imaging.
Cataract removal has very good and sustainable results. Most people’s sight improves soon after surgery. However, as with each surgical procedure, you should keep a few things in mind. Read through the following sections to learn more about the process of cataract surgery and what happens during each step of the procedure.
Cataract Surgery explained
With cataracts, the crystalline lens of the eye becomes gradually clouded, causing impaired vision. The cloudy lens needs to be removed and replaced by an artificial intraocular lens to restore vision. Watch the video to learn about the changes in the natural lens and the process of cataract surgery.
Undergoing Cataract Surgery
What happens during treatment
Cataract surgery has proven to be a safe and effective treatment method for many years. As the most common surgical procedure in the world, it is a routine treatment usually performed on an out-patient basis. It takes between 15 to 30 minutes. The surgery is performed on one eye at a time. The second eye if also affected by cataract is usually treated a few days to a few weeks later. However, it becomes more and more common to treat both eyes in one procedure, at the same day.
Here is a step-by-step guide to everything that occurs before and during the process: from preparations at home to walking out of the operating room.
Preparations on the day of the operation
On the day of your operation, there are few things you should keep in mind:
- Do not wear any lotion, make-up, after-shave, or perfume.
- Wear normal and relaxing clothes.
- Eat a light meal no later than five hours before the procedure and stay hydrated to ensure a stable circulation for the procedure.
- Arrange for transportation afterwards.
You will be brought into the operation room lying on a surgical bed during your appointment. The procedure generally does not require sutures, which aids a quicker recovery. You will be allowed to go home after a short observation period on the day of the surgery.
Steps of Cataract Surgery
What to expect
Firstly, a few days or weeks prior to the surgery, the eye is precisely measured to calculate the correct power that is needed for the intraocular lens.
Directly before the procedure, you will be given an injection, or drops of anaesthesia, to numb the eye and to ensure the process is painless. An eyelid holder is used to prevent you from blinking during surgery. Furthermore, your eyelids and the surrounding skin will be disinfected.
3. Incision of the Cornea
4. Protection of the Inner Eye
To protect intraocular structures and create space for surgical tools a jelly-like substance called “Ophthalmic Viscosurgical Device” (OVD) is injected in the eye. OVDs protect the corneal endothelium and other tissues during surgery by minimizing the interaction between tissues and instruments.
5. Opening the Capsular Bag
With a thin scalpel, the surgeon creates a small opening in the capsular bag, where the natural lens is located.
The cataract lens is softened and broken apart using a small high-frequency ultrasound device called a ‘phaco tip’. It is removed, using gentle suction. This step is called phacoemulsification.
7. IOL Insertion
The intraocular lens is then carefully positioned in the capsular bag where the original lens was located before. The incisions heal by themselves.
8. Post-Operative Eye Protection
The surgeon will place a protective patch over your eye.
After the Procedure
What to expect after cataract surgery
First Steps After Surgery
- Get someone to drive you home afterwards.
- Try to take a long nap after to keep your eyes closed and rested.
- Resist the urge to rub your eyes if they feel itchy.
- If you are feeling any discomfort or slight pain, ask your doctor for eye drops or an over-the-counter mild pain reliever.
- Explain your symptoms to your doctor during the follow-up visit.
Right After Surgery
Relaxation for a Quick Recovery
- a strong pain in your eye
- a re-appearing redness in your eye
- unusual headache or nausea
- considerable vision deterioration
- light flashes, or huge increase of floaters in your vision
Cataract Surgery Complications
Potential risks and side effects
Surgery is a proven and established procedure and considered to be safe and less stressful for the body. Most patients decide to undergo cataract surgery for the following reasons:
- Improved vision.
- Increased mobility and independence.
- Relief from the fear of going blind.
Like all surgeries, however, it is not completely free of risks and side effects. Your ophthalmologist can explain all the possible risks and decide whether you are eligible for cataract surgery.
General Risks and Complications
Infections and Minor Complications
- Increased pressure in the eye.
- Droopy eyelid.
Minor complications usually clear up with medication and more healing time. Be sure to report any change to your ophthalmologist immediately. He or she can monitor the healing process and see if you need any medication.
Light Phenomena After Surgery
Some patients may experience some visual phenomena like glare or halos right after cataract surgery, especially in poor lighting conditions. Halos are bright circles that surround a light source, like headlights. Glare, on the other hand, is light that enters your eye interfering with your vision, and is more likely to appear in the daytime.
This occurs, for example, when driving at night or when there’s artificial light in the dark. These phenomena typically diminish a few weeks to a few months post-procedure, because the brain automatically adapts to the intraocular lens and compensates for it. Most patients do not feel disturbed by the light phenomena.
Consult your ophthalmologist for a check-up if you notice light phenomena even after the healing process has finished.
Posterior Capsule Opacification
A posterior capsule opacity (PCO) is one of the most common cataract surgery complications. It is a result of the growth and proliferation of lens epithelial cells on the capsule during surgery. These cells can migrate to the posterior capsule, where they approach the visual axis, and may cause a dimness of vision. Although some people call PCO a “secondary cataract,” it isn’t. Once a cataract is removed, it does not come back.
Fortunately, a PCO can easily be treated with a YAG laser (a special type of laser using a YAG-crystal and commonly applied in the medicine). Your ophthalmologist can perform this procedure in his practice. It is very effective, painless and takes only a few minutes.
Most people can expect their vision to improve within a day. If you are struggling with continuous bad vision after your IOL operation, contact your ophthalmologist to discuss the next possible steps together.
Costs of Cataract Surgery
What role should the price play?
If you’re considering correcting your vision, please keep in mind that there is no standard price for cataract surgery. The prices may differ considerably depending on different factors. While you might find the prices daunting at first, remember this is most likely a one-time investment in your vision and more importantly, it is probably covered by your health insurance.
Does My Health Insurance Cover the Surgery?
Whether your health insurance covers the costs of your cataract surgery varies on the individual provider, country or regional system. Often, basic cataract surgery is considered necessary from a medical point of view and is therefore covered by healthcare plans. If you plan to have a presbyopia-correcting IOL on the other hand, you should discuss with your health insurance whether they pay for that “premium package” or not.
Speak with your doctor and health insurance company to weigh your options. Some doctors also offer a payment plan to make cataract surgery more affordable.
Cost factors to Consider
- Treatment procedure.
- The type of intraocular lens used.
- Pre- and after care.
- Services included.
A face-to-face consultation or personally calling the clinic is recommended, if you have questions regarding prices. If you meet with an ophthalmologist or clinic representative, you can also ask whether the price covers just one eye or both, which examinations are included, and which extra services are being offered.
Factors to Consider When Choosing a Clinic
Everyone ranks what they find important regarding cataract surgery differently. Some patients prefer clinics that are nearby, others prioritize an earlier date. Many patients however, consider and search for the factors below when looking for a clinic:
- Specialty: The focus of the clinic and the specific qualifications and training of the surgeon.
- Experience: The total number of operations performed.
- Availability: The option of meeting a potential doctor at your consultations, immediately before surgery and his or her flexibility (e.g. appointments in the evening if you are employed).
- Offerings: Which types of intraocular lenses are offered and if you can find one that is right for you.
- Relationship: Whether you feel comfortable with the doctor and the answers you get to your questions.
- Price: Whether it includes pre- and post-treatment care and to what extent.
- Recommendations: Whether the clinic has good reviews and is recommended by doctors or patients.
- Location: The distance from the place you live may increase the general costs by additional travel and hotel expenses. Depending on the region or country you live, the health care insurance pays completely or a part of the treatment.