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Cataract Surgery: A Q&A with Drexel Ophthalmologist Dr. Williamson

Elderly man examined by an ophthalmologist

According to the National Eye Institute (NEI), the risk of developing a cataract increases with each decade of life starting at about age 40. By age 75, half of all white Americans have cataracts, which increases to 70% by age 80. In comparison, 53% of blacks and 61% of Hispanic Americans have cataracts by age 80. By 2050, the number of people in the U.S. with cataracts is expected to double from 24.4 million (in 2010) to about 50 million. While cataracts are a natural part of the aging process, they may begin to affect daily activities, such as reading and driving. Drexel Ophthalmologist Kelly A. Williamson, MD, who specializes in cataract surgery, answers some common questions and explains when it might be time to have surgery.

What is a cataract and what causes it?

Inside our eyes, there is a crystalline lens that helps light to focus on our retina and provide a clear image for the brain. When we are young, our lenses are usually crystal clear. A cataract is when the natural lens in a patient’s eye becomes cloudy or opacified. This essentially blurs the "window" that light passes through to reach the back of our eyes, resulting in blurry vision and/or glare. The most common type of cataract is simply the result of aging, but UV light, smoking, injury to the eye, previous eye surgery, certain medications (such as steroids) and certain medical conditions (such as diabetes), have also been found to increase the risk of cataract formation. Less commonly, some people are born with cataracts, and these may need to be removed in infancy if they are large enough. But in the majority of cases, a cataract is just a natural part of the aging process of the eye.

Are there other ways besides surgery to treat cataracts?

Many patients have cataracts that do not require any treatment other than possibly a new glasses prescription to maximize their vision. Cataracts may be present for years without a need for surgery. Currently, however, there are no medications or drops that are approved for the treatment of cataracts, and surgery is the primary method of treating this condition.

When is it necessary to have cataract surgery?

Ophthalmologist making incision during cataract surgery

Cataract surgery is an elective procedure, which means it is not an emergency, and it is rarely urgent to remove a cataract. We usually decide to perform cataract surgery when a patient tells us that they can no longer perform their normal daily activities, such as driving or reading, because of their poor vision. For some people, like airline pilots or those who drive for a living, this time may come earlier when a cataract is still moderately small. Other patients may be able to wait longer before a cataract becomes bothersome. But surgery is typically done when a patient finds that the blurring of their vision or glare is something they can no longer live with, and glasses can no longer correct their vision to an acceptable level to function in their daily life.

What does a patient need to do to prepare for cataract surgery?

Once a patient has decided to have cataract surgery, they need to ensure that they follow up with any scheduled physical examinations that may be necessary to make sure they are medically healthy enough for anesthesia. They should also make sure that there is a friend or family member who can accompany them to the surgery, as we do not allow patients who have received anesthesia to go home alone. Patients should also make plans to take time off from certain physical activities and work if necessary – the need for time off depends on the type of job or activity they do, so this is an important discussion to have with their doctor in advance. Finally, the patient should have a discussion with their surgeon about the different options for lens implants available for their cataract surgery, as there are several options and some may not be covered by their insurance benefits.

What is cataract surgery like?

Cataract surgery is typically performed under "MAC" or "twilight" anesthesia, which means that your eye is numbed with drops and/or gels and medications are given to you through an IV that will keep you calm and comfortable. Some doctors also inject medications around the eye to provide numbing. Your eye will be cleaned to ensure it is sterile, and a sterile drape will be placed over your face to keep the operating field free of bacteria. During surgery, you will simply rest on your back and look up into a bright light while the doctor operates.

Cataract surgery can be very quick and can usually be completed within about 15 minutes. Some patients may have more complex or difficult cataracts, and these can take a little longer. During surgery you may be able to feel water and some pressure on your eye, and you will see lights and hear noises. You may even hear your doctor talking, and they may give you instructions on where to look during surgery. The surgeon will use an ultrasound machine to remove the cataract from your eye, and an artificial lens implant will then be inserted to help your eye focus light. Cataract surgery usually does not require any stitches as the wounds are self-sealing. Most patients find that the process is quick, easy, and comfortable. Many patients will feel a scratchy feeling or soreness in their eye after surgery, but pain is not common afterward.

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What does the patient need to do to recover from cataract surgery?

Your vision will often be very good even the first day after surgery, but for some people it may take a few days to clear up completely. We often ask that patients do not do any heavy lifting, bending or strenuous physical activity for about 10 days after surgery to avoid stress on the surgical wounds. We also advise patients to avoid getting water in their eye, which may require a different method of showering or washing for the first 1-2 weeks after surgery. Low-impact activity, however, is acceptable in the period after surgery. You should talk with your doctor about specific work or leisure activities that may need to be avoided after surgery.

Are there any common risks or complications following cataract surgery?

Even with our best preparations, some patients will still need a small prescription for glasses to achieve their clearest vision at distance and/or near after cataract surgery. It is also common for patients to develop an "after-cataract" in the months to years after surgery. This is not actually a recurrence of a cataract, but rather a clouding of the capsule that is holding the lens implant inside the eye. Surgeons can fix this with a quick and painless in-office laser procedure. Some patients may develop swelling of the front or back of the eye after surgery, which may take weeks to months to fully clear up. Your doctor will let you know you before surgery if you are higher risk for this to happen and may take extra steps during or after surgery to reduce the chance of this happening. It is important to talk about all of the possible risks and complications with your doctor before surgery, so that you are making an informed decision to have the procedure.


Related Physician

Kelly A. Williamson, MD

Kelly A. Williamson, MD
Title: Faculty
Practice: Drexel Eye Physicians
Specialty: Ophthalmology


The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

 
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