Cataract Surgery - Types, Recovery, Risks & Complications

What is Cataract

A cataract is a clouding or blurring of normally clear parts of the eye. Most cataracts develop due to ageing, injury, or radiation therapy. When proteins and fibers in your lens begin to break down and start to interfere with the light passing through your iris causing your vision to be blurry and hazy. Cataracts usually start in your peripheral vision and gradually make their way to the center. If left untreated, cataracts can cause complete loss of vision.

Types of Cataract

Different types of cataracts are classified based on where and how they develop in your eye. 

• Nuclear cataract: A nuclear cataract is an opacity or clouding that develops at the center of your lens, or the nucleus, and causes it to become yellow and sometimes brown. 
• Cortical cataract: Cataracts that affect the edges of the lens are referred to as cortical cataracts. They usually begin as whitish, wedge-shaped streaks on the outer edge of the lens but slowly start to make their way toward the center of the lens and interfere with the passing of light through it. 
• Posterior subcapsular cataract: Often referred to as PSC, these types of cataracts form faster than any other types of cataracts and affect the back of the lens. Symptoms of PSC include light sensitivity, glare, and decreased vision. 
• Congenital cataract: Unlike previously mentioned cataracts, congenital cataract is the clouding of the lens of the eye that is present at birth. These types of cataracts are not related to factors such as aging and are relatively rare. Surgery for these types of cataract usually happen as early as 6-8 weeks of age. 
• Traumatic cataracts: These types of cataracts develop after an injury to the eye that disrupts the lens fibers. 
• Radiation cataract: Radiation cataracts can develop after a person undergoes radiation therapy for cancer. However, symptoms of radiation cataracts can appear 1-2 years after exposure.

Why is Cataract Surgery Required?

While there can be multiple reasons behind a cataract, the majority of cases are related to ageing. Over time, cataracts become worse and start to interfere with our daily lives and activities. Normal tasks such as reading or driving can become increasingly difficult and if left untreated, cataracts can also cause complete loss of vision.

If you suffer from a cataract, it is recommended to undergo surgery before it can start to seriously impair your vision. If allowed to persist, cataracts can become hyper-mature in which case, they become significantly more difficult to treat and chances of complications either during or after the surgery are higher.
Preoperative Preparation

The following are prerequisites to be fulfilled before proceeding with cataract surgery:

• Examination: Before the cataract surgery, your ophthalmologist will perform a series of tests and examinations to assess your physical and medical condition. Your doctor will also measure the size and shape of your eye. This procedure helps in determining the right type of lens implant. 
• Food and medications: You may be instructed to not eat or drink anything for 12 hours before the surgery. Your doctor may also advise you to temporarily stop taking any blood thinning medications that could increase the risk of excessive bleeding during surgery.

Methods of Cataract Surgery

There are primarily 3 methods of cataract surgery: 

Phacoemulsification

Often referred to as phaco, phacoemulsification is one of the most commonly preferred and minimally invasive methods of cataract surgery. In this procedure, the surgeon makes very tiny incisions on the cornea. Once the incision has been made, the surgeon uses high-frequency ultrasonic waves to break the lens into tiny pieces. These tiny pieces are then removed through gentle suction and replaced by a specially designed implant called an Intraocular Lens (IOL). After the artificial lens has been placed, the surgeon closes the incision that was made in the beginning using a very tiny amount of saline. The saline swells the cornea slightly and as a result, closes the opening. The entire procedure is performed under local anesthesia and takes about 15-20 minutes. Your doctor may recommend eye drops to help with the recovery process. 

Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Femtosecond Laser Assisted Cataract Surgery or simply FLACS is one of the most medically advanced and minimally invasive procedures to treat cataracts. In this procedure, the clouded lens is removed through a small incision made in the cornea using a laser. Once the clouded lens is removed, it is replaced with a specially designed IOL. The procedure is usually performed under local anesthesia but your surgeon may use general anesthesia. The procedure takes 10-15 minutes and is performed on an outpatient basis meaning, you will be able to go home on the same day of surgery. 

Microincision Cataract Surgery (MICS)

MICS is an advanced technique for cataract surgery in which an incision less than 1.8 mm is made to be minimally invasive and quicker to heal as compared to procedures like FLACS or phacoemulsification. In this procedure, the lens is completely removed and replaced with a clear artificial lens. Any person with any grade of severity of cataract is suitable for this procedure. MICS is a highly sophisticated cataract procedure that demands high precision from surgeons but is also proven to have better results and minimal disruption of daily life. The entire procedure is performed under local anesthesia and takes about 10-15 minutes to be completed.

Post-operative care and recovery

Post-operative care after a cataract surgery is one of the most important elements of your surgical journey. Following is the complete timeline of your recovery process: 

• 1-3 days: In the first 24-72 hours after your cataract surgery, it is normal to feel mild pain, blurry vision, and redness around your eye. You may feel a strong compulsion to scratch or rub your eyes but you must refrain from doing so. After a couple of days, your surgeon may schedule a few eye examinations to ensure the implant is still in place and recommend some medications and eye drops if necessary. 
• 1-2 weeks: After 1-2 weeks of your cataract surgery, the previously mentioned side effects such as blurry vision, mild pain and redness should subside. You should feel the need to rub your eyes and you should be able to see clearly. If any of the side effects still persist or worsen, you should contact your optometrist as soon as possible. Your optometrist may schedule a second eye exam to determine if you still require eye drops. 
• 1 month and beyond: The recovery process after 1 month of your surgery is almost complete and your vision should return to normal. There should be no inflammation or pain around your eye. Your optometrist may schedule a final eye exam to make sure there are no abnormalities or complications with the IOL but generally, you can return to your normal lifestyle.

Do’s and Don'ts during recovery

You can support healing after cataract surgery by doing these things: 

• Getting plentiful sleep and rest
• Using eye drops as prescribed
• Wearing an eye shield when taking a bath
• Using sunglasses when going outdoors

After your cataract surgery, you should avoid these things: 

• Activities which put strain on your eyes like reading or driving
• Swimming pools and hot tubs
• Perform heavy lifting or strenuous exercises
• Rub or scratch your eyes
• Getting water in your eyes.