Cataract Surgery

A cataract is a cloudiness that develops in the lens of the eye. The lens, about the size of an aspirin, is the transparent fine focusing part of the eye located behind the pupil. It is comprised of a strong, transparent outer covering or capsule filled with a clear gel material. When the gel becomes cloudy, the incoming light rays are distorted or blocked before reaching the retina at the back of the eye. As the cataract develops, vision is increasingly reduced. Your eye doctor will usually discover developing cataracts in the course of routine eye exams. If you have cataracts that are causing visual difficulties, your doctor will usually recommend surgery, the only known cure for cataracts.

What is a cataract?

The natural lens in our eye focuses light on our retina, just as a camera lens focuses light on film. In our eyes, the natural lens becomes cloudy over time, and virtually all people will develop cataracts as we age. When it becomes cloudy enough to interfere with vision, then cataract surgery is a quick and painless way to not only remove the cloudy lens interfering with vision but also reduce the need for glasses using a new artificial lens.

Treatment

Removing the cloudy lens
The surgeon first makes tiny incisions in the cornea. The clear capsule of the natural lens is opened, and the hard cataract is broken up and removed using an ultrasonic vacuum tool called the phacoemulsification probe. The rest of the capsule is left intact to provide support for the new artificial lens.  Once a cataract is removed, it never comes back, and our lenses can be expected to last a lifetime.

Replacing the focusing power

When the natural lens is removed, its focusing power is also removed. To replace it, a tiny artificial lens implant can be inserted into the original lens capsule. This lens implant is held securely in place by soft, flexible arms called haptics. Artificial lens implants are available in a wide range of powers to fit our diverse patients’ eyes and their visual goals. Most people find that they are much less dependent on glasses after cataract surgery, although glasses may still be needed for some activities such as driving or reading.

At Achieve Eye and Laser, we offer the latest in aspheric monofocal lenses, toric lenses for astigmatism, multifocal lenses to allow both eyes to see far and near without glasses, and even light-adjustable lenses that can be fine-tuned after surgery. It is important to note that different lenses are appropriate for different kinds of eyes, and your doctor will discuss options that are a good fit for your eye and your lifestyle at your pre-operative appointment.

Risks

Any surgery carries risk.  Thankfully, cataract surgery is a very routine, low-risk surgery, and we can expect it to go very smoothly in the vast majority of cases.  Problems that do occur can almost always be resolved so vision is not permanently lost.   Your surgeon will carefully examine your eyes prior to surgery and inform you of any risk factors specific to your individual eyes.  All our surgeons live in Kitsap County and are readily available should you have any problems.

Your Surgery Experience

Our surgeons use the Pacific Surgery Center and Surgery Center of Silverdale.  Both are conveniently located, but please verify that you can easily find your surgery center on the day of surgery.

You will find out your arrival time a few days before your surgery.  Schedulers from the surgery center will call you.  We do not know your time until two days before your surgery.  Please call the surgery center if you do not hear from them by noon the day before surgery.

When you arrive at the surgery center, you are treated as a special guest. Patient counselors verify your insurance and answer billing questions.

You will meet the nurses and the anesthesia team, and they will ensure that you are safe and comfortable through your surgical experience.  Before entering the surgical suite, you will change into a clean gown.  Your eye is numbed with drops (not needles!) and our excellent anesthesia team gives sedation through an IV to ensure that you are comfortable, relaxed, and still breathing comfortably without a breathing tube.  

The experience of surgery is painless.  You may see a colorful light show and feel water around your eye.   Most cases are completed in 10-15 minutes, after which you can enjoy a quick snack in the recovery room before returning to your home or local hotel.  

The next morning you come back to Achieve Eye and Laser Specialists office for a quick check up.

The magic of the experience at Achieve Eye and Laser Specialists is more than skillful surgery. There is an atmosphere of care and compassion from the doctors and staff.

You can feel confident that each of our surgeons have performed thousands of cataract surgeries and are very comfortable performing standard as well as complex cases.

Light Adjustable Lens (LAL) Technology

Light Adjustable Lens (LAL) Technology is an advanced cataract surgery technology that uses a special light-adjustable intraocular lens, allowing doctors to fine-tune a patient’s vision after surgery using targeted UV light treatments.

After-surgery care

You will likely see better in the first few days, and the vision continues to clear over the following weeks.  Some note a small amount of itching or irritation, while others feel normal from the first day out.

Your surgeon will follow up with you until you are stable.  In some cases, patients may return to their regular eye doctor for after-surgery care.  It is comforting to know that you always have access to your surgeon at Achieve Eye and Laser Center if you have a question or concern after your surgery.

You will take prescribed eye drops for about 3-4 weeks after surgery, and have a few days restrictions on bending, lifting, and swimming.  There are no travel or flying restrictions, as long as you can make your post operative appointments.

After-surgery clouding

In about a third of cataract surgery cases, the clear capsule that holds the new plastic lens becomes cloudy or frosted over. Again, vision is reduced.  This is NOT the cataract returning.  This opacity is easily treated with laser at our office.  No incisions or cuts are involved; a beam of laser light is used to make a small opening in the back of the cloudy capsule to restore clear vision.  It is quick, painless, and typically covered by insurance.

For more information

The American Society of Cataract and Refractive Surgeons web site contains a wealth of information about cataracts and their treatment.

The EyeSmart website has more information and videos about cataracts and cataract surgery.

FAQ

  • Can cataracts be prevented?

    While there is no way to fully prevent cataract formation, there are factors that influence the speed of cataract formation.  Smoking accelerates cataract formation, and we encourage anyone who smokes to consider quitting.  Volatile or persistently elevated blood sugar can also accelerate cataract formation, so for folks with diabetes we recommend working with your primary care team.

  • What is involved in cataract surgery?

    In essence, we are removing the cloudy natural lens and replacing it with a new artificial lens.  This means that not only can we expect improved vision, but also that the type of lens you choose may allow you to reduce your need for glasses after surgery.  The procedure typically takes about 15 minutes and is done at an outpatient surgery center.  The surgery is done with an ultrasonic vacuum device called a phacoemulsification probe or “phaco” for short.  Once the cloudy lens material is removed, the new artificial lens can be inserted in its place.  The lens unfolds inside the eye and remains held in place by two small arms called “haptics” that push against the sides of the lens capsule to keep it centered and stable for a lifetime.  The tiny incisions are then closed without stitches by simply swelling the edges shut with saline. 

  • What do patients experience during cataract surgery?

    We do our cataract surgery with the help of an excellent anesthesia team.  Patients receive enough sedation through an IV that they are comfortable and relaxed, but still breathing on their own without the need for a breathing tube.  This allows patients to have a surgery free from anxiety without the additional risk and recovery time involved with general anesthesia.  The eye is numbed thoroughly with drops for the surgery, and many patients report seeing bright lights and swirling colors, but not the instruments of surgery.  Our patients consistently report an easy, comfortable surgical experience. 

  • What does recovery look like after cataract surgery?

    We expect a fast and painless recovery after cataract surgery.  That being said, every eye heals at its own pace.  For example, an eye that has a very dense cataract removed can be expected to take more time to heal and see well, because it requires more ultrasonic energy to remove a dense cataract.  Most people report no pain after surgery, but itching around the eye the first night is common.  For a routine cataract surgery, we expect the vision to improve quickly within the first week, and sometimes it’s already 20/20 without glasses the first day!  We ask patients to avoid heavy lifting, swimming, or rubbing the eye during the first week after surgery, but otherwise most normal activity can be resumed as soon as the patient feels comfortable.

  • When do I need cataract surgery?

    As a general rule, once someone gets to a point where they feel their vision is no longer adequate to do what they like to do in their daily life, even with a good pair of glasses or contacts, cataract surgery is a good next step to consider.  Common reasons people pursue cataract surgery include difficulty driving at night time because of glare, difficulty reading, or difficulty seeing well for other hobbies.  Cataract surgery may also be needed even when the cataract is still clear to address other anatomic issues inside the eye, such as angle closure glaucoma.

  • Which lens is best for me when I have cataract surgery?

    This is a very important and personal choice that depends on many factors.  Here are some questions to consider that may be helpful in guiding your lens selection: 

     

    • How do I feel about wearing glasses?  
    • What are the things that are most important for me to be able to see without glasses?  
    • Is night time driving a top priority or not?  

    Additionally, the anatomy of your eye may influence which lenses you are a candidate for.  For example, patients with a history of LASIK or other refractive surgery are at increased risk for “refractive surprise”, meaning they might rely on glasses more after surgery than expected.  This can be prevented with the Light Adjustable Lens (LAL) by allowing for modification of the focus after surgery.