How is Cataract Surgery Performed?
Cataract surgery is considered one of the safest surgical procedures performed today. Recent advances in technology and technique have made it gentler and more reliable than ever.
Cataract surgery can be completed on an outpatient basis. The following five steps describe the process you will undergo when receiving cataract surgery:
Step 1: Preparation of the Eye
To ensure that cataract surgery is as comfortable as possible, two forms of anesthesia are used to numb your entire eye. Topical anesthesia bathes and numbs the surface of the eye, while the intraocular medication Xylocaine eliminates all sensation inside of the eye. This method of numbing the eye without needles is used in order to maximize patient comfort.
Step 2: Self-Sealing Incision made
Once the eye is completely numb, your surgeon will use an instrument to make a tiny, beveled “self-sealing” incision. This self-sealing incision allows the eye to heal without stitches. It works because the eye’s internal pressure holds the incision tightly closed. The self-sealing incision is less than 2.5 mm long, and is made at the edge of the clear cornea (the transparent covering of the front of the eye).
Step 3: Cataract Removal
Cataracts form inside of the lens capsule, which is like an elastic bag that holds the lens in place. To remove the cataract, the surgeon carefully opens the front portion of the lens. Next, a tool called a phacoemulsifier is inserted through the incision. The phacoemulsifier is used to gently break up the cataract with ultrasonic vibrations and then remove it out of the lens capsule. The surgeon is careful to leave the lens capsule intact so that a lens implant can be inserted into it.
Step 4: IOL Replaces Cloudy Lens
After the cataract has been completely removed, an intraocular lens (IOL) is inserted in place of the natural lens. This allows light to focus on the retina, resulting in clearer vision. There are many types of lenses that can be placed in the eye. IOLs can correct a wide range of preexisting refractive problems, including farsightedness, nearsightedness, and even astigmatism. For more information on the various types of IOLs available, visit our page on Multi-focal Lenses.
Step 5: Antibiotics and Anti-inflammatory Medicine Placed in the Eye
Before your surgery is complete, antibiotics and anti-inflammatory medicine will be placed inside your eye. The antibiotics will reduce your risk of infection, while the anti-inflammatory medicine will promote healing and lessen your need for post-operative eye drops, which can be inconvenient and cause side effects.
Before your Cataract Surgery
Should someone accompany me on the day of surgery?
We request that you bring someone with you on the day of cataract removal surgery.
How long will I be at Tomoka Surgery Center the day of my surgery?
Most patients should plan to be at TSC between 2-3 hours from the registration to discharge.
What should I bring with me the day of surgery?
We recommend that you bring the following when coming to Tomoka Surgery Center:
Friend or family member (someone to help with paperwork, driving home, etc.)
Medicare or insurance cards
Medication – enough for the time you will be away from home
Current prescription glasses (even if not worn presently)
List of prescription medication including dosage and strength
Sweater or jacket
Reading material or busy work
I take several prescription medications, including a blood thinner. Should I continue these before surgery?
Yes. Take all prescription medications as you normally would with a sip of water.
I wear contact lenses. May I wear my contacts until the day of surgery?
Please stop wearing soft contact lenses at least one week prior to surgery, and hard lenses two weeks prior to surgery.
May I eat before surgery?
No. We recommend that you do not eat before arriving.
May I wear makeup?
Please do not wear any makeup on the day of surgery.
I’m on oxygen. Should I bring it with me?
Yes, bring more than enough oxygen for a 3 hour stay.
During your Cataract Surgery
Will I feel anything during surgery?
Most patients feel only gentle pressure during cataract removal surgery at our Florida practice.
What do I see during surgery?
Most patients only see the bright lights of the microscope.
May I have medication for my nerves?
It is not required, but some patients do request medication to help them relax. If you do elect to take medication for your nerves, please have someone accompany you to the clinic if possible.
Will I need to have blood drawn before the surgery?
No, we do not draw blood.
I was told to take antibiotics before receiving dental work. Should I take them before eye surgery also?
Unlike the mouth, the eyes are very clean. You will not need to take antibiotics unless instructed by your doctor before the operation.
How soon may I leave after having cataract removal surgery?
Most patients are able to leave within an hour of having cataract surgery.
I was told I need surgery on both eyes. When may I receive treatment for my second eye?
You may have your surgeries one week apart.
Will I be able to see immediately after the operation?
Most patients’ vision is quite blurred after the surgery from the dilating drops and bright microscope lights.
What will happen before I’m discharged?
After the surgery, you will be taken to the recovery room where we will assess your vital signs (pulse, blood pressure etc.) and check your eye pressure. At this time, we will also explain your postoperative instructions and medications to you and a friend or family member. Afterward, we will make arrangements to check you the following day.
My back keeps me from lying flat. What position must I be in for the surgery?
We will need you to lie down for surgery; however, our experienced OR team has worked with virtually every medical condition that presents special needs. We will be able to work with you to make your experience as comfortable as possible.
Does every patient need an implant?
The vast majority of patients require an implant to replace the natural lens or cataract. Only in very rare cases of extreme nearsightedness is an implant not required.
May I drive myself home?
No, we recommended patients bring a friend or family member to drive them home due to relaxing medication.
Sometimes my blood pressure gets high when I’m nervous. What happens if it’s too high?
If we are unable to manage your blood pressure with medication, your surgery may be postponed until you consult with your primary physician.
Do I need a physical before surgery?
Yes, on the day of surgery a staff physician will assess your general health so we can grant medical clearance for your surgery.
After your Surgery
Did I receive a lens implant during surgery?
Intraocular lenses are required except in very rare cases of extreme nearsightedness.
What material is my implant made of?
Most of the implants used at Tomoka Surgery Center are made of either silicone or PMMA (plastic).
Will the implant need to be replaced in the future?
The intraocular lens implant will remain in your eye permanently and will not “wear out.”
Can my eye reject the lens implant?
No, since the intraocular lens is not made up of human tissue, your body cannot reject it.
Was a laser used to remove my cataract?
Your cataract was removed by ultrasound, not laser. In a process called phacoemulsification, sound waves were used to gently break up the cataract before it was removed from the eye. Lasers are currently being developed to remove cataracts.
Should I wear my old glasses after surgery?
Wearing your old glasses will not harm your eyes, but will probably not give you optimal vision either. Most patients find it best to wear glasses only for reading.
How come my close-up vision isn’t as good as my distance vision?
Your ability to see well up-close depends on the type of intraocular lens you received. For most IOLs, it is normal to require reading glasses after cataract surgery.
Is it safe to resume activities such as golf and reading?
Yes, we encourage you to resume normal activities as soon as you wish. Routine activities such as bending and lifting will not harm your eye.
How soon may I resume driving after surgery?
For most cataract surgery patients, vision improves significantly in the first 24 hours after surgery. You may drive as soon as you feel comfortable doing so.
Is it safe to fly after cataract surgery?
Flying after cataract removal surgery will not harm your eye.
When may I wear make-up again?
You may wear lipstick and powder immediately after surgery. However, you should avoid eye make-up for two weeks after surgery.
Is it safe to have my hair done or get a permanent?
Yes, as long as you take sensible precautions to avoid chemical contact with your eyes.
Why does it feel like there is something in my eye after my surgery?
During cataract surgery, a microscopic incision was made on the surface of your eye. When you blink, you may feel a slightly scratchy sensation until the incision heals. After surgery, many patients find that using artificial tears helps to alleviate discomfort.
The eye drops that I was instructed to use after surgery sting my eye. Is this normal?
It is common for some eyedrops to burn or sting. You should continue to use your eyedrops as prescribed. However, if your discomfort seems to be worsening, or you experience a decrease in vision, call us immediately.. Some patients find that using “artificial tears” five minutes before placing medicated drops in the eye decreases irritation.
After surgery, I noticed a spot of blood on the white of my eye. Should I be concerned?
The white part of the eye (sclera) is covered by a clear layer of tissue (conjunctiva). When a tiny blood vessel breaks, the blood becomes trapped below the conjunctiva. Since the tissue is clear, the blood is clearly visible. If this were to happen on your arm, you would have a blue or purple bruise because the skin is not transparent. This will not affect your vision and will gradually resolve on its own.
On the way home from surgery I saw huge halos around all the lights. What causes this?
This dramatic glare was due to the fact that your pupil was still dilated from the surgery. After dilation wears off, vision should return to normal.
My glare problem has improved dramatically since the surgery, but I still occasionally notice halos or streaks on lights at night. What causes this?
There are many factors that can cause glare. A slight need for glasses (refractive error) is one of the most common reasons you may notice slight glare at night. Also, some patients experience minor corneal swelling after surgery that may cause temporary glare.
Since my surgery a few weeks ago, everything has a pink tint. What causes this?
This pink tint is due to slight swelling in the retina and is not uncommon after surgery. It will gradually go away as you use your postoperative eye drops. However, always contact your eye doctor if you notice a change in your vision. Since sun exposure can aggravate this problem, it is also important to protect your eyes with sunglasses when outdoors
Why does everything have a blue tint since surgery?
Patients with cataracts see their world through a yellow tint. It’s just like wearing yellow-tinted (”blue-blocker”) sunglasses, which block colors from the lower end of the color spectrum (blues and violets). When the cataract is removed and replaced with a clear implant, you will see these unfamiliar colors again. This is much more dramatic for some patients than others.
If you have additional questions about cataract removal surgery, please contact one of our surgical coordinators.