Standard Cataract Surgery 
What is Cataract Surgery?
C This procedure involves the removal of the cloudy lens along with the insertion of an artificial intraocular lens to take its place. There are several different types of procedures to remove the cataract.
Cataract Surgery
Cataract surgery
Phacoemulsification is the standard procedure where the cloud lens is removed through a small incision (@2mm) in the cornea. A circular window is formed in the thin clear membrane (capsule) holding the cataract. A thin probe is inserted into the eye which emulsifies the lens matter. These tiny fragments are then aspirated from the eye. Once the cataract is removed, an artificial lens implant is placed in the same capsular bag that the cataract previously occupied. This intraocular lens is essential to help your eye focus after surgery.
Age Related Macular Degeneration and Cataract
Advanced aging changes have an increased risk of converting from dry to wet after routine cataract surgery and can be an excess of associated vision loss. The non-standard use of anti-VEGF agents (agents that reduce the chance of abnormal blood vessels developing and bursting) may be helpful in reducing the excess risk of vision loss during cataract surgery. Ask your Eye Surgeon if this is relevant to you.
Diabetic Retinopathy and Cataract
Diabetic retinopathy needs to be controlled before and after cataract surgery. In adequate control can lead to sight threatening vision changes due to abnormal new vessels growing on the retina and the development of a boggy, swollen macular. Ask you Eye Surgeon if this is relevant to you.
Fuch’s and Cataract
Patients with Fuch’s are at excess risk of corneal clouding and visual loss after cataract surgery. As well as overt corneal clouding and reduced vision, it is also responsible for a mediocre visual outcome, after routine cataract surgery. New cataract surgical techniques and new corneal transplantation techniques have improved the outlook for this patient group. Ask your Surgeon if this is relevant to you at the time of planning your cataract surgery.
Glaucoma and Cataract
There is increasing evidence for the use of glaucoma stents inserted during cataract surgery, patients with poor glaucoma control on two or more drops should ask their Eye Surgeon if this is relevant to them at the time of planning your cataract surgery.
Keratoconus and Cataract
It is unusual to require a stitch in the eye at the end of the operation because the incision is so small it is nearly always self-sealing. Eyes that have a thin corneal wall (keratoconus) tend to be floppy and these do require a stitch to avoid wound sag and degradation of the expected visual outcome.
This procedure requires the use of anaesthetic around the eye and sedation and is often referred to as “Twilight Sedation”. It tends to induce amnesia before and after surgery however, if you want to remember something, it is likely that you will. This amnesia is the reason why we insist that you have a carer overnight before admitting you for surgery. For a clear demonstration, please view the following link: Why You Need a Carer Overnight
Targeting an eye with keratoconus to see well unaided after routine cataract surgery is more difficult than in a normal eye. Most routinely used formulae to calculate the correct lens power for an eye make assumptions and the more severe the keratoconus the more these assumptions no longer hold. Ask your Surgeon if this is relevant to you at the time of planning your cataract surgery.
Lazy Eye and Cataract
Patients with a lazy eye can have a variable improvement at the time of catract surgery. Your Eye Surgeon should make every attempt to discern your dominant from your non-dominant eye. The lazy eye patient often finds it difficult to functionally adapt if the lazy eye ends up seeing better in the distance than the dominant eye. Ask your Surgeon if this is relevant to you at the time of planning your cataract surgery.
Accommodating Lens Implants
These are lenses move when implanted in the eye and try to mimic the body’s own natural lens movements. They aim to give good vision over a range of distances. In reality, because they move their resting point in the eye is more unpredictable and more people end up a little more short or long sighted than they bargained for. Additionally, most do not move enough and so you still need reading glasses for near. They also tend to move too slowly so there is a significant lag time ( speed of accommodation ) when you look from the distance to focus on something up close which can be quite frustrating. Others accommodating lenses move too easily in a bid to obtain more near vision and there are a few anecdotes that with a good sneeze one can apparently be left short sighted unexpectedly on the freeway!
Toric Lens Implants
Patients with high levels of astigmatism can utilise Toric Lens technology, which is designed to neutralise any astigmatism arising from the cornea. Toric lenses correct distortions in one particular meridian/ axis. They can be found in single distance vision lenses and in multifocal implants. Correcting astigmatism is the second most important optical correction impacting the quality of the unaided visual outcome after correcting defocus (how long or short sighted a patient is).
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