Overview of Cataract Treatments
Surgery is the only way to cure cataracts, but it's not always necessary. Some people can improve their vision with lifestyle changes.
Lifestyle Measures to Treat Cataracts
To reduce glare, you should wear sunglasses and a wide-brimmed hat when outdoors. Other lifestyle measures include choosing the appropriate type and amount of indoor lighting, using a magnifying glass, and buying large-print reading materials. A stronger prescription for eyeglasses or contact lenses may help as well.
Surgery for cataracts involves removing all or part of the lens and replacing it with an intraocular lens implant (IOL). Cataract removal is the most frequently performed surgery in individuals over age 65 and is considered by many doctors to be the most effective surgical procedure in all of medicine. If the eye is normal except for the cataract, surgery will improve vision in more than 95 percent of cases.
Cataract surgery is remarkably safe. Significant postsurgical complications, such as inflammation, infection, bleeding, retinal detachment, swelling, and glaucoma, are rare. Serious complications occur in only 1 to 2 percent of people. Those with medical problems, such as diabetes, and other eye diseases are most at risk for complications.
Overview of Cataract Surgery
Prior to the 1970s, most eye surgeons performed cataract surgery with the naked eye or with the aid of loupesspecialized glasses that provide a small amount of magnification. Today, microsurgery is standard. In a microsurgical procedure, an operating microscope is placed over the eye undergoing surgery to magnify the eye to four to six times its normal size.
If you have cataracts in both eyes, your surgeon will operate on them at separate times to allow you and your surgeon to assess the outcome of the first surgery. The interval between surgeries gives the first eye time to recover and gives the surgeon a chance to perform the second operation differently if any complications occurred. Also, if the results with the first eye are good enough, a second operation may not be needed.
Cataract surgery usually takes less than 30 minutes. Most of the surgeries are done on an outpatient basis with a local anesthetic, given by either injection or eyedrops. (Local anesthetics make a targeted tissue or part of the body insensitive to pain or sensation. General anesthesia, used only in people who are allergic to local anesthetics or who are extremely anxious, causes complete unconsciousness and relaxation and prevents pain in the entire body.) Your physician may give you a sedative before the surgery to make you drowsy and relaxed.
Before your surgery, you will be asked to see your primary care doctor, who will review your medical history. He or she will ask you about your past and current medical conditions, current medications, and allergies. Using an ultrasound laser, your eye surgeon will measure the length of your eyeball. This measurement, in addition to measurements of your cornea, helps to determine the appropriate power of the IOL that you will receive.
If the surgeon can't see the retina in the back of the eye because the cataract is too opaque, another test called B-scan ultrasonography is performed. This test uses reflected sound waves to look at structures in the back of the eye.
Originally published in The Johns Hopkins White Papers: Vision (2011)
Susan B. Bressler, M.D.
Julia G. Levy Professor of Ophthalmology
Wilmer Eye Institute, Johns Hopkins University School of Medicine
Harry A. Quigley, M.D.
A. Edward Maumenee Professor of Ophthalmology
Director, the Glaucoma Service and the Dana Center for Preventive Ophthalmology at the Wilmer Eye Institute at Johns Hopkins Hospital
Oliver D. Schein, M.D., M.P.H.
Burton E. Grossman Professor of Opthalmology and Vice-Chair for Quality and Safety, Wilmer Eye Institute at Johns Hopkins Hospital
Joint Appointee, Department of Epidemiology at the Johns Hopkins University School of Hygiene and Public Health