ALL ABOUT CATARACT SURGERY

Cataract surgery is the permanent solution for cataracts.

A cataract is an eye condition where the natural lens of your eye, also known as the crystalline lens, develops cloudy patches. This causes a decrease in your vision.

The natural lens of the eye normally focuses light onto the back of the eye so you can see objects clearly and without distortion. Hence, a cloudy lens during cataract disease impairs your vision.

Metabolic changes of the crystalline lens fibers and certain environmental factors over time lead to the development of this eye condition. Also, cataracts can be congenital, meaning they’re present at birth.

Congenital cataracts are considered one of the leading causes of childhood blindness.

Cataracts are painless but can cause progressive blurred vision. They can present with dull color vision, increased nearsightedness, and occasionally, double vision in one eye.

Poor night vision and increased glare from lights are also frequent.

Even though it’s your decision whether or not to go ahead with cataract surgery, if a cataract makes it difficult for you to carry out your everyday activities, your doctor may suggest the procedure.

After all, cataract surgery is not painful, and recovery time is very short. It is performed by an eye doctor (ophthalmologist) on an outpatient basis.

Ultimately, the procedure allows to restore vision and improve the quality of life. Also, patients with high myopia or hyperopia can have cataract surgery for refractive correction purposes.

Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on October 19, 2021

What Techniques are Currently Used for Cataract Surgery?

Monofocal or Multifocal Lens?

Which Patients are Eligible for Cataract Surgery?

What are the Benefits and Risks Involved in Cataract Surgery?

Preparation for Surgery.

How Long does the Cataract Surgery Last? Is it painful?

How is the Recovery After a Cataract Surgery?

Cataract Surgery Aftercare.

How Much does Private Cataract Surgery Cost?

Special Considerations for Foreign Patients.

FAQ about cataract surgery.

WHAT TECHNIQUES ARE CURRENTLY USED FOR CATARACT SURGERY?

Today, cataract surgery is a highly effective and low-risk procedure. Indeed, this surgery is one of the safest and most common ophthalmological interventions carried out each year.

In simple words, cataract surgery involves removing the content of the clouded lens using ultrasound or laser technology. Then, most likely, your doctor will replace the crystalline lens with an intraocular lens (IOL) personalized for each patient.

Intraocular lenses (IOL’s) are made from durable materials, such as acrylic, plastic, or silicone. Some IOL s can even block ultraviolet light.

They become a permanent part of your eye, and you can expect them to last a lifetime.

There are currently various types of intraocular lenses:

Monofocal intraocular lenses which correct distance vision. However, you still may need glasses to see up-close.
Multifocal intraocular lenses which can correct both distance and up-close vision.
Astigmatism correction (toric). If you have important astigmatism, a toric lens can improve your vision.

Depending on the results from the preoperative tests, cataract specialists can offer several alternatives for cataract surgery.

Phacoemulsification with intraocular lens implant (IOL)

For the phacoemulsification technique, your surgeon makes a tiny incision (2- to 3-mm) in the front of your eye (cornea) and inserts a thin probe where the cataract has formed.

This technique uses rapidly vibrating ultrasound waves to emulsify and break up the cataract. Then, your surgeon will suction out the fragments.

The back of your lens (the lens capsule) is left intact to serve as an outer housing for the artificial lens to rest. After removing the emulsified debris, your surgeon inserts the foldable IOL through the incision into the space within the capsule.

Finally, stitches may be used to close the tiny incision in your cornea to complete the procedure.

Phacoemulsification is one of the safest and most precise surgical techniques of modern ophthalmology.

Femtosecond laser-assisted cataract surgery (FLACS)

This is a laser-assisted technique that has been extensively developed at Barraquer Eye Hospital. Intralase technology achieves excellent results while being less aggressive for the eye.

The femtosecond laser is applied for less than a minute and is a totally painless procedure.

It gives greater precision when making the cuts. Also, the desired flap thickness can be programmed. Following this, the intraocular lens (IOL) is implanted.

Additionally, with the laser, your doctor can make an arcuate incision to correct astigmatism.

Astigmatism happens when the front of the eye has an irregular shape, causing blurred vision. Hence, FLACS can make it possible for you to function without glasses.

However, Femtosecond laser-assisted cataract surgeryis more expensive than other techniques. So it would be best if you discussed this option with your doctor.

MONOFOCAL OR MULTIFOCAL LENS?

Multifocal lenses or accommodating lenses allow the eye to focus on both near and distant objects. These lenses work the same as glasses with bifocal or progressive lenses.

The lens has different focusing strengths in different areas, adjusting for near, medium, and far vision. Hence, you will be less dependent on glasses and have a better quality of life.

In general, patients who choose multifocal lenses instead of monofocal lenses express greater satisfaction.

However, this type of lenses can cause halos and starbursts in some patients’ vision. Though most people can adapt, some find it very difficult, so you may want to discuss this with your doctor.

Also, multifocal lenses have a higher cost. Therefore, the patient should consider all the factors when making the final decision.

Conversely, if your doctor uses a monofocal intraocular lens, you will probably need glasses.

The monofocal lens only has a single focus strength for distance vision. This means the lens will be fixed for either near or distance vision, but not both.

Often, patients choose to set them for distance vision and use reading glasses for near vision.

There is another option called “accommodating-focus monofocal.” Although these lenses have a single focus strength, they can respond to eye muscle movements and shift focus to near or distant objects.

However, after the procedure, many patients may need to wear glasses for minor tasks like reading. This could happen regardless of the type of lens they have fitted!

Your vision will improve significantly, but it may not be perfect.

Your doctor will let you know when your eyesight has healed enough for you to get a new prescription for eyeglasses. This will be between one and three months after surgery (preferably six weeks after the procedure).

WHICH PATIENTS ARE ELIGIBLE FOR CATARACT SURGERY?

Many patients think that cataracts have to be at an advanced stage before considering surgery.

If left untreated, cataracts will slowly progress and could result in complete blindness. However, this condition is completely reversible and curable.

But the reality is that nowadays, cataract surgery can be carried out when the patient and the doctor consider that their vision affects their quality of life.

Having cataract surgery effectivelyforestalls the aging of the crystalline lens that ends up producing cataracts.

Crystalline lens surgery with the implantation of an intraocular lens (IOL) improves the patient’s vision. Also, it allows them to forgo their glasses or contact lenses to do many of their daily activities.

Additionally, cataract surgery can be an option for patients with refractive errors, such as presbyopia (age-related long-sightedness).

The Barraquer Eye Hospital does not work with the PresbyLASIK technique to correct presbyopia (age-related long-sightedness), as the results obtained from other clinics have not been satisfactory.

Additionally, PresbyLASIK technique is a temporary solution. With time, the patient usually finds him or herself at the starting point again.

The solution for presbyopia (age-related long-sightedness) is to have cataract surgery for refractive correction purposes. Intraocular lenses (IOL) have been developed to correct both cataracts and presbyopia (age-related long-sightedness) at the same time.

Those patients who also go in for cataract surgery with refractive correction purposes are over 50 years old. They may suffer from high myopia (short-sightedness) or hyperopia (long-sightedness) for whom LASIK surgery is contraindicated.

WHAT ARE THE BENEFITS AND RISKS INVOLVED IN CATARACT SURGERY?

Currently, cataract surgery with intraocular lenses (IOL) is the only alternative for removing cataracts.

Around 95% of the people who choose to have cataract surgery with intraocular lenses experience a total recovery of their vision.

Additionally, continuous innovations in techniques and instruments used make the procedure safer than ever. However, as in any surgery, the patient should also be aware of the risks.

Complications from cataract surgery are rare if the patient is in good health and does not suffer from another eye condition or a serious disease.

For high risk patients, the incidence of serious complications secondary to cataract surgery is estimated at around 1 in 50 cases. You could have increase ocular pressure or detached retina.

Occasionally, cataract surgery fails to restore vision successfully because of underlying eye damage secondary to other conditions, such as macular degeneration or glaucoma.

Also, after 2 to 4 months, some patients could complain that their vision has become blurred again. This condition is known as secondary cataract or posterior capsule opacification (PCO).

This minor complication happens when the back of the lens capsule becomes cloudy and impairs your vision. PCO is effectively treated with a painless, five-minute laser procedure called yttrium-aluminum-garnet (YAG) laser capsulotomy.

PREPARATION FOR CATARACT SURGERY

Once the date for the intervention is set, you must go a few days before to Barraquer Eye Hospital facilities to have a series of preoperative tests.

Your eye doctor will perform a painless ultrasound test to measure the size and shape of your eye. This will help decide the treatment and the type of intraocular lens (IOL) you will have implanted.

Also, whichever IOL you choose, the surgeon will need to select the appropriate power of IOL (similar to an eyeglass prescription) to correct the refractive error.

Barraquer Eye Hospital (Barcelona, Spain) is a world reference in cataract surgery.

Doctor Elena Barraquer (cataract specialist) received in 2018 the award of excellence from the Queen Sofia Spanish Institute. Doctor Elena Barraquer is one of the top five ophthalmologists in Spain, according to Forbes magazine nº49.

Professor Rafael Barraquer (cataract specialist) was appointed in 2017 as President of EVER (European Association for Vision and Eye Research).

HOW LONG DOES THE CATARACT SURGERY LAST? IS IT PAINFUL?

Most cataract interventions last between 15 and 30 minutes.

It is outpatient surgery without the need for hospitalization. It allows the patient to return home almost immediately.

This intervention is not painful thanks to anaesthetic eye drops, local anaesthesia, and relaxing medication (intravenous sedative), if needed.

You may experience slight discomfort, although intense pain is uncommon. Also, the recovery time is very short.

Some patients may present with an excessive watering of the eye or dry eye sensation, though.

HOW IS THE RECOVERY AFTER A CATARACT SURGERY?

Immediately after the operation, you will probably feel a little groggy if you receive a mild sedative in addition to the local anaesthetic.

The doctor will put a protective eye patch in place on the day of surgery. You may need to use it for a few days, including a protective mask when you sleep.

You will stay in observation for a few hours. Then, a specialist will tell you how to take care of your eye at home and prescribe some medication to reduce inflammation and control eye pressure.

They will probably prescribe a gentle treatment for dryness in the eye so that you feel as comfortable as possible and improve your vision.

After cataract surgery, your vision will improve within a few days. Colors may seem brighter after your surgery and may present with light sensitivity.

Blurriness is normal shortly after cataract surgery.

This will improve as the eye heals and adjusts in a matter of days, but it may take longer in some cases. However, vision will not reach its optimum state until 2-4 months afterward.

In a few days, most of the discomfort should disappear. Complete healing occurs after eight weeks.

Additionally, double vision is not uncommon after cataract surgery and can have many causes. More often than not is a result of your brain getting used to its new visual acuity. It will improve in a few days after surgery, so don’t worry.

CATARACT SURGERY AFTERCARE

The eye may be sensitive and itchy for a few days. Hence, it is important to avoid rubbing your eye and prevent anything from going into it to prevent infection.

While you’re recovering:

You should wear sunglasses while outdoors to protect your eyes from sunlight.
You shouldn’t use make-up until the doctor allows it.
Strenuous efforts or activities that could increase eye pressure are out of the question. This includes bending over or lifting heavy objects for at least a week or so.
You should try to sleep on your back. Avoid sleeping on the side of your healing eye!
You will be able to resume normal activities within a few days, including driving.
You could return to work within 2 to 5 days if you feel comfortable with your vision.

HOW MUCH DOES PRIVATE CATARACT SURGERY COST?

Private cataract surgery cost depends on intraocular lenses used. Multifocal intraocular lens is more expensive than monofocal one.

If you want to receive a quote, please, fill in the contact form. You can send us your recent medical reports, so we can offer you the solution that best suits your needs.

You can be sure that this information will always be treated with maximum confidentiality.

SPECIAL CONSIDERATIONS FOR FOREIGN PATIENTS HAVING CATARACT SURGERY.

Can both eyes be operated on for cataracts at the same time?

If you have cataracts in both eyes, the doctor usually schedules the second surgery after the first eye has completely healed.

For foreign patients, your doctor will try to organize the surgery within the same week (there are two to four days between surgeries) so that the patient can return home as soon as possible.

How long will the patient be in Barraquer Eye Hospital after cataract surgery?

Cataract surgery is an outpatient procedure. Usually, patients spend only a few hours in Barraquer Eye Hospital and can return home the same day.

International patients should plan for a stay of 10 days in Barcelona for postoperative tests. Although cataract surgery is very quick, your vision will probably not be at its best immediately after the surgery.

FAQ about cataract surgery:

Is there an alternative to surgery for removing cataracts?

Although cataract symptoms at an early stage can be treated in various ways, surgery is the only way to eliminate them.

Can cataracts and presbyopia (age-related long-sightedness) be corrected at the same time?

Yes, they can. In recent years, multifocal IOL intraocular lenses have been developed to correct cataracts and presbyopia (age-related long-sightedness) at the same time. In fact, Barraquer never recommends the PresbyLASIK technique to correct presbyopia (age-related long-sightedness) because the results obtained from other clinics have not been satisfactory. It is also a temporary solution as, with time, the patient usually finds him or herself at the starting point again. The solution for presbyopia (age-related long-sightedness) is cataract surgery with refractive correction purposes.

Could I end up blind because of cataracts?

If the cataracts are not treated in time they can eventually cause blindness.

When is the best moment for me to have my cataracts operated on?

Many people think that cataracts have to be at an advanced stage before they can be removed. But that is not true. Nowadays, cataract surgery can be carried out when the patient and the doctor consider that their vision is affecting their quality of life.

Is general anaesthetic necessary for cataract surgery?

As it is not a very long intervention, it is not necessary to administer general anaesthetic. Instead, the surgeon will use topical/local anaesthetic eye drops to numb the eye, which means that during the intervention, you would be awake.

If I have cataracts in both eyes, is it important not to let too much time pass between the operation on the first eye and on the second?

Yes. Although you may feel that your vision hasn’t completely adapted since the first intervention, it is important to keep in mind that vision depends on both eyes working together as soon as possible.

How long will it take before I can see after cataract surgery?

Each patient and each eye is different. Many patients experience a great improvement in their vision just after the intervention, but their vision will not reach its optimum state until 2-4 months afterwards.

What is the lifespan of an intraocular lens (IOL)?

Intraocular lenses (IOL’s) are made from durable materials so they don’t usually get damaged and you can expect that they will last all your life.

Is there an alternative for young patients with cataracts?

When it comes to a young person suffering from cataracts, before taking a hasty decision, it is important to analyze the case thoroughly. In young patients, doctor will try to preserve the crystalline lens. It would all depend on the degree of the cataract and if the cataract is significantly reducing the vision. After analyzing the medical tests, specialists at Barraquer Eye Hospital will advise you and indicate which alternatives you have.

Can cataracts increase the likelihood of developing another eye condition?

On occasion cataracts cause other conditions such as myopia (short-sightedness) and hyperopia (long-sightedness). And on rare occasions, if they are not operated on in time, the cataract can end up becoming so big that it causes some kind of glaucoma.