Last updated: 11/24/2009

People might have cataracts for years before vision is impaired enough to warrant surgery. Eye doctors may first suggest eyeglasses to temporarily help improve vision. But as the lens grows cloudier, vision deteriorates.

As cataracts develop...

and worsen, patients may notice these common symptoms:

• gradual (and painless) onset of blurry vision
• poor central vision
• frequent changes in prescription for corrective lenses
• increased glare from lights
• near vision improvement to the point where reading glasses may no longer be needed
• poor vision in sunlight

Cataracts grow faster in younger people or diabetics, so doctors will recommend surgery more quickly in those cases. Surgery may also be recommended sooner if the patient suffers from other eye diseases such as agerelated macular degeneration and if the cataract interferes with complete eye examination.

When symptoms worsen to the point that everyday activities become problematic, surgery becomes necessary. A complete ocular exam will determine the severity of the cataract and what type of surgery the patient will receive. For some denser cataracts, the older method of extracapsular extraction is preferred.

The diagnostic exam should include measurement of visual acuity under both low and high illumination, microscopic examination of eye structures and pupil dilation, assessment of visual fields, and measurement of intraocular pressure (IOP).

If cataracts are detected in both eyes, each must be treated separately.

Overall patient health must also be considered, and how it will affect the surgery's outcome. Surgeons may recommend a complete physical examination before surgery.

Although preoperative instructions may vary, patients are usually required not to eat or drink anything after midnight the day of the surgery. Patients must disclose all medications to determine if they must be discontinued before surgery. Patients taking aspirin for blood thinning usually are asked to stop for two weeks before surgery. Blood-thinning medications may put patients at risk for intraocular bleeding or hemorrhage. Coumadin, the prescription medicine for blood thinning, might still be taken if the risk for stroke is high. People should consult with their eye doctor and internist to decide the best course of action.

An A-scan measurement, which determines the length of the eyeball, will be performed. This helps determine the refractive power of the IOL. Other pre-surgical testing such as a chest x ray, blood work, or urinalysis may be requested if other medical problems are an issue.

The surgeon may also request patients begin using antibiotic drops before the surgery to limit the chance of infection.

Cataract surgery is done on an outpatient basis, so patients must arrange for someone to take them home after surgery. On the day of the surgery, doctors will review the pre-surgical tests and insert dilating eye drops, antibiotic drops, and a corticosteriod or nonsteroidal anti-inflammatory drop. Anesthetic eye drops will be given in both eyes to keep both eyes comfortable during surgery. A local anesthetic will be administered. Patients are awake for the surgery, but are kept in a relaxed state.

The patient's eye is scrubbed prior to surgery and sterile drapes are placed over the shoulders and head. The patient is required to lie still and focus on the light of the operating microscope. A speculum is inserted to keep the eyelids open.