How does cataract surgery work?

Interview transcription:

We interviewed Dr. Leonard Teye-Botchway to understand the typical routine on the day of cataract surgery.  

Leonard Teye-Botchway: Cataract surgery works by removing the cloudy lens, which is causing blurring and replacing it with an intraocular lens. Once we make the diagnosis, if the decision is to proceed with surgery, you would need to undergo some tests to determine certain aspects of your eye.

We need to know the length of your eyeball, the shape of your eyeball, your refraction, and that will let us determine what implant would be best for you.

Before cataract surgery

Before embarking on the surgery, the ophthalmologist will council you. Typically, you’ll be in the hospital for about two hours, maybe a little bit more than that sometimes. The first hour would be for the nurses to put drops in your eyes. For the surgery, we need to have you very well dilated. In other words, we will need to get your pupil to be very wide open so the surgeon can see the lens very well. It makes the surgery easier if there’s a bigger and clear operating field.

During cataract surgery

You’ll be in the surgery for about half an hour in total. That includes preparing you on the table, getting the microscope across, cleaning the eye and everything. The actual surgery takes about 10 to 15 minutes, typically. Once the surgery is over, we will send you to the recovery room where you’ll be for about another 15 minutes or so, and then you can go home.

At surgery, once we’ve anaesthetised the eye, we place a speculum in the eye. A speculum is a special instrument that keeps the lids apart so that even if you try to blink, you won’t be able to. Some patients ask, what would happen if I blink, but this doesn’t happen because the lids are securely open. Then we use a special instrument we call a phacoemulsification machine to remove the cloudy lens after carefully separating the capsule from the lens itself. Finally, we get all the cloudy lens out and then replace it with an implant.

The implants

There are different forms of implants, and we discuss the choice of the implant before surgery with you. Some patients opt for correcting their vision with just single-vision glasses for distance, so they have single-vision glasses and also wear glasses for reading. Some patients choose for what we call monovision, in which we create a slight disparity between the two eyes, giving one eye an advantage for far and the other for near. Through new adaptation, the brain can use both eyes properly for all distances.

The other choice is multifocal lenses; bifocals or trifocals, in which the lens we place in the eye has the ability for patients to see all distances. These intraocular lenses have improved quite a bit over the years, and their side effects – which include glare, halos and loss of contrast sensitivity – have minimised quite significantly. By and large, patients are pleased with their trifocals and bifocals, so long as they make the right decision before surgery.