What is Cataract Surgery and How Does It Work?

Cataracts are a normal, common part of ageing. Because we all age, this makes cataract surgery one of the most commonly performed surgical procedures in the Western world. While the first real cataract extraction was performed in the 1700s by a French surgeon, modern cataract surgery has come a long way, now even involving the use of lasers.

Before we explain what is cataract surgery, let’s first dive into what a cataract actually is. 

What is a Cataract?

A cataract is an opacity of the crystalline lens of the eye. This lens is positioned behind the coloured iris and is held suspended in place by a ring of fibres called zonular fibres, attached to a circular muscle known as the ciliary muscle.

This crystalline lens is responsible, in part, for the bending (also known as refraction) of light as it passes through the eye. With the help of the ciliary muscle, the lens can actually flex its shape to adjust the way light is refracted through its structure. This process is known as accommodation and is the reason why we can focus on objects at different distances.

When we’re born, a healthy lens is nice and transparent to allow light to pass through unhindered. However, as we get older, the lens fibres gradually begin to lose their clarity, becoming hazy or foggy. This results in an age-related cataract also called a senile cataract. The opaque nature of the lens means that light is unable to pass through as easily. Because sharp vision depends on light rays being able to focus to a point on the retina at the back of the eye, if a cataract is blocking a lot of this incoming light, our vision becomes compromised. Symptoms of a cataract include:

● Hazy, foggy, cloudy, or blurry vision

● Increasing difficulty with vision in low contrast conditions, such as reading in dim lighting or driving in the rain

● Increased glare sensitivity, such as when faced with oncoming car headlights

While age-related cataracts are the most common type, there can be other causes of cataracts. These include:

● Congenital causes. These may occur for no identifiable reason or may be a result of a maternal health condition during pregnancy, such as rubella.

● Trauma. A traumatic cataract may be a result of a blunt blow or a penetrating injury to the eye, such as a shard of glass. Electric shocks and radiation may also cause traumatic cataracts.

● Systemic metabolic diseases. In addition to diabetes, other systemic diseases such as galactosaemia or Lowe’s syndrome can include cataract as a symptom.

● Iatrogenic. Iatrogenic cataracts occur as a result of a medical procedure or treatment, such as eye surgery for another condition. Long-term steroid use, whether taken as tablets, intravenous injection or directly administered to the eye, may induce a cataract. Some types of retinal detachment surgery are also known to cause a cataract as a side effect.

In most cases, cataract surgery is able to restore sight to what you were experiencing before the cataract developed. Exceptions to this may be in the case of congenital cataracts that have been left unaddressed for too long, or when there is the presence of another eye disease or injury that affects the vision. In these situations, while cataract surgery may improve the vision somewhat, there will still be limitations of the sight due to these other factors. So, what is cataract surgery and how does it work?

What is Cataract Surgery?

Cataract surgery is currently the only definitive treatment for a cataract. The aim of cataract surgery is to remove the cataract by extracting the entire crystalline lens from the eye and then replace it with an artificial lens implant, known as an intraocular lens (IOL).

In Australia, ophthalmologists may use one of two methods of cataract surgery. The conventional method of cataract surgery is called phacoemulsification while the more recent technique is known as femtosecond laser-assisted cataract surgery (FLACS). Some surgeons may even offer both techniques, depending on the particular patient. Both surgery methods require the eye to be anaesthetised, either using a local injection or a topical eye drop. General anaesthesia is rarely used but may be recommended in specific circumstances.

During phacoemulsification cataract surgery, a handheld tool is used to create an incision at the edge of the cornea, the clear dome at the front of the eye. With FLACS, this step may be performed using the femtosecond laser. The membrane bag holding the cataract must then be opened, again either using a handheld tool or with a laser, to allow access to the cataract. Phacoemulsification then utilises an ultrasound probe to fragment the cataract while FLACS employs the laser to first soften the cataract before applying the ultrasound probe. The small pieces of the cataract can then be suctioned out of the eye and the IOL inserted into the membrane bag and manipulated into position.

While different eye surgeons may have different preferences regarding phacoemulsification versus femtosecond laser-assisted cataract surgery, studies have shown that both techniques are safe and effective at treating a cataract.

For those wondering what is cataract surgery recovery like in the postoperative period, you’ll be pleased to know that vision is often noticeably improved almost immediately after surgery. In the following weeks, your vision continues to stabilise as the eye heals and the IOL settles. Depending on the IOL chosen in discussion with your surgeon, you may find you have excellent vision without the glasses or contact lenses you once wore! 

If you have a cataract and believe you may be ready for cataract surgery, book your appointment with Dr Anton van Heerden by calling us on (03) 9000 0389 today.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.