When should I have the surgery?
Usually, you can decide if, and at what stage to have the operation. The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while. If visual impairment interferes with your ability to read, to work, or to do the things you enjoy then you will probably want to consider surgery.
In the past, eye specialists often waited until the cataract became 'ripe' before suggesting you had it removed. Nowadays, with modern surgery the operation can be carried out at any stage of the cataract's development, and in fact, is a little safer to do before the cataract becomes 'ripe'.
What are the surgical options?
Majority of cataracts today are removed by Extracapsular surgery, in which the posterior capsule of the natural lens is left in place to support the IOL, which is implanted at the time of surgery. There are two types of extracapsular surgery.
Conventional extracapsular surgery: The nucleus of the lens, which is too hard to simply remove by aspiration, is taken out in one piece, and the softer parts of the lens are then aspirated. The surgeon makes an incision (10-12 mm in size) where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.
Phacoemulsification: It is a form of extracapsular surgery. In phacoemulsification, the hard nucleus is broken up by ultrasonic fragmentation (using sound waves) within the eye, and can then be aspirated. This allows a smaller incision (3 mm in size) to be used.
The other way of removing cataract is Intracapsular surgery, in which the whole lens is removed in a single piece, without leaving the posterior capsule behind. The patients are rehabilitated with glasses or contact lenses. This form of surgery is being done in a few villages and camp surgeries in India.
What is lens implantation?
The function of the normal lens is to focus the image on the back of the eye (retina) so that it forms a sharp image. Once the opaque lens (cataract) is removed, an artificial plastic lens is implanted inside the eye for this function. This lens is known as Intra-Ocular Lens (IOL).
Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear thick eyeglasses after cataract surgery without IOL implantation. They are also more convenient than contact lenses because they remain in the eye and do not have to be removed, cleaned, and reinserted.
Occasionally the doctor will decide that someone's eye is not suitable for a lens implant. In these cases contact lenses or special glasses will be prescribed instead.
