How safe is cataract surgery? And do you really need it?

Karen’s elderly mom complimented Karen on her new green blouse. Except that it was blue. Karen realized her mom’s vision was fading and suspected she needed cataract surgery. No worries, right? Everybody has cataract surgery and it’s super safe, right?

Yes, cataract surgery is safe, said Sudhir Shenoy, MD, an ophthalmologist on the medical staff at Baylor Scott & White Medical Center – Round Rock. But it is still surgery, complete with all the risks that come with surgery, and should occur only when necessary.

“Make sure you’re having enough problems in your daily activities before pursuing surgery,” Dr. Shenoy said. “People assume that because they have friends and family who’ve had cataract surgery and so much goes well for them, that it’s no big deal. What could possibly go wrong?”

There are some things that are in your surgeon’s control and some things that aren’t.

“For example, I could come in and do a perfect cataract operation and someone could get a bad infection and end up with a bad result,” Dr. Shenoy said. “I’m not trying to scare you off. Cataract surgery is successful about 95 percent of the time, but you need to make sure you’re having enough of a problem to justify having surgery.”

Do I need cataract surgery?

“Everybody’s individual needs are different,” Dr. Shenoy said.

It might be time for surgery if cataracts are causing difficulty in your daily activities. For instance:

• You can’t see road signs easily while driving.
• The refracted glare of the sun, headlights or streetlights obstructs your vision.
• You can’t make out people’s faces from a moderate distance.
• You can’t read with ease.
• Double vision makes it difficult to distinguish objects clearly.
• “Halos” around lights hinder driving at night.

When should I get cataract surgery?

When you have surgery is largely determined by how much the clouded vision bothers you. In other words, a truck driver whose job is dependent on his eyesight may need cataract surgery before a retired postal carrier who spends their days watching television.

You don’t need a referral for cataract surgery.

“If you feel like you are having issues with your vision, I would recommend getting a full eye exam,” Dr. Shenoy said. “Not only can we see how your cataracts are affecting you but we can also look for other pathology in the eye, like macular degeneration or glaucoma. If the cataracts are significant and affecting your daily life, we would pursue cataract surgery.”

What is cataract surgery like?

In most cases today, cataract surgery is done on an outpatient basis with a local anesthetic (either eye drops or an injection). You’ll be awake during the 20- to 30-minute procedure.

Your ophthalmologist will make a small slit in your cornea and remove your cataractous lens. The old lens will be replaced with a new one made of acrylic.

“The new lens is foldable, so we can make a very small incision,” Dr. Shenoy said. “The lens goes in, rolled up or folded, and then opens up in your eye.”

Common misconceptions about cataract surgery

One common misconception is that cataract surgery means no more glasses. Not necessarily so.

“While that may be achievable for a small subset of patients with a more expensive, premium intra-ocular lens, it does not work for everyone,” he said. “Especially if there are other abnormalities with the eye, including issues with the retina, cornea or optic nerve, to name a few.”

There’s another factor patients have to take into account: The passage of time. Your eyes simply won’t work as well in middle-age or later as they did in your 20s, even with the replacement lens.

“Having regular eye exams and discussing the options with the cataract surgeon, and setting realistic goals for after the surgery, is the key,” Dr. Shenoy said.

Will I need cataract surgery for my other eye, too?

Because our lenses become cloudy as we age, everyone will eventually need cataract surgery. And once you’ve had it in one eye, Dr. Shenoy said, you’ll realize the difference between the eye with the new lens and the other eye.

“The non-operated eye will eventually need cataract surgery when it is affecting the patient’s activities of daily living and their measured vision has gotten worse,” he said.

But there’s no medical reason to rush into it, Dr. Shenoy added.

“At follow-up exams, we would offer cataract surgery in the other eye only when it qualifies,” he said. “The risk-benefit of doing surgery before the eye qualifies for surgery is not worth it, in my opinion.”

What are the risks of cataract surgery?

Though cataract surgery is one of the most common operations performed in the United States, it still has some risks. As with all operations, you risk bleeding and infection.

Additionally, Dr. Shenoy said, unique to the eye is the risk of retinal detachment, which occurs less than 5 percent of the time and can even occur months or years after the surgery.

“It is a very safe procedure,” he said. “But you’ve got to remember that it’s surgery and you shouldn’t take it lightly.”

What can I do to improve my chances of successful cataract surgery?

Dr. Shenoy said to take the following precautions prior to your cataract surgery to increase the chances of a good outcome:

• Be as healthy as possible prior to your surgery date.
• If you have a cold, cough, allergies or an active infection, reschedule your surgery for a later date.
• Stop smoking.
• If you are diabetic, make sure your diabetes is under control.

After your cataract surgery, you should:

• Take your eye drops as prescribed.
• Follow your doctor’s instructions regarding your activities.
• Don’t bend or lift.
• Don’t rub your eye or let it get hit.
• Keep your follow-up appointments with your physician.
• Contact your surgeon immediately if you have increasing pain or decreasing vision

If your vision is not what it used to be, find an eye doctor near you to help you see better.