Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.
A cataract needs to be removed only when vision loss interferes with everyday activities, such as driving, reading, or watching TV. Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your elderly parent's eye care professional finds a cataract, your parent may not need cataract surgery for several years. In fact, he or she might never need cataract surgery. By having vision tested regularly, an eye care professional can discuss if and when treatment is needed.
Kinds of Cataracts Surgery
There are two types of cataract surgery.
- Phacoemulsification or Phaco
A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called small incision cataract surgery.
- Extracapsular Surgery
The doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of the eye. Light is focused clearly by the IOL onto the retina, improving vision. Your elderly parent will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these people, a soft contact lens, or glasses that provide high magnification, may be suggested.
Risks of Cataract Surgery for Seniors
In most cases the cost of treatment of cataracts is covered by Medicare, HMOs, and other health insurance plans. But, check insurance coverage to determine at what level of impairment it will or will not cover before cataract surgery.
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, the doctor may ask your parent to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, keep the eye clean, it is important for the caregiver or senior to wash their hands before touching the eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase the risk of retinal detachment after cataract surgery.
One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in the field of vision. If your elderly parent notices a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. The eye must be examined by an eye surgeon as soon as possible.
A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.
Success Rate of Cataract Surgery
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.
What Happens Before Cataract Surgery
A week or two before surgery, the doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of the eye. This information helps the doctor choose the right type of IOL.
As a caregiver it is important to plan for preparatory care. Your elderly parent may be asked not to eat or drink anything 12 hours before surgery. Many times, antibiotic and anti-inflammatory drops are prescribed to be administered into the patient's eye two to four times a day, and in many cases, a senior may need help with getting the drops properly into the eye.
What to Expect During and After Cataract Surgery
When your loved one arrives at the hospital or eye clinic, drops will be put into the eye to dilate the pupil. The area around the eye will be washed and cleansed. The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time.
If your parent is awake, he or she will have an anesthetic to numb the nerves in and around the eye. After the operation, a patch may be placed over the eye. Your loved one will rest for a while. The medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. The patient will need someone to drive them home.
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. The eye may be sensitive to light and touch. If your parent has discomfort, the doctor can suggest treatment. After one or two days, moderate discomfort should disappear.
For a few days after surgery, your doctor may ask your parent to use eyedrops to help healing and decrease the risk of infection. Ask the doctor about how to use the eyedrops, how often to use them, and what effects they can have. Your elderly parent will need to wear an eye shield or eyeglasses to help protect the eye. It is important to avoid rubbing or pressing on the eye.
When your loved one is home, remind them they should not bend over from the waist to pick up objects, as it increases pressure in the eye. Do not lift any heavy objects. They can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on the senior's progress.
Complications After Cataract Surgery
Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.
An after-cataract is treated with a laser. The doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, the doctor may prescribe eyedrops to lower eye pressure before or after the procedure.
When Does Normal Vision Return?
Your parent can return quickly to many everyday activities, but vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask the doctor when your parent can resume driving.
If your loved one received an IOL, he or she may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, your parent will become used to improved color vision. Also, when the eye heals, the vision change may necessitate new glasses or contact lenses.
What to Do If You've Already Lost Vision from Cataracts
If your parent has lost some sight from cataract or cataract surgery, ask the eye care professional about low vision services and devices that may help make the most of your parent's remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
The National Eye Institute (NEI) conducts and supports research that leads to sight-saving treatments and places a key role in reducing visual impairment and blindness.