Questions to Ask Your Cataract Surgeon

cataract is a clouding of the eye's lens and the leading cause of blindness in people older than 55. Most older people have some degree of lens clouding, which is a normal part of aging. With a cataract, you may feel like you are looking through a foggy window. You may need a lot more light to read. People with cataracts often complain about glares and halos around lights while driving at night. Sometimes night driving becomes almost impossible.​

If you are considering cataract surgery, be sure to do your research so you know what to expect. Following are five questions to ask your doctor before he or she performs your cataract surgery.

1

Will I Know When It's Time for Cataract Surgery?

A female opthamologist listens to her patient.
Getty Images/Thomas Northcut

The answer to this question in some ways is simple: when you feel that your vision is not as good as you would like it to be. In the real world, it is sometimes difficult to tell when that is. Cataracts usually grow slowly so it's not always easy to tell. Ask your doctor what the quantity and the quality of your vision is. One way to measure the quantity of vision is to find out what your best corrected visual acuity is. This means exactly how good your vision can be with corrective glasses or contact lenses. This will give you an idea of how bad your cataracts are. Normal eyes see 20/20. If your vision is 20/60, that is several times worse than normal. The quality of your vision can be measured by a brightness acuity test (BAT). A BAT will simulate how your vision is when faced with headlights while driving at night. You may have 20/25 best corrected vision, but when measured by a BAT test, your vision may drop to 20/100.

2

What Type of Surgery Will I Have?

A surgeon uses surgical tools to remove the lens from the eye of a patient with a cataract
A surgeon uses surgical tools to remove the lens from the eye of a patient with a cataract. Getty Images/MedicImage

A few years ago, most people had cataract surgery by phacoemulsification. The procedure was completed using a small blade for an initial incision, followed by a procedure conducted with a phacoemulsifier. A phacoemulsifier is an ultrasound device that vibrates at such a high speed that the cataract is emulsified or dissolved into tiny fragments and gently suctioned out of the eye. Fast forward to 2011 when the FDA approved "laser cataract surgery" or more precisely, "femtosecond laser cataract surgery." In laser-assisted cataract surgery, a surgeon can view a magnified, high-resolution image given to him or her by a built-in OCT device. A peripheral incision, a capsulorrhexis, and fragmentation of the lens can be done with the assistance of a laser.

There is no question that in the hands of a highly trained cataract surgeon, laser cataract surgery is an excellent and advanced option. However due to variations in anatomy, some people cannot have laser cataract surgery, in which case phacoemulsification is still an option. Part of your decision will be based on cost, as Medicare and commercial insurance companies do not cover laser-assited cataract surgery.

3

What Type of Lens Implant Will Be Placed in My Eye?

Intraocular (artificial) lens on gloved finger.
Intraocular (artificial) lens on gloved finger. Getty Images/GIPhotoStock

Multifocal intraocular lens implants are the newest option, and attempt to deliver high-quality distance vision, intermediate vision, and near vision in order to decrease dependency on glasses after the surgery. While the multifocal technology is indeed advanced, most surgeons will make sure the patient understands that there is no guarantee that they will have totally glasses-free vision.

4

What Is My Risk of Possible Complications?

Senior man rubbing eye
Getty Images/Brad Wilson

All cataract surgery carries the risks of infection, bleeding, and retinal detachment. However, some people may have a higher risk of these complications than others. For example, people that are highly nearsighted have a higher risk of having a retinal detachment during their lifetime than someone who is not nearsighted. When surgeons have a patient that is high risk, they may take special precautions or have a retinal specialist on call in case problems occur. Another example may be a patient who is taking a blood thinner or anti-coagulant for heart problems. These patients are sometimes asked to discontinue these medications for a couple of days before surgery. 

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  1. Johns Hopkins Medicine. Cataracts FAQ.

  2. Kellogg Eye Center Michigan Medicine. Cataract.

  3. American Academy of Ophthalmology. Traditional cataract surgery vs. laser-assisted cataract surgery. Updated August 28, 2019.

  4. American Optometric Association. Cataract surgery.

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