What Is Pseudophakia?

Implanting an Artificial Lens in the Eye

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To hear your ophthalmologist use the word pseudophakia when discussing what may happen as part of cataract surgery may be a little off-putting, but not to worry. It means that an artificial or fake lens, otherwise known as an intraocular lens (IOL), will be put in your eye in place of the clouded one, with the cataract being removed.

Diagram of the eye in four different stages of the cataract removal process

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What Is a Pseudophakic IOL?

Pseudophakic lenses can be made of plastic composites, silicone, or acrylic material. Just like your eyeglasses or contact lenses, IOLs can compensate for most vision issues you may have, such as nearsightedness or farsightedness.

They are also selected in strengths specifically for your eyes. There are four different types of lenses that you may be offered. These include:

  • Monofocal IOLs: These are the most common lenses implanted and are all one power. This means they're clearest when you're focusing in a certain range. Most often, these are set for distance vision, with reading glasses used to see up close.
  • Multifocal IOLs: Some prefer the idea of pseudophakic correction for both near and distance simultaneously, which multifocal lenses allow. Like bifocal spectacles, different areas of the lens provide differing amounts of correction.
  • Accommodative IOLs: These can provide different corrections as they are attached to the ciliary body in the eye. This muscle's movement changes the shape of the lens to create clear near, intermediate, and distance vision.
  • Toric IOLs: A toric lens can correct errors for those with astigmatism caused by an uneven cornea.

It's not uncommon to still need glasses sometimes with pseudophakic IOLs. Discuss with your practitioner which lens might best suit your needs and lifestyle.

Purpose of IOL Surgery

Cataract surgery removes a clouded lens and replaces it with a clear pseudophakic IOL. While the practice of removing such a lens dates back to the ancient Egyptians, it wasn't until the 1940s when ophthalmologist Harold Ridley invented the first phakic IOL.

An artificial IOL helps you to see after your own cloudy lens is removed. When the light enters the eye, a lens focuses it. When the light is focused to the right strength, you can see sharply. The pseudophakic lens will be clear, just as your natural lens once was.

Age-related cataracts tend to occur when proteins in the lens begin to break down and stick together in places, interfering with the clear transmission of the light to the retina at the back of the eye.

With the most common cataract surgery type, a small wand is inserted into the eye through a tiny cut. This gives off sound waves that break apart the cataract into tiny pieces, which can then be suctioned out of the eye. The pseudophakic lens can then be put into the area to replace the original lens.

Another approach sometimes used for removal is extracapsular cataract surgery, where a larger cut is made. This may be used if it appears the cataract may be difficult to break apart. Your natural lens can then be removed in one piece and the pseudophakic lens inserted.

The IOL may be placed in the anterior chamber (between the iris and the cornea) or the posterior chamber (between the usual location of the lens and the iris).

Procedure

The surgery itself is an outpatient procedure. Here's an idea of what to expect.

Presurgery

Before surgery, be sure to alert your practitioner about any chronic conditions you might have, such as heart disease, high blood pressure, or diabetes, to ensure these are under control.

Also, discuss any medications you may be taking. While cataract surgery doesn't typically cause much bleeding, it may be suggested that you temporarily discontinue any blood thinners. But discuss this with the prescribing doctor first.

Be sure to also mention if you're taking any alpha-agonists such as Flomax (tamsulosin), Uroxatral (afuzosin), Hytrin (terazosin), Cardura (doxazosin), or Rapaflo (silodosin), since these can potentially interfere with the procedure.

Before surgery begins, your eyes will be measured with biometry to help determine the right power pseudophakic lens for you. You'll also likely be expected to take some eye drops to prepare.

During Surgery

On the day of surgery, expect to spend around two to three hours at whatever facility your procedure is being done. The procedure itself will only last around 30 minutes, and you will be awake the entire time.

You will likely first be given a sedative to relax you. You'll also be given a local anesthetic to block any pain. The doctor may administer some antibiotics or other drops just before the surgery and again right after.

After Surgery

Once the surgery is done, your eye will be bandaged, and the staff will explain what you need to do to care for your eye over the next few weeks during your recovery.

After resting for about half an hour, you can then go home. But be sure to secure a ride ahead of time since the surgery will preclude you from driving.

Outcome

Over the next several months, you will be asked to return for some postoperative visits. These usually begin just one day after surgery. At the visit, the practitioner will look at your eyes, test your vision, and make sure your eye pressure has remained more or less constant.

To ward off infection and tamp down inflammation, you will also be asked to take drops for a while. Your vision will be somewhat blurry the first few days after surgery, but it will begin to clear within the first few weeks.

In nearly all cases, vision improves after cataract surgery. However, you may be prescribed glasses or contacts to wear as well. This prescription will likely be different from any previous one.

Complications

In most cases, placement of the pseudophakic lens goes smoothly, but some occasional complications can occur. These can include:

  • Your vision is corrected too much or too little.
  • The lens is incorrectly positioned or moves.
  • The shape of the pupil can be ovalized.
  • Fluid can collect on the retina, causing Irvine-Gass syndrome, also known as cystoid macular edema (CME). This can cause macular swelling and result in blurriness of the central vision.

In addition, cataract surgery itself may at times have some complications such as:

  • Infection
  • Bleeding
  • Retinal detachment
  • Vision loss
  • Glaucoma
  • Requiring a second surgery

A Word From Verywell

Implantation of a pseudophakic IOL after cataract surgery is a very common, highly successful procedure. With this technique, most individuals have excellent vision, not unlike what they enjoyed before the cataract developed.

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Article Sources
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  1. Columbia University Department of Ophthalmology. Pseudophakia.

  2. American Academy of Ophthalmology. IOL implants: Lens replacement after cataract surgery. Updated April 19, 2021.

  3. Harvard Medical School. Cataract surgery: What to expect before, during and after. January 2020.

  4. Cleveland Clinic. Cataracts. Updated April 27, 2020.

  5. Kaiser Permanente. Cataract surgery pre-operative instructions.

  6. Harvard Medical School. Considering cataract surgery? What you should know. Updated October 13, 2020.

  7. University of Michigan. Cystoid macular edema.

  8. American Refractive Surgery Council. Is cataract surgery with vision-correcting IOLs safe?