As an optometrist today it’s very exciting to be comanaging cataract surgery with highly experienced eye surgeons who are performing all laser cataract surgery. In addition, there are many options as far as which type of lens implant to recommend. Often patients have many questions when it comes to cataract surgery due to the various options that are available.

Therefore, as an optometrist it is my job is to explain and share information that I believe is best suited for each of my patients. The following are some of the questions and answers I discuss.

Are there different types of cataract surgery?

Yes. The technique used by a cataract surgeon depends on many factors, including the health of the eye undergoing the procedure, the surgical equipment used and the expertise of the surgeon.

In the United States and other developed countries, the most common type of cataract procedure performed today is called phacoemulsification (or “phaco”) cataract surgery with foldable intraocular lens (IOL) implantation.

An exciting new technology is laser-assisted cataract surgery, which offers a higher level of precision for certain steps in a cataract procedure. This procedure requires only very small incisions, and no stitches are needed at the end of surgery. Hand-held instruments are used to gain access to the cataract, which is then broken up with ultrasonic energy and removed from the eye in small fragments with gentle suction. A special applicator is then used to insert the flexible IOL, which unfolds inside the eye. The surgeon securely positions the IOL in the same location where the natural lens resided (directly behind the pupil).

Laser-assisted cataract surgery—also called LACS or laser cataract surgery—is a modern variation of the standard phaco cataract procedure. In laser cataract surgery, a number of steps that traditionally have been performed with a hand-held surgical instrument are instead done with a computer-controlled, high-speed laser for added precision. These steps include making the initial incisions in the eye, creating an opening in the anterior capsule of the lens to gain access to the cataract and fragmenting the cloudy lens prior to its removal from the eye.

During your pre-operative eye exam and consultation, ask your cataract surgeon for more details about the different types of cataract surgery and which procedure and technique is best.

Are there other options besides surgery?

At this time—and for the foreseeable future—cataract surgery is the only viable treatment for cataracts. Though some evidence suggests a healthy diet may help prevent cataracts, making healthful dietary or lifestyle changes will not reverse cataracts once they are present.

Researchers are investigating whether it is possible to develop eye drops that can prevent or cure cataracts, but these studies are in very early stages. It is impossible to predict when such a treatment might be available and whether it will be as effective as cataract surgery to restore vision.

In addition to restoring vision that has been lost due to cataracts, cataract surgery can correct nearsightedness, farsightedness and astigmatism with the intraocular lens (IOL) that is implanted in the eye after the cataract is removed. This means that in addition to restoring clear vision, modern cataract surgery can also reduce your need for eyeglasses or contact lenses after the procedure. There even are multifocal IOLs and accommodating IOLs that can be used during cataract surgery to treat the normal age-related loss of near vision called presbyopia and thereby reduce your need for reading glasses.

What happens if cataracts are left untreated?

In most cases, cataracts will continue to worsen over time, causing continual reduction of vision. Driving can be affected—which could be dangerous—and so can overall quality of life. Many people become legally blind from untreated cataracts, and cataracts can even cause total blindness if left untreated for long periods.

It’s impossible to accurately predict how quickly a cataract will worsen. If you notice your vision is getting worse prior to your next regularly scheduled eye exam, don’t wait—see your eye doctor and have your vision checked.

If you’re tempted to put off your cataract surgery, discuss it with your eye doctor. It’s usually better to have the surgery as soon as possible instead of waiting months or years. In some cases, a change of your eyeglass prescription will improve your vision if your cataract is worsening; other times it will not. If you aren’t sure if your cataract is bad enough to have surgery or if Medicare will pay for it, consult with your eye doctor or cataract surgeon.

Untreated cataracts can become “hyper-mature”—a condition that makes them more difficult to remove and more likely to cause cataract surgery complications. Generally, for better outcomes, cataract surgery should be performed soon after vision problems develop rather than waiting many months or years.

Having a comanaging eye doctor you feel comfortable discussing your health history and eye concerns with and will give you the time and attention you need is very important to the outcome of your surgery.

By Maty Youngewirth, OD