Cataract Surgery | Phacoemulsification | FLACS | ROQUE Eye Clinic

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You are here because you have been searching for answers to questions regarding cataract.

These may include its definition, cataract symptoms, cataract surgery (phacoemulsification, FLACS), intraocular lens implant options, cataract surgery packages, and other frequently asked questions.

We have all the answers for you, including videos, animations, and comparison tables.

WHAT IS A CATARACT?

The most common age-related eye disease affecting vision is a cataract. If you or your loved one would like to get rid of eyeglasses, or would like to improve the quality of vision, then cataract surgery may be the solution. Surgery to remove cataracts is one of the most frequently performed, one of the most successful, and one of the safest procedures in medicine today.

WHAT TO DO WHEN YOU HAVE A CATARACT

CATARACT SURGERY | PHACOEMULSIFICATION | FLACS1

Videos

By adding videos and animations, we have made it easy for you to learn about cataract surgery. There are also tables comparing numerous intraocular lenses and packages.

Book your cataract evaluation via Online Booking. Alternatively, you may call up our BGC Clinic or our Alabang Clinic to speak with one of our staff.

CATARACT SURGERY | PHACOEMULSIFICATION | FLACS2

Tests

Our staff will assist you with booking your refractive cataract surgery diagnostic examinations at the eye center. Depending on your ocular status, you may also need to have the following done: keratograph, fundus photo, OCT, B-scan, etc.

CATARACT SURGERY | PHACOEMULSIFICATION | FLACS3

Counseling

The ophthalmic diagnostic test results will be evaluated by Dr. Manolette Roque in clinic. The best surgical approach and intraocular lens implant will be offered based on your vision requirements, ocular status, and budget.

CATARACT SURGERY | PHACOEMULSIFICATION | FLACS4

Scheduling

Once you have decided with your cataract surgery, picked your intraocular lens, and have the necessary HMO letter of authorization (LOA), Philhealth pre-approval, and retina/medical clearance, you may pick the nearest available surgical slot, at your convenience.

ESTIMATED TIMELINE

  • PLANNED SURGERY DAY MINUS 7 TO 90 DAYSAt least 1 week prior to surgery

    EXAMINATION & COUNSELING

    Ocular examination is performed in clinic. This may include, but are not limited to, refraction, slit lamp biomicroscopy, ocular surface examination, ophthalmic pressure checks, and dilated fundus examination. Once eye diagnostic results are available, intraocular lens implant computation may be made and the power is chosen. This power is unique for your eyes, and is ordered from the distributors. If they are available in stock, then they may be delivered within a day or two. If they are unavailable, it may take 1-2 weeks for shipping from the manufacturer. If the lens needs to be customized, then they may be prepaid fully then ordered. Customized lenses may take 6-12 weeks to make and deliver.

    EYE DIAGNOSTICS

    Cataract screening tests (refraction, biometry, specular microscopy, topography, dry eye keratograph, retina fundus photos, OCT, etc.) are performed at the eye center/institute. The results are generally valid for around 90 days. We prefer to repeat the tests for cataract surgeries performed after 3 months from the date of examination.

    LABORATORY EXAMINATIONS

    Blood extraction, ECG, and x-ray, if necessary, are requested and performed at the laboratory. If they are not within normal limits, then a medical clearance will be requested. Laboratory results are usually accepted for review within one to two weeks from extraction/imaging.

    MEDICAL CLEARANCE

    Laboratory results are taken to the internist for cardiopulmonary clearance. Blood sugar and blood pressures are commonly silently elevated in our subset of patients. If you do not have a current internal medicine doctor, we can refer you to one.

    INSURANCE GOP

    Insurance companies issue a guarantee of payment (GOP) several days prior to the surgery date. The validity is variable. If your insurance has coverage for an intraocular lens (IOL) implant, a separate GOP for IOL coverage must be secured.

    PHILHEALTH PRE-APPROVAL

    Philhealth requires a minimum of 5 business days to process cataract surgery pre-approval. Our staff will assist you in securing this.

  • PLANNED SURGERY DAY MINUS 3 DAYSThree days prior to surgery

    HMO LOA

    Each Health Maintenance Organization (HMO) issue a letter of authorization (LOA) with a short validity of 3 days only. It is, therefore, important to finalize your surgical schedule prior to requesting for an LOA from your HMO. If your HMO has coverage for an intraocular lens (IOL) implant, a separate LOA for IOL coverage must be secured.

    COVID RT-PCR NASAL SWAB

    All patients scheduled for surgery are required to have a negative COVID RT-PCR nasal swab performed 3 days prior to surgery. This may be done in any DOH-accredited COVID RT-PCR nasal swab testing center. At the moment, COVID RT-PCR saliva tests are not yet recognized as a suitable alternative by hospitals.

  • PLANNED SURGERY DAY 0Cataract Surgery Day

    OUT PATIENT, DAY SURGERY

    This is the day that you have been preparing for. The actual day to say goodbye to your cloudy vision. The surgery is usually performed under topical (eye drop) anesthesia. Sometimes, cases are performed under monitored anesthesia care, or light sedation. Less commonly, it is performed under general anesthesia. Cataract surgery is usually completed within half an hour, from start to finish. You will definitely spend more time getting yourself admitted and prepared for surgery, as well as, awaiting billing and discharge from the hospital.

    POST-OPERATIVE EXAMINATION

    After the surgery, you will be asked to begin your eye drops while awaiting final discharge. Once discharged, you will be asked to proceed to the clinic for an immediate post-op examination prior to your departure for your residence. Alternatively, immediate same day post-operative examination may be scheduled 1-2 days after the surgery.

    OPHTHALMIC MEDICATIONS

    Our main job is over. It is your turn to follow the prescribed ophthalmic medications. You will be given written and digital prescriptions by our clinic. These eye drops are meant to minimize intraocular inflammation and prevent potential infection, in order to provide you with the best visual outcomes.

  • POST-OPERATIVE DAY 2 ONWARDSAt least two days post-op

    CATARACT SURGERY ON THE OTHER EYE

    Surgery on the fellow eye is usually performed at least 2 days after surgery of the initial eye. The schedule is variable. Most of our patients prefer to have them done a couple of days apart in order to have only one period of 'down time' applying ophthalmic medications. Some patients prefer to have the other eye done once the initial eye has healed completely.

  • POST-OPERATIVE WEEK 1-2One to two weeks post-op

    ROUTINE POST-OP VISIT

    Your eye will be examined. The intervals of application of ophthalmic medications will be revised. This is your intermediate eye check up.

  • POST-OPERATIVE WEEK 5-6Four to six weeks post-op

    ROUTINE POST-OP VISIT

    You will have very little ophthalmic medications left at this time. You may be given ophthalmic lubricants and oral supplements.

  • POST-OPERATIVE MONTH 3-6Three to six months post-op

    FINAL REFRACTION, ETC.

    A final refraction and specular microscopy are performed at this time. If you feel that you need post-operative prescription glasses to further improve the quality of your vision, then you may purchase a new pair of prescription glasses.

  • POST-OPERATIVE YEAR 1-2One to two years post-op

    SECONDARY CATARACT, POSTERIOR CAPSULE OPACIFICATION

    Secondary opacification of the posterior capsule, which wraps around the artificial intraocular lens implant, may lead to 'cloudy' or blurred vision. This is not a true cataract, and is actually a result of the healing process. This may be removed with a single out-patient procedure called YAG laser capsulotomy. Vision quality improves immediately after the procedure.

    ANNUAL WELL EYE EXAMINATION

    An annual eye examination is recommended to screen for aging eye conditions, and maintain ocular health.

CATARACT SURGERY

Phacoemulsification

Phacoemulsification is a machine-assisted cataract surgery technique allowing small sutureless corneal incisions with foldable intraocular lens implantations. Click on the eMedicine link below to read up on a manuscript on phacoemulsification which Dr. Roque prepared for eMedicine Medscape.

FLACS

A small instrument will be placed between your eyelids to keep you from blinking. In Bladeless Laser Cataract Surgery (aka Femtosecond Laser Assisted Cataract Surgery or FLACS), the laser is used to make the opening in the eye, an opening in the lens itself and to treat the lens. Dr. Roque uses the advanced Alcon LenSx system. If needed, an ultrasonic instrument will then gently break the cataract into microscopic particles, which are then suctioned away.

INTRAOCULAR LENS IMPLANT OPTIONS

An appropriate intraocular lens (IOL) for your specific visual requirements has been chosen preoperatively. This IOL may be an aspheric monofocal (Alcon IQ, Freedom Fold, HumanOptics Aspira, J&J Tecnis, Medicontur Bi-Flex T, Ocuflex, PhysIOL microAY123, Rayner Aspheric, VSY Acriva, Zeiss CT Asphina) aspheric monofocal toric (Alcon IQ Toric, HumanOptics Toric A, Medicontur Toric, Rayner Toric, Zeiss TORBI), aspheric multifocal (Alcon ReStor, Alcon Panoptix, HumanOptics Diffractiva, Medicontur Liberty, Oculentis Lentis MplusX, PhysIOL FineVision microF, Rayner Trifocal, VSY RevIOL, Zeiss AT Lisa, Zeiss AT Lisa Tri), aspheric multifocal toric (Alcon ReStor Toric, Alcon Panoptix Toric, Medicontur Liberty Toric, Oculentis Lentis MplusX Toric, PhysIOL PodFT, Rayner Trifocal Toric, Zeiss AT Lisa Toric). The IOL you chose to correct your vision will be inserted into the same location that your natural lens occupied. Once the IOL is locked into position, the micro-incision seals itself, typically without the need for sutures. It remains tightly closed by the outward pressure within the eye and provides a fast and much more comfortable recovery.

IOL Options

MONOFOCALMONOFOCAL TORICMULTIFOCALMULTIFOCAL TORICEDOF VARIFOCAL POLYFOCALADD ON
Distance VisionYesYesYesYesYesYes
Intermediate VisionNoNoYesYesYesYes (Multifocal only)
Near VisionNoNoYesYesYesYes (Multifocal only)
Astigmatism CorrectionNoYesNoYesYes (Varifocal Toric only)Yes (Toric only)
AsphericYesYesYesYesYesYes
PreloadedYes (Hoya 251, Micro123, Aspira, Bi-Flex HL)NoYes (AT LISA Tri)NoNoNo
BrandsAlcon IQ, Freedom Fold, HumanOptics Aspira, J&J Tecnis, Medicontur Bi-Flex T, Ocuflex, PhysIOL microAY123, Rayner Aspheric, VSY Acriva, Zeiss CT AsphinaAlcon IQ Toric, HumanOptics Toric A, Medicontur Toric, Rayner Toric, Zeiss TORBIAlcon ReStor, Alcon Panoptix, HumanOptics Diffractiva, Medicontur Liberty, Oculentis Lentis MplusX, PhysIOL FineVision microF, Rayner Trifocal, VSY RevIOL, Zeiss AT Lisa, Zeiss AT Lisa TriAlcon ReStor Toric, Alcon Panoptix Toric, Medicontur Liberty Toric, Oculentis Lentis MplusX Toric, PhysIOL PodFT, Rayner Trifocal Toric, Zeiss AT Lisa ToricSymfony, MPlus Comfort, MPlus MF20, MPlusX, MPlus MF30, WIOLToric, Multifocal, SML
Average Cost (in Philippine Pesos)10,000 - 25,00040,00060,000 - 75,00075,000 - 90,00075,000 - 90,00075,000 - 90,000

Prices listed are for the cost of an IOL only. Professional fees and hospital fees are not included. To view the complete cataract package, please proceed to the Cataract Surgery Packages.

POST-OPERATIVE CARE

Post-operative Care

You will be released soon after the procedure to go home and relax for the rest of the day. Your eye will not be patched and most patients are able to see well after surgery.Visual recovery varies from patient to patient but most patients return to their normal activities within a day or two. If you have cataracts in both eyes, the second procedure will usually be scheduled within a week or two.

Serious complications are extremely rare, but it is surgery and there are some risks involved. One of our counselors will provide you with additional information about the risks associated with cataract surgery. Choosing an experienced surgeon for your procedure can significantly minimize the risks involved with your cataract procedure.

CATARACT SURGERY PACKAGES

Per Eye | Philippine Pesos | Asian | St. Luke’s | as of 01JUN2018
CATARACT SURGERY | PHACOEMULSIFICATION | FLACS

Phacoemulsification

Phacoemulsification Cataract Surgery at JCI-accredited hospitals

  • St. Luke's Medical Center Global City
  • Asian Hospital Medical Center
  • Most insurance companies and HMOs provide coverage for phacoemulsification cataract surgery. Philhealth provides basic coverage subject to a 5-day pre-approval process. If bladeless femtosecond laser-assisted cataract surgery is desired, please choose the Platinum packages instead.

CATARACT SURGERY | PHACOEMULSIFICATION | FLACS

FLACS

This is the latest premium state-of-the-art bladeless Femtosecond Laser-Assisted Cataract Surgery

  • St. Luke's Medical Center Global City (LenSx)
  • Most insurance companies and Health Maintenance Organizations (HMO) do not provide coverage for premium FLACS. Philhealth provides basic coverage subject to a 5-day pre-approval process. Choose this package if you wish to say goodbye to manual incisions and blades, and say hello to laser-precision, improved healing, faster visual recovery, and better visual outcomes.

Cataract Surgery Packages

IOLCASH ONLYCASH + PHILHEALTHCASH + PHILHEALTH + HMO
MONOFOCALNon-Aspheric76,00060,00010,000
Aspheric91,00075,00025,000
Toric106,00090,00040,000
PRESBYOPIAMultifocal126,000110,00060,000
Toric141,000125,00075,000
ADDONSpherical116,00090,00040,000
Toric141,000125,00075,000
Multifocal141,000125,00075,000
SML146,000130,00080,000
IOLCASH ONLYCASH + PHILHEALTHCASH + PHILHEALTH + HMO
MONOFOCALNon-Aspheric111,00095,00010,000
Aspheric126,000110,00025,000
Toric141,000125,00040,000
PRESBYOPIAMultifocal161,000145,00060,000
Toric176,000160,00075,000

LEGEND

  • IOL. Intraocular Lens implant. Implanted to improve vision after cataract surgery.
  • PHILHEALTH. Philippine Health Insurance Corporation. First Payor. If cataract surgery is pre-approved, Philhealth provides coverage of 16,000 pesos.
  • HMO. Health Maintenance Organization. Second Payor. Provides coverage, after Philhealth, for the rest of the hospital bill, and professional fees. If Philhealth is not available, the HMO usually requires the individual to shoulder the Philhealth coverage of 16,000 pesos. An IOL is usually not covered, and is paid out of pocket.
  • MONOFOCAL. An intraocular lens which provides a correction for a single point of focus, usually far. It does not correct for astigmatism. If used for far correction, the individual must use reading glasses all the time
  • TORIC. An intraocular lens used to correct for astigmatism. Astigmatism is a type of refractive error in which the eye does not focus light evenly on the retina, resulting in distorted or blurred vision at all distances.
  • MULTIFOCAL. An intraocular lens which provides correction for all distances (far, intermediate, near). Provides around 90% spectacle independence in the real world setting. One may need to use prescription glasses for 10% of the time (small print, low light conditions, bright light conditions).
  • PRESBYOPIA. Presbyopia is a condition associated with age. As people age, the lens becomes harder and less elastic, making it more difficult for the eye to focus on close objects. Presbyopia correcting IOLs, e.g. multifocal IOLs, provide correction for all distances. See MULTIFOCAL.
  • ADDON. A second intraocular lens implant inserted in an anatomic space called the sulcus, in front of an existing intraocular lens placed in the capsular bag. It may correct for post-operative spherical refractive errors, astigmatism, and presbyopia. The SML, Scharioth Macula Lens, is a Low Vision implant useful for patients with age -related macular degeneration or other maculopathy (central vision problems).
  • NON-ASPHERIC (SPHERICAL). A spherical intraocular lens can induce minor optical imperfections called higher-order aberrations (HOAs), which can affect quality of vision, particularly in low-light conditions such as driving at night.
  • ASPHERIC. Premium aspheric IOLs approximate the shape and optical quality of the eye's natural lens, and provide sharper vision, especially in low light conditions and for people with large pupils.

HOW TO USE THE TABLE

COLUMN

  • Choose the CASH column if you have no insurance and are paying 100% out of pocket.
  • Choose the CASH + PHILHEALTH column if you have PHILHEALTH. This is your total bill minus 16,000 pesos paid by Philhealth.
  • Choose the CASH + PHILHEALTH + HMO column if you have both PHILHEALTH and HMO/Insurance. The amount shown here is basically the cost of the intraocular lens implant, which is paid out of pocket.

ROW

  • Choose the MONOFOCAL row if you would like far correction only. You are willing to wear reading glasses all the time.
    • Choose NON-ASPHERIC if your astigmatism is less than -0.75D and you don't require excellent quality of vision at night.
    • Choose ASPHERIC if your astigmatism is less than -0.75D and you require excellent quality of vision at night.
    • Choose TORIC if you have astigmatism greater than -0.75D.
  • Choose the PRESBYOPIA row if you would like to have correction for all distances (far, intermediate, near) in order to be less dependent on glasses. You understand that you will be spectacle free for 90% of the time in the real world setting. You are willing to wear prescription glasses for small print, low light conditions, and bright conditions.
    • Choose MULTIFOCAL if your pre-operative astigmatism is less than -0.75D.
    • Choose TORIC if your pre-operative astigmatism is greater than -0.75D.
  • Choose the ADDON row, if you had previous cataract surgery, and have an unacceptable post-operative refraction.
    • Choose SPHERICAL if you have a significant spherical error and would like to have clearer distance vision.
    • Choose TORIC if you have significant astigmatism and would like to have clearer distance vision.
    • Choose MULTIFOCAL if you have acceptable distance vision, but would like to say goodbye to reading glasses.
    • Choose SML if you have low vision due to age-related macular degeneration, and would like to have magnification for your your near vision requirements in your non-dominant eye.

COLUMN + ROW

The intersection of the COLUMN and the ROW that you have chosen is the amount that you have to settle for your cataract surgery.

  • Cataract Surgery with intraocular lens implantation under local anesthesia is performed:
    • by Dr. Manolette Roque
    • in St. Luke's Medical Center Global City daily except Sundays and holidays. Scheduled patients must arrive one (1) hour prior to surgery.
    • in Asian Hospital Medical Center, in Alabang, Muntinlupa every Tuesday afternoon. Scheduled patients must arrive two (2) hours prior to surgery.
    • with any of the following phacoemulsification units: Alcon Centurion/Infiniti or B+L Stellaris.
    • with the Alcon LenSx Femtosecond laser for FLACS.
  • Cataract screening and post-operative follow up examinations may be done in Asian Hospital MOB 509 or St. Luke's Medical Center Global City MAB 217.
  • Phacoemulsification Cataract Surgery Packages are limited to surgeries performed under local anesthesia in either hospital. FLACS is only done in St. Luke’s. If sedation is requested, add 30,000 pesos to the Cataract Surgery Package.
  • STOP the following medications, one (1) week prior to planned cataract surgery:
    • All blood thinners (Aspirin, Aspilet, Clopidogrel, Heparin, Enoxaparin, Ardeparin, Danaparoid, Warfarin, Vitamin E, Gingko Biloba)
    • All prostate medications (Harnal, Tamsulosin, Flomax, Hytrin, Avodart, Duodart, Proscar, among others)
  • The Cataract Surgery Packages may only be used for routine cataract surgery. It may not be availed with cataract surgery combined with trauma, glaucoma, uveitis, cornea, or retina diseases. These combined surgeries are much longer and require more consumables, and are therefore associated with additional expenses.
  • Package Inclusions:
    • Professional fee
    • Hospital bill (peri-operative services, operating room fee, phacoemulsification machine use, surgical microscope use, consumables needed for surgery, surgical instruments, sterilization, post-operative medications, post-operative services); femtosecond laser machine use for FLACS
    • Intraocular lens implant, 3 free post-operative follow up visits (usually day 0 or 1, week 1, month 1).
  • Package Exclusions:
    • Pre-operative consultation
    • pre-operative diagnostic tests
    • pre-operative medications.
  • All Cataract Surgery Packages are inclusive Senior Citizen Discount and exclusive of eVAT. It may not be combined with other promos and discounts.
  • Additional charges will be billed for the use of Iris Hooks, Malyugin Rings, Triamcinolone Acetonide, Ozurdex Dexamethasone implant, and other devices.
  • Philhealth pre-approval is required five (5) working days prior to the scheduled surgery. Please submit your Philhealth ID, MDR, and other documents 1 week prior to scheduled surgery.
  • Only Philippine FDA-registered IOLs may be used when availing of Philhealth benefits. For premium IOLs which are not yet registered, Philhealth may not be filed.
  • HMO letter of authorization (LOA) or Insurance guarantee of payment (GOP) needs to be requested three (3) days prior to scheduled surgery.

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions on Cataract

What is a Cataract?

A cataract is a clouding of the eye's lens that can cause vision problems. The most common type is related to aging. More than half of all Americans age 65 and older have a cataract. In the early stages, stronger lighting and eyeglasses may lessen vision problems caused by cataracts. At a certain point, however, surgery may be needed to improve vision. Today, cataract surgery is safe and very effective.

What is the lens?

The lens is the part of the eye that helps focus light on the retina. The retina is the eye's light-sensitive layer that sends visual signals to the brain. In a normal eye, light passes through the lens and gets focused on the retina. To help produce a sharp image, the lens must remain clear.

What are cataracts?

A cataract is a progressive clouding of the eye's natural lens that hampers with light passing through to the retina. People who suffer from cataracts usually describe the condition as being similar to looking through mist, smoke, a cloud, a waterfall, or a piece of wax paper, with a gradual blurring or dimming of vision.

Who gets cataracts?

More than half of people over the age of 60, and quite a few younger than that, suffer from cataracts. It is said that everyone will develop a cataract if they live long enough.

What are the symptoms of cataracts?

Reading may become more difficult and driving a car can actually become dangerous. Cataract sufferers may also be troubled by a bothersome glare, halos around lights, or even double vision. And as the cataract becomes worse, frequent changes in eyeglass prescriptions may become necessary.

What are the different types of cataract?

  • Age-related cataract: Most cataracts are related to aging.
  • Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.
  • Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.
  • Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.

Can cataracts be prevented?

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, there is only one way to achieve clear vision again, and that is to physically remove the cataract from the eye.

Although we don't know how to protect against cataracts, people over the age of 60 are at risk for many vision problems. If you are age 60 or older, you should have an eye examination through dilated pupils at least every 2 years. This kind of exam allows your eye care professional to check for signs of age-related macular degeneration, glaucoma, cataracts, and other vision disorders.

How is it treated?

For an early cataract, vision may improve by using different eyeglasses, magnifying lenses, or stronger lighting. If these measures don't help, surgery is the only effective treatment. This treatment involves removing the cloudy lens and replacing it with a substitute lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you decide on surgery, your eye care professional may refer you to a specialist to remove the cataract. If you have cataracts in both eyes, the doctor will not remove them both at the same time. You will need to have each done separately.

Sometimes, a cataract should be removed even if it doesn't 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.

Is cataract surgery effective?

Cataract removal is one of the most common operations performed in the world today. It is also one of the safest and most effective. In about 90 percent of cases, people who have cataract surgery have better vision afterward.

How is a cataract removed?

There are two primary ways to remove a cataract. Your doctor can explain the differences and help determine which is best for you:

Phacoemulsification, or phaco. Phacoemulsification is an advanced technique of cataract extraction. It is also known as small-incision cataract surgery. Others call it the "no-needle, no-stitch" technique. After application of a local anesthetic, your doctor makes a small incision on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The doctor then inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the cloudy center of the lens so it can be removed by suction. Most cataract surgery today is done by phaco.

Extracapsular surgery. Your doctor makes a slightly longer incision on the side of the cornea and removes the hard center of the lens. The remainder of the lens is then removed by suction.

After placing topical anesthesia, clear corneal incision is made with a crystal/diamond keratome. This is usually only 2.75 mm in size. This is a self-sealing incision which allows a sutureless procedure.

Arguably one of the more delicate steps in the procedure of cataract removal, continuous curvilinear capsulorhexis (CCC) is the careful creation of a well-controlled tear in the anterior capsule of the cataract.

Ultrasonic vibrations (phacoemulsification) are now created to crush the cataract into manageable particles which are then aspirated into a port using the same tip (handpiece).

The conventional way of approaching the removal of a cataract is by the "divide and conquer" method. The cataract is rotated and grooving is continued to create manageable pie shaped segments.

This provides a side view of the actual inclination of the phaco tip (handpiece) as it proceeds with phacoemulsification of the cataract.

After removal of the tough nuclear component, the softer cortical material are then aspirated with an irrigation/aspiration (I/A) handpiece. Complete removal of the cataract lessens the likelihood of developing an "after cataract" or posterior capsular opacification necessitating a YAG laser capsulotomy post operatively.

After injection of viscoelastic material into the capsular bag and the anterior chamber a foldable intraocular lens is then inserted and unfolded into the eye.

The intraocular lens is then dialed into place. The remaining viscoelastic material is removed. The eye is then checked for leaks.

In most cataract surgeries, the removed lens is replaced by an intraocular lens (IOL). An IOL is a clear, artificial lens that requires no care and becomes a permanent part of your eye. With an IOL, you'll have improved vision because light will be able to pass through it to the retina. Also, you won't feel or see the new lens. The self-sealing corneal incision precludes the need for stitches, however, one may receive one or several stitches in some instances.

Some people cannot have an IOL. They may have problems during surgery, or maybe they have another eye disease. For these people, a soft contact lens may be suggested. For others, glasses that provide powerful magnification may be better.

What happens before surgery?

A week or two before surgery, your eye care professional will do some tests. These may include tests to measure the curve of the cornea and the size and shape of the eye. For patients who will receive an IOL, this information helps your doctor choose the right type of IOL. Also, doctors may ask you not to eat or drink anything after midnight the morning of your surgery.

What happens during surgery?

When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed.

The operation usually lasts less than 1 hour and is almost painless. Many people choose to stay awake during surgery, while others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch will be placed over your eye and you will rest for a while. You will be watched by your medical team to see if there are any problems, such as bleeding. Most people who have cataract surgery can go home the same day. Since you will not be able to drive, make sure you make arrangements for a ride.

What happens after surgery?

It's normal to feel itching and mild discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, your eye care professional may suggest a pain reliever every 4-6 hours. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about 6 weeks.

After surgery, your doctor will schedule exams to check on your progress. For a few days after surgery, you may take eyedrops or pills to help healing and control the pressure inside your eye. Ask your doctor how to use your medications, when to take them, and what effects they can have. You will also need to wear an eye shield or eyeglasses to help protect the eye. Avoid rubbing or pressing on your eye.

Problems after surgery are rare, but they can occur. These can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, or light flashes. With prompt medical attention, these problems usually can be treated successfully.

When you are home, try not to bend or lift heavy objects. Bending increases pressure in the eye. You can walk, climb stairs, and do light household chores.

When will my vision be normal again?

You can quickly return to many everyday activities, but your 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 your doctor when you can resume driving.

If you just received an IOL, you may notice that colors are very bright or have a blue tinge. Also, if you've been in bright sunlight, everything may be reddish for a few hours. If you see these color tinges, it is because your lens is clear and no longer cloudy. Within a few months after receiving an IOL, these colors should go away. And when you have healed, you will probably need new glasses.

What is After-Cataract?

Sometimes a part of the natural lens that is not removed during cataract surgery becomes cloudy and may blur your vision. This is called an after-cataract. An after-cataract can develop months or years later. Unlike a cataract, an after-cataract is treated with a laser. In a technique called YAG laser capsulotomy, your doctor uses a laser beam to make a tiny hole in the lens to let light pass through. This is a painless outpatient procedure.

Do you want more information on phacoemulsification with intraocular lens implantation? Read this eMedicine manuscript.

PHACOEMULSIFICATION FEATURE

Medscape Phacoemulsification with Intraocular Lens Implantation

eMedicine Medscape Ophthalmology
Phacoemulsification with Intraocular Lens Implantation

Authored by Dr. Manolette Roque for eMedicine Medscape Ophthalmology


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