Ophthalmic [Eye] Surgery at VA Boston health care

Cataract Surgery

Cataract surgery is offered to patients when their eye’s natural lens has become cloudy (a cataract) and no longer focuses the light on the retina in an undisturbed fashion (i.e., it is causing image distortion, blur, glare, etc.). If the symptoms are significantly impacting the patient, in completing their normal day-to-day activities safely and without difficulty, and the ophthalmologist feels that the cause of the patient’s visual troubles relate substantially to a developing cataract (and not other problems with the eye), then cataract surgery will be offered.

The goal of cataract surgery is to remove the cloudy lens and replace it with a clear intraocular lens. The procedure typically takes 15-30 minutes, though in some cases with increased complexity it can take up to one hour or more. On the day of surgery, patients should expect to be in the outpatient surgery area of the hospital for approximately 

3 hours total. The cataract itself is surrounded by a very delicate capsule, which is suspended in the front part of the eye by a system of fibers called zonules, just behind the pupil (the black circle in the center of the iris). The surgeon will numb the eye with topical anesthetics and an anesthesia provider will be present to give mild sedation, if needed for anxiousness. The surgeon makes two very small incisions (around 2.5mm and 1mm) in the edge of the cornea, the clear dome that covers the front part of the eye. This allows the surgeon to access the cataract. A circular opening is created in the capsule covering the cataract and a specialized instrument, called phacoemulsification handpiece, is introduced. The tip of this handpiece vibrates nearly 50,000 times per second, emitting ultrasound shock waves which can disrupt the cataract. Using this advanced technology, the cataract is “sculpted” and then cracked into smaller pieces and the same handpiece can then vacuum up and emulsify the fragments of cataract. Once the cataract is removed, the remaining capsule is cleaned up (some thin, wispy material called cortex is removed gently). The intraocular lens is then folded and injected into the eye within the pouch of the patient’s original capsule, where it unfolds and settles into optimal position.

Some patients may have heard of laser-assisted cataract surgery and occasionally have the misperception that a laser can “dissolve” the cataract without the need for incisions. The laser can do certain steps of the cataract procedure, such as creating the corneal incisions, the circular opening in the capsule, and pre-fragmenting or “softening” the cataract. However, immediately after the laser portion of the procedure is performed, the patient needs to undergo standard phacoemulsification (cataract surgery) utilizing the specialized handpiece described above, in order to remove the actual cataract pieces or fragments. VA Boston has a dedicated femtosecond laser for performing laser-assisted cataract surgery; however, large studies have confirmed that the outcomes are the same between standard cataract surgery and laser-assisted cataract surgery. So, at this time, we perform less than 5% of our cases with the laser, but any patient requesting laser-assisted cataract surgery can be accommodated, as long as there are no contraindications.

Postoperatively, the patient will go home on the same day as surgery and usually commence eye drops 4-6 hours later. There are usually three different eyedrops- an antibiotic, a steroid, and a non-steroidal anti-inflammatory drop- which the patient uses 4x/day in the operative eye for the first week. After the first week, the antibiotic is discontinued and the remaining two drops are continued, in varying dosages, for another three weeks. Routinely, patients are seen on postoperative day 1, week 1, and month 1. Depending upon the density of the cataract and how much ultrasound energy is required to break it up, the patient’s visual recovery can be quite fast, with the vast majority of patients seeing better on postoperative day 1 than the day before surgery. Though sometimes it may take several days, or even more than a week, for swelling to subside and vision to improve, especially for very dense or complex cataracts.

External links to Ophthalmic [Eye] surgery patient education information

The links below  take you to an external web sites and do not imply VA endorsement.  This information is being provided to help you along with your surgeon, to make informed decisions regarding your care.

Glaucoma FAQs - American Glaucoma Society [AGS]

Oculoplastic Surgery - American Society of Ophthalmic Plastic and Reconstructive Surgery [ASOPRS]

Retina Surgery - American Society of Retina Specialists [ASRS]

Strabismus - American Association for Pediatric Ophthalmology and Strabismus [AAPOS]

Neuro-ophthalmology - North American Neuro-Ophthalmology Society (NANOS)

Uveitis -The Ocular Immunology and Uveitis Foundation [OIUF]

How to Make an Appointment

If you aren't currently being seen by Ophthalmology surgery, you can be referred by your Primary Care Provider for an initial consultation. If you are already being followed by Ophthalmology Surgery, please call the clinic directly at .