Cataract Treatment for Seniors

Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.


A cataract needs to be removed only when vision loss interferes with everyday activities, such as driving, reading, or watching TV. Sometimes a cataract should be removed even if it does not 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. If your elderly parent's eye care professional finds a cataract, your parent may not need cataract surgery for several years. In fact, he or she might never need cataract surgery. By having vision tested regularly, an eye care professional can discuss if and when treatment is needed.


Kinds of Cataracts Surgery

There are two types of cataract surgery:


Phacoemulsification or Phaco

A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called small incision cataract surgery.


Extracapsular Surgery

The doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.


After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of the eye. Light is focused clearly by the IOL onto the retina, improving vision. Your elderly parent will not feel or see the new lens.


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


Risks of Cataract Surgery for Seniors

In most cases the cost of treatment of cataracts is covered by Medicare, HMOs, and other health insurance plans. But, check insurance coverage to determine at what level of impairment it will or will not cover before cataract surgery.


As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, the doctor may ask your parent to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, keep the eye clean, wash your hands before touching the eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.


Cataract surgery slightly increases risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase the risk of retinal detachment after cataract surgery.


One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in the field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. The eye must be examined by an eye surgeon as soon as possible.


A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.


Success Rate of Cataract Surgery

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


What Happens Before Cataract Surgery

A week or two before surgery, the doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of the eye. This information helps the doctor choose the right type of IOL.


You may be asked not to eat or drink anything 12 hours before surgery. Many times, antibiotic and anti-inflammatory drops are prescribed to be administered into the patient's eye two to four times a day, and in many cases, the person may need help with getting the drops properly into the eye.


What to Expect During and After Cataract Surgery

When you arrives at the hospital or eye clinic, drops will be put into the eye to dilate the pupil. The area around the eye will be washed and cleansed. The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. 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 the eye. After the operation, a patch may be placed over the eye. You will rest for a while. The medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. The patient will need someone to drive them home.


Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. The eye may be sensitive to light and touch. If your parent has discomfort, the doctor can suggest treatment. After one or two days, moderate discomfort should disappear.


For a few days after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask the doctor about how to use the eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect the eye. Avoid rubbing or pressing on the eye.


Once you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores. In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.