As cataracts get worse and worse, they significantly impair vision and make it harder to read and do things throughout your day.
Fortunately, there is cataract surgery which can lead to some remarkable improvements. It’s a low risk procedure that has lots of great benefits.
But that’s not what we are here to talk about today.
Sometimes cataract surgery may not lead to the improvement you are expecting afterwards. While rare, there is a risk of permanent vision loss after cataract surgery. Even without losing vision, however, there are ways cataract surgery can impact your eyes and how you see in unexpected ways.
So here are the main disadvantages of cataract surgery.
Potential for Worse Vision
The vast majority of individuals after cataract surgery will notice much improved vision.
But sometimes the recovery after cataract surgery doesn’t go as planned. Certain complications after cataract surgery can cause the vision to get worse.
Swelling in the retina
In the very back of our eye is the retina. The retina acts like the photoreceptor for the eye and takes all the light information from the world around us and translates that information into signals the brain can process. The macula is the very center part of the retina; This is the very center part of our vision.
The retina; Image by BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons / cropped from original
About 1% of the time after cataract surgery, the macula can become significantly swollen. Because the macula is the center of our vision and where we process all the fine details of what we are looking at, vision can become blurry when the macula is swollen.This is perhaps one of the biggest causes of worse vision after cataract surgery.
This swelling doesn’t occur immediately after cataract surgery, it can take some time to develop. It will typically peak around the the first month or two after cataract surgery. This will cause a slow decline in vision after cataract surgery.
Fortunately, this swelling generally resolves on its own with minor treatment. NSAID or steroid eye drops can be used to speed up the resolution and get the vision recovery back on track. It is very rare for this to persist beyond a couple of months.
Infection
Perhaps the most feared issue that can cause you to lose vision after cataract surgery is an infection. But fortunately, infections are rare; the risk is only about 0.04% (which is about 1 in 2,500 cataract surgeries).
Remember that retina that can get swollen? It can also be damaged by an infection; If an infection is not caught and treated promptly, it can damage the retina and cause permanent loss of vision.
An infection is at greatest risk for developing within the first few weeks out after cataract surgery. (This is the reason for restrictions after cataract surgery).
Having: Increased Pain, Worsening Vision and Eye Redness are all reasons to give your surgeon a call to be seen to be evaluated for an infection.
Retinal detachment
If you’ve been paying attention so far, when the retina gets damaged, you can have loss of vision. Again, this is what happens if the retina becomes detached.
Just underneath the retina is a blood supply. Like anywhere else in the body, the retina relies on this blood supply to get crucial nutrients. If the retina loses access to this blood supply, it will die.
The retina doesn’t just detach on its own. Within our eye is a jelly-like substance called vitreous keeping everything in place. But eventually this vitreous pulls away from the retina. This creates floaters that become become familiar with in their vision. (of note, by getting rid of the blur from cataracts and providing a clear view, floaters can become more noticeable after cataract surgery).
This process of the vitreous pulling away from the retina is speed up by cataract surgery. When this happens, the vitreous may tug on certain parts of the retina and cause a tear. If this tear isn’t treated promptly, fluid can get underneath the retina and cause it to detach.
Retinal detachments can occur anywhere up to a few years out after cataract surgery! Check out The 3 Must Know Late Complications Of Cataract Surgery to learn more about this and other late issues that can occur after cataract surgery.
But again like infections, prompt recognition and treatment are the goal. Having flashing lights followed by the development of floaters could mean a retinal tear has developed and necessitates a dilated eye exam to examine the retina. Having a shade or curtain of vision loss is a sign of a retinal detachment and is an emergency.
Prescription Issues
While the above can cause permanent loss of vision, luckily they don’t happen all too often. The bigger disadvantage after cataract surgery is that the prescription of the eye can change.
Before cataract surgery, your eyeglasses prescription is determined by how much focusing your cornea does and how much your own natural lens does.
Light focusing in the eye; image by Sunshineconnelly at en.wikibooks, CC BY 3.0, via Wikimedia Commons
After cataract surgery, this changes. The natural lens (which turned into a cataract) is removed. This focusing power must be replaced by a new artificial lens.
Now, for most people, this can actually be an advantage. This artificial lens doesn’t have to have the same focusing power that your own natural lens had. Instead, typically the power of this lens is picked to get out of glasses as much as possible (typically for the distance). If you had a terrible eye glasses prescription before cataract surgery, you will notice a large improvement.
This disadvantage part, however, comes if you liked the prescription of your eyes before cataract surgery.
Why would someone like needing glasses to see? The biggest reason is if you are nearsighted before cataract surgery. If you are nearsighted before cataract surgery, then you can read things up close without any glasses. You only need to put on glasses to see things in the distance. And perhaps most of your day involves up close work without needing any glasses.
If this suddenly changes after cataract surgery, this will be frustrating. Instead of being nearsighted and able to see up close without glasses, you will require reading glasses.
But fortunately, this can be prevented ahead of time.
- Instead of picking an artificial lens to focus off in the distance, you can discuss with your surgeon about choosing one that will instead keep that up close focus.
- Special “lifestyle" lenses or monovision can be used to sharpen the vision for both the distance and for up close. Check out Your Complete Guide Of Lenses For Cataract Surgery to learn more.
Short-Term Discomfort
The eye is the most sensitive structure in our body. So, it shouldn’t come as any surprise that surgery on the eye can irritate it.
As slick and as smooth cataract surgery is, it isn’t exempt from this. About 10-15% of individuals can notice an increase in irritation on their eye after cataract surgery.
Sometimes this additional irritation comes from inflammation inside the eye left over from cataract surgery. This can cause an ache or discomfort and extra sensitivity to light. This happens roughly about 1% of the time after cataract surgery and is readily treated with extra steroid eye drops.
But the majority of the time, this extra irritation is only indirectly related to the cataract surgery. This irritation instead comes from the surface of the eye. The biggest culprit? Dry eye.
Cataract surgery will exacerbate dry eye, at least for the short term. Eye drops placed in the eye before cataract surgery, betadine antiseptic used to prevent infection (which is not only toxic to bacteria but also toxic to the cornea), and the eye being exposed during cataract surgery all cause the build up of irritation and inflammation on the surface of the eye. All of which prevents the eye from adequately protecting itself; the eye is more prone to drying out.
After cataract surgery, this is exacerbated by the prescription eye drops used to control inflammation, prevent swelling and further prevent infection. Each of these eyedrops have preservatives in them to prevent bacteria from growing in the bottles. These preservatives are also an irritant to the eye.
Going into cataract surgery with preexisting dry eye (whether you are aware of it or not), will cause it to become worse.
This can cause a
- Moderate to mild eye pain or discomfort
- Sensitivity to light
- Burning
- Itching
- The feeling like there is something in the eye
Gradually, as the eye gets further from cataract surgery and eye drops are no longer needed, this continues to improve and resolve. But it takes time for things to heal up. And so cataract surgery may cause a short-term discomfort in the eyes for the first few months.
Using preservative free artificial tears can help this irritation resolve quicker. For more moderate and severe irritation, check with your eye doctor about more advanced ways to treat this ocular surface irritation and dry eye.
Change In The Way The Eye Looks
Finally, one last disadvantage is that the eyes can look different after cataract surgery.
If you look closely at the pupils of people who have had cataract surgery, you may be able to catch a brief glimmer of reflection. This reflection doesn’t exist before cataract surgery. Our own natural lens doesn’t give off this reflection. Artificial lenses are different.
A lot has gone into the design of these artificial lenses to make them safe, effective and easy for the surgeon to use during cataract surgery. But the engineering of these lenses can cause the lens to reflect light more and give off a glimmer.
Note the multiple reflections of light within the pupil due to the artificial lens. These reflections change as the eye moves around.
This occasional reflection doesn’t negatively effect vision, other people just may notice it from time to time.
Check out How Do Eyes Look Different After Cataract Surgery to learn more about why it happens and how it can potentially can be minimized.
Summary
One of the most disconcerting disadvantages of cataract surgery is that sometimes a complication can occur that causes permanent vision loss. Fortunately that is rare. More commonly, cataract surgery will change the prescription of the eye and that can affect how you see without glasses. Cataract surgery can also cause the eyes to be more uncomfortable and can change the way the eye looks.
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