Refractive Cataract Surgery Overview
What You Need to Know About Refractive Cataract Surgery
As technologies advance, treatment options in eye care are expanding. Standard cataract surgery was once the only treatment option available to remove cataracts and restore optimal vision. With modern, state-of-the-art advancements, cataract removal surgeries have become increasingly effective in repairing vision.
Following standard cataract surgery, patients often require corrective eyeglasses to fix refractive errors, such as astigmatism, nearsightedness, farsightedness, and presbyopia (farsightedness caused by loss of elasticity of the eye’s lens).
Refractive cataract surgery eradicates cataract eye disease and corrects refractive errors.
The goal of a refractive cataract procedure is to successfully eliminate the need for prescription eyeglasses with full vision correction after cataract removal. The risks associated with cataract surgery have diminished over the years, as advanced lasers enable cataract surgeons to create calculated incisions with exact measurements.
Refractive surgery has become increasingly popular as people opt for permanent vision repair, as opposed to temporary methods of vision repair like glasses and contact lenses. Following standard cataract surgery, a person may wear glasses or contact lenses to correct improper refraction. Refractive cataract surgery goes the extra mile to repair vision while removing cataracts.
What are refractive errors?
A refractive error in the eye occurs when the eye does not bend light to reach the retina properly. Our entire vision is dependent on the ability of the optic nerve to send visual information from the retina to the brain. The retina bends light, turning light into electrical impulses. The optic nerve then sends this information to the brain, where the brain makes sense of our visual information and produces images. Without this translation between the retina, optic nerve and brain, our quality of vision can weaken, or ebb completely.
Many people experience these refractive errors. The NEI (National Eye Institute) determines that “approximately half of all American adults don’t have the 20/20 vision that physicians consider optimal due to refractive errors.”
Similarly, the WHO (World Health Organization) estimates that “153 million people worldwide live with visual impairment due to uncorrected refractive errors.”
The most common types of refractive errors are:
- Nearsightedness (myopia): Inability to clearly perceive far-away objects
- Farsightedness (hyperopia): Inability to clearly perceive nearby objects
- Astigmatism: Inability to clearly perceive both far-away and nearby objects
- Presbyopia: Inability for people to clearly perceive nearby objects due to natural aging
A person with visual refractive errors may experience blurry vision, double vision, halos around lights, and headaches. When there is no cataract present, refractive treatments like LASIK and PRK eye surgery can help to restore vision.
If a person has refractive errors and cataracts and decides to undergo standard cataract surgery, they can expect to experience the same refractive errors post-treatment. Standard cataract surgery utilizes the simplest intraocular lens implant—a monofocal intraocular lens (IOL). This classic IOL doesn’t correct refractive errors; in fact, studies have shown monofocal IOLs to worsen refractive errors, (specifically astigmatism).
This is why refractive cataract surgery is such a groundbreaking advancement. This procedure utilizes complex, multifocal IOLs to replace the natural lens and restore the eye’s ability to perceive nearby and far-away objects—without the need for glasses or toric contact lenses.
Who is eligible for refractive cataract surgery?
The first factor that qualifies a person for refractive cataract surgery is having cataracts. A person must have a cataract for a surgeon to remove a cataract.
Secondly, to be an eligible candidate, the patient has to have an eyeglass or toric contact lens prescription that falls within a certain range to mitigate potential risks and reduce the chances of poor refractive outcomes.
However, an eye surgeon will perform a series of tests in order to further determine eligibility for refractive cataract surgery if the initial two requirements are met.
After a series of testing, an eye surgeon may determine that the patient’s refractive errors are too severe or too mild to achieve the intended refractive outcome from surgery, which would deem the patient ineligible.
Testing will also determine whether it’s medically possible for the patient to completely eliminate the need for glasses after treatment. The eye surgeon may determine that a patient will still need reading glasses, but can successfully eliminate the need for distance vision glasses with refractive surgery.
If the eye surgeon determines that the patient will experience the same unimproved vision after standard surgery or refractive surgery, the surgeon will likely suggest standard cataract surgery. Both of these treatments are safe and effective, but standard cataract surgery is considerably more affordable than refractive surgery.
What happens during refractive cataract surgery?
During refractive cataract surgery, advanced femtosecond lasers are used to soften the cataract and break the cloudy lens into pieces. The clouded lens pieces are then gently suctioned off of the outer eye lens.
Once the obstructed lens is removed, an advanced multifocal IOL is implanted through a small incision and placed behind the iris. This procedure takes cataract surgery a step further by permanently reshaping the cornea (the clear, round, visible surface of the eye that allows light to enter).
The reshaping/remodeling of the cornea is the part of the procedure that corrects refractive errors. By reshaping the cornea, light is able to bend and reach the retina properly, which can rectify astigmatism, nearsightedness, farsightedness, and presbyopia.
How does refractive cataract surgery differ from standard cataract surgery?
There’s one main difference between the purpose of standard cataract surgery and the purpose of refractive cataract surgery: the need for glasses post-treatment.
Both standard cataract surgery and refractive cataract surgery will improve a patient’s vision drastically, but many people who undergo standard surgery require glasses after treatment.
Standard cataract surgery successfully removes the cataract and replaces the eye lens, but refractive errors that inhibit vision may still be present. The intention behind refractive cataract surgery is not only to remove cataracts, but to restore vision without the need for prescription eyeglasses or contact lenses to correct refractive errors.
During refractive cataract surgery, the surgeon uses advanced multifocal IOLs to restore vision. During standard cataract surgery, the surgeon implants a standard monofocal IOL. A monofocal intraocular lens provides focused, clear vision at one distance, with a singular lens power. A multifocal intraocular lens provides focused, clear vision at various distances, with more than one lens power.
The tools and instruments used in both procedures differ as well. Standard cataract surgery utilizes hand-held surgical tools, and refractive cataract surgery utilizes advanced femtosecond lasers for increased accuracy and precision.
Depending on the severity of a person’s refractive errors and the anticipated refractive outcome, the cataract surgeon may suggest one treatment option over the other.
Risks of Refractive Cataract Surgery
Though the risks associated with cataract surgery have shrunk notably over the years, there are still potential risks—as with any procedure.
People with medical conditions, like glaucoma or autoimmune diseases, are at a higher risk of complications from cataract surgery. Patients with existing medical conditions may not be eligible for refractive cataract surgery.
Some potential risks of refractive cataract surgery include:
- Dry eyes
- Increased astigmatism
- Intraocular lens dislocation
- Sensitivity to light
- Macular edema (central retina swelling)
- Double vision or halos around bright lights
- Development of secondary cataracts
- Overestimated or underestimated vision correction
Laser Cataract Surgery
Laser cataract surgery is the modernized form of standard cataract surgery. The purpose of both standard and laser cataract surgery is to remove the clouded eye lens to clarify vision.
The difference between the two treatment options is the technology used. Laser cataract surgery employs femtosecond lasers, while standard cataract surgery uses hand-held tools to remove the eye lens and implant an artificial IOL.
Unlike refractive cataract surgery, laser cataract surgery doesn’t reshape the cornea to correct refractive errors.
Refractive Cataract Surgery Recovery
After undergoing refractive cataract surgery, you may experience some discomfort in your eye. The eye may feel irritated with a slight stinging or burning sensation, and your surgeon may recommend some pain-relieving medication to reduce any discomfort or soreness.
You may experience some tearing or watering of the eyes and may feel inclined to rub or itch the eye. It’s important that you don’t rub your eyes, as this can result in further complications.
A person healing from cataract surgery may also experience increased sensitivity to light, so it’s recommended to take a few days away from work to rest. Any soreness or discomfort should lessen after a few days, but it can take around 4 to 6 weeks for a full recovery.
During the recovery period, you should refrain from high-stress activities, like heavy lifting and exercising. Don’t submerge your eye in a pool, and don’t drive for at least 24 hours.
If your surgeon prescribes you eye drops to reduce the chances of inflammation and irritation, use these as instructed. With recent advancements in eye care technologies, some cataract procedures are considered dropless and won’t require postoperative medical drops.
The intention of refractive surgery is to reduce, or eliminate, a person’s dependency on prescription glasses or contact lenses. Our ophthalmologist, Dr. Mehul Patel, is highly-experienced and qualified in successful refractive cataract surgery.
Dr. Mehul Patel’s specialities lie in ophthalmology and the evaluation and management of eye diseases. Dr. Patel understands the importance of preserving optimal vision for as long as possible, and his goal is to maximize each patient’s visual outcome.
Through our (UCF) Health Services, patients can schedule appointments with medical specialists for annual check-ups and preventative care. As a top-rated medical specialist, Dr. Mehul Patel is known for providing personalized care to empower each of his patients to make informed decisions that will benefit them for years to come.
National Eye Institute: https://www.nei.nih.gov/sites/default/files/health-pdfs/HVM09_Fact_Sheet_Final_tagged.pdf
Mayo Clinic: https://www.mayoclinic.org/tests-procedures/cataract-surgery/about/pac-20384765
World Health Organization: https://www.who.int/features/qa/45/en/
All About Vision: https://www.allaboutvision.com/conditions/cataract-complications.htm
Ophthalmology Times: https://www.ophthalmologytimes.com/refractive/refractive-cataract-surgery-overview-current-landscape