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Is Cataract Surgery Painful ?

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Author : Dr Deepak Garg

Some of our patients postpone undergoing a cataract procedure despite not seeing well. They say they are fine. Over time I have realized that these individuals postpone surgery because of the fear of surgery. It could also be fear of pain during the surgery.

Some even tell us they are anxious about undergoing surgery and commonly ask us," Is Cataract Surgery Painful ? ". While I understand some may be anxious about surgery, I want to explain that anxiety should not be a reason not to undergo cataract surgery.

HOW IS CATARACT SURGERY DONE?

Cataract surgery is performed by a technique called phacoemulsification.   It is also known as laser cataract surgery, even though there is no actual use of laser. Phaco is one of the cataract surgery techniques. There are a few other techniques that are not as commonly used today. Modern cataract surgery involves making a small 2mm incision on the cornea. The cornea is the front-most layer of the eye. It is usually transparent. Through this incision, an opening is created in the eye's lens, which is now cataractous. This opening is made in the lens capsule which is like a bag holding the lens in place.

Once this opening is made, specific instruments are inserted into the eye through this 2mm incision. The hard lens material or cataract is liquified and sucked out of the eye. This liquification process is known as emulsification. Most of the time, after this is done, doctors find some lens material still sticking to the outer layer of the lens bag. This, too, is removed from the eye.   Once this is done, we insert a lens in the eye. This lens is called the intraocular lens.   These days, the lenses can fold on themselves and enter the eye through the same incision made to remove the cataract. After this, doctors make sure that all the incisions made in the eye are not leaking. Some eye drops are inserted in the eye, and the eye is patched. These drops are steroid drops and antibiotic drops.

HOW IS THE EYE NUMBED DURING CATARACT SURGERY?

This is another commonly asked question before cataract surgery. How will my eye be numbed? When we operate on cataracts, we use certain numbing eye drops. These eye drops are topical anaesthetic agents. They numb the front surface of the eye. This is the surface on which we make the 2mm incisions. Usually, for cataract surgery, no other anaesthetics are needed.

Sometimes when we expect the surgery to be difficult, like a hard cataract or a pupil that is not dilating, then we may inject anaesthetics to numb the eye.

We have a stand by anaesthetist in the operation theatre for all our surgeries. Sometimes when patients are very anxious, the anaesthetist may give anxiety-reducing medications to calm the patient down.

SO IS THE CATARACT SURGERY PAINFUL?

A short answer to this question is no. However, let me explain.

When we do the surgery, we have to insert a particular instrument in your eye to keep it open. That way, even if you want to shut your eye, you cannot. Because of the medications we have put in your eye, you don't feel any pain when placing this instrument.   The incision and the next few steps of surgery also are painless.

You don't feel pain during surgery, but you may feel a certain heaviness in the eyes. Patients also describe this heaviness as a feeling of slight pressure in the eyes, which may happen when we inject a particular jelly in the eye to keep the eye formed and prevent it from going soft.

The iris is the brown or black portion of our eyes. Usually, the iris is not touched during surgery. But if the iris is touched during surgery, there can be pain in the eye. This pain, if at all, lasts only for a few seconds.

Finally, as mentioned earlier, the last step in the cataract surgery procedure is inserting the lens inside the eye. This lens is your lens of choice, and you and your eye doctor would have decided on the lens before surgery. This time too, the patient may feel a sensation of pressure in the eye. This time too, the pain lasts for only a few seconds, and before you know it, the feeling of pressure or heaviness would disappear.

So yes, you will be aware that something is going on. You may experience us moving your eye about. But there is no actual pain during the surgery. As mentioned, a few instances may occur but nothing to write home about.

WHAT ABOUT THE PAIN AFTER CATARACT SURGERY?

One can safely say that cataract surgery is usually uneventful. We don't expect much to happen regarding discomfort after the cataract surgery.

Sometimes, if the eye's pressure increases, there can be pain after surgery. This increased pressure is known as Glaucoma. We instruct patients to take certain tablets and use specific eye drops when this happens. These medications reduce eye pressure and reduce pain.

I mentioned earlier that if the cataract is hard or has weak support, the surgery takes a little more time. Increased surgical time may lead to increased inflammation inside the eye after the surgery, leading to pain, watering and light sensitivity for the first few days after surgery. One may have blurry vision, which subsides a week after surgery.

As long as you follow your ophthalmologist's advice and put your drops in the eye undergoing the procedure, you will be fine. These drops usually consist of a steroid drop, antibiotic drop, and sometimes NSAID drops. NSAIDs are used in diabetics to prevent retinal swelling after cataract surgery in people with diabetes.

The most important thing to remember is that two weeks after cataract surgery, if not sooner, your eyes have almost completely healed. You would have to continue drops but take a head shower and even go swimming without worrying about eye infections.

WHAT IS THE DIFFERENCE IN PAIN BETWEEN THE FIRST EYE AND SECOND EYE SURGERY?

Ophthalmologists perform surgery for your cataracts in both eyes the same way. There is no difference between the surgeries, assuming both were uneventful. But many of our patients complain that the second eye surgery was more painful than the first.

Here is the reason. When a patient walks in for the first cataract surgery, he is very anxious on the day of surgery. He is expecting the worst. Now, after he undergoes the cataract surgery, most likely the patient tells himself," oh well, that was not too bad". So, the reality of the cataract surgery was way better than his expectations.

Because of this wonderful experience, the patients come in for the second eye surgery expecting it to be a walk in a park. And as explained earlier, there can be occasions when you feel something while your doctor performs the surgery. Because the patient expected the second eye surgery to be a walk in the park, this experience leaves him with the feeling of second eye surgery being more painful than the first.

WHAT ELSE MUST I KNOW ABOUT CATARACT SURGERY?

Sometimes when we anticipate a challenging surgery, we inject you with a local anaesthetic, which completely numbs your eye. Once we give you this injection, you will feel no pain during cataract surgery. You will feel nothing. Yes, the injection may hurt slightly, but this pain subsides in less than 5 minutes. Sometimes the cataract is very hard or when the pupil is tiny and not dilating well with drops. Sometimes, the cataractous lens is not stable and does not have all the support needed, and then your cataract surgeon may choose to inject a local anaesthetic instead of using drops.

The actual procedure of the cataract operation takes between 10-15 minutes. You should know this so that even if you have anxiety, you should know that it's a matter of only 10-15 minutes.

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