Cataract surgery is a procedure to remove the natural lens of your eye that has developed an opacification, which is referred to as a cataract. This opacification leads to a decrease in vision that causes problems with your ability to perform normal daily tasks. Cataract surgery is performed to improve vision and thereby improve quality of life. During cataract surgery, your cloudy natural lens is removed and replaced with a clear artificial lens implant. A common question patients have is whether they will be able to see out of their eye during the cataract surgery procedure.
Can you see during cataract surgery?
The short answer is no, you cannot see out of your eye during cataract surgery. This is because the surgery is performed with the patient fully anesthetized lying flat on their back. The anesthetic ensures the patient remains still during surgery and also blocks any sensation, including vision, during the procedure. Here are some key points on vision and anesthesia during cataract surgery:
- Cataract surgery is performed under either local, topical or general anesthesia depending on patient factors, surgeon preference and type of implanted lens.
- Local and topical anesthesia numb the eye but do not induce sleep or sedation.
- General anesthesia renders the patient fully unconscious throughout the procedure.
- Regardless of anesthesia type, the eye is fully numb during surgery.
- Numbing eye drops are also administered to block any potential sensation.
- The vision is additionally blocked by inserts used to hold the eye open.
- Even if vision was possible through numbness and inserts, you would only be able to see light and movement due to the surgical microscope over the eye.
- In summary, you are not able to see out of the eye during cataract surgery due to anesthesia, eye inserts and the surgical microscope.
What to expect with anesthesia during cataract surgery
The anesthesia administered for cataract surgery blocks all pain and sensation in the eye during your procedure. Here is an overview of what to expect with the different anesthesia options:
Local anesthesia
This involves injecting anesthetic medication around the eye with a needle to numb the area. You remain awake during the procedure.
- Given as eye drops to numb the surface and an injection around the eye to numb deeper tissues.
- Blocks sensation but you remain awake and conscious.
- Provides sedative medication by IV to relax you.
- Eye padded closed after surgery until anesthetic wears off.
Topical anesthesia
This involves anesthetic eye drops to numb the eye without any needles. You remain awake during the surgery.
- Numbing drops applied to anesthetize the eye surface.
- No injections or IV sedation given.
- Blocks sensation but you remain fully awake and alert.
- Eye padded closed after surgery until drops wear off.
General anesthesia
This involves IV medication to fully put you to sleep throughout the procedure.
- Given by IV to fully sedate you into unconsciousness.
- Allows the surgery to be performed while you are fully asleep.
- Wakes you up after the surgery is over.
- Eye padded closed after surgery until fully awake.
Your ophthalmologist will discuss the best anesthesia choice for your individual case based on factors such as your age, health issues, medications, recovery time and type of implanted lens.
Why you cannot see during cataract surgery
There are several reasons why you are unable to see out of the eye undergoing cataract surgery. These include:
Anesthesia blocks sensation
As outlined above, the anesthesia administered prevents any pain or sensation in the eye during surgery. Local and topical anesthesia numb the eye, while general anesthesia renders you unconscious. In all cases, this blocks your vision.
Eye is held open by an insert
During the procedure, your eyelids are held open using a device called a speculum. This metal or plastic insert keeps your eye open and fixed during the surgery. This covers a large portion of the eye blocking vision.
Microscope over eye blocks view
The surgeon uses an operating microscope which is positioned directly over your eye during the procedure. This large apparatus further impedes your view and blocks out most light.
Eye focuses light unpredictably
Even if vision was possible through the anesthesia and instruments, the light would focus unpredictably on the retina without your natural lens. This distorted focus would only allow perception of light and vague movements rather than clear sight.
Purple dye introduced
A purple dye is injected into the eye during the procedure to better visualize the lens capsule for removal. This dye would block a clear view.
Normal vision obstructed
Lastly, the normal visual pathway is disrupted by the anesthesia, speculum and microscope. This blocks clear images from being transmitted to the brain for visual perception.
Steps of cataract surgery leading to loss of vision
Cataract surgery involves a number of steps that ultimately result in temporary loss of vision during the procedure. These steps include:
Anesthesia administered
The surgery starts with administration of either topical drops, local injection or general anesthesia to numb the eye. This causes immediate loss of visual sensation.
Eye dilated
The pupil is dilated with medicated eye drops to allow access to the lens. This induces blurry vision prior to complete numbness.
Eye held open
A speculum is inserted to prop the eyelids open during surgery. This covers the field of vision.
Microscope positioned
The operating microscope is set up and swung into place over your eye. This further limits visual input.
Incisions made
Small incisions are made in the eye to gain access to the cloudy lens. Even faint perception of light becomes difficult at this stage.
Lens removed
The cataractous natural lens is broken up using ultrasound and suctioned out. Removal of the lens causes complete loss of vision.
New lens inserted
The new artificial replacement lens is inserted through the same incisions. Sight does not return until healing occurs.
Recovery of vision after cataract surgery
Vision is impaired on the day of cataract surgery due to anesthetic agents and the trauma of the procedure. Here is an overview of visual recovery after cataract surgery:
- First day: Very poor vision from anesthetic and swelling.
- 1 week: Improved but blurry vision as eye heals.
- 1 month: Good vision but may fluctuate.
- 3 months: Stable vision in most cases.
- Final vision is variable and depends on underlying eye issues.
- Majority achieve 20/40 vision or better.
So while you cannot see during the cataract procedure itself, your vision usually starts to improve within a few days after surgery. Complete visual recovery takes around 3 months in most patients.
Conclusion
In summary, it is not possible to see out of your eye while cataract surgery is being performed. This temporary vision loss is caused by the anesthesia, dilating drops, eye speculum and operating microscope used during the procedure. Vision begins to recover within the first week after surgery as the eye heals. With insertion of the new artificial lens, cataract surgery aims to restore your vision and improve visual function after recovery from the operation.