Pseudophakia Eye Surgery to Treat Cataracts

"Pseudophakia" refers to an artificial or fake lens, also known as an intraocular lens (IOL), that is implanted in your eye in place of the clouded lens removed during cataract surgery. The new false lens can significantly improve your vision and quality of life.

Pseudophakia is a very common, highly successful outpatient procedure performed under local anesthetic. Complications are unlikely but can include imperfect vision correction and IOL mispositioning or movement. Post-surgery, most individuals enjoy vision similar to what they experienced before their cataract developed.

This article will take you through pseudophakia lens options, the procedure, and possible outcomes.

What Is a Pseudophakic IOL?

Pseudophakic lenses can be made of plastic composites, silicone, or acrylic material. Just like your eyeglasses or contact lenses, IOLs can compensate for most vision issues you may have, such as nearsightedness or farsightedness.

They are also selected in strengths specifically for your eyes. There are four different types of lenses that you may be offered, including:

• Monofocal IOLs: These are the most common lenses implanted and are all one power. This means they're clearest when you're focusing in a certain range. Most often, these are set for distance vision, with reading glasses used to see up close.
• Multifocal IOLs: Some prefer the idea of pseudophakic correction for both near and distance simultaneously, which multifocal lenses allow. Multifocal IOLs include a new trifocal version that corrects intermediate in addition to near and distance.
• Accommodative IOLs: These can provide different corrections as they change shape in response to the contraction of the eye's ciliary muscles, which allows the eye to focus closer than a traditional monofocal IOL. This muscle's movement changes the shape of the lens to create clear near, intermediate, and distance vision. (However, the near vision is not as strong as a multifocal IOL.)
• Toric IOLs: A toric lens can correct errors for those with astigmatism caused by an irregularly shaped cornea.

It's not uncommon to sometimes still need glasses with pseudophakic IOLs. Discuss with your practitioner which lens might best suit your needs and lifestyle.

Purpose of IOL Surgery

Cataract surgery removes a clouded lens and replaces it with a clear pseudophakic IOL. Ophthalmologist Harold Ridley invented the first phakic IOL (in which an IOL is inserted without removing the patient's natural lens) in the 1940s.

An artificial IOL helps you to see after your own cloudy lens is removed. When the light enters the eye, a lens focuses it. When the light is focused to the right strength, you can see sharply. The pseudophakic lens is clear, just as your natural lens once was.

Age-related cataracts tend to occur when proteins in the lens begin to break down and stick together in places, interfering with the clear transmission of light to the retina at the back of the eye.

Signs You May Need IOL Surgery

You may want to consider IOL surgery when your vision becomes significantly reduced and begins to affect daily living. 

Specific vision issues include:

• Sensitivity to light
• Difficulty seeing in low-light conditions
• Double vision
  
• Blurry vision
• Seeing halos (luminous circles around bright objects, like streetlights)
• Second sight (a temporary improvement in vision)
• Changes to color perception (colors may appear dull, altered, and faded)
• Frequent prescription changes

Procedure

The surgery itself is an outpatient procedure. Here's an idea of what to expect.

Presurgery

Before surgery, alert your practitioner about any chronic conditions you might have, such as heart disease, high blood pressure, or diabetes, to ensure these are under control.

Also, discuss any medications you may be taking. While cataract surgery doesn't typically cause much bleeding, it may be suggested that you temporarily discontinue any blood thinners. Discuss this with the prescribing doctor first.

Also mention if you're taking any alpha-agonists such as Flomax (tamsulosin), Uroxatral (afuzosin), Hytrin (terazosin), Cardura (doxazosin), or Rapaflo (silodosin), since these can potentially interfere with the procedure.

Before surgery begins, your eyes will be measured with biometry to help determine the right power pseudophakic lens for you. You'll also likely be expected to use some eye drops to prepare.

During Surgery

On the day of surgery, expect to spend around two to three hours at the facility. The procedure itself will only last around 30 minutes, and you will be awake the entire time.

You will likely first be given a sedative to relax you. You'll also be given a local anesthetic to block any pain. The doctor may administer some antibiotics or other drops just before the surgery and again right after.

With the most common cataract surgery type, a small wand is inserted into the eye through a tiny cut. This gives off sound waves that break apart the cataract into tiny pieces, which can then be suctioned out of the eye. The pseudophakic lens can then be put into the area to replace the original lens.

Another approach sometimes used for removal is extracapsular cataract surgery, where a larger cut is made. This may be used if it appears the cataract may be difficult to break apart. Your natural lens can then be removed in one piece and the pseudophakic lens inserted.

The IOL is placed in the posterior chamber (between the usual location of the lens and the iris).

After Surgery

Once the surgery is done, the staff will explain what you need to do to care for your eye over the next few weeks during your recovery.

After resting for about half an hour, you can then go home. But be sure to secure a ride ahead of time since the surgery will prevent you from driving.

Outcome

Over the next several months, you will be asked to return for some postoperative visits. These usually begin just one day after surgery. At the visit, the practitioner will look at your eyes, test your vision, and make sure your eye pressure has remained more or less constant.

To ward off infection and tamp down inflammation, you will also be asked to use drops for a while. Your vision will be somewhat blurry the first few days after surgery, but it will begin to clear within the first few weeks.

In nearly all cases, vision improves after cataract surgery. However, you may be prescribed glasses or contacts to wear as well. This prescription will likely be different from any previous one.

Complications

In most cases, placement of the pseudophakic lens goes smoothly, but some occasional complications can occur, such as:

• Your vision is corrected too much or too little.
• The lens is incorrectly positioned or moves.
  

In addition to complications with pseudophakia, cataract surgery itself may at times carry some risks such as:

• Infection
• Bleeding
• Retinal detachment
• Vision loss
• Glaucoma
• Corneal edema or swelling
• Inflammation
• Requiring a second surgery

Summary

Implantation of a pseudophakic IOL after cataract surgery is an outpatient procedure that can correct vision issues for a lifetime. They are made from a variety of materials and come in different strengths and types. While complications are rare, all surgeries carry risks which should be discussed with your healthcare provider

A Word From Verywell

When a cataract is removed, it's typically replaced with a pseudophakic IOL. Different strengths and types are selected based on measurements taken of the eye, the ocular history, and the goals of the patient. Although there are many options to reduce glasses dependency after surgery, it's not unusual to still need correction for at least some tasks. Cataract surgery with IOL implantation is generally a low-risk procedure that can improve visual function and overall quality of life.

— CHRISTINE L. LARSEN, MD, MEDICAL EXPERT BOARD