Anesthesia for cataract removal surgery has improved as the cataract removal procedure has been refined. Modern cataract surgery involves very small incisions and takes less time than in the past.
The more gentle nature of this surgery requires much less cataract removal surgery anesthesia to keep you comfortable.
Common questions for those contemplating cataract removal are, Is cataract removal surgery painful, How painful is cataract surgery, and Does Cataract surgery hurt? The answer is that with modern anesthetics and surgical techniques, the surgery is usually both quick and comfortable for patients. This post will review the types of anesthesia used from ancient to modern times for cataract removal surgery.
For centuries, cataracts were repaired, not by removing them, but by knocking them out of the way. The lens would fall back into the back of the eye and it would let the patient have some view of the world again. While some had opium for comfort back then, most had only alcohol so it required two people to do the surgery, one to knock the lens out of the way, and one to hold you down.
There are isolated reports of surgeons removing the lens rather than just knocking it out of the way in ancient history, but this approach was not widely adopted until the mid 1700’s.
Two competing procedures emerged, intracapsular and extra capsular cataract removal surgery. The intracapsular approach was the most popular until the 1950’s. It required an incision that when half way around the eye, multiple sutures, and staying in the hospital for 10 days with sand bags around your head so you wouldn’t move.
Cocaine was the first injectable anesthetic invented. Ultimately novacaine, and lidocaine where developed. If these were injected behind the eye, the eye went numb and was temporarily paralyzed so it wouldn’t move. If it were injected under the skin in front of the ear, the muscles that cause the eye lids to squeeze tight were temporarily paralyzed.
In the 1950’s, extra capsular cataract removal became more popular due to the widespread use of the operating microscope. The microscope provided greater magnification allowing ophthalmic surgeons to perform more precise surgery.
It only required an incision that went 1/4th of the way around the eye. This required less time and fewer sutures. The eye was more stable, so patients didn’t need to stay in the hospital.
Anesthisia was accomplished with an injection of lidocaine behind the eye and in front of the ear with relaxing medicines given by IV.
Phacoemulsification was invented in the late 1960’s but wasn’t commonly used until the 1990’s. It requires an incision that is around 1/8th of an inch.
This incision is so small that sutures are usually not required. Most eye surgeons have stopped giving injections of anesthesia behind the eye and in front of the ear because the cataract removal is less traumatic and more comfortable.
Most of us simply use lidocaine eyedrops to numb the surface of the eye, put a small amount of preservative free lidocaine inside the eye, and have an anesthetist give relaxing and comfort medicine by IV. The anesthetist can regulate the amount of anesthesia given IV to match you anxiety.
Some patients prefer to be mostly awake and chat during the surgery. This makes them feel more in control of the event. Others prefer to be very groggy and have little or no recollection of the cataract removal surgery. We tailor the amount and type of anesthesia to your preferences.
In the end, it still takes a surgeon and someone to give anesthesia to remove your cataracts. The surgeon’s job has changed over the years as much as the one who gives anesthesia. When it comes time for your surgery, I am sure you will be glad that the job of modern anesthetists is to hold your hand and give you medicines to relax you down rather than to hang on tight to hand hold you down. If you are prone to above average pain in other surgical procedures you had previously, it would be helpful to discuss this with your surgeon and anesthetist so they could consider elevating the amount of anesthesia they provide to ensure your comfort.
If you have any further questions about staying comfortable during your cataract removal, please post a comment or schedule a time to meet with me at one of our offices.