Refractive Cataract Surgery

Refractive cataract surgery is a type of eye surgery that is used to treat cataracts, which are cloudy areas in the lens of the eye that can cause vision loss. In refractive cataract surgery, the cloudy lens is removed and replaced with an artificial lens called an intraocular lens (IOL).

One of the main goals of refractive cataract surgery is to improve the patient’s vision by correcting any refractive errors, such as nearsightedness, farsightedness, or astigmatism. This can be achieved by choosing an IOL with the appropriate power to match the patient’s specific visual needs.

Refractive cataract surgery is usually performed using a technique called phacoemulsification, in which the cloudy lens is broken up using ultrasonic waves and then removed through a small incision in the eye. The procedure is typically performed under local anesthesia and takes about an hour to complete.



Eligibility for Refractive Surgery The following are some of the criteria that a person opting for refractive surgery must fulfill.

  • You must be at least 18 years old.
  • Must have had a stable refractive index for the previous 6-12 months.
  • must not have an ocular surface disorder like “dry eye”
  • Contact lenses should not have been worn in the previous 15 days.
  • should have adequate corneal thickness

Before a patient is selected for surgery, he or she is thoroughly examined by the doctor to exclude any contraindications. Besides routine examination, this procedure involves another test called the “Pentacam,” which is a detailed analysis of a person’s cornea—its shape, topography, thickness, elevations, and abnormalities. It is only after this that the patient may be declared absolutely fit for refractive laser correction.

Wave-front guided Customized laser correction The Excimer laser is used for refractive laser surgery. The wavefront laser is a more advanced type of excimer laser. It scores over the latter in being a customised technique so that every surgical procedure is “tailor-made” for that particular eye. This procedure corrects not only refractive errors, but also minute aberrations (called higher order aberrations) in the optical system of the eye, resulting in improved vision quality. The aberrations are detected by an instrument called an aberrometer, and then both the refractive error and the higher-order aberrations are fed into the laser machine. The laser then ablates the cornea in such a way that these aberrations are removed.



There are several techniques that may be used in refractive cataract surgery to correct vision and remove cataracts. Some of the most common techniques include:

  • Phacoemulsification: This is the most commonly used technique for refractive cataract surgery. It involves making a small incision in the eye and using ultrasonic waves to break up the cloudy lens (cataract) into small pieces, which are then suctioned out of the eye.
  • Laser-assisted cataract surgery: In this technique, a laser is used to make precise incisions in the eye and to break up the cataract. The laser may also be used to shape the artificial lens (intraocular lens, or IOL) that will be implanted in the eye.
  • Extracapsular cataract extraction (ECCE): This is an older technique that involves making a larger incision in the eye and removing the cataract in one piece. It is not commonly used today, as phacoemulsification is generally considered a safer and more precise method.
  • Small-incision cataract surgery (SICS): This technique involves making a small incision in the eye and removing the cataract manually, using special tools. It is similar to phacoemulsification but requires less specialized equipment.

The specific technique used in refractive cataract surgery will depend on the patient’s individual needs and the preferences of the surgeon. All of these techniques can be effective in improving vision and treating cataracts.

Wavefront analysis of the eye



The goal of the surgery is to correct vision problems caused by the cataract and, in some cases, to also correct other vision issues such as nearsightedness or farsightedness. Here is an overview of the procedure:

Pre-surgery preparation: Before the surgery, the patient will undergo a thorough eye examination to assess their overall eye health and determine the best type of IOL for their needs. The patient may also be asked to stop taking certain medications or to arrange for transportation home after the surgery.

Anesthesia: The surgery is usually performed under local anesthesia, which numbs the area around the eye. The patient will be awake during the surgery but will not feel any pain.

Incision: The surgeon will make a small incision (cut) in the eye to access the cataract. The size and location of the incision will depend on the specific technique used.

Removing the cataract: The surgeon will use specialized instruments to carefully remove the cataract. This may involve breaking up the cataract into small pieces and suctioning them out of the eye.

Inserting the IOL: Once the cataract has been removed, the surgeon will insert the artificial lens (IOL) into the eye. The IOL is folded to fit through the small incision, and then it unfolds and settles into place once it is inside the eye.

Closing the incision: The surgeon will close the incision with sutures (stitches) or a special type of glue. The stitches or glue will dissolve or be absorbed by the body over time.

Post-surgery care: After the surgery, the patient will be monitored for a short time and then released to go home. They will be given instructions on how to care for their eye and when to return for follow-up visits. Most people are able to return to their normal activities within a few days of the surgery.


Refractive cataract surgery is typically recommended for patients with cataracts, which are cloudy areas in the lens of the eye that can cause vision loss. Cataracts are a common condition that typically occurs as a result of ageing or other factors such as injury, exposure to UV radiation, or certain medical conditions.

Cataracts can cause a variety of symptoms, including:

• Blurry or distorted vision

• Difficulty seeing at night

• Sensitivity to light and glare

• Double vision in one eye

• Fading or yellowing of colors

• Frequent changes in eyeglass or contact lens prescriptions

If these symptoms are interfering with your daily activities or quality of life, your eye doctor may recommend refractive cataract surgery. The surgery can help improve vision and restore clarity by removing the cloudy lens and replacing it with an artificial lens (intraocular lens, or IOL).

Overall, refractive cataract surgery can significantly improve vision and quality of life for patients with cataracts. It is a safe and effective procedure that is performed by trained eye surgeons.