The decision to have cataract surgery is one that you and your eye doctor should make together. You'll probably have plenty of time to consider and discuss your options. In most cases, waiting to have surgery won't harm your eye. If your vision is still quite good, you may not need cataract surgery for many years, if ever. In younger people or people with diabetes, however, cataracts may progress rapidly, making the need for surgery more immediate.

Base your decision on the degree of vision loss and how much the cataract affects your daily life. Can you see to do your job and drive safely? Do you have problems reading or watching television? Is it difficult to cook, to shop, do yardwork, climb stairs or take medications? How active are you? Do vision problems affect your level of independence?

Typically, two things happen during cataract surgery — the clouded lens is removed, and a clear artificial lens is implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.

Before surgery, your eye doctor measures the size and shape of your eye to determine the proper power of the lens implant. The measurements are made with a painless ultrasound test. Cataract surgery is typically an outpatient procedure that takes less than 30 minutes. Most people are awake and need only local or topical anesthesia.

Cataract Surgery
Corneal Transplant Surgery
The cornea is the tissue on the very front of the eye. It is clear and covers the iris and pupil. It works with the lens to provide focusing power to the eye, and, in fact, provides about 60% of the focusing power in the eye.  If the cornea becomes opaque, swollen, or scarred, vision is compromised. Medication to control the damage to the cornea is usually the first line of treatment, but once it is clear that medication will not halt or alter the damage, a corneal transplant is considered. This surgical procedure involves the removal of the damaged tissue and replacement with a healthy, donated human cornea.

A newer technique and modification of a standard full-thickness corneal transplant is DSEK (Descemets Stripping Endothelial Keratoplasty). This procedure is becoming more popular because it involves making a smaller incision in the eye which makes recovery quicker, post operative discomfort less and allows prescribing post operative glasses sooner after surgery. This technique has began to be popular in 2005, but now accounts for a significant percentage of corneal transplant surgeries. Not everyone qualifies for this type of surgery

Because this procedure is a transplant of foreign tissue into the eye, rejection of the tissue by the immune system of the recipient is one of the greatest risks. However, drugs can be used to control the rejection process, both before it occurs and even after the fact. Despite the availability of immunosuppressive drugs, the rejection rate for corneal transplants is about 6-8%, but varies significantly with the condition.

What Is Refractive Surgery?
Refractive surgery includes several surgical procedures designed to eliminate or reduce the need for glasses or contact lenses. These procedures correct refractive errors by changing the focus of the eye. Common procedures such as LASIK and PRK do this by reshaping the curve of the cornea (the clear front window of the eye) to move the point at which light is focused onto the retina (light-sensitive tissue lining the back of the eye). Procedures such as conductive keratoplasty (CK) use radio frequency energy to bend the cornea, and phakic intraocular lenses (IOLs) place an artificial lens inside the eye to more accurately focus light onto the retina.

Excimer Laser Procedures
LASIK (Laser In Situ Keratomileusis) LASIK combines two techniques of surgery to correct refractive error. First, a laser called a femtosecond laser or a surgical blade called a microkeratome creates a thin flap in the cornea. Next, an excimer laser sculpts the underlying cornea into a new shape to correct the refractive error. The flap is then repositioned and adheres on its own without sutures after only a few minutes. Eyedrops and/or ointment are placed in the eye to facilitate the healing process. Vision recovery typically is rapid, and there is little or no post-operative pain.

PRK (Photorefractive Keratectomy)
PRK reduces low to high myopia, low to moderate hyperopia, and astigmatism. In PRK, the epithelium, the layer of cells covering the cornea, is removed and the excimer laser sculpts the cornea to correct refractive error. A bandage contact lens is usually placed on the eye following the procedure to speed the epithelial healing process, which usually takes three to four days. Because PRK sculpts the outer surface of the cornea, patients experience some discomfort after surgery and recovery time lasts for a period of several weeks. PRK has been largely displaced by LASIK because LASIK provides less discomfort, faster vision recovery, and the ability to enhance or refine the outcome easily in as little as three months following the initial surgery. However, PRK is sometimes recommended instead of LASIK because it does not create a flap in the cornea and may be a better option for people who have thin corneas or whose occupation makes it more dangerous to have a flap.

Intrastromal Corneal Ring Segments (INTACS)
Intrastromal corneal ring segments (Intacs) are semicircular pieces of plastic that are implanted within the cornea to treat mild forms of myopia. They also are sometimes used for other conditions affecting the cornea, such as keratoconus. They are designed to change the shape of your cornea, adjusting the focusing power of your eye so that light is focused onto your retina. The Intacs are inserted through a small incision near the upper edge of the cornea. The incision is closed with two small sutures that are usually removed two to four weeks after surgery.

Unlike laser eye surgeries, Intacs are reversible; if they are removed, your cornea usually returns to its original shape after a few weeks.

Accommodative and Multifocal Intraocular Lenses
Used to treat nearsightedness (myopia), farsightedness (hyperopia) and the inability to focus at near with age (presbyopia), accommodative and multifocal IOLs are artificial lenses surgically implanted in the eye, replacing the eye’s natural lens. These lenses enable your eye to regain its focusing and refractive ability.

Refractive Lens Exchange (RLE)
Refractive Lens Exchange (RLE) is used to treat moderate to high degrees of nearsightedness, farsightedness and patients who are not candidates for the LASIK procedure. This is a non-laser procedure where the natural, clear lens of the eye is removed and replaced with an artificial intraocular lens (IOL). As with accommodative and multifocal IOLs, the cornea is not reshaped in the RLE procedure.

In a procedure where a flap is created, it is created either with a microkeratome, as shown above left, or using the femto-second laser, as shown above right
In either case once the flap is created it is lifted and folded to the side while the excimer laser is used to ablate, or remove corneal tissue resulting in a reshaping of the front of the eye
Refractive Surgery
In a full thickness corneal transplant roughly the central 70% of the cornea is removed and replaced with a donor cornea
in DSEK, just the back surface (endothelial) layer is removed, then replace through a relatively small incision. The smaller incision allows for fewer serious complications.