Cataract surgery: 

What it is, what options exist, and how it is performed at Instituto HPA

HPA Magazine 24 // 2025

Dra. Marilyn M. Machado

Ophthalmologist

Dr. Miguel Boncquet Vieira

Ophthalmologist

Dr. Pedro M. Baptista

Ophthalmologist

Dr. Pedro Duarte Gonçalves

Ophthalmologist

1. What is a Cataract? 
A cataract is the progressive loss of transparency of the crystalline lens, the eye's natural lens. Instead of allowing light to pass cleanly to the retina, the lens becomes opaque, causing blurred vision, colour distortions, increased sensitivity to light, and difficulty performing daily tasks such as reading, driving, or recognizing faces. Some people report seeing halos around lights or notice that colours, especially blue and yellow, appear faded. 
According to Dr. Marilyn Machado, “cataracts can be congenital, present at birth usually due to maternal infections during pregnancy such as rubella, herpes, or cytomegalovirus, or due to genetic and chromosomal alterations such as Down syndrome”. 
However, most cataracts are acquired and appear with the natural aging of the eye, typically from the age of 60. In some cases, they may develop earlier due to associated risk factors.
Additional risk factors include diabetes, prolonged use of corticosteroids, ocular trauma, radiation exposure, excessive alcohol and tobacco consumption, as well as diseases like glaucoma and uveitis. Other metabolic conditions or retinal dystrophies can also contribute to cataract development. 
Often, the progression is so gradual that patients adapt to the visual loss without realizing it. Nevertheless, signs such as frequent changes in glasses prescription, difficulty in brightly lit environments, or "cloudy" vision should not be ignored. It is important to emphasize that there are no eye drops or medications capable of reversing or halting cataracts. 
As Dr. Marilyn highlights, "the treatment is exclusively surgical," and fortunately, it is a safe, minimally invasive outpatient procedure. Thanks to the latest technology, the recovery is quick, and in most cases, the patient can return home on the same day and resume normal activities within a few days.

2. What Types of Intraocular Lenses Are Available? 
During surgery, the crystalline lens is removed and replaced with an intraocular lens (IOL). The choice of lens directly influences the visual outcome and should be adapted to each person's visual needs and lifestyle. This decision requires careful evaluation, considering ocular anatomy, daily routine, and patient expectations. 
Dr. Pedro Baptista notes that the major advancement in cataract surgery is due to the diversity and sophistication of lenses available today: "modern lenses allow correction of different refractive errors and tailor vision to each patient's profile." Since the introduction of the first intraocular lens by Sir Harold Ridley in 1949, ophthalmology has evolved remarkably, integrating advances in optical physics and imaging technology. 
Monofocal lenses are the simplest, correcting vision at a single distance — usually for distance vision — requiring glasses for near tasks. In cases of significant astigmatism, toric lenses are used, with specific geometries that compensate for the cornea's asymmetrical curvature, optimizing visual quality. 
Multifocal lenses, in turn, offer vision at far, near, and intermediate distances, providing greater independence from glasses. However, they can cause side effects such as halos, dysphotopsias, and a slight reduction in contrast sensitivity, especially in low-light conditions. 
The latest generation includes extended depth of focus (EDOF) lenses, which create a single broader focal point instead of multiple separate points, offering smoother, more natural vision with fewer undesirable effects. These lenses better meet modern visual demands, such as frequent use of computers, tablets, and smartphones. 
Selecting the ideal lens requires a detailed evaluation not only of ocular anatomy but also of personal preferences, daily activities, and visual goals. With high-definition imaging technology and artificial intelligence algorithms, we now achieve remarkable precision in IOL planning, providing customized solutions that optimize patients' quality of life. 

3. Clear Lens Exchange (CLE): A Solution for Those Without Cataracts 
Lens replacement surgery is not exclusive to cataracts. The technique known as Clear Lens Exchange (CLE) applies to individuals with still-clear crystalline lenses who suffer from presbyopia or refractive errors like myopia, hyperopia, and astigmatism, seeking a definitive solution for their vision. 
This approach becomes particularly relevant from the age of 40-45, when presbyopia naturally sets in. 
As Dr. Pedro Gonçalves explains, "CLE replaces the crystalline lens with a customized intraocular lens, providing clear vision at far, near, and intermediate distances." This surgery is particularly suitable for those wishing to be free from glasses or who can no longer tolerate prolonged contact lens use, especially in cases of dry eyes or discomfort from extended screen time. 
Beyond visual freedom, CLE can bring additional clinical benefits. In patients with elevated intraocular pressure or at risk for angle-closure glaucoma, replacing the crystalline lens can help reduce pressure by creating more space within the eye and contributing to better pressure control. CLE is a painless, quick, and minimally invasive surgery performed with 2.4 mm incisions using modern phacoemulsification techniques. 
This method reduces the risk of complications and ensures a comfortable, safe recovery. 
Hospital discharge typically occurs on the same day, allowing a prompt return to daily activities. For many, CLE represents not only a significant visual improvement but also long-term economic savings by avoiding repeated expenses on progressive glasses and frames. 
However, a complete and personalized ophthalmologic evaluation is essential to confirm if CLE is the most appropriate option for each case. The decision is individualized, based on rigorous clinical criteria and the patient's visual expectations and lifestyle, ensuring the best possible outcomes.

4. What Is the Surgical Experience Like at Instituto HPA? 
We offer an integrated approach where every stage of the process — from diagnosis to post-operative care — is meticulously planned to guarantee safety, comfort, and excellent visual outcomes. Dr. Miguel Vieira explains, "Our goal is to offer patients a personalized surgery with the highest standards of quality and safety." 
Each patient is followed from the first moment with attention to detail, ensuring a smooth and confident experience. 
At the initial consultation, a detailed clinical history is taken, focusing on current medications, pre-existing conditions, previous ocular surgeries, and refractive history.
Whenever possible, preoperative exams are performed on the same day, meaning the appointment may take some extra time. These tests assess the eye's overall health, corneal and retinal integrity, and determine the most suitable intraocular lens, including the need for astigmatism correction.
Based on these results, an individualized surgical plan is created and discussed clearly with the patient. Our clinical management team also coordinates with insurance companies to streamline the authorization process, ensuring a hassle-free experience. Surgery is performed in an environment designed to ensure patient well-being, with a team dedicated to providing technical excellence and comfort. 
Patients are welcomed at the reception and directed to the recovery area, where preparations begin: pupil dilation and administration of anaesthetic eye drops. Anaesthesia is local, applied via drops, with no need for sedation. The procedure is painless, with an average duration between 10 and 20 minutes. Each step is carefully organized to maximize comfort and safety, with constant support from the specialized team. Generally, each eye is operated on separate days according to the established plan. After surgery, the patient returns to the recovery room, where postoperative instructions, eye drops, and the follow-up appointment are provided before same-day discharge. 
Recovery is usually quick, allowing a return to daily activities with minimal restrictions within a few days. "Our commitment is to ensure every patient feels safe, informed, and well-supported at every stage," says Dr. Miguel Vieira. 
This attention to detail explains the high levels of patient satisfaction and consistent results achieved. 
In summary, cataract surgery today is a highly personalized and technologically advanced intervention, capable of restoring not just vision but also freedom and quality of life. At Instituto HPA, every surgery is performed with technical rigor and human care so that every patient can see — with clarity — the best of their future.