In the next few minutes we will show you what
cataracts are and how they can be treated with surgery. We’ll talk about some other
types of lenses that can be implanted, some risks of surgery and what you can expect afterwards.
In the healthy eye, light rays enter through the clear cornea, pupil and lens. The light
is focused directly onto the retina, the light sensitive tissue lining the back of the eye.
The retina converts light into electrical signals which travel through the optic nerve
to the brain where they are recognized as images.
Cataracts occur when the lens inside the eye becomes cloudy. The cataract blocks
light entering the eye and causes blurry vision. It usually happens slowly, over a period
of years, as we get older. When cataracts interfere with your daily activities such
as reading, watching television or driving, surgery
can usually improve your vision. Patients with cataracts who do not have problems
with their vision can safely wait to have surgery. An exam by an optometrist may
show whether your vision can be improved with glasses or contact lenses. The
goal of cataract surgery is to help you see better when glasses no longer help. Your eyes will be measured to determine the
power of the lens to be implanted after the cataract is removed. It’s called biometry.
If you normally wear contact lenses, please do not wear them for at least 1 week before
this test so that an accurate measurement can be taken.
Once you are booked for surgery, you’ll receive some information in the mail. This
will include the date of surgery, and a visit with your surgeon before the procedure,
known as a preoperative or pre-op appointment. After your surgery, your will have 1 or 2
post-op appointments including a final visit with an optometrist. There will be co-pays
for each of these visits. It’s a good idea to
plan on staying in town for the first week after
surgery. If you have any conflicts with these dates, please call our office right away.
If you will be having surgery on both eyes, the second eye will be scheduled 1 to 2
months after the first eye so that the first eye will have time to heal.
At the pre-op appointment, you’ll have a chance to discuss your lens options with
your surgeon and to ask any questions about the procedure. Your doctor will send an
electronic prescription for eye drops to a nearby Kaiser Permanente pharmacy.
Carefully follow all directions listed on the label. After this visit, any changes that
you would like to make to the planned lens or
surgery should be discussed directly with your
surgeon. You won’t need to see your regular medical
doctor or take additional lab tests unless you’ve experienced a recent change in your
health. If this is the case, please notify our
office. You also won’t need to stop aspirin or other blood-thinners, such as Coumadin,
unless advised by your doctor. You’ll know the date of your surgery from
the mailed information, but the exact time of your surgery won’t be known until one or
two days before. You’ll get a phone call advising you when to arrive at the surgery
center. Don’t worry if you’re not home, we’ll leave the time to report to the surgery center
on your answering machine or voicemail. You may eat and drink up to 6 hours before
your surgery appointment. After this, please don’t take anything by mouth except
necessary medications, like blood pressure and heart medicines. And take them with a
small sip of water. If you are a diabetic, however, do NOT take your diabetes pill or
inject insulin on the morning of surgery since you will be fasting.
You’ll need a responsible adult to drive you, stay with you and drive you back home
from the surgery center. Wear comfortable clothes, no facial make-up and leave any
jewelry at home. The actual operation only takes about 15 to 30 minutes, but be
prepared for a 3-hour total visit as there are many steps involved in preparing for your
surgery. You’ll receive IV medication to help you relax
without putting you fully asleep. You’ll also receive some drops, which will numb the
eye . During the operation, we’ll ask you to lie
quietly and stare into a light. Your surgeon will make a small opening in the side of your
cornea and on top of the cataract. Ultrasound is then used to liquefy the cataract
and then vacuum it out. A foldable lens implant is then placed into a clear bag called
the capsule, where it unfolds and remains permanently. Your surgeon will then place
a shield over your eye to protect it overnight. After surgery, you’ll receive instructions
on the care of your eye. Please read these carefully. Most patients are able to resume
their usual activity, including driving, within a
few days. Your vision should improve during the first
week but some patients may take a little longer to heal. Everyone’s a bit different.
It’s normal for your eye to feel a little scratchy for a while after your surgery. But
you should call right away if you notice pain
in your eye, redness or worsening vision. Presbyopia: In younger people, a tiny muscle
inside the eye can make the flexible lens change shape. This change in shape allows
us to see things up close. As we age, our lens becomes less flexible and stops changing
shape, so we lose this ability to focus up close. This is called presbyopia. Presbyopia
is the reason why we need reading glasses or bifocals when we get older.
Standard Lens: The standard lens implant, which is included in your surgery, is made
from a crystal clear synthetic material and is chosen for you based on your biometry eye
measurement. This lens focuses at only one distance. Most patients who choose the standard
lens want the lens focused for far vision for things such as watching television and
for driving. Patients with cataracts in both eyes usually choose to have each eye matched
for far vision. This means that you will need to wear reading glasses for up close vision.
Toric Lens: Patients who have astigmatism will need glasses for both near and far vision
with the standard lens implant. Astigmatism means that the cornea is ovalshaped, more
like a football than perfectly round. Glasses and contact lenses are a common way of correcting
for astigmatism. Now, there is a lens implant available, for an additional fee that can
correct astigmatism. It’s called a toric lens. Toric lenses are
made from the same material as standard lenses but are shaped so that they can correct for
astigmatism. If you have astigmatism, the toric lens offers you the best
chance of seeing clearly without glasses at a single distance.
Monovision: The first way to correct for more than one distance is using a technique that
has been used for years in contact lens patients called ‘monovision’. For cataract surgery,
one eye is corrected for far vision and the other eye is usually corrected at arms-length
vision at about the distance of a typical computer monitor or a menu. This takes a little
getting used to but in a few weeks, the brain is able to combine the 2 images together.
Because your depth perception will be somewhat affected, monovision is not the best solution
for everyone. Multifocus Lenses: The second way to get both
far and near vision is by implanting a multifocus lens, available for an additional fee. It’s
a special lens that focuses some of the light rays coming into the eye for far
tasks and some for near. Each eye receives this lens and each eye is able to focus at
far and near. Multifocus lenses in both eyes, offer more balanced vision than monovision.
It takes a few weeks after surgery in both eyes to get used to the multifocal lenses.
Some patients experience mild symptoms of glare at night. If you require very precise
vision or if you don’t mind wearing glasses, then these lenses may not be the best
for you. 1. You may need a small prescription for glasses
to get the sharpest vision. 2. Occasionally, a film develops on the bag
or capsule holding the lens implant. You’ll notice it when your vision gets a little blurry,
months or years after surgery. A simple inoffice laser procedure, called a “Yag” can correct
this. 3. Another risk of surgery occurs when the
bag or capsule holding the lens tears during surgery. In this case, your surgeon may need
to implant a different lens than the one planned, so that it will safely remain
in position. Your eye may also heal a little more slowly. In most cases, however, the final
result is excellent. 4. Other, more serious risks of surgery include:
– The possibility that cataract pieces could be left behind after surgery
– The lens implant might slip out of place – The retina could detach
– Or you could develop a serious infection of the treated eye
Some problems may require another surgery and rarely, permanent vision loss or
blindness may result. If you have other conditions affecting the
vision in your eye such as macular degeneration, glaucoma or diabetes, cataract
surgery alone may not be able to restore full and complete vision.
You may also choose not to have surgery. Cataracts develop slowly and waiting to
have surgery later on, when your vision is more affected, will not usually decrease your
chances of a successful surgery. The good news is that in most cases, cataract
surgery offers a fast, painless way to improve your quality of life.