Cataract

CAUSES

Old age is certainly the largest cause of cataract formation, however, other factors that can raise your risk of cataracts include:

• Diabetes
• Certain prescription medications
• Exposure to UV rays
• Smoking and alcohol consumption
• Nutritional Deficiency

CATARACT SURGERY

OVERVIEW:

Cataract surgery is a procedure to remove the natural lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear.

Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don't have to stay in the hospital after the surgery. Cataract surgery can be done traditionally using ultrasound energy to remove the cloudy lens or it can be removed with laser-assisted technology.

Cataract surgery is very common and is generally a safe procedure.

WHY IS CATARACT SUREGRY DONE?

Cataract surgery is performed to treat cataracts. Cataracts can cause blurry vision and increase the glare from lights. If a cataract makes it difficult for you to carry out your normal activities, your doctor may suggest cataract surgery.

When a cataract interferes with the treatment of another eye problem, cataract surgery may be recommended. For example, doctors may recommend cataract surgery if a cataract makes it difficult for your eye doctor to examine the back of your eye to monitor or treat other eye problems such as age-related macular degeneration or diabetic retinopathy.

In most cases, waiting to have cataract surgery won't harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever.

When considering cataract surgery, keep these questions in mind:

1. Can you see to safely do your job and to drive?
2. Do you have problems reading or watching television?
3. Is it difficult to cook, shop, do yardwork, climb stairs or take medications?
4. Do vision problems affect your level of independence?
5. Do bright lights make it more difficult to see?

RISKS:

Complications after cataract surgery are uncommon, and most can be treated successfully.

Cataract surgery risks include:

• Inflammation
• Infection
• Bleeding
• Swelling
• Drooping eyelid
• Dislocation of artificial lens
• Retinal detachment
• Glaucoma
• Secondary cataract
• Loss of vision

Your risk of complications is greater if you have another eye disease or a serious medical condition. Occasionally, cataract surgery fails to improve vision because of underlying eye damage from other conditions, such as glaucoma or macular degeneration. If possible, it may be beneficial to evaluate and treat other eye problems before making the decision to have cataract surgery.

CATARACT CONSULT

Prior to cataract surgery, the ophthalmologist will perform a comprehensive eye exam to check the overall health of your eyes, evaluate whether there are reasons why you should or should not have surgery and identify any risk factors you might have.

What to bring to your appointment:

When you arrive for your appointment a technician will get you ready to see the doctor. The technician is required to review all medical information with you at EVERY visit. Its helpful for both the patient, technician and doctor if you bring an updated list of all medical history, surgical history, family history, allergies and medications.

• UPDATED MEDICAL HISTORY:

  In order to better prepare for surgery, the doctor must know of any medical history that you have including surgeries.

  • Diabetes / hypertension
  • Prior eye surgeries (Lasik, retinal detachment surgery)
  • Pace maker / defibrillator
  • Orthopedic conditions or surgeries that could affect positioning during surgery. (Back / neck)

• UPDATED LIST OF CURRENT MEDICATIONS:

  It is always important to bring an updated list of medications to every doctor’s appointment with you, but especially if your coming in for a surgical consult. Certain medications, vitamins and herbal supplements can interfere with surgery and it is vital for the surgeon to know exactly what you are taking while discussing surgery with you.

  Important medications to note:

  • Anticoagulants (Coumadin, Plavix, Eliquis)
  • Prostate medications (Flomax, tamsulosin)
  • Aspirin (81mg and 325mg)

• ALLERGIES:

  We MUST know ALL allergies that you have most importantly, medications and latex

  Important allergies to note:

  • Latex
  • Anesthesia’s
  • Sulfa

You will go through several pre-diagnostic tests during your prescreening.

PRESCREENING:

• Checking visual acuity
• Refraction:
  • A refraction will be performed to accurately determine the amount of nearsightedness, farsightedness and/or astigmatism you have prior to surgery. Additional measurements of your eyes will be taken to determine the curvature of your cornea and the length of your eye.
• Dilation
  • This will help the doctor to better evaluate the extent of your Cataract.
  • View your retina to see if there are any other medical issues or concerns happening behind the cataract.
• Photography:
  • There will be photos and scans taken of the back your eye this will also help in determining if there are any increased risk factors like macular degeneration or glaucoma.

EXAM:

After the doctor thoroughly examines your eyes, they will then go over their findings with you and discuss your options.

They will first determine what outcome you are looking for following your cataract surgery. Knowing this will help them to better determine your IOL (intraocular lens) options. Nearly everyone who has cataract surgery will be given an artificial lens called an intraocular lens (IOL). These lenses improve your vision by focusing light on the back of your eye.

You won't be able to see or feel the lens. It requires no care and becomes a permanent part of your eye.

A variety of IOLs with different features are available. Before surgery, you and your eye doctor will discuss which type of intraocular lens (IOL) might work best for you and your lifestyle. Cost may also be a factor, as insurance companies may not pay for all types of lenses.

IOLs are made of plastic, acrylic or silicone. Some IOLs block ultraviolet light. Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close.

However, many IOLs are flexible, allowing a smaller incision that requires few or no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once inside the eye, the folded IOL unfolds, filling the empty capsule.

LENS OPTIONS:

• Fixed-focus monofocal. This type of lens has a single focus strength for distance vision. Reading will generally require the use of reading glasses.
• Accommodating-focus monofocal. Although these lenses only have a single focusing strength, they can respond to eye muscle movements and shift focus on to near or distant objects.
• Multifocal. These lenses are similar to glasses with bifocal or progressive lenses. Different areas of the lens have different focusing strengths, allowing for near, medium and far vision.
• Astigmatism correction (toric). If you have a significant astigmatism, a toric lens can help correct your vision.

Discuss the benefits and risks of the different types of IOLs with your eye surgeon to determine what's best for you

The doctor will also discuss the different type surgical methods that are available and what he thinks would best fit your needs.

SURGICAL METHODS:

ULTRASOUND:

Using an ultrasound probe to break up the lens for removal. During a procedure called phacoemulsification, your surgeon makes a tiny incision in the front of your eye (cornea) and inserts a needle-thin probe into the lens substance where the cataract has formed.

Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The very back of your lens (the lens capsule) is left intact to serve as a place for the artificial lens to rest. Stitches may or may not be used to close the tiny incision in your cornea at the completion of the procedure.

LASER ASSISTED:

Using an advanced laser technique to remove the cloudy lens. In laser-assisted cataract surgery, the surgeon uses a laser to make all incisions and soften the cataract for removal.

The CATALYS®: Precision Laser System

Many of the steps of cataract surgery that are traditionally performed using handheld instruments can now be completed using the precision of a laser. The CATALYS® Precision Laser System–developed in the heart of Silicon Valley–is the world’s most sophisticated laser cataract surgery system. Thousands of patients have been successfully treated with Precision laser system:

Once you and your doctor have decided to move forward with surgery, you will be contacted by a surgical coordinator within 48hours of your visit. The surgical coordinator will review all aspects of scheduling the surgery and pre-operative testing.

PREPARING FOR YOUR SURGERY:

There are several important steps that need to be done prior to having your cataract surgery.

• PRE-OP MEASURMENTS: Prior to your surgery, you will come in for a series of tests. This helps determine the right type of lens implant (intraocular lens).
  • If you are a current contact lens wearer you will need to stop wearing them, prior to the measurements. Once the measurements are completed you can resume wearing them until the day before your surgery.
• MEDICAL CLEARANCE: 2 weeks prior to your cataract surgery you will need to have an appointment with your PCP (primary care physician) to be medically cleared for surgery.
• If you are followed regularly by any specialist (Cardiologist, Endocrinologist, Nephrologist, etc.), you may be required to obtain additional clearance from them in addition to your PCP.
• STOP TAKING CERTAIN MEDICATIONS. Your doctor may advise you to temporarily stop taking any medication that could increase your risk of bleeding during the procedure. Let your doctor know if you take any medications for prostate problems, as some of these drugs can interfere with cataract surgery. Prior to stopping any medications, you must get the OK from the prescribing physician.
• USE EYEDROPS TO REDUCE INFECTION RISK. You will start using antibiotic and anti-inflammatory drops several days prior to your surgery.
• FAST BEFORE SURGERY. You may be instructed not to eat or drink anything 12 hours before the procedure.
• PREPARE FOR YOUR RECOVERY. Normally you can go home on the same day as your surgery, but you won't be able to drive, so arrange for a ride home. Also arrange for help around home, if necessary, because your doctor may limit activities, such as bending and lifting, for about a week after your surgery.