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Cataract Extraction
By far, the most common surgical procedure I perform is cataract surgery. Every week I help a handful of people see better by removing their cataracts.
What is a cataract?
A cataract is a cloudy natural lens of the eye. It is usually a result of normal aging of the eye, although chronic illness, trauma, and exposure to other insults can make cataracts develop at a younger age. The cataract is located inside of the eye just behind the iris (the colored portion.)
CATARACT SURGERY FAQs
PREPARING FOR SURGERY
IF I AM TAKING MEDICINES, DO I NEED TO STOP THEM IN PREPARATION FOR SURGERY?
No, continue them as usual. We will tell you which medicines to take the morning of surgery. Be sure to bring your medicines with you to the preoperative appointment so we can review them with you.
The exceptions to this rule are FLOMAX® (tamsulosin) and similar medicines [Jayln, Silodosin (Rapaflo), Doxazosin (Cardura), Prazosin (Minipress), Alfuzosin (Uroxatral), and Terazosin.] Ideally, these should be stopped 2 weeks in advance, but at least at the preoperative visit we will have you stop them. The most important thing is letting your surgeon know if you have ever taken these or any other medicine for BPH(enlarged prostate), even if you stopped them long ago.
IF I AM USING EYE MEDICATIONS, SHOULD I STOP THEM?
Don't stop them, use them as usual. If you are taking a Prostaglandin inhibitor (Latanoprost, Travatan®, Lumigan®) I will have you stop them for 1 month after surgery. In the unoperated eye use your drops as usual.
CAN I TAKE BLOOD THINNERS BEFORE MY SURGERY?
Ask the doctor during your preoperative visit. We almost always have you continue to use them. Since there is no injection to numb the eye, and the wound is in the cornea, there is a very minimal risk of bleeding.
PATIENTS SCHEDULED FOR COMBINED CATARACT AND GLAUCOMA SURGERY(Trabeculectomy):
This is one instance where we will want you to stop your blood thinners. Aspirin should be stopped at least a week in advance. Plavix® and Warfarin/Coumadin® should be stopped 5 days before. Those on NOACs (Pradaxa®, Xarelto®, Eliquis®, Savayasa®, etc.) need to stop them at least 2 days before surgery. Please feel free to discuss this with your Cardiologist or PCP. We can proceed with glaucoma surgery if you have a medical necessity to continue any of these medicines.
CAN I WEAR MY CONTACT LENSES BEFORE SURGERY?
It is okay to use soft lenses. Rigid lenses should be stopped 2 weeks (sometimes more) before your preoperative visit. These lenses can “warp” the cornea and interfere with implant measurements.
CAN I WEAR EYE MAKEUP THE MORNING OF SURGERY?
No
CAN I EAT OR DRINK BEFORE SURGERY?
Have nothing to eat or drink after midnight the night before surgery.
DO I TAKE MY INSULIN THE MORNING OF SURGERY?
Unless we tell you to, do not take your morning insulin. Since you will have an empty stomach we don't want your sugars dropping.
THE DAY OF SURGERY
HOW LONG WILL I BE AT THE SURGERY CENTER?
Plan to be at the surgery center for several hours. The surgery center likes you there far in advance so that you don't feel rushed and they can fully prepare you for surgery. We will tell you when to arrive.
WHAT SHOULD I WEAR?
Don't wear jewelry. Wear pants and a shirt that is easy to get off. You will wear a gown over your top but be allowed to keep your pants. If you wear a hearing aid, you may wear it, ideally, on the side opposite the eye that is having surgery.
HOW LONG DOES THE SURGERY TAKE?
It only takes about 20 minutes.
IS THE OPERATION PAINFUL?
You are given medicines both through your veins and drops in your eyes to make you more comfortable. Most people feel no pain and minimal anxiety during the surgery. If you do feel discomfort or anxiety, let us know. We can always give you more medicine.
WILL I BE AWAKE DURING SURGERY?
Many people doze off, however, most people are awake for most of the case. The medicines relax you so you don't worry about things so much. The medication also makes you temporarily forgetful, so you may remember very little of what went on.
WILL I HAVE TO KEEP MY EYE OPEN DURING THE PROCEDURE?
No, we have a simple device that holds your lids open.
WILL I SEE YOU OPERATE ON ME?
No. The other eye is covered with a drape. The eye we operate on can see lights, color, and motion but won't be able to make anything out.
WHAT IF I COUGH?
If you are very sick you should cancel your case. A cough here and there we can handle with medicines. Most importantly let me know if you have to cough during the case.
WILL I GET STITCHES IN MY EYE?
The vast majority of the time sutures aren't necessary. Occasionally they are needed. When needed, they can be easily be removed in the office after numbing the eye with drops.
IS CATARACT SURGERY DONE WITH A LASER?
No. This is a common misconception. Most people are confusing Cataract Surgery with many of the other kinds of things we do with lasers. I use a state of the art Phacoemulsifier. It uses ultrasonic energy to turn the cataract into tiny pieces that can easily be sucked through a small wound.
Some surgeons use “Laser assisted cataract surgery.” A phacoemulsifier is still used to take out the cataract. For the most part, this helps with the easiest parts of the procedure. It always adds time and a whole lot of extra expense to the procedure. Some studies even hint at increased complications. For these reasons, I don't use this.
AFTER SURGERY
WILL MY EYE HURT AFTERWARD?
The eye may feel a little gritty or a little achy. Lots of people are more bothered by the patch than the surgery itself.
WHAT CAN I DO WHEN I LEAVE?
Just go home and take it easy. If you want to go out to eat before going home it is okay. Since you have had sedation: don't drive, do anything strenuous or make any important decisions for 24hours.
HOW DO I USE MY EYE DROPS?
We will give you written instructions during your first exam after surgery. Generally, it involves 3 types of drops. They are stopped at different times so mark your calendar. Be sure to wait 5 minutes between different kinds of drops so you don't just rinse one out with the other. It is not unusual for the drops to sting; this doesn't indicate you are intolerant to them.
IS IT NORMAL TO SEE AN ARC IN THE CORNER OF MY VISION?
It is common to see either a bright or dark arc in your peripheral vision. This is called “dysphotopsia” and is believed to be caused by stray light falling on the edge of your implant. In the majority of people, this isn't too bothersome and goes away over several weeks.
HOW WELL WILL I SEE AFTER SURGERY?
Vision the day after surgery can vary from fantastic to downright blurry. Almost everyone with blurry vision the day after surgery notices daily improvement in their vision over the following days. The best vision is often not achieved until you are ready for new glasses.
If your vision the day after surgery was better with the first eye than the second, don't worry, it will get better. If you think about it there is a 50/50 chance that the second eye starts off a bit blurrier than the first. People who have a better experience with their second eye don't question how things are going.
WILL I NEED GLASSES AFTER SURGERY?
A common misconception is that everyone after cataract surgery can “throw away their glasses.” The truth is most people have a reduced dependency upon their glasses, however, most need glasses if they want to see their best. From my experience, the decision not to wear glasses after surgery has more to do with the person than the results of the surgery. I have seen plenty of people with excellent vision get glasses to see their best, for the convenience of bifocals or because they have always worn them. On the flip side, I have seen plenty of people with “just-okay” vision declare their vision is perfect and decide not to wear glasses.
WHEN CAN I RETURN TO WORK?
This depends upon the work you do and how anxious you are to return. Ask me.
WHAT ARE THE LIMITATION TO MY ACTIVITY FOLLOWING SURGERY?
• For the first two days after surgery, avoid getting dust or tap water in your eye. You can shower, just close the eye. If you think you got water in the eye put a drop of the antibiotic in the eye.
• For the two weeks following surgery: wear your shield at night and don't rub your eyes.
• For two weeks following surgery, minimize: heavy lifting or bending so your eye is below your waist.
WHEN CAN I RESUME MY NORMAL ACTIVITIES?
Two weeks afterward.
WHEN CAN I DRIVE AFTER MY SURGERY?
Since you have had anesthesia you shouldn't drive for 24hours following your procedure. After that, it is a judgment call. If you feel your vision is limiting your ability to drive safely, don't drive.
HOW SOON CAN I WEAR MAKEUP?
Avoid eyeliner and mascara for at least 3 days (a week is better.) Other makeup you can use right away.
ARE THERE RISK TO CATARACT SURGERY?
No surgery is risk-free. Serious complications are uncommon but can occur. Here are some of the risks:
1. Complications requiring additional treatment and/or surgery
2. Need for glasses or contact lenses
3. Complications requiring the removal of the implanted lens
4. Partial or total loss of vision