Typically, the existence of a cataract is first noted in the course of a well-patient yearly eye exam, a routine appointment that evaluates your vision and ocular health, including glaucoma and retinal testing. This is why it is so important for adults over the age of 40 to be sure to schedule an annual exam. Living in Santa Barbara exposes us to a great deal of sunlight, which is a factor in cataract formation.
It is among the safest surgeries performed worldwide. In recent years more than three million procedures are performed annually in the U.S. with over a 98% success rate. In our hands we have been able to keep the complication rate to less than one half of one percent. Typically, the surgery is done in two separate procedures (one eye at time) on an outpatient basis under local anesthesia. The patient's normal activity is usually resumed in about 24 hours.
If a cataract is found, the determination of whether cataract surgery should be performed sooner or later involves a combination of factors. Your lifestyle and your specific visual needs may dictate that the cataract be removed promptly. For example, such things as the need to drive at night, one’s hobbies or athletic pursuits (such as seeing a golf ball at 200 yards), and the ability to do the reading one likes are all factors. Other considerations are the general health of your eye as well as your overall health. My experience is that many patients fail to consider their overall health as a factor. If you have any other serious health issues, it is better to consider cataract surgery sooner rather than later.
Perhaps the most important consideration in determining when to schedule your surgery is the hardness of your cataract. As the cataract matures it yellows (a process called nuclear sclerosis) and hardens. This induces a shift that favors near vision over distance vision, causes a general decrease in vision and produces glare and halos around lights. The yellowing also distorts your color perception. This growth and change in the cataract is so gradual that on a day-to-day basis you are unaware it is happening. I know of many stories where patients put in new carpeting or painted their house only to find after cataract surgery that they did not select the color they intended.
From a technical point of view, as the cataract hardens, surgery becomes more hazardous and prone to complications; so it is better not to wait until the cataract becomes too mature. Cataract surgery involves phakoemulsification, which is the use of ultrasound to break up and liquefy the cataract so that it can be extracted. The harder the cataract, the more energy is required for its removal. This is where the greater risk of a complication occurs. The notion of waiting until the cataract is “mature” is outdated, and your determination to proceed with the surgery should be based primarily on your visual needs.
Once the decision is made to go ahead with your cataract surgery, I will discuss with you the potential of and/or need for premium intra-ocular lenses (IOLs). I will perform a test called an OCT, something akin to an ultrasound, to ensure that your retina is healthy.
A follow-up appointment approximately a week prior to your surgery will take between 30-45 minutes. Jeff Harbison, my certified ophthalmic technician, will perform an ultrasound with the Zeiss IOL Master to determine the power of the lens that will be implanted following removal of your cataract. This will take 5 minutes or less.
The rest of this appointment will be used to go over the Cataract Patient Informed Consent Form, including the risks and benefits of the surgery, and your prescriptions. Three prescriptions for medicines needed for the surgery will be given to you. Two of the prescriptions are for drops that are started 3 days prior to your surgery. These are started together (spaced 5 minutes apart) and are used 4 times per day. The eye drops will include an antibiotic to prevent infection and a non-steroidal anti-inflammatory medicine. The third prescription, a steroid anti-inflammatory, will be started on the day of surgery following the procedure.
Finally, at this appointment you will be advised of your arrival time at the Santa Barbara Surgical Center on the Tuesday of your surgery. Since cataract removal involves such a small incision, there is no need to stop any medicines, even blood thinners, prior to your surgery. I want you to take all your normal medications on the morning of surgery (although NO food and only the water needed to swallow your pills). Aspirin, Coumadin, Warfarin, and Plavix are all OK.
On surgery day, you should take all your normal pills with a sip of water but NOTHING ELSE. No coffee. No breakfast. After arriving at the Surgical Center, you will register before being taken to the pre-op waiting area. You will be given a gown to wear in place of your shirt or blouse. Your pants and socks are left on. A nurse will ask a few questions about your general health, instill drops to dilate your pupil, and place an anesthetic jelly in your eye. I will mark the correct eye for the surgery, and the anesthesiologist will interview you.
You are then wheeled into the operating room where your eye area will be washed with betadine solution. At this point I start telling you what to expect, from the bright light of the operating room microscope to what you will feel. There are no shots or needles around the eye and the surgery is painless. An anesthesiologist will administer mild intravenous (IV) sedation to relax you, but you will remain awake. As the surgery takes only 10-12 minutes, I prefer you to be more awake than asleep. This is SAFER for you. During that time, you will feel water dripping and the sensation of being touched, but you will not feel pain. I will be talking to you throughout the surgery, so you will know what to expect and there are no surprises.
At the end of surgery I will NOT put a patch over your eye. You will be able to see but vision will be quite blurry and you may notice a pink or red cast to objects. This is a residual from the brightness of the microscope and can last up to 24 hours before going away. You may also feel a mild foreign body sensation for the first 24 hours as well.
After surgery you can eat normally at home but I want you to remain quiet for the day. I would prefer that you do no lifting or bending and that you keep your eye above the level of your heart.
I will see you the morning after surgery in my office for a short appointment. I will check your vision and intraocular pressure, and examine your eye. I will hand you a post-op instruction sheet that details your drop regimen. After this appointment you can resume full activities, including golf or other athletics, and you may lift or bend over. The only restriction is that I do not want you swimming with your head/eye under water for two weeks.
Your next appointment will be in 3 weeks at which time I will give you a prescription for new glasses if that is appropriate. And that is all there is to cataract surgery!
In the majority of cases, at some point a small membrane will need to be removed in the office using a simple 20-second laser procedure known as a YAG capsulotomy. This small membrane will form in the eye months or even years later as cells deposit themselves between the IOL and the back wall of the lens capsule, a condition known as posterior capsular opacity (PCO).