Advanced Cataract Surgery
Cataract surgery is the most common and successful surgery in all of medicine. There are approximately 4 million procedures done in the United States each year. Everyone will get visually significant cataracts if you live long enough. A visually significant cataract is defined as a cataract that is diagnosed by your doctor which explains the cause of your vision loss for which the deficit is debilitating to your daily activities. The time at which we develop age-related, visually significant cataracts varies greatly from age 40 to 100 but most commonly occurs in the late 60s and early 70s.
How safe is cataract surgery?
CATARACT SYMPTOM CHECKER
Cloudy or blurry vision
Light & glare sensitivity
Fading or yellowing of colors
Trouble seeing at night
Seeing "halos" around lights
What is a cataract?
A cataract is a clouding of the natural crystalline lens inside your eye. The native lens is located behind the iris (the colored part of the eye) and works just like the lens of a camera focusing light images on the retina, which then sends the images to your brain. The human lens, made mostly of protein and water, can become clouded – so clouded it keeps light and images from reaching the retina.
How does a cataract impact my vision?
The most common symptom of cataract is blurring of the vision, including difficulty reading, driving and watching television. Other important symptoms may include night vision glares, halos around bright lights, double vision, dim vision and distorted vision. Dr. Rush will examine your eyes to diagnose cataract and determine if it is the reason for your vision loss. Visually significant cataract is based upon how bothersome the vision defect caused by the cataract is for your daily activities. No two patients are exactly alike. The threshold point for favoring surgery depends upon what type of activities you do and how limiting the vision is for successfully performing them.
How is cataract surgery performed?
Modern cataract surgery uses an advanced phacoemulsification medical device that integrates ultrasound power to dissolve your cataract into smaller pieces where it is subsequently extracted from the eye. Then, the foldable intraocular lens implant is positioned inside the eye in place of the old cataractous lens to restore your vision. A picture is worth a thousand words when describing a medical procedure.
What type of lens implants are used during cataract surgery?
The main goal of cataract surgery is to get rid of cataract, not get rid of glasses and contact lenses. But with new technology lens implants can reduce your dependency on glasses and contact lenses. This is especially advantageous to those with high prescriptions that are used to thicker glasses. We use the Alcon AcrySof®family of lenses, and they are the most advanced and commonly used implants in the field of ophthalmology. They have been successfully implanted in tens of millions of patients. Among the Alcon lens implants, there are several options and models to consider, each with their own relative merits
Single Vision Distance
This is the most common option with the standard wavefront lens implant. Most prefer their best distance vision with both eyes working together for optimized depth perception. But with this option, you will always need reading glasses to see up close.
This scenario allows for your dominant eye to be set for distance and your fellow eye aimed for near. This option makes you less dependent on glasses for distance and near but has a relative disadvantage of decreasing depth perception since both eyes are not focused together as a team. Patients that have used this in the form of contact lenses for many years adapt to it and love it. Not everyone will tolerate the two eyes being slightly off balance. We would recommend experimenting with this using contact lenses to see how you are able to tolerate it before consideration.
Toric Intraocular Lens Implant
This premium technology implant is necessary for all patients with significant astigmatism that want to have the least amount of dependency on glasses post-operatively. Having either clear distance or near vision will make you less likely to need bifocals afterward.
Vivity Intraocular Lens Implant.
This newly-approved implant uses non-diffractive X-WAVE™ technology, which offers patients a more seamless range of vision without splitting light into different sectors of the lens. This allows the Vivity lens to deliver the same high quality of vision and contrast of a single focus lens implant, but with the added benefit of excellent intermediate at arm’s length. It has the ability to make you much less dependent upon reading glasses, especially when working on a computer.
PanOptix Multifocal Lens Implant
This premium technology implant is the absolute best option to make you completely independent from glasses for both distance and near. It is able to split the light to focus some of it at near and some of it at distance. It is also designed in a toric-style that will correct your astigmatism simultaneously.
Light Adjustable Intraocular Lens Implant.
This fully-customizable implant uses new technology in which the material of the lens can be reshaped by exposure to UV light so that your vision can be later adjusted in order to maximize the clarity of vision after the surgery. This gives you the most accurate and fine-tuned vision for distance performance.
The premium lens implants are not covered by medical insurance companies. There are several financing options that make this new technology readily available for you. Many patients discover that this is well worth it to be free from bifocals, especially when you will otherwise continue to spend money getting a new updated pair every couple of years. Dr. Rush will be able to discuss the various options with you so that you decide on the ideal situation for your specific circumstances.
What happens when I have cataract surgery?
Cataract surgery is a day surgery in our outpatient ambulatory surgery center. It does not require hospitalization. It requires that you remain without food or drink at midnight the night before the surgery in preparation for various types of anesthesia. The exception is that you will take all of the medicines by mouth that you would normally take with a sip of water, even on the morning of surgery, which includes any blood thinners. You will first meet our nurse anesthetist, who is there primarily for your safety but will also be there to ensure that you are comfortable during the procedure. They are able to give numbing eye drops, intravenous sedation and oral medications to ensure comfort and reduce anxiety. It is tailored to meet your specific needs. However, you will not be totally asleep during the surgery. We expect that you will see bright lights, feel light touch and pressure from time to time as well as cool fluid coming off and on the surface of the eye but no pain. You will also have gentle pressure on the eyelids as the speculum holds them open so that you don’t have to worry about blinking or closing your eyes during the procedure. A sterile drape covers you so as to keep the surgical field sterile, but you will have cool air blowing underneath to give you plenty of breathing space where your oxygen levels and other vital signs are closely monitored. You should understand that there is no special action required on your part except to listen to our instructions where we coach you through the entire procedure in a stepwise fashion. The surgery itself lasts approximately 15 minutes start-to-finish but you will spend up to two hours at the surgery center, most of the time spent preparing for surgery and being discharged with post-operative instructions. You must have a driver to take you to and from the surgery as it is not safe to travel alone with effects of IV sedatives in your bloodstream.
The first post-operative visit will occur within 24 hours of the surgery, many of them on the same day of surgery so as to eliminate your travel time, especially for those traveling from out of town. You will be given post-operative instructions at this first visit, including any activity restrictions and on the use of the eye drops. The eye medication is used in the operative eye with one drop being used three times daily for a total of 3 weeks from the time of the surgery. Your next visit will occur either one more time immediately prior to the surgery of the second eye to ensure good healing progress or else three weeks from the time the surgery on the second eye is completed. Usually, your vision will start to recover dramatically over the course of the first few days. But as with surgery anywhere else on your body, your eye requires a healing process in order to achieve your best vision. On average, this healing occurs over a time period of 3 weeks in order to achieve your maximum visual outcome, some people quicker, some people a little bit longer. No two individuals will be exactly alike and, furthermore, each individual eye will have a slightly different experience both during and after the surgery. All detailed instructions will be reviewed and given to you in written form after your surgery. In the interim period between surgery of the two eyes, it is typical for the eyes to be imbalanced. Many patients discover that the old glasses don’t work well during this time. This is why we try to schedule the surgery on both eyes back-to-back within a week of each other if possible. In the meantime, you may use over-the-counter readers alone or some patients even remove the lens from the old glasses. You will have to decide what will work best for you. At the three-week post-surgery follow-up visit from the time of the second eye surgery, you will be sent back to your regular eye care provider to receive prescription strength glasses if necessary. It requires this healing time for our most accurate prescription measurements, otherwise, we would have to change or update them immediately if it shifts due to incomplete healing time. It is important to allow this time for it to settle.
Most patients are able to return to their normal activities including work within the first few days after surgery. We ask that you don’t do anything overly strenuous that would be outside your normal activity routine. We don’t ever tell people to drive or don’t drive. We don’t work for the Department of Transportation and don’t make these determinations for you. All we can tell you is what your vision is, but you have to make this determination if you are safe to drive based on your confidence level and the applicable government regulations from the DOT.
As with any surgical procedure there are inherent risks, and your results cannot be guaranteed. Your doctor will provide you with more detailed information about the potential risks and benefits to help decide whether or not you are an appropriate candidate for cataract surgery. Written informed consent document will be reviewed at the time of your evaluation.