Cataracts and Cataract Surgery
What is a Cataract?
A cataract is a clouding of the normally transparent lens of the eye.
The lens of the eye, located behind the pupil and the iris, is normally clear. Like the lens of a camera it is used to focus images onto the retina at the back of the eye before they are transmitted to the brain. When a cataract forms, the images are not clearly focused onto the retina.
The clouding of the eye’s lens is usually caused by chemical changes associated with the normal aging process. However, heredity, infection, eye injury, increased UV light exposure, smoking, poor nutrition, and diabetes are other factors that can lead to cataracts.
How common are cataracts ?
Cataracts are the leading cause of blindness among adults in the United States. They account for one out of every seven cases of blindness in people age 45 and older. Although most prevalent in adults, a cataract can occur in young people, and sometimes can be found in a baby’s eyes at birth.
Who is at risk?
As medical advances have succeeded in lengthening the human lifespan, more and more Americans are – and will be – entering the age group associated with the development of cataracts. Most of us will develop cataracts.
What may you notice as the symptoms of a cataract ?
- Problems driving at night
- Cloudy, fuzzy, foggy, or filmy vision
- Changes in the way you see colors
- Increased glare from lamps, headlights or the sun
- Frequent changes in your eyeglasses prescription
- Double vision
- Distortion or ghost images in either eye
Since the symptoms usually develop gradually, most people don’t suspect cataracts. Routine eye exams by Dr. Duplessie can pick up the early signs of cataracts.
Treating cataracts: Can they be prevented?
The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while. There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. When your vision interferes with your normal activities, cataract surgery should be considered. Cataracts are removed with an ultrasound device. Surgery is the only way to remove a cataract. In cataract surgery, the cloudy lens is replaced with a clear artificial lens. The lens is permanent.
WILL CATARACT SURGERY IMPROVE MY VISION? IS CATARACT SURGERY RIGHT FOR ME?
Today, cataract surgery is safe and very effective. Cataract surgery is the most frequently performed surgery in the United States. It is also one of the most consistently successful. Over 95% of cataract surgeries improve vision, but no surgery is risk free. Dr. Duplessie has performed over 10,000 thousand surgeries and specializes in the removal of cataracts.
CATARACT SURGERY CUTS CAR ACCIDENT RATE IN HALF
A recent study in The Journal of the American Medical Association determined that patients with cataracts are nearly twice as likely to have a car accident.
CATARACT SURGERY AND MACULAR DEGENERATION
If you have Macular Degeneration, what are your chances of seeing better after cataract surgery?
Dr. Armbrecht, of The Royal Infirmary of Edinburgh, studied this question and concluded that most patients with mild to moderate degrees of age-related macular degeneration (ARMD) experienced significant improvements in their quality-of-life following cataract surgery.
Removal of the cataract allowed more clear, undistorted light to fall on the retina, so even damaged retina tissue could function better. Cataract surgery on most patients with mild to moderate ARMD is beneficial in improving their quality-of-life.
Dr. Armbrecht’s research team found that no surgical patients progressed from mild to moderate ARMD to severe “wet” ARMD following cataract extraction.
Even if the surgery itself is successful, the eye may still not see as well as you would like. Other problems with the eye, such as macular degeneration, glaucoma and diabetes may limit vision after surgery. Even with such problems, cataract surgery may still be worthwhile. If the eye is healthy, the chances are excellent that you will have good vision following removal of your cataract.
What happens before surgery?
Once you and Dr. Duplessie have decided that you will have your cataract removed, a physical examination by your medical doctor is necessary so that Dr. Duplessie may be alerted to any special medical risks. Your eye will be measured to determine the proper power of the intra-ocular lens that will be placed in your eye during surgery.
Where is the surgery done?
Dr. Duplessie uses state of the art outpatient eye surgery; you will go home after the procedure.
Can the cataract return:
A cataract cannot return because the lens has been removed.
Will you need eyeglasses after surgery ?
Multi-focal cataract lenses are a way to reduce if not eliminate your need for eyeglasses. If get a single vision lens [usually for distance correction], you will get an eyeglasses prescription two weeks after surgery, if you require one. There is a chance you may not require eyeglasses.
How is a cataract removed ?
Dr. Duplessie preferred technique is a quick vision, small incision, no shot, no-stitch, no-patch cataract surgery. The surgery is called Phacoemulsification, or phaco. Phaco-emulsification is the most advanced form of cataract surgery. Using an operating microscope, a microscopic incision is made into the eye. An ultrasound device is used to remove the cataract lens from the eye.
A plastic intra-ocular lens (IOL) implant will be placed inside the eye to replace the natural lens that was removed. Stitches are not typically required.
Is there a special type of intra-ocular lens for me?
Dr. Duplessie uses the finest intra-ocular lenses available. There are three materials presently used for intra-ocular lenses:
- Polymethylmethacrylate (PMMA)
Today’s intra-ocular lenses are very safe and effective.
3 types of intraocular lenses (IOLs).
The most common lenses implanted in the eye. Worldwide this accounts for about 93% or greater of implanted lenses. Traditional IOLs are monofocal, meaning they offer vision at one distance only (far, intermediate or near).
have special features that correct your near, intermediate, and distance vision in the same lens. Multifocal IOLs provide your best chance at being free of glasses for the majority of activities. One in fifteen lenses implanted is a multifocal lenses. There is a premium charge for this lens as this lens is more technologically advanced and more complicated so the lens is a little more expensive.
The new diffractive technology — a design that responds to how wide or small the eye’s pupil might be — is able to provide near, intermediate and distance vision.
Clinical studies used to support FDA approval showed that 80 percent of people who received the lens didn’t use glasses for any activities .
Levels of Astigmatism – Is an Astigmatic Lens Needed?
A very common eye condition, astigmatism does not always require corrective lenses. Many people have some degree of astigmatism, but a minor level astigmatism is normal and requires no correction. Even if a person needed cataract surgery and had a minor degree of astigmatism, a toric IOL would probably not be necessary.
Blurred or distorted vision is typically experienced by patients with moderate or high degrees of astigmatism. These patients can correct for the vision problem through the use of contact lenses or corrective eyeglasses or through refractive surgery.
Astigmatic patients with cataracts, however, can request the use of toric IOLs or laser to treat their astigmatism.
Toric lenses are designed for people with astigmatism. Dr. Duplessie can discuss whether a toric lens or laser is the most effective treatment to get rid of your astigmatism. Dr. Duplessie believes the laser is the most accurate way to get rid of astigmatism.
Must someone accompany me on the day of surgery?
It’s not absolutely necessary, but advisable. Our staff is more than happy to assist patients who are alone.
￼How long does the procedure take ?
Plan to be at the eye center for 1 1/2 hours from the beginning to your discharge.
What should I bring with me the day of surgery?
Friend or family member (someone to help with paperwork, driving home, etc.)
Current prescription glasses (only if worn presently)
List of prescription medication including dosage and strength
Medication – enough for the time you will be away
Sweater or jacket (advised for those who chill easily)
Reading material or busy work
￼I am a contact lens wearer. May I wear my contacts until the day of surgery?
I take a blood thinner and several other prescription medications. Should I continue this before surgery?
Yes. The reason you are on it is more than important than the risks of stopping it. Take all prescription medications as you normally would before surgery.
May I eat before surgery?
No. No food after midnight the night before or eight hours before surgery.
May I wear makeup?
Please do not wear any makeup on the day of surgery.
￼I’m on oxygen. Should I bring it along?
Yes, bring more than enough oxygen to meet your needs.
Will I need to have blood drawn before the surgery?
You will need a pre-operative physical but we do not routinely draw blood unless there is a specific indication.
￼I was told that I need to take antibiotics before any dental work. Is this true for eye surgery also?
Yes, if you typically take medication for surgical procedures, please see your medical doctor for an antibiotic prescription.
My back keeps me from lying flat. What position must I be in for the surgery?
We need you to lie down for surgery, however, our experienced OR team has worked with virtually every medical condition that presents special needs.
We will be able to work with you to make your experience as comfortable as possible.
￼Does every patient need an implant?
Only in very rare cases of extreme nearsightedness is an implant not required.
￼May I drive myself home?
￼Sometimes my blood pressure gets high when I’m nervous. What happens if it’s too high?
If my anesthesia team is unable to manage your blood pressure with medication, your surgery may be postponed until you consult with your primary physician.
￼Do I need a physical before surgery?
Yes. Your general health needs to be assessed prior to surgery by a physician so he/she can grant medical clearance for your surgery.
￼I live a long distance from Dr. Duplessie’s office. How long must I stay for follow up?
Patients having routine cataract surgery may usually leave the area within one or two days after surgery. Please stay in the country for three days. If you do plan on going home immediately after surgery, please make arrangements for a qualified doctor to provide follow-up care in your area.
The Day of Surgery:
Take all your usual morning medications except diuretics (water pills), insulin, or diabetes pills. Take your medications with just enough water to swallow them.
Bring ALL of your medications in the bottles (including pills, insulin, inhalers, and eye medications) with you or a list of their names.
Remove contact lenses prior to your procedure. Bring a contact lens case or an eyeglasses case with you.
Dress comfortably. Wear a loose fitting shirt or blouse that buttons or zips.
Arriving for Surgery:
Arrive one hour before the surgery time.
A nurse will help you prepare for surgery by reviewing the procedure.
Make sure you wear comfortable clothes.
The anesthesiologist will examine you and review your health history on the morning of surgery. Discuss with them the degree of sedation you would prefer to have during the procedure.
You will have an intravenous line (IV) started to provide fluid and medication during your surgery.
In the Operating Room
You will have Dr. Duplessie, operating room nurses, and anesthesia personnel with you during your operation.
You will be connected to the monitors to ensure your safety during your operation.
You will be given eye drops, and medications to help you relax. A local anesthetic will make the operation painless. You will not have to worry about keeping your eye open.
Will I feel anything during surgery?
Dr. Duplessie uses special solutions that numb the eye. Most patients feel only gentle pressure.
What do I see during surgery?
Most patients only see the bright lights of the microscope.
￼Would a cough prevent me from having surgery?
It is very important that you don’t cough unexpectedly during surgery. Before the operation, we can give you throat spray or a cough suppressant.
May I have medication for my nerves?
Yes, an anesthesiologist will be on hand.
Your nurse will check your vital signs.
You will be offered a light snack.
Warm blankets will be provided.
The person who accompanied you will be notified when your surgery is completed. Dr. Duplessie will speak directly to this person after surgery.
How soon may I leave after surgery?
Most patients may leave within thirty minutes after the surgery.
￼I know I need surgery on both eyes. When may I have my second eye done?
If surgery is recommended on both eyes, you may have them one week apart.
￼What will I be able to see right after the operation?
Every patients’ vision is quite blurred after the surgery and will remain so for the first 3 days.
￼What happens before I’m discharged?
After the surgery, you will be brought into the recovery room where we will assess your vital signs, such as your pulse and blood pressure. We will explain your postoperative instructions and medications to you and a friend or family member.
Recovery at home:
During the first 24 hours after your surgery, please observe the following guidelines.
If possible, arrange for someone to be with you the first night after surgery. Occasionally some nausea can occur due to the anesthesia.
Limit your activities at home the evening after surgery.
Do not drive the day of surgery. Most people can drive safely the next day; check your driving status with Dr. Duplessie.
Do not do anything that could be dangerous to yourself or others for 24 hours following surgery (this includes climbing ladders, handling boiling water, using electrical appliances, moving furniture, etc.). If it seems like a bad idea –it probably is.
Do not sign any legal documents or make important decisions for 24 hours after surgery (the anesthetic may affect your judgment).
Avoid heavy lifting (over 25 lbs). Bend from the knees when lifting. Avoid very strenuous activities until the eye has healed. No sit ups.
Return to your normal eating habits.
Do not drink alcoholic beverages for 24 hours after surgery.
It’s normal to feel itching and mild discomfort for a short term after cataract surgery. Use lubricating drops if your eye is irritated.
Did I receive a lens implant?
The cataract is actually the lens of your eye. Since the lens is responsible for 1/3 of the eye’s focusing power, it must be replaced with a lens implant for you to see clearly. Intraocular lenses are required except in very rare cases of extreme nearsightedness.
What is my implant made of?
The implants used by Dr. Duplessie are made of either silicone, acrylic or PMMA (plastic).
￼How long will my implant last?
The intraocular lens is placed permanently in your eye and will not “wear out”.
￼Can my eye reject the lens implant?
No, since the intraocular lens is not human tissue, your body cannot reject it.
￼Was laser used to remove my cataract?
Your cataract was removed by ultrasound, not laser. In a process called phacoemulsification, sound waves gently break up the cataract and it is removed from the eye. However, lasers are presently being developed to remove cataracts.
￼Should I wear my old glasses after surgery?
Wearing your old glasses will not harm your eyes, but since the prescription won’t be optimal for your surgery eye, you will probably see best without them. Most patients find it easiest to only wear glasses for reading.
￼I see great at a distance, but why can’t I read without glasses?
Your implant is a single-focus lens. If your lens was chosen for distance vision, you will need reading glasses for close range work. Some patients elect to have one eye focused for close vision so they can read without glasses. However, this may compromise distance vision. Patients who require precise distance vision do best with both eyes focused for distance and reading glasses for near.
￼Is it safe to resume activities I enjoy such as golf and reading?
We encourage you to resume normal activities as soon as you wish. Routine activities such as bending will not harm your surgery. Do not lift heavy items.
￼How soon may I resume driving after surgery?
Most cataract surgery patients enjoy a significant improvement in their vision within the first 24 hours. You may drive when you feel comfortable.
￼Is it safe to fly after cataract surgery?
Flying will not harm your eye after cataract surgery. You can fly three days after surgery.
￼Initially your pupil will be small and your night vision will be poor
Your pupil will be small and your night vision will be poor for three days because of swelling and a medication to lower eye pressure.
￼When may I wear make-up again?
You may wear make-up on your face such as lipstick and powder immediately after surgery, but eye make-up should be avoided for three days.
￼Is it safe to have my hair done or get a permanent?
￼Why does it feel like there is something in my eye after my surgery?
You’ve had a microscopic incision on the surface of your eye. When you blink, you may feel a foreign body sensation until the incision heals. After surgery, our patients find that using artificial tears helps to alleviate the symptoms.
￼After surgery, I noticed a spot of blood on the white of my eye, should I be concerned?
The white part of the eye (sclera) is covered by a clear layer of tissue (conjunctiva). When a tiny blood vessel breaks, the blood becomes trapped underneath the conjunctiva. Since the tissue is clear, it’s easy to see the blood. If this were to happen on your arm, you would have a blue or purple bruise because the skin is not transparent. This will not affect your vision and will gradually resolve on its own.
￼On the way home from surgery I saw huge halos around all the lights. What causes this?
This dramatic glare and blurred vision was due to inflammation and medication. It will be a couple of weeks till the vision will return to normal.
My glare problem has improved dramatically since the surgery, but I still occasionally notice halos or streaks on lights at night. What causes this?
Glare may be caused by many factors. A need for glasses is one of the most common reasons you
may notice slight glare at night. Also, some patients experience minor corneal swelling after surgery that may cause temporary glare.
￼Since my surgery a few weeks ago, everything has a pink tint. What causes this?
This pink tint is due to slight swelling in the retina and is not uncommon after surgery. It will gradually resolve. However, always contact Dr. Duplessie if you notice a change in your vision. It is also important to protect your eyes with sunglasses when outdoors since sun exposure can aggravate this problem.