Am I a Candidate for Cataract Surgery?
Because cataracts develop slowly, it can be difficult to pinpoint a specific time when cataract surgery becomes necessary. It can be delayed after diagnosis, but eventually, corrective glasses or contacts may not be enough, and surgery becomes inevitable. The biggest indication that surgery is necessary is when your cataracts affect daily tasks like reading or driving.
You should begin by consulting your eye doctor. He or she will review your medical history and determine if you need cataract surgery. Then you can begin to discuss which specific cataract surgery option is best for you.
Questions for Your Eye Doctor
Having a basic understanding of the procedure beforehand will help facilitate the conversation, as will having some prepared questions such as:
- How advanced are my cataracts?
- Which type of intraocular lens (IOL) would I benefit most from?
- Will any of my current prescriptions or over-the-counter drugs complicate the surgery or recovery process?
- What will my vision be like after recovery?
- How much does cataract surgery cost?
- Who will perform the actual surgical procedure? You or another surgeon?
- What is the post-surgery follow-up process?
Understanding the Surgery
Cataract surgery is the only way to remove a cataract from your eye in order to restore your vision. It is one of the most common and effective surgical procedures performed in the Europe and one of the safest as well.
It’s important to understand that just because you have cataracts, you don’t necessarily need surgery. You can manage them for years with glasses and contact lenses. It is only when your cataracts start to interfere with your daily activities that you need to consider surgery.
Annual visits to your eye doctor are important as you age so he or she can track developments in your cataracts. With an understanding of your lifestyle and the history of your eye care, your doctor will be able to make recommendations on whether surgery is necessary and which type of artificial lens you should get.
Costs and Insurance
A portion of traditional cataract surgery is usually covered by private insurance or local medicare. It is important to note that many advanced technology artificial intraocular lenses (IOLs) that correct other visual impairments, such as astigmatism, may not be fully covered, but many doctors also offer payment plans. The specific out-of-pocket costs will vary depending on where you live and what type of intraocular lens you have implanted.
Because cataract surgery is so common, it has become one of the most effective and safest surgical procedures performed in the Europe. Each eye doctor’s procedure may differ slightly, but in general you can expect the following:
- The operating room is a sterile environment—just like any other major surgical procedure.
- After the topical anesthetic is applied to your eye, you may hear sounds of the instruments and the surgical team talking, but you probably won’t be able to see them.
- A nurse will start intravenous fluids or provide an oral sedative and attach you to a heart rate monitor. A drape will be placed around your face so that only the eye to be operated on is visible.
- Most people feel no pain during the procedure, which usually lasts 15 to 30 minutes.
- The surgeon will make a small incision in the cornea with either a hand-held blade or a laser machine. A small probe breaks up and removes the cataract and the new lens is inserted. In most cases, the incision is so small that stitches are not required.
- Once the cataract surgery is complete, the surgeon will cover the eye with a bandage or shield. In many cases, the bandage may be removed within a few hours. After a short recovery period, you can have someone drive you home.
Safety and Risks
Modern cataract surgery is one of the safest and most effective medical procedures today. More than 95 percent of the 3 million cataract surgeries performed in the Europe each year are considered successes, meaning no complications.
But even with such a stellar success rate, every surgery has risks, including the potential for loss of vision. These complications are very rare, and most can be addressed immediately while you are still under your doctor’s care. The following types of risks can be associated with cataract surgery:
Tearing of the Posterior Capsule — The posterior capsule is the thin, tissue-like layer in the eye that holds your eye’s lens in place. During surgery, as your clouded lens is removed from the posterior capsule, it can sometimes tear. If this happens, the surgeon will repair the tear and seal it.
Inflammation — Non-infection-related swelling is usually minor and can be treated with eye drops after surgery.
Cystoid Macular Edema — For up to three months after cataract surgery, the tissues of the macula may swell. This is the part of the retina responsible for seeing fine detail and will cause your vision to be blurred. This can be treated with a non-steroidal anti-inflammatory drug.
Visual Effects — Seeing halos around lights, blurry vision and difficulty seeing at night are a few symptoms a patient sometimes experiences as the brain adjusts to a new multifocal lens.
Secondary Cataract — A secondary cataract will sometimes form after cataract surgery. These can be corrected in a quick and painless outpatient procedure.
Incision Leak — If the corneal incision begins to leak, your doctor may apply a bandage over your eye to decrease the chance of infection. In some cases, the incision must be closed with a stitch.
Other complications are possible. Be sure to talk to your doctor about all the risks associated with surgery.
Modern cataract surgery technology allows for a quick and painless procedure, usually 15 to 30 minutes with a rapid recovery time. The use of a topical and/or local anesthetic means you can be in and out of the surgical center the same day with no overnight stay.
The procedure begins with an incision in the cornea so small that stitches are rarely needed. Then begins a process called phacoemulsification, or “phaco” for short. A rapidly oscillating ultrasonic probe is placed through the incision and used to break up the cloudy lens into small pieces. The tip of this same probe is used to suction out the broken-up pieces. The new lens is then inserted, and the recovery begins.
Some offices now have the capability of making these incisions with a laser.
Intraocular Lens Choices
Cataract surgery is a very important decision, but the type of synthetic lens you choose can be equally significant. Depending on your lifestyle and the anatomy of your eyes, the right lens could not only restore your vision but may improve it beyond what you’ve ever experienced. Here are a few of your options:
Monofocal lenses are the basic replacement lenses and are designed to provide clear vision at one distance. They will remove the cloudiness you are experiencing but cannot correct pre-existing problems such as astigmatism or presbyopia. Monofocal lenses typically focus on only objects in the distance. This means that if you wear glasses or contact lenses now, you will still need them to see up close such as when reading or viewing the computer.
This is a technique in which a monofocal lens for near vision is used in one eye and one for distance vision is used in the other. This requires adaptation, since each eye is oriented differently, but can provide a wider range of improved vision.
These are monofocal lenses, but they move in response to your eyes’ own muscles, giving you the ability to see multiple focal points. However, your range of vision may not be as great as you would get from multifocal lenses.
Multifocal lenses can change how you see the world by allowing you a full range of improved vision, from near to far. They can drastically reduce your dependency on glasses or contacts, even if you’ve required them your entire life.
Astigmatism-correcting lenses, also known as toric lenses, are specifically designed to correct for astigmatism. Their unique shape minimizes imperfections in your cornea, allowing light to enter your eye with much less distortion. Even if you’ve needed glasses for years, a toric lens can greatly reduce your dependence on glasses for distance vision.
Choosing a Surgeon
While cataract surgery has a very high success rate, you should still take the time to carefully research and select your surgeon. You can start by asking family or friends who have had the procedure for recommendations. Your primary care physician or eye doctor should also be able to make some suggestions. Use these factors to narrow down your list of potential candidates.
Credentials – Look into how long they’ve been practicing and where they trained.
Testimonials – Seek out stories from patients who have had the surgery to get a good idea of what to expect. The surgeon may have some on their website, or you may be able to find a third-party source online with greatly unbiased anecdotes.
Attitude – Consider how comfortable you feel when talking with the surgeon and staff.
Finding an Advanced Technology Surgeon
Most intraocular lenses (IOLs) fitted today are monofocal lenses that correct your cataract while providing vision for a single focusing distance such as near or far. Also available are advanced technology IOLs that correct your cataract and pre-existing conditions, such as presbyopia or astigmatism, or provide a full range of vision. While most surgeons are experienced in implanting monofocal lenses, you should seek a specialist if you are interested in advanced technology IOLs. These specialized IOLs require precise placement and centering to work accurately, so a surgeon who has experience with advanced technology IOLs is a necessity.
It’s important to note that advanced technology IOLs have their limitations and can still produce visual distortions such as glare at night. When discussing advanced technology IOLs with your surgeon, you’ll know they are taking an honest approach if:
- No guarantees of perfect vision are made
- You are told you may still need eyeglasses under certain conditions
- The surgeon has a good follow-up policy in place to address any post-op complications
- You are advised that enhancement surgeries may be needed, and they are fully explained and the extra costs detailed
Questions to Ask Your Doctor
Once your cataracts have developed to the point where they interfere with your daily activities, such as driving or reading, it’s time to set up a consultation with an eye doctor to discuss your treatment options. Because there is no single solution that works for everyone, it is helpful to have a list of questions ready to guide you to the right option.
Which type of intraocular lens (IOL) would I benefit most from?
Most people choose monofocal lenses because they give high-quality vision at a single distance and are covered by Medicare and most insurers. However, there are advanced-technology options to consider, especially if you have multiple eye conditions. Each IOL type has its own strengths and weaknesses, and your eye doctor will help you select the lens implant best for your eye.
How long is the recovery time?
Recovery times vary for each patient. Ask your doctor when you can resume activities like sports, swimming, driving or heavy lifting.
What will my vision be like after recovery?
For almost all patients, your vision will be significantly improved.
Will I still need to wear glasses or contacts after the procedure?
This will depend on the type of IOL you select. You have the opportunity to select advanced technology IOLs that can reduce your dependence on glasses. If you still need glasses or contacts, you will most likely need a new prescription.
Do I have any general health or other eye conditions that could rule out cataract removal?
Your eye doctor will review your medical history before determining if cataract surgery is right for you. Cataract surgery is minimally invasive and even patients with severe medical problems can be safely treated. However, some medical problems such as diabetes mellitus require special care.
If I have other eye conditions, how can I best manage these conditions together?
Advanced technology IOLs are available to help treat cataracts along with astigmatism or presbyopia. Glaucoma can also often be treated surgically at the time of cataract surgery.
Will any of my current prescriptions or over-the-counter drugs complicate the procedure or recovery process?
Certain medications, such as prostate drugs and drugs used to treat cancer or immune diseases, can increase the risk of complications.
How much does cataract surgery cost?
A portion of traditional cataract surgery is usually covered by private insurance or Medicare. It is important to note that many advanced technology artificial intraocular lenses (IOLs) that correct other visual impairments, such as astigmatism, may not be fully covered, but many doctors also offer payment plans. The specific out-of-pocket costs will vary depending on where you live and what type of intraocular lens you have implanted.
What is the post-surgery follow-up process?
Understanding the follow-up process will reduce the risk of complications and help you prepare beforehand.
Ready for Cataract surgery? Here are some important tips You should know!
Because cataracts can deteriorate your vision slowly over the years, you may not notice the effect they have on your daily activities. Fortunately, your eye doctor can help you detect cataracts early through standard eye and retinal examinations.
The Importance of Eye Exams
After a standard vision test, your doctor will typically dilate your pupil to examine the lens and other parts of your eye. These annual eye exams are especially important as you age so that you can diagnose cataracts as they start developing and respond accordingly. It is important to make sure your glasses or contact lenses are strong enough to compensate for your decreased vision. As your cataracts develop, you can discuss with your doctor whether surgery would be beneficial.
In the week leading up to cataract surgery, your eye doctor will usually need to perform a series of tests to determine the shape and size of your eye for a proper lens fitting. In addition to this, to appropriately prepare for cataract surgery, there are a few simple measures you should take the day of your cataract surgery to make sure everything runs smoothly:
- Make sure to take at least one day off of work for recovery
- Don’t drink alcoholic beverages for at least 24 hours prior to the operation
- Only eat breakfast if your doctor has explicitly allowed it
- Be clear about which medications you must avoid on the morning of surgery
- Shower and wash your hair to help maintain a clean surgical environment
- Arrange a ride home, because you will not be able to drive after the surgery
Immediately After Surgery
After your cataract surgery is complete, you will probably rest in the post-operative room for about an hour with a protective covering for your eye. Before you leave, you will most likely:
- Feel a bit groggy from the anesthesia. This usually wears off fairly quickly
- Receive prescription medications, such as antibiotic or anti-inflammatory eye drops, to use for the next few weeks
- Receive instructions on how to care for your eye
- Schedule a follow-up appointment for the next day
You may not be able to drive for at least 24 hours after surgery, and you should have a caregiver bring you home and pick up any prescriptions. You may still feel a stinging or slight grittiness in the eye. This is normal, and you should not rub or put pressure on the eye. Light activities like reading, walking or watching TV are okay, but avoid anything strenuous, such as heavy lifting, for at least a week. You should also wear the protective eye shield overnight and avoid sleeping on the side of the body that was operated on.
The Adjustment Period
Most people notice a significant improvement within 24 hours after cataract surgery—within a month you should be fully recovered. Your brain continues learning how to work with your new artificial lens, and your vision should be optimal at six months. After one year and every year thereafter, you should have a complete eye exam by your eye doctor to ensure there are no new problems such as a secondary cataract.
New Cataract Lenses: Practice and Adjustment
Your brain needs time to get used to having a new lens in your eye. It may take some time to become completely adjusted, but there are things you can do to accelerate the process. Practicing your sight at different distances can help strengthen your vision, especially if you have multifocal lenses. Here are some activities that may help speed along the adjustment period.
For Near Vision:
- Drawing, needlework or other close work
- Using a handheld device such as a smartphone
For Intermediate Vision:
- Looking at a computer monitor
- Watching TV
For Distance Vision:
- Watching a movie in a theater
- Sports like golf or tennis that require you to focus on an object in the distance
Combining the Distances:
- Activity that includes people or things approaching and receding from you, like playing with pets or children
- Exploratory activity like hiking in which you look at things near and far
- Sports that require you to use your eye over the entire visual range