According to the American Academy of Ophthalmology, more than half of all Americans will develop cataracts by age 80. A cataract is a clouding of the lens in the eye, which can cause one's vision to become blurry. They are common with age and can occur in one or both eyes. The clouding usually occurs slowly, but can happen quickly, especially after trauma to the eye. While cataracts are not painful, they do cause many symptoms such as blurry vision, fewer details, glare while driving or reading, dull colors, changes in your glasses prescription and double vision in one eye.
New advances and techniques have made cataract surgery one of the most successful and life-improving surgical procedures performed. We offer the latest procedures available to help remove cataracts and restore your vision, including the placement of intraocular lenses. Most cataract surgeries are performed on an outpatient basis and more than 95 percent of surgeries improve vision.
Is cataract surgery an inpatient procedure?
No, it's outpatient. You'll be there about 2-3 hours total but the actual procedure is less than 15 minutes.
Am I asleep while you are taking out the cataract?
It's twilight sleep, where you receive intravenous sedation but you do not have general anesthesia. With general anesthesia, a tube is placed to control your breathing and administer anesthetic gas, and the recovery is longer. With cataract surgery, topical anesthetic is placed before we start, and additional medication is placed in the eye, while the sedation drugs go in through the IV. It is similar to the medication used in a colonoscopy.
Does my insurance cover the surgery?
Generally, yes. With so many different policies, we'll have our billing coordinator speak with you on the day you schedule your appointment so that you will know how much you will pay out of pocket. Medicare covers the hospital portion and 80% of the allowable fee for the surgeon, with additional costs for the anesthesia professional, also 80% of allowable. We'll walk you through it. Some new technology lens implants are associated with extra costs, which will be thoroughly discussed if they are appropriate for you.
Is my eye actually taken out to operate on it?
No, an eyelid retractor is used to create enough exposure to get at the cataract. Don't worry, you won't feel it. And once the retractor is removed you'll be able to blink normally since we don't use injections around the eye or lids.
Do I have to stop my blood thinner before surgery? My internist and cardiologist don't want me to stop it.
Because there are no injections around the eye, and no incisions through tissues that contain blood vessels, cataract surgery with topical numbing agents and IV sedation is bloodless. There is no need to stop your blood thinners, even warfarin (coumadin). We have done hundreds of cases for people on all kinds of blood thinners (anticoagulatives), and it is not a problem.
Do I need to take antibiotics by mouth before the surgery? I have a prosthetic heart valve (or an artificial joint).
Cataract surgery is considered "clean" surgery by the infectious disease specialists and prophylactic antibiotics are not considered necessary.
Do I need a driver?
Yes. You should not drive for 24 hours after your surgery, and this includes the day of surgery.
What are the limitations on activity after cataract surgery?
There are few limitations. On the day of your cataract surgery, you should not drive. Also, do not swim for at least two weeks. There is no limitation on lifting or bending; however, we do ask you to shield the operated eye for three days after surgery when sleeping.
Will my eye hurt?
- Most people have no pain and very little light sensitivity. In some cases, patients have noted some mild discomfort, often describing it as "something in my eye". However, most people usually don't take anything for it. The morning after surgery, most people are very comfortable.
- Typically, we don't routinely prescribe pain medication after surgery because in our experience most people don't experience any major discomfort.
What about changing my glasses?
We often advise patients to have their optician take the prescription lens out of their current glasses on the side operated. We'll give you a new prescription if you need it, about three weeks after surgery. If you are having the other eye done, (usually two weeks later), we advise you wait until after the second surgery to change your glasses–if you need them.
How soon will I see better?
Colors and contrast are noticeably better by the morning after surgery. If you don't have much residual astigmatism, the vision is usually 20/40 by the next day, and it should continue to improve. If you have factors that might make your recovery slower (like glaucoma, high farsightedness, a corneal condition, etc.), I will make sure to let you know that before we agree on your surgery.
How soon can I shower?
The day after your procedure.
What's the worst thing that could happen?
- Risk of infection (currently estimated at 1:3000 to 1:8000 cases) while it is highly unlikely to occur, can ruin an eye. Therefore, prevention is key. We guard against infection by: asking you to use a disinfectant eye scrub three days before surgery; use an antibiotic eye drop one day before and four days after surgery; not rubbing the eye. We also use a standard solution of povidone-iodine prep in the operating room (OR) before your surgery, both in and around the eye. At the end of surgery, an antibiotic in solution is placed within the eye itself.
- Our track record for infection and that of our ORs is outstanding.
- The most common sight-threatening complication is retinal detachment, 1.5% of cases overall but more common in younger patients, nearsighted patients (=longer eyes), and males. Retinal detachment might require additional surgery for repair, which is generally successful, over 90% of the time.