I Need Cataract Surgery. What Should I Expect?
Cataract surgery is a procedure to remove the cloudy lens from your eye and replace it with an artificial lens. Cataract surgery is performed by a medical doctor who specializes in diseases and surgery of the eye (ophthalmologist). It takes place in an outpatient surgery center, which means you do not have to stay in a hospital after surgery. Your eye will be anesthetized prior to surgery so that you do not experience any pain. An anesthesiologist will provide intravenous sedatives to help you relax during the procedure. The eye is numbed with anesthetic eye drops and a small incision is created. Through this incision, additional anesthetic medication is placed inside the eye to “put it asleep deeply”. The average cataract surgery takes 15-20 minutes. The entire visit to the surgery center from check-in to check-out typically takes a couple of hours.
After surgery, a clear, plastic shield will be taped over your eye for protection. Your vision may be better the first day when you return for your follow-up exam. However, unlike LASIK surgery, the vision after cataract surgery may take a few additional days to clear. You may still need to wear glasses to obtain the very best vision, although new technologies like the LensAR femto-second laser for laser cataract surgery and premium intraocular lenses make it possible to reduce your dependence on glasses. Cataract surgery is very common and is generally considered a proven and safe procedure.
You Have Options When It Comes to Cataract Surgery
Option 1: Manual Cataract Surgery vs Femtosecond Laser Cataract Surgery
In manual cataract surgery, the entire surgery is performed “by the hand of the surgeon”. This is in contrast to using a femtosecond laser to perform important parts of the surgery and to correct corneal astigmatism (up to ~2 diopters). One major difference between the two options is that manual cataract surgery does NOT correct corneal astigmatism. Also, the round opening in the cataract is nearly perfectly round when performed by laser which may help the intraocular lens center better. This is important when using premium intraocular lenses. In dense cataracts, the laser starts breaking up the lens, making it slightly easier for the surgeon to remove. There are additional out-of-pocket costs associated with femtosecond laser cataract surgery with astigmatism correction and premium intraocular lenses which are not completely covered by insurance.
Watch this video to learn more about traditional, manual cataract surgery.
Watch this video to learn more about femtosecond laser cataract surgery with LensAR.
One bonus of upgrading to femtosecond laser cataract surgery with or without a premium intraocular lens is the use of the ORA intraoperative aberrometer (see the video below). Normally, we take measurements with a special device in the clinic to determine the power of the lens to be used with the cataract still in the eye. This provides excellent results in most cases. However, when we are aiming for a more precise clinical outcome, we use the ORA to take real-time measurements during the surgery after the cataract has been removed from the eye. This allows us to refine the power of the lens that will implanted and gives the surgeon added confidence that the most precise lens power for your eye is being used. This ensures the best visual outcome for the patient after surgery.
Watch this video to learn more about the ORA System with Verifeye+ Technology.
Option 2: Monofocal vs Multifocal or Extended Depth of Focus Lens vs Toric Lens
The PanOptix® multifocal intraocular lenses uses special technology to interpret the amount of light entering the eye and focus it on the appropriate part of the retina. This lens is sometimes called a presbyopia-correcting intraocular lens and allows a patient to see at distance, intermediate, and near. 9 out of 10 patients who receive a PanOptix® lenses do not need glasses or bifocals.
Extended Depth of Focus
The SymfonyTM and VivityTM extended depth of focus lenses are similar to multifocal lenses. They attempt to provide good distance, intermediate, and near vision. They can be used and are sometimes preferred in patients who have undergone LASIK surgery in the past or who have diseases like mild glaucoma or mild, dry age-related macular degeneration. The near vision provided by an extended depth of focus lens is sometimes less than true multifocal lenses, but may be a patient's only premium option and may still outperform monofocal lenses.
Toric intraocular lenses are used specifically to treat higher levels of astigmatism in cataract patients. In most cases, we use the femtosecond laser to correct astigmatism up to 1.75 diopters. However, when and eye has greater levels of astigmatism, a toric lens may be the best option.
Who Performs the Cataract Surgery and Lens Implants?
All cataract surgeries and lens implant procedures at the San Antonio Eye & Face Institute are performed by Relief Jones, III, M.D. Dr. Jones is Board-Certified in Ophthalmology by the American Board of Ophthalmology. He has almost 2 decades of experience performing cataract surgery. He received his education and training at some of the world’s best institutions, including Stanford, Duke and Harvard.
As a Glaucoma Sub-Specialist, he has special expertise and experience dealing with some of the most complicated types of cataracts, including mature cataracts, pseudoexfoliation cataracts, and traumatic cataracts. Dr. Jones has performed cataract surgeries for patients from all over the globe. He’s taken care of other physicians and their parents, lawyers, engineers, farmers, ranchers, pilots, executives, and individuals from practically all walks of life. His personal, one-on-one approach is what patients enjoy most, and that is why they continue to refer friends and family.
Final Review: Surgery Risks & Safety
While cataract surgery is one of the safest procedures available in medicine with a high rate of success, rare complications can arise.
- Complications can include pain, infection, inflammation, bleeding, swelling of the retina, retinal detachment, need for further surgery, loss of vision, or even loss of the eye. Fortunately, modern day cataract surgical techniques and medications make these complications extremely rare.
- In most cases, you will be referred to your primary care provider for pre-operative clearance.
- Antibiotics and anti-inflammatory medications are typically started before and continued after surgery.
- Blood thinners like aspirin, coumadin, plavix, vitamin E, and fish oil (just to name a few), rarely have to be stopped before modern cataract surgery. However, if you will be having a glaucoma procedure with your cataract surgery, you may need to stop your blood thinners 2 weeks before surgery.
- Patients should not eat or drink anything 6 hours before their surgery time.
- Patients should plan to arrive one hour before their surgery time.
- Transportation from the surgery center will need to be pre-arranged prior to arriving at the surgical center. Because sedation is administered, operating a motor vehicle is prohibited immediately after surgery.
- You will be seen within 24 hours after surgery, 1 week after surgery, and 1 month after surgery. If you require glasses to obtain the best vision, they will be prescribed at the 1 month post-operative visit.