Cataract Surgery: Journey from A to Z

By Dr Latif Hamed MD

Cataract surgery is lens exchange surgery wherein the cloudy natural lens is removed and replaced with a synthetic clear lens implant. Almost every human being eventually develops cataracts, as sure as getting grey hair, and some people are either born with cataracts or develop them in childhood.

The indication for cataract surgery in general is a decrease in vision that negatively impacts the activities of daily life. A micro surgeon requires excellent near vision and a truck driver excellent distance vision. The visual impairment caused by significant cataracts may include difficulty with reading fine Print or needle work, watching TV or reading captions, day or night driving, glare and halos at night, difficulty following a golf ball, or failing to appreciate how beautiful or handsome one's spouse is.

Two requirements must be met. The surgeon looks into the patient's eye and sees a significant cataract, and the patient looks out of the same eye through the cataract and reports visual difficulties. An eye examination is performed to evaluate the eye health, noting other conditions that must be taken into account to individualize and optimize the cataract surgery. Preexisting conditions such as glaucoma, macular degeneration, corneal disease, dry eye, and inflammation are noted, as well as the choice of the proper intraocular lens implant to achieve safe and effective outcomes. A history of LASIK laser surgery is taken into account as it impacts the lens power calculation and, sometimes, lens implants choices.  The choice of the optimal lens implant is discussed with the patient and educational material is given as "homework". The patient is given an appointment to return to the office in order to obtain precise high-tech measurements to calculate the power of the lens implant that best fits the patient's eye and fulfills her needs.

Informed consent is obtained from the patient after reviewing the risks, benefits, options, and alternatives to surgery and after the patient's questions are addressed. The patient may at this point schedule the procedure which is performed at our state-of-the-art ambulatory day surgery center in Ocala. The patient is instructed to scrub the eyelashes with baby shampoo the night prior to surgery and not to eat or drink after midnight since a sedative is administered during the procedure. The patient is given a prescription for drops to be instilled in the eye a few days before surgery and to be continued after surgery for approximately two weeks.

Upon arrival at the surgery, the patient is assessed by the nursing staff and medical history and vital signs are obtained.  Dilating eye drops are instilled, and an intravenous line is established through which anesthetic agents are administered.  The patient is taken to the operating room where the eye is prepped and draped in a sterile manner. The surgeon uses computerized high-tech machines and a high-definition microscope to perform the surgery, which typically takes from 5 to 15 minutes.

The patient is then taken to the postoperative area where drinks and snacks are provided, and the postoperative drops are reviewed. The patient is discharged and is normally picked up by a friend or family member. The patient is advised not to drive or operate heavy machinery on the day of surgery and further written instructions are provided.

The next day visit at the office is normally a happy and often joyful occasion as the patient recounts the observed improvement in sharpness and vividness of colors etc, but the vision continues to improve for days to weeks (and often months) post-op. The vision may remain blurry for days due to the dilating drops and postoperative swelling. Given that about 50 percent of brain cells are connected to the visual system, there is a period of neuroadaptation (the brain is recalibrating) for the best vision to emerge.

Cataract surgery is typically performed one eye at a time.  We fix one eye and take the outcome into account in deciding what to do for the other eye to achieve the best binocular results. There is normally very little to no pain during or after surgery, save for occasional mild irritation. However, pain is subjective and therefore everyone experiences the procedure differently. Modern intraocular lens implants are far superior in material and design than their counterparts used in the 1940s and 1950s. Modern lenses literally last a lifetime, even when used in children, and rarely need to be replaced.

Cataract surgery has come a long way from the days when patients used to be admitted to the hospital overnight. Most patients are expected to resume light activities the next day; heavy lifting can be resumed a week later.

Cataract surgery is quick, but it is performed with computerized machinery that requires skilled surgeons to deliver wonderful outcomes that make the patient happy for a lifetime, and the surgeon gratified and thankful.

Ready to see life more clearly? Call 352-237-0090 to schedule a consultation today and discover how modern cataract surgery can restore your vision and brighten your world.