Cataract Instructions and Information...

An Overview
The type of cataract surgery performed by Dr. D is named "Clear cornea, topical cataract surgery". This remarkable procedure is typically bloodless. It's hard to imagine having surgery without losing a single drop of blood but it's true. This amazingly advanced procedure represents the latest technology in the field of ophthalmology and is the result of extensive research and innovation.

Compared to traditional cataract surgery, this procedure does not employ needles, stitches or forceps and has a lower risk profile. Complications with this type of procedure are rare, (about one in a thousand.)

Dr. D uses drops to numb the eye and a soft cotton swab to gently position the eye. Dr. D constructs two microscopic incisions in the eye and removes the cataract. Because of their small size, these incisions heal rapidly. No stitches, patches or activity restrictions are necessary. Dr. D performs this procedure in about half the time of traditional cataract surgery; which means the patient spends less time in the operating room. After the procedure, patients are able to return to their normal lifestyles with no change in their routine. It's truly amazing when compared to traditional cataract surgery in which patients cannot bend over, lift anything heavy, or cough for a period of time.

Due to the bloodless nature of the procedure, there is no need to stop blood thinners, such as aspirin or coumadin. Patient's undergoing cataract removal by Dr. D should continue taking ALL OF THEIR MEDICATIONS, INCLUDING BLOOD THINNERS. This is a tremendous safety benefit, since stopping blood thinners can have adverse effects on patients who need them for continued health. It also means that no overnight hospital stay is required as with traditional cataract surgery. This saves the patient and the hospital time and money.

Many people are surprised to learn how much cataract surgery techniques differ. The more you know, the more we think you will appreciate the advanced level of care we provide. Furthermore, we want our patients and their families to have as much information as possible so they can help us achieve outstanding visual results. Here are a few of the most commonly asked questions about this exciting cataract procedure. If you have any other questions, please call, we are always happy to help. Through better education, together we can achieve better vision.

Is This Special Type of Cataract Procedure Painful?
We have developed a protocol that allows us to perform this procedure with NO DISCOMFORT IN MOST PATIENTS. Our patients generally comment that they NEVER FELT A THING. Some people, however, are more sensitive to pain than others. To address this we have a fully trained anesthesiologist and a registered nurse anesthetist to administer more pain medicine at the slightest bit of discomfort. We want our patients to have a pleasant experience. Providing a pain free procedure is at the top of our list.

We have found that patients who take medicine for chronic discomfort, such as back pain or arthritis, tend to be more pain sensitive. Also, patients occasionally feel the second procedure is more uncomfortable than the first. This is a side effect of the relaxing medicine, which causes partial amnesia. If you feel that you may be pain sensitive, please let us know, so that we can plan to give more pain medicine and assure a painless procedure.

How Long Does it Take for Vision to Clear Up After the Procedure?
Because there is no patch, some patients can see shapes, forms and colors right after the procedure. Most people, however, will have very blurred vision right after the procedure and will take a week to a month before the vision clears up. In rare cases, it can take the eye even longer to heal, especially in association with certain medical conditions such as diabetes mellitus. Remember that even though this procedure is very advanced, it is still considered MAJOR SURGERY and thus, it will take the eye a while to heal and start seeing normally again. Some people report seeing a red or yellow tint after the procedure. This is a normal response to the microscope light, and the discoloration will fade within a week or so.

Are Glasses Needed After the Procedure?
Most people will need glasses to get their best vision after the procedure. When we take out the cataract we replace it with an artificial lens implant. The implants available presently have no ability to dynamically focus. That means the patient will need glasses to get the best possible vision for both near and far. Contrary to popular belief, there is no way to get the eye to dynamically focus after the cataract procedure. Presently, research is being done on artificial lens implants that "focus"; but until those lenses are proven safe and effective, most people will need glasses to see their best after the cataract procedure.

Is There Discomfort After the Procedure?
Some people report a gritty sensation in the eye after the procedure, which is described as feeling like an eyelash or a grain of sand in the eye. Most of this discomfort resolves in a day or two and responds well to Tylenol or other over the counter pain medications. True post operative pain is very unusual.

What Restrictions are There on Activity after Clear Cornea Topical Cataract Surgery?
Due to the advanced nature of this procedure, there are no restrictions after the procedure; however, it is wise to use common sense. Try not to vigorously rub the eye for two days. Because the relaxing medicine we give the patient during the procedure can impair judgment for the first day after the procedure, it is smart to stay away from heavy machinery and driving for one day. Furthermore, some people take a while to get used to their "new eyes". This is normal and it may affect depth perception until the brain adjusts to the new vision. Be aware that depth perception may have changed and caution should be used when judging distance.

What Medications are Used for Cataract Surgery?
Zymar, (antibiotic drop), Pred Forte (steroid) and Acular, which helps stops inflammation.

• Two days before the surgery start taking all three drops to the appropriate eye FOUR TIMES A DAY.
• Take all three drops four times daily for two weeks, then continue the drops until the bottles are empty.

Take the drops while awake only (do not get up from sleep to take the drops.) Wait about 5 minutes between drops. It does not matter which drop you put in first.

Will I Ever Get Another Cataract In The Same Eye?
No, but a small percentage of people do get a secondary cataract after the procedure. This is corrected with a quick and painless office based laser procedure, called a YAG LASER.

What are the Warning Signs that Something is Going Wrong After Cataract Surgery?

• EYE PAIN that does not respond to over the counter pain medications.
• EXTREME REDNESS associated with pain. (Slight redness and discomfort are normal.)
• WORSENING VISION (the vision may be blurry at first, but it should improve over time, NOT GET WORSE WITH TIME.)
• If there is a problem, the best course of action is early treatment. We always have a doctor on call to take care of our patients.
• If you have a problem, please call.

In the event you cannot reach an eye doctor we ask that you call the nearest emergency room.

Will I Ever Get Another Cataract In The Same Eye?
Assuming the patient has a cataract in the other eye and it is adversely affecting vision, we can remove it one month after the first procedure, depending on how quickly healing occurs and scheduling availability.

What is the Flow of This Procedure from Start to Finish?
First, Dr. D confirms a diagnosis of a visually significant cataract. The patient and Dr. D will then decide together the best course of action based on the patient's individual needs and desires. If the patient decides to have the cataract removed, they will return to Specialty Eye Care for a special pre-operative workup. At this work up, numerous measurements will be performed that will allow customization of the procedure to each of the patient's eyes.

The patient will then be sent to the surgical center for pre-operative labs and evaluation. Assuming there are no problems, we will perform the surgery on the scheduled date at a time given to the patient by the surgical center. After the cataract procedure the patient will take their drops and follow-up with Dr. D typically on the same day of the surgery, 7 days after the surgery, and about one month after the surgery. If no problems occur, the patient will be given a prescription for glasses after the last eye to be operated on has been stable for about one month. The patient will be seen again about 4 months after the completion of the last eye to check lens position and eye pressure. Following that, the patient will be seen yearly to monitor lens position, pressure and vision.

How Will My Vision Be Different After the Procedure?
Once the eye has healed, the patient's vision should be clearer than before the surgery. Colors will be more vibrant. Night vision will be improved and small details will be much more visible. Since more light comes into the eye, glare may be increased. For this we recommend antireflective coating and UV tinting as well as sunglasses for outside vision. Some patients report seeing "floaters" after surgery, which are completely normal, and will not affect the overall vision.Our goal at Specialty Eye Care is to give you the best possible vision, keep you healthy, and treat you with care and respect. We feel that we have a special assembly of talent and we are very proud of our team. If you have any suggestions on how we might improve our service, please let Dr. D or one of our team members know. We are here for you and we will do everything we can to make your stay in our care a pleasant experience.

What Are Cataracts?
Cataracts are a clouding of the lens in the eye. The normally clear lens lets light enter the eye. A cataract is a clouding of the lens which SCATTERS LIGHT as it enters the eye. Cataracts are common with age and can occur in one or both eyes. The clouding of the lens usually happens slowly over time, but can happen quickly. Most people have cataract surgery around age 65.

What Causes Cataracts?

• Normal Maturity (OK, aging.)
• Diabetes or other eye diseases
• Past eye infections, injuries, or surgery
• Some medicines (such as steroids)
• Too much ultraviolet (UV) sunlight, (do you have sunglasses?)

What Are the Symptoms of Cataracts?
Cataracts are not usually painful, but the glare can be irritating.

• Blurry vision is usually present
• Difficulty reading or driving at night.
• Details may become difficult to see.
• Glare when driving or reading
• More light is needed to read
• Colors may seem dull.
• Your prescription for glasses may change more than in the past.
• Double vision in one eye may be present.

When Should You See Your Eye Doctor?
Regular eye exams help Dr. D. see if cataracts are affecting your vision. Have exams as often as Dr. D. recommends, but if your vision suddenly gets worse, see Dr. D. right away. It could be an eye problem that needs prompt care. During your eye exam, you and Dr. D can discuss a plan to help improve your vision. This may not always require surgery.

Your Eye Exam
When checking for cataracts, Dr. D will do the following:

• Ask you questions about your health and family history. This helps Dr. D. rule out other vision problems.
• Test your vision to tell how well you see and whether your vision is getting worse. Bring any glasses and contact lenses you wear to your exam.
• Examine your eyes. Drops are used to dilate your pupils. This allows Dr. D. to better see your cataracts. It also lets Dr. D. check for other problems inside your eye, such as Macular Degeneration or Glaucoma.

When Is Surgery Needed?
Since cataracts develop slowly, you may not need surgery right away. Dr. D. tends to be VERY CONSERVATIVE when making recommendations for surgery. We only consider surgery if we are certain that it will help, otherwise, we will avoid surgery and use other means to improve your vision, such as glasses with special coatings to minimize glare.

Cataract Surgery
The procedure is a VERY ADVANCED outpatient procedure. The clouded lens is removed and is replaced by an artificial lens. There are no stitches, needles or patches needed. Dr. D. will remove the cataract, one eye at time, using a wonderful instrument called a PHACO (pronounced FAY-COE). The eye will heal rapidly in most cases so you can get back to your normal routine right away. There are no limitations to activity after surgery. You can go dancing, bowling, work in the yard, and shower the next day.

After Your Eye Has Healed:
Your vision should be noticeably improved. Other steps may be taken to make your vision even better:

• Eyeglasses may be used to sharpen your vision to its maximum.
• Occasionally a special YAG laser may be used to further improve your vision after surgery if the capsule that holds the new lens becomes cloudy. This procedure is very safe and quick (about 45 seconds) and is performed in the office.
• Some patients notice "floaters" after the surgery, which are completely harmless. Some patients notice more dust in their house after cataract surgery due to their improved vision, happy cleaning!

What Preparation is done before Cataract Surgery?

• Wash face and eyelids vigorously with antibacterial soap for THREE DAYS before surgery
• Begin using Zymar, Pred Forte, and Acular LS drops for TWO DAYS before surgery FOUR TIMES A DAY. Use one drop from each bottle, and wait five minutes between drops.

What preparation is done on the day of surgery?
ONE HOUR BEFORE REPORTING TO THE SURGERY CENTER, put one red top drop FOUR TIMES in the surgical eye, FIVE MINUTES APART. Continue using Zymar, Pred Forte, and Acular LS FOUR TIMES A DAY.

What preparation is done after Cataract Surgery?

• Continue using Zymar, Pred Forte, and Acular LS FOUR TIMES A DAY until the bottles run out. The drops should be taken for two weeks.