Cataract Surgery

WHAT IS A CATARACT?

A cataract is a clouding of the lens inside the eye just behind the pupil. When the lens become cloudy, the light rays cannot easily pass through it and vision becomes blurred, for both near and distant objects. Sensitivity to glare in bright sunlight and distortion or ghosting of images may also occur. Cataracts are the most common cause of failing vision over the age of 60 in North America. Over one million cataract operations are performed each year in North America alone. They are a normal part of aging. Less commonly, cataracts can also occur in babies, children and young adults. Other causes include eye and systemic diseases, eye trauma and as side effects of medication.

WHEN DO CATARACTS NEED TREATMENT?

Cataracts may need no treatment at all if the vision is only a little blurry, and often a change in glasses will help improve the vision due to early cataracts. It’s when a cataract interferes with your daily life that surgery should be considered. Surgery is the only way to remove a cataract and should be undertaken when the symptoms frustrate your enjoyment of life or work. The idea of waiting for a cataract “to be ripe” before surgery is outdated; in general, surgery is performed when the quality of your vision has deteriorated and it is interfering with your functioning and life. Over 98% of patients will have improved vision after cataract surgery. Complications, although rare, can occur; some of the more serious complications could include: infection, bleeding and detachment of the retina. The risk of vision loss after cataract surgery is less than 1/1000. The risk of requiring a second surgery (e.g. if the cataract is difficult to remove) is less than 1/100.

THE OPERATION

Surgery is performed under topical anaesthetic (number eye drops only) at the Eye Care Centre at VGH (2550 Willow Street, Vancouver). Your total stay is usually 2-3 hours, while the actual surgery itself only takes 20 to 30 mins. You do not need to change out of your clothes. Cataracts are removed by “SMALL INCISION, NO STITCH TECHNIQUE”, using ultrasound. The entire procedure takes place through a small incision in the eye. After the cataract is removed, a lens implant is placed in the eye to replace the function of the removed lens. Many different types of lens implant are available and you should speak to your eye surgeon as to which type is best for you. You need not to worry about keeping your eye open or still during surgery. Typical concerns such as the need to cough or inability to lie completely flat are rarely a problem. After your operation, someone MUST accompany you home.

BEFORE YOUR SURGERY

On the day of surgery, take all of your regular medications as you normally would. Do not stop blood thinners (e.g. aspirin, Plavix, warfarin, etc), and take all other regular medications as well. If you have ever taken the drug Flomax (tamsulosin), please inform your surgeon.

You will be given a prescription for 3 different eyedrops. Please purchase these before the surgery, and start using them 3 days prior (e.g. if the surgery is scheduled for Friday, start taking them on Tuesday). You will continue to use these drops after the surgery.

AFTER YOUR CATARACT OPERATION

You will need to arrange for a responsible adult to take you home from the surgery (this is the hospital’s policy). It is advisable to have someone stay with you on the night of surgery, although this is not necessary. When you leave from the surgery, you are allowed to resume all normal activities except: no exercise, no heavy lifting, and no swimming for 1-2 weeks. Try to keep your eyelids clean, and do not allow water into your eye for 1 week after surgery.

Your eye may feel scratchy or irritated for a few days or weeks after the surgery; this usually resolves on its own with time. Your vision may be blurry for the first few days after surgery before it starts to clear up. Sometimes your eye may feel dry or sensitive even for several months after cataract surgery and you may require lubricating eye drops to help manage this.

You will usually have a check-up at your surgeons office the day after your surgery.

TYPES OF INTRA-OCULAR LENSES

Cataract surgery involves removing the cloudy lens and inserting a replacement lens, which is called an IntraOcular Lens or IOL. You have a choice of three types of IOLs:

1. Monofocal Foldable IOL

This lens provides sharp vision and image quality in varying light conditions and minimizes the incidence of halos and glare.

With this lens you can choose to make your eyes more farsighted (better for distance), or nearsighted (better for near work). You cannot have both, unless you choose to make one eye better for distance, one eye better for near tasks.

After implantation, your vision will likely be very good but you will need glasses for distance or near vision (depending on which you choose). Patients with significant astigmatism will also need glasses to correct astigmatism at all distances (both near and far).

2. Monofocal Foldable TORIC IOL

With the same benefits as the Foldable Lens, the TORIC Lens also has a unique optic design to reduce or eliminate astigmatism.

Similar to the Foldable Lens, with the toric lens you can choose to make your eyes either more farsighted or more nearsighted (or one of each). Most patients will not require glasses to correct astigmatism, but may still require glasses for some activities.

3. Multi-Focal Foldable IOL

The Multi-Focal Lens provides a full range of vision from Near to Far Distance. After implantation, 80% of patients are spectacle free and do not need any glasses. This lens also provides correction for astigmatism.

However, this lens can sometimes cause more glare in your vision, especially at night. Not all patients are suitable candidates for multi-focal lenses. Not all patients will be completely free of glasses. If you have questions, please discuss them with your surgeon.

“So which lens should I choose?”

This is a decision that takes into account many factors: whether or not you have astigmatism, whether you want to be free from glasses (and to what extent), and whether you wish to pay for your lenses. You will have an appointment with Dr Nathoo to discuss your options and to choose your lens.