WHAT IS A CATARACT?
The lens of our eye is normally clear; when it becomes cloudy we call this a ‘cataract’. Cataracts usually develop due to normal aging, but there can be other causes for developing cataracts (e.g. trauma, medications, other medical conditions, etc). Cataracts usually develop in both eyes, although one eye may be worse than the other.
Most people with cataracts notice difficulties with daily activities (e.g. driving, reading, etc). Some people with cataracts get used to them and do not notice the change in their eyesight, even when they no longer meet legal driving requirements.
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.
Dr Nathoo usually performs cataract surgery under topical anaesthesia (with numbing eye drops). You will not be put to sleep for your surgery, although you can usually request some extra sedation (either by mouth or by IV) if you are nervous.
Surgery is done at the VGH Eye Care Centre (2550 Willow Street, Vancouver BC). Your total stay is usually 2-3 hours, while the actual surgery itself usually only takes 10-15 mins.
** 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 eye drops. Please purchase these before the surgery, and start using them 3 days prior. 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
After the cataract is removed, a lens implant is placed in the eye to replace the function of the removed lens; this artificial lens is called an IntraOcular Lens or ‘IOL’. Many different types of lens implant are available and Dr Nathoo can advise you on which type of IOL is best suited to your eye and your lifestyle.
In general, there are several categories of IOL’s:
1. Monofocal 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 many activities. Patients with significant astigmatism will also need glasses to correct astigmatism at all distances (both near and far).
2. Presbyopia-Correcting IOL
These IOL’s aim to lessen your dependence of glasses for a wider variety of activities. There are many types of presbyopia-correcting IOL’s:
– Distance IOL with an extra boost of intermediate vision: This choice is good for distance activities (e.g. driving, watching TV) and gives a bit of sharper vision for intermediate tasks (e.g. looking at the dashboard, looking at your watch). However, you will still require reading glasses for most intermediate and near activities (e.g. computer work, reading, etc).
– Extended-range-of-vision IOL: This choice is good for distance activities (e.g. driving, watching TV) and also good for intermediate tasks (e.g. computer work). You will likely still need glasses for near activities (e.g. reading books, detailed hobbies, etc).
– Multifocal/Trifocal IOL: This choice is the best for reducing dependence on glasses as it usually provides fairly clear vision for distance (e.g. driving), intermediate (e.g. computer), and near (e.g. reading). Some patients may still require glasses for certain activities. This lens sometimes also induces some glare (e.g. with oncoming headlights) that may make certain activities challenging (e.g. night driving).
3. TORIC IOL (for astigmatism correction)
All IOL options mentioned above come in a toric version to neutralize astigmatism.
“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 or have MSP cover them for you (i.e. no extra cost to you). You will have an appointment with Dr Nathoo to discuss your options and to choose your lens.