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Pfoff Laser and Eye, 6881 South Yosemite Street | Centennial, Colorado 80112 | 303-588-7900| info@pfofflaserandeye.com

Undergoing Cataract Surgery

 

Background

Pre Op

The Surgery

Possible Complications

Post OP

Global Period

After Care beyond the Global Period and possible need for YAG Laser Treatment

 

Background

Now that you have decided to have your cataract operation, several things are necessary to insure a smooth and uncomplicated surgi-center and postoperative experience. You should know that you may undertake a hospital stay before your surgery, after, or both. However, according to federal law, cataract surgery done on an in-patient basis without a bona fide medical justification will not be paid for by your insurance plan.

It is therefore advisable to undergo virtually all cataract and secondary lens implant surgery as an out-patient. This method saves you or your insurance company approximately $1,000 over the longer hospital stay and has been shown statistically to be as safe and effective as the longer hospital stay.

 

Preoperative Preparation

Before we begin, it is necessary to obtain preadmission testing at our office. This consists of an ultrasound axial length measurement of the eye and measurement of the curvatures of the cornea. These tests are charged to your insurance company. These tests allow us to determine the power of the lens implant we will place in your eye. The test allow us to come close to determining the type of vision you will have after surgery, but, because your body is a complex biological system, it may not be exact.

Eye drops given to you prior to surgery make your eye as sterile as possible before surgery. It is never possible to remove all of the bacteria and micro-organisms from your tissues, but infection is statistically less likely if the drops are given. They usually grow out again in about five weeks and patients tell us the character of their eyelashes is the same as before surgery.

It is necessary that you have nothing to eat or drink for period of eight hours before your operation is scheduled. Should you have anything to eat or drink during this period, the anesthesiologist will refuse to provide services for the operation.

You will be sedated via hypodermic to relax you, and more eye drops will be administered. Intravenous solutions will be started. This gives us a readily available pathway to your vascular system should we need to administer any drugs that require a rapid effect before, during, or after your surgery.

 

The Surgery

Approximately half an hour before your surgery you will be taken to a holding area on a gurney. You will then be taken to the operating room, where you will be introduced to your operating room nurses, a very important part of our team. Adhesive pads will be attached to your chest and left side to hold leads to an electrocardiograph monitor in place so that your heart may be observed during surgery. A blood pressure cuff will be placed on your arm to allow us to watch your blood pressure during surgery. You will periodically feel a tightness as pressure is being checked.

The anesthetic is mainly from drop. We do not inject anything directly into the eye. Patients are amazed  at how easy and pain free it all was.

Next, the area around your eye will be cleansed with antibacterial soap, again to reduce the normal bacterial population to a minimum. An oxygen tube will be placed near your mouth and nose to give you plenty of air after drapes are placed over your face to further seal off the sterile field to prevent bacteria from getting into the eye.

We will proceed with your operation. If you require more sedation and are not relaxed enough, just let us know and more can be administered by way of the intravenous tube before or during your surgery. One misconception is that we take the eye out to do the surgery. Let me assure you that this is impossible; we merely rotate the eye to the required position and proceed with the operation from there.

After the successful termination of your operation an eye patch and metal shield will be applied to protect the operative wound. Ordinarily the patch must be worn until you return to our office the day after surgery. Then either the metal shield or your glasses are required for protection for a period of 3 days following surgery.

Next, you will be taken back to the recovery area for a brief stay prior to discharge. You will be given an instruction sheet containing the "do's and don'ts" regarding your postoperative care.

Post Op Care

Office visits are usually scheduled the next day after surgery depending on how your recovery proceeds. You do not need to do anything to the eye, such as drops, until you are seen the next day. The one thing that is most important: Do not rub the eye, even through your eyelid for at least a month. This can cause a blinding complication. 

Glasses are prescribed at one month.  Virtually everyone who has had cataract surgery will have to wear glasses either full or part timeunles one eye is corrected for distance and one eye for near (monovision). We can only correct one for one focal distance. If you require glasses, they will consist of a bifocal to allow for normal distance and near vision full time. You will be able to see reasonably well without glasses but the glasses will "put the frosting on the cake".

While our doctors try to be available to oversee all emergency situations for our postoperative patients personally, there are those instances when we are out of town teaching or seeing patients. Under those circumstances we have arranged for back-up coverage. Should it be necessary for you to see a doctor on call, there will be a charge from that doctor for his services.

You will be our cataract patient for the rest of your life. However, your postoperative visits will gradually be spaced out until you are only coming in about every year or year and a half. We do not believe in discharging a patient from our practice, never to return. We want to see how you are doing from time to time and we think this is good medicine.

 

Possible Complications

Include:

Most patients report feeling something scratchy in the eye.  This can be due to many things, but is usually related to the irregular tissue surface induced by the surgical wound. This may take a long period of time to resolve. It may always be present. Many times lubricating eye drops help. We rarely use stitches anymore, and this makes a much more comfortable eye.

Occasionally,  a drooping of the eyelid is present after surgery. It isn't entirely known what causes this. In the immediate postoperative period we believe it is due to an anesthetic which affects the eyelid, the muscles attached to the eye and the pain sensation nerve fibers. It usually goes away within the first year after surgery. On rare occasions, however, it is permanent. In these cases eyelid surgery can be performed to elevate the eyelid to its normal position.

Not infrequently, floating objects are seen in the field of vision. This is sometimes normal and sometimes abnormal and should be mentioned on the next visit.

  1. If there is a large dark object creeping into your vision from the periphery while you are looking straight ahead.
  2. If you have a sudden or gradual loss of vision.
  3. If you have severe pain, you should call the office immediately.

After cataract surgery many people tell us that colors are more vivid, especially at the blue end of the spectrum. Indeed, there is a loss of near ultraviolet light filtration that occurs with the normal lens in place. For this reason, spectacle lenses which filter out this ultraviolet light are recommended to prevent theoretical damage to the retina of the eye over a long period of time. We do place UV filtering material into the lens implant, but it is still recommended that you have an invisible UV filter put into your glasses.

Prior to the prescription of eyeglasses, a blurring of vision for the operated eye with your old glasses will likely occur. You will probably also notice streaks of refracted light from bright lights, especially at night. Some objects may appear to be distorted or slanted. This is due to normal postoperative astigmatism and will go away after the prescription of new glasses. It may be necessary to change glasses several times during the first year after surgery.

Sometimes the pupil, the black hole in the center of the colored part of the eye, is irregular, to one side, or different in size compared to the other eye. This is due to the normal trauma of surgery in some cases and cannot be avoided. It usually does not alter vision.

We strongly recommend the use of blue blocking and ultraviolet filtering lenses, not only for post op cataract patients, but for all of humanity, from the day they are born.

 The Global Period

You will not be charged for examinations made in the three months following surgery. After this period, visits will be billed at the normal rate, and you or your insurance company will once again be responsible for payment.

Aftercare And The Possible Need For Nd-YAG Laser Treatment Later

In 20-60% of patients undergoing cataract surgery as it is currently performed, there will be a clouding of the lens capsule that is intentionally left in the eye to prevent complications. This may require treatment with a YAG laser later, and it is done as an out-patient in the hospital. This procedure is painless and does not require restrictions in activity as does the cataract surgery itself. Your insurance company will be charged for this procedure.

We hope that this will help you understand what to expect with your surgery. If you have any questions, please don't hesitate to ask. We hope you continue as our patient for your remaining care.

We wish you as pleasant a surgical experience as possible.

Cataract FAQ

Dangerous Symptoms |  Laser Surgery |  Site Map | Meet Our Doctors  |  Map  | Forms | Photos 

 Home | Patient Education | Patient Instructions | Laser FAQ | Cataract FAQ | About Our Doctors
Pfoff Laser and Eye, 6881 South Yosemite Street | Centennial, Colorado 80112 | 303-588-7900| info@pfofflaserandeye.com