Cataract Surgery
Cataracts can affect one's quality of life. A cataract needs to be removed when vision loss interferes with everyday activities, such as driving, reading, or watching TV. Because the vision loss is gradual in onset, patients are often unaware of the extent of their visual loss. Delaying cataract surgery will usually not affect the health of the eye. As a cataract surgeon, Dr. Auker delights in the surprise patients express the day following surgery over the improvement in vision quality. Our responsibility is to inform eligible patients of the possibility of improved visual functioning. Cataract surgery is an elective procedure and the decision to have cataract surgery is a personal one unless the vision falls to a level mandated by the DMV and law enforcement.
At times, cataract surgery can be beneficial even if the eye has limited vision potential. For example, macular degeneration may limit central vision yet removing the cataract can improve one's useful peripheral vision as well as our ability to examine the eye. Cataract surgery can also benefit those with a condition known as narrow angle glaucoma. Removing the thickened cataract lens decompresses the front of the eye and results in lower pressure within the eye and less risk of damage to the optic nerve.
Is cataract surgery safe and effective?
Cataract removal is the most common operation performed in the U.S. today. It is also one of the safest and most effective. It is our expectation that all patients will appreciate improvement in their visual functioning following cataract surgery. Dr. Auker has over 20 years of cataract surgery experience. It is his passionate goal to continue to have happy and satisfied patients. While the above statement is intended to reassure prospective cataract patients no surgeon can guarantee success for any individual patient. Every intraocular procedure carries with it the possibility of vision loss due to infection, bleeding, or other rare causes. Dr. Auker encourages his patients to proceed confidently in their decision-making as supported by his own experience and outcome analysis.
There are, of course, risks associated with cataract surgery and severe or total loss of vision can occur during or following perfectly performed cataract surgery. Yet, the risk is exceptionally low and the success rate should inspire confidence in those anticipating cataract removal.
How is a cataract removed?
Cataract surgery is always performed on one eye at a time. Either the more advanced cataract or the cataract in the dominant eye is removed first. If a cataract exists in the other eye and is symptomatic, it can be removed within a week of the first eye, or at any time in the future.
Small incision, clear cornea, or stitchless cataract surgery describe the most modern techniques available in removing cataracts. Dr. Auker has utilized and perfected these techniques since their inception and performs 99% of his surgeries via these methods. Phacoemulsification allows the cataract to be removed via tiny 2.75 mm slit incision in the clear cornea that forms the clear dome the colored iris and pupil at the front of the eye. Typically, the procedure is done with the patient under mild sedation and only anesthetic drops applied to the surface and interior of the eye are required to provide complete comfort during the case. No injections or needles are required for the vast majority of patients.
The phacoemulsification device emits ultrasound waves that soften and break up the cloudy center of the lens so that the tiny particles can be removed by suction. This technique allows the use of the tiny incision and minimal disruption of the integrity of the eye.
After removal of the cataract lens, an intraocular lens is placed in the same location as the removed material. This clear, man-made lens is flexible and becomes a permanent part of the eye. It replaces the natural focusing power of the natural lens allowing most patients to see well after surgery without spectacle correction. Without the lens implant, one would have to wear very thick glasses or contact lenses in order to see well. The new intraocular lens is imperceptible soon after the surgery and becomes as stable and secure as the natural lens was within weeks. Occasionally, in the first few weeks after cataract surgery, a glimmer or reflection will be detected off to the periphery before the lens is firmly sealed in the contracted capsule or membrane that once contained the natural lens material.
What happens before surgery?
Once you have decided to proceed with cataract surgery, precise measurements need to be taken of the eye. Corneal curvature and length of the eye will determine the strength of the implant placed into the eye. Our outcome analysis assures the best possible statistical accuracy of this calculation. This accuracy provides for the best possible uncorrected vision. Despite our meticulous efforts, every eye is unique, and the measurements are subject to standard deviation. For some patients, correction of the vision with glasses, contacts or laser vision correction may be necessary following cataract surgery.
You will need medical clearance before undergoing cataract surgery. While cataract surgery is not an invasive procedure and puts little stress on the body as a whole, regulations and safety considerations demand this process of health assessment prior to surgery. A recent EKG is also required for most patients. You will need to set up a pre-operative appointment with your primary care physician.
Mild sedation relaxes one during any procedure and makes the experience an easier one. For your safety, our anesthesia Clear liquids may be taken up until 4 hours before surgery. No food is to be taken after midnight the night before surgery.
What happens during surgery?
After you arrive at the surgery center, you will be given eye drops to dilate the pupil as well as others to sterilize and numb the surface of the eye. You will be taken to the operative suite and mild sedation provided via an I.V. The area around your eye will be washed and cleansed. A small device known as a lid speculum will hold your eyelids open during the surgery and surgery will begin. The topical and intraocular anesthetic drops will numb the eye and can be supplemented as necessary.
The operation usually lasts less than 15 minutes and is performed with the patient lying flat. You will be awake and relaxed; or, conversely, you may have no recollection of the procedure. It is safest when the patient is alert enough to be aware that cataract surgery is being performed and can cooperate in maintaining a still position.
After the operation, a shield is placed over the eye to prevent inadvertent rubbing or trauma to the eye. You will be able to see out through the holes in the metal shield immediately after the surgery. You will be observed for an average of about 30 minutes following surgery before returning home to rest indoors. Because of the sedation and policies in place, you will not be able to drive home and you should make arrangements for a ride.
What happens after surgery?
It's normal to feel itching and mild discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, Tylenol is usually effective. Significant discomfort is not normal and should be reported immediately. You will leave the shield in place until the post-op visit the following day. You will wear the shield at bedtime for one week. Avoid rubbing or pressing on your eye.
Problems after surgery are rare, but can occur. These can include elevated pressure, infection, bleeding, and inflammation. Pain, increasing redness, loss of vision, or a thick discharge are not normal and demand immediate attention. With prompt medical attention, these problems usually can be treated successfully.
Most patients experience immediate improvement of their vision. You can quickly return to many everyday activities, even if your vision is slightly blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask us about when you can resume driving and what should be done about your previous glasses. When you have healed, you will probably need a new lens for your glasses over the operative eye.
What is an "after-cataract"?
Sometimes the natural membrane surrounding the implant changes from transparent to an opaque film which can cause blurry or cloudy vision. This is called a secondary or after-cataract. An after-cataract can develop months or years later.
Unlike a cataract, an after-cataract is treated with a laser. In a technique called YAG laser capsulotomy, a laser beam is used to make a tiny hole in the opaque, thin membrane just behind the implant lens to let light pass through. This is a simple and painless in-office procedure.
