Dr. Christine Erlich

Cataract

What is a cataract?

A cataract is a density in the natural lens in the eye which is located just behind the iris and pupil.

Click To Play Video

Click To Play Video

Why is it a problem?

Cataracts cloud the vision in the eye as we have to look through the lens to see the world. Cataracts cause blurring, loss of contrast, glare at night, fading or yellowing of colours and if severe, even blindness.

When should they be removed?

Cataract surgery is indicated when the vision is significantly impairing your activities of daily living such as reading, driving, or walking safely.

What happens during cataract surgery?

The surgery takes about 30 minutes. Medications will be given to you through a small needle in your arm to help you relax and lie still. After local anesthetic is applied to the eye a small cut is made into the eye. The lens is then removed with a small machine called a phacoemulsifier, which breaks up the cataract into pieces and removes it. Following this, a clear piece of plastic called an intraocular lens (IOL) is inserted into the eye. It does the same job as your old lens but it is clear. A clear protective shield is placed on the eye and then you can go home.

What needs to be done to prepare for cataract surgery?

You will be required to get a limited physical examination by your family doctor. These results must be faxed to the hospital. Before surgery, special measurements of the eye need to be taken to determine the correct lens implant (IOL) required for your eye. This will be arranged at the office and can be done with either laser or ultrasound. A prescription for anti-inflammatory eye drops called Acular LS is to be started 3 days prior to surgery. These help prepare the eye for surgery.

No food or drinks are allowed after midnight on the day of surgery. Sips of water are allowed with regular medications. No diabetic pills are to be taken in the morning prior to surgery. If in doubt, bring your medication with you to the hospital and the nurses will help you determine which to take. Arrive at the correct time at the hospital. Additional eye drops will be applied once you arrive at the hospital.

Does it hurt?

Cataract surgery is usually painless although you will feel sensations. Saline (salted water) will be dropped onto the eye during surgery to keep it wet. You will feel your eyelids being touched and your eye being moved a little. The microscope light will be shining on your eye and is bright but your eye accustoms to this quickly.

What happens after cataract surgery?

You are moved to the recovery area where you change back into your clothes. The nurse explains to you all the instructions for taking care of your eye and gives you the appointment time to return to our office the next day. She gives you a new prescription for two more eye drops. You will have to go to the pharmacy on the way home to get these and start them once you are home. Just lift the eyeshield, shake the bottles well and apply the 3 bottles, one drop each , 5 minutes apart. Apply them 4 times a day. Leave the shield on for 24 hours. The eye may feel irritated for 2-3 days and some people require Tylenol or Advil for this. Wear the shield at night or nap time for one week. Return to the office for follow up appointments at 1 day, then 1 week, then 2 more weeks. Do not press or rub your eye. In fact, the less you touch it the better. Clean it gently with a warm wet cloth for the first 2 weeks after surgery. You can shower but keep your eye closed so no soapy water gets into your eye. Small red spots of blood may be visible on the white of the eye after surgery for a few days. These will resolve harmlessly. Your vision may be blurry for a few days after surgery and your old glasses may be incorrect. They can be adjusted about a month after surgery.

What are the choices for IOL?

All patients receive an IOL during cataract surgery. The strength or power of the IOL is custom measured to the size and shape of the eye. Measurements for the IOL are done by A-scan or IOL-Master.

Monofocal lenses have one focus point. They can be” set ” for either distance, intermediate, or near vision. Most people choose distance vision. They then require glasses to read. Others prefer to read without glasses and don’t mind wearing glasses to correct distance vision.

Toric lenses are monofocal lenses that correct for astigmatism as well. Astigmatism is an oval shape of the natural eye. It can be corrected with glasses or by a Toric IOL. Toric IOL’s will reduce or eliminate the need for glasses correction for distance vision after cataract surgery. Reading will still require glasses.

Multifocal IOL’s correct both distance and near vision leaving you 95% spectacle independent. Not all patients are candidates for this IOL. An ophthalmological evaluation will determine eligibility.

Click To Play Video

Click To Play Video

Click To Play Video

Click To Play Video

What activities are allowed after cataract surgery?

There are few limits on  your activity. You can read, watch TV and walk as normal. You must avoid swimming and any activity that could injur the eye. Heavy work such as lifting more than 10 lbs should be avoided for two weeks. For the first week you should shower with your operated eye closed. Clearer vision will return by 4 weeks when the eye is fully healed. Colours and contrast will return to normal.

What are the risks of cataract surgery?

Cataract surgery is very successful with over 95% of patients having improved vision following surgery. However, as with any surgery, there are risks:

• Infection or bleeding in the eye. This is the most serious risk and is also the most rare (1 in 1500). This could lead to loss of vision in the eye.
• Retinal detachment (1 in 100).
• Glaucoma. This is usually temporary and can be treated with eye drops.
• Need for additional surgery. This occurs when not all of the cataract can be removed safely during the initial surgery (1 in 500).
• Swelling of the retina. This usually occurs weeks or months after surgery and can be treated with eye drops.

When should I call the doctor?

Call the doctor immediately if:

• You have sudden loss of vision.
• The eye becomes very painful.
• There is a lot of discharge from your eye.

You should go to our Emergency Department if outside regular office hours.

Please ask your doctor if there are any further questions.