How many appointments / visits is cataract surgery?

In this area, the number of surgeon visits is typically 3 + 2 Optometry co-management visits.  The number depends on the surgeon and co-management arrangements at other clinics (such as ours).

Surgeon visit #1 – consultation to assess cataract and ocular health / prioritize / educate on options

Surgeon visit #2 – measurements done for lens selection (typically done with technician)

Surgeon visit #3 – surgery day (some surgeons do a later-same-day follow-up)

~Surgeon visit #4 – possible next day visit to surgeon’s clinic or co-management facility

Visit #5 – possible 1 week visit to surgeon’s clinic or co-management facility

Visit #6 – 1 month follow-up and refraction (new glasses prescription)

Why are drops used before cataract surgery?

Some surgeons will ask patients to use eye drops several days prior to cataract surgery.  These drops help reduce the risk of infection and post-surgery inflammation.

It is important that you follow the instructions exactly!  Not taking drops can lead to a last-minute cancellation of your surgery.

Also - it is a good practice to use non-preserved re-wetting drops prior to your eye measurements and also your cataract surgery.  Separate instilling these drops from the prescription medications by at least a couple of minutes or you risk diluting the medicine.

How is modern cataract surgery done?

There are lots of online highly graphic surgical videos but the KISS explanation that I use in clinic is:

Step 1] In a sterile specialized operative suite – day surgery – no general anesthetic
Step 2] Lots and lots of drops to numb the eye, sterilize the area and dilate the pupil
Step 3] Lots of bright light!
Step 4] Ultrasound or laser is used to break up natural lens which is then removed through small incision
Step 5] The implant lens is inserted rolled-up and unfolds to the same space which held the natural lens
Step 6] Lots of drops to control healing, pain and infection risk

Remember - You are in the hands of a skilled surgeon or I would not have referred you there!

See the end of this simple whiteboard video as well...

I only see well from one eye – I am scared of having any surgery to my good eye!

Having poor vision in one eye due to injury or lazy eye (amblyopia) certainly increases the anxiety of having cataract surgery.   I typically advise to wait until surgery to the ‘good’ eye absolutely needed (e.g. driving requirement).

Obviously, the actual procedure has no more risk that normal… it is the understandable anxiety that needs to be added into the equation as to when to do the cataract removal.

Sometimes there is an argument to do cataract surgery in a poorly seeing (amblyopic) eye.  If your prescription ended up very different between your two eyes post-surgery… this can introduce perceptual, vertigo and balance issues.  It depended how much the poorly seeing eye was actually being used vs. suppressed pre-surgery.

Can I go blind from cataracts?

Not all cataracts progress to completely limit sight.  However cataracts often progress to a level that severely limits daily functions like driving, reading and watching TV.  It is loss of this functional vision that motivates even the most nervous folks to proceed with cataract surgery.

I tell patients that if they had to choose something wrong with their eyes... cataracts are the best choice.  Cataracts are 'easy' to fix compared to most other eye health issues.  Results from cataract surgery are very predicable and successful.

Can I go blind from cataract surgery?

As with any surgery, you will discuss all risks with your surgeon’s team prior to you agreeing to proceed with surgery. 

The most serious complication of cataract removal that will be discussed is endophthalmitis.  This is an infection inside the eyeball and can be sight threatening.   In thousands of cataract surgery co-managements, I have never seen this in my practice but it certainly will be discussed as a risk.

The most common complications that I see are: Increased eye pressure (treated with drops), retinal inflammation (treated with time and/or drops) and foreign body sensation (treated with drops and time).

How is cataract diagnosed?

A cataract is diagnosed by a regulated health professional.   It can be observed in the lens of the eye with a hand-held ophthalmoscope or biomicroscope.

Cataracts are usually graded (0-4) on their density and the type is noted.  Sometimes dilating eye drops are required to better assess the type of cataract.

There is a danger in attributing vision loss solely to cataract without a full eye exam.   The eye is complex and often has concurrent issues (e.g. macular degeneration + cataract).  Only a full exam can sort out if vision loss is 100% attributable to cataract development.

When should I do cataract surgery?

There is no exact answer here.   The factors that are typically considered are :

1] Visual Acuity.  
Albeit low risk, there are risks involved with cataract surgery.  The benefit of the surgery has to exceed the risk.  A decision to proceed with cataract removal is based on many factors but in general terms, most surgeons in this area will discourage a patient from proceeding until visual acuity falls below 20/50-ish.

2] Visual Demands and motivation
If you are a retiree and spend a limited amount of time at a computer, your visual demands may make it acceptable for you to tolerate less-than-perfect best vision.   If you are working as e.g. a full-time accountant or transport truck driver, your high visual demands would require you get cataract surgery sooner.
Some folks are just simply queasy about eyes and have low motivation to proceed.  You can procrastinate with cataract surgery (most) without worry however there will likely be a point where the procedure simply needs to be done (e.g. failed driving requirements)

3] Status of other eye
If you see well from your other (no or low cataract) eye.   There may be less rush to a surgical solution.

4] Driving status / Caregiver status
If you have a standard driver’s license or a special license or if you are caregiver to others… these things should be taken into consideration for when to do cataract surgery.

5] Symptomology
Years of looking in eyes has taught me that you cannot always predict someone’s symptoms based on the objective look of the cataract.   Some folks have minor cataract changes but are devastated by the blurry vision.  Others have what objectively appears as a advanced cataract, but are getting along fine with their day-to-day lives.    With low symptomology, a surgeon is much less like to proceed.

6] Interest in enhanced refractive improvement
For a patient to consider the increased expenses of enhanced cataract procedures, they are generally going to be highly motivated and anxious to proceed as soon as possible.

7] Secondary ocular health factors
There are some eye conditions where removing cataract early is important.  If the surgery is left too long, there is greater risk for a poorly placed or dislodged implant.  Your doctor will tell you if you have a condition that requires early cataract surgery.

8] Payor
Albeit a controversial topic, payors can influence decisions when cataract surgery is done: Personally funded vs. co-funded vs. government-funded vs. third-party funded
Payors also ultimately influence the type of cataract surgery: Basic vs. enhanced (premium or astigmatic or multifocal implants)

9] Large prescription swing of one eye
As a cataract develops it can cause a large shift in a prescription.  E.g. If one eye experiences a dramatic nearsighted shift the imbalance will not likely be tolerable and cause issues that are hard to fix with glasses.   The recommended solution is to restore the right/left balance through surgery to one or both eyes).