If you’re over the age of 50, you might have noticed a few changes in your eyesight in recent years. (Source: National Eye Institute)

Maybe your vision has become blurrier…

Maybe you’ve become sensitive to light and glare…

Or maybe none of the above have happened yet, but you know it’s coming.

If that’s you, then you might be considering cataract surgery. Like any surgical procedure, there’s a lot to consider. And reading resource after resource might leave you feeling overwhelmed and confused about what advice to follow.

Today, you can rest easy, because all that’s about to change. In this comprehensive guide, we’ll walk you through everything you need to know about cataract surgery, and whether it’s right for you.

Let’s get started with some basics.

Part 1: Do I Have Cataracts?

What Is a Cataract?

A cataract is a clouding of the eye’s natural lens which causes reduced vision.

What Causes Cataracts?

As we age, protein in our eye lenses can degrade and “clump” together, reducing the clarity of the image reaching the retina. Over time, the cataract may grow larger and cloud the lens further, affecting your vision.

Contrary to popular belief, a cataract can’t spread from one eye to another, nor can it be caused by overusing your eyes. (Source: National Eye Institute)

Who Is at Risk?

According to AllAboutVision, cataracts affects more than 22 million Americans age 40 and older, and that number is expected to exceed 50 million by 2050: Source: National Eye Institute.

Source: National Eye Institute.

When Should I Talk to a Doctor?

  • Clouded or blurry vision. Your vision may become hazy and blurry like you’re viewing the world through frosted glass.
  • Fading or yellowing of colors. If you notice colors fading and lacking the brightness they once did, you might need to have your eye examined.
  • Sensitivity to light and glare. This can be painful, particularly to those with posterior subcapsular cataracts (Source: Mayo Clinic)
  • Seeing “halos” around lights. This makes activities like driving at night especially dangerous. One Australian study found motorists suffering from cataracts were less capable of noticing and responding to potentially dangerous hazards on the road, and thus, more prone to getting into road accidents. (Source: Marrington S.A., Horswill M.S., Wood J.M.)
  • The need for brighter light for reading and other activities. If your vision at night becomes affected, you might be experiencing the beginning of a cataract.
  • Double vision or multiple images in one eye. Be aware as this symptom is known to clear as the cataract gets larger (Source: National Eye Institute)

Frequent prescription changes in your eyeglasses or contact lenses. If you wear glasses or contact lens, you may find the prescription weakens over time.

Making an Appointment.

An ophthalmologist (eye doctor) will determine whether you have early signs of cataract development using what’s called a “dilated eye exam.” This is when a special magnifying lens is used to examine your retina and optic nerve for signs of damage and other eye problems.

It’s important to mention here that a cataract should NOT be removed just because it’s present.

In fact, minor changes in your vision can often be improved with prescription glasses.

If, though, your vision deteriorates to the point where you’re no longer able to do everyday activities, then it’s advised you book an appointment with an ophthalmologist.


Part II. What Is Cataract Surgery?

Cataract surgery involves removing the cloudy lens from the eye and replacing it with an artificial, intraocular lens implant (IOL) lens.

The procedure, generally performed by an ophthalmologist, uses local anesthesia in an outpatient setting (which means you can often go home the same day) and causes little to no harm to the patient (in fact, most patients are often surprised with how quick the procedure is).

With an overall success rate of 98 percent or higher in restoring vision and a turnaround time of about 20-25 minutes, cataract surgery is one of the safest, same-day procedures in the world. (Source: All About Vision)

Phacoemulsification Cataract Surgery

There are several types of cataract surgery (intracapsular, extracapsular, etc.) but the most common surgical technique is called phacoemulsification cataract surgery (otherwise known as small-incision surgery).

How Does Phaco Surgery Work?

Before surgery, the length of your eye and the curve of your cornea will be measured using an “A-Scan” and a technique called “keratometry.” This will help the ophthalmologist determine the correct replacement lens for your surgery.

During the procedure, itself, your ophthalmologist will make one or more incisions in the front of your eye. Then, using a phaco probe—which transmits ultrasound waves—he or she will break up (emulsify) the cataract and remove the remaining fragments before placing the intraocular lens implant (IOL) lens into the remaining lens capsule.

If you have cataracts that affect your vision in both eyes, you’ll need two separate operations, usually carried out 2 weeks apart. (Source: National Health Service)

Femtosecond Laser Cataract Surgery

Not all cataracts are created equally. We have learned over time that certain cataract types are not optimal for manual cataract surgery. Cataracts that are very dense, cataracts that are associated with a weakened cornea and cataracts that are unstable are some of the instances where manual cataract surgery is not ideal.

This is where laser cataract surgery shines. Femtosecond laser cataract surgery enables the surgeon to break up a rock-hard cataract before entering the eye, enables the creation of perfect circular openings in unstable and misaligned cataracts and minimizes the creation of by-product energy that can harm surrounding tissue. In short, it is a much needed and precise tool for these complex cases.

A secondary function of the femtosecond laser is astigmatism correction via astigmatic keratotomies. These are precisely placed incisions in the cornea, the clear, dome-shaped tissue covering the eye.

The Ziemer Z8 for Cataracts

Milan Eye Center has available an ultra-mobile, precise femtosecond laser (it’s Swiss!) for use in cataract and LASIK patients. The Ziemer Z8 has been a tremendous tool for our surgeons in tackling the most complex as well as routine cases – all our surgeons have their own philosophy regarding its utility. The role of this technology in your surgical care, therefore, has to be based on a discussion regarding its efficacy and utility for your eye.

How Much Does Cataract Surgery Cost?

While most of the cost of cataract surgery will typically be covered by Medicare or private medical insurance (if, that is, you’re over the age of 65 and are a United States citizen), the amount insurance companies will provide for the procedure will vary on a number of factors (including the type of intraocular lens used for the procedure).

If you don’t have Medicare or private medical insurance, you’ll be responsible for the entire cost of cataract surgery. The cost, itself, will vary depending on market conditions and the surgeon’s fee.

According to a 2015 report conducted by AllAboutVision, the average cost of cataract surgery with a standard IOL performed in the United States for someone without Medicare or private health insurance was $3,542 per eye. (Source: All About Vision)


Part III. Should I Get Cataract Surgery?

What Are The Benefits of Cataract Surgery?

With 3 million Americans going under the knife each year, cataract surgery is one of the most common and successful surgical procedures performed today. (Source: AllAboutVision)

Aside from the more obvious benefits of improved vision (e.g. seeing things in focus, being able to tell the difference between colors, etc.), cataract surgery has benefits that extend beyond eyesight, too.

A few of the most recent and exciting findings include:

  • Improved quality of life. Health and vision-related quality of life have been shown to improve after cataract surgery. A study published in 2013 found that quality of life for patients who had cataract surgery improved by 36 percent. (Source: Brown et al 2013)
  • Decreased risk of falling and fracturing bones. A common consequence of cataracts is falling more often (and with greater severity). A 2012 study found patients who had cataract surgery had lower odds of fracturing their hips within one year after surgery. (Source: Victoria et al 2012)
  • Improved chance of living longer. One 2013 study—comparing people over the age of 49 years who had cataract-related vision loss and had cataract surgery—found that there was a 40 percent lower long-term mortality risk in those who had the surgery. (Source: Fong et al 2013)

What Are The Risks of Cataract Surgery?

While cataract surgery is extremely safe, as with any surgical procedure, there are risks (though most are rare and can be quickly and easily treated).

If, for example, you have another eye condition (e.g. glaucoma or macular degeneration) your risk of complicating the procedure becomes higher.

This is why it’s important to discuss any concerns you might have with your ophthalmologist before deciding whether to go ahead with cataract surgery.

The following are the most common risks you need to be aware of.

  • Posterior capsular opacification (PCO). One of the most common cataract surgery complications is a posterior capsule opacity (or PCO). This occurs when the thin clear membrane that surrounds the natural lens (called the lens capsule) becomes clouded, causing hazy vision. Treating PCO is fairly straightforward and normally requires creating an opening in the back the back of the lens capsule so that the light can once again pass directly to the retina.
  • Retinal detachment. This is when the retina (the neurosensory lining the back of our eye) becomes detached from the inner back wall of the eye, often months or even years after a successful cataract procedure. If you experience floaters (spots within your vision that move or “float” when you look around), flashes of light or curtain-like vision loss after surgery, make an appointment with your ophthalmologist, immediately. Failing to get retinal detachment treated can result in permanent loss of vision.

Other cataract surgery complications include infection (endophthalmitis), bleeding and swelling of the retina (cystoid macular edema), though these are less common.

As always, if you have any concerns about any of the risks of cataract surgery, ask your ophthalmologist.

What Happens If You Don’t Get Cataract Surgery?

As we learned before, a cataract is caused by clouding in the eye’s natural lens. When the cataract hardens, it becomes “ripe” or “mature”, affecting your vision.  And as the cataract grows larger, the entire lens may eventually become white.

In the past, you would have been advised to wait until your cataract was “ripe” before having surgery.

Today, though, it’s a different story.

With modern advances in cataract technology, it’s advised you have it removed sooner rather than later (when, exactly, we’ll discuss in the following section).

If a cataract is left untreated, it will gradually get worse and affect your eyesight to the point where you may no longer be able to perform daily activities such as driving or reading.

Furthermore, it may prevent your doctor from identifying other eye-related problems or operating in the future, should you need it. (Note: if a cataract becomes “hyper-mature”, surgical complications become far more likely.)

Can Cataracts Cause Blindness?

While outcomes like blindness are rare, it is possible (though legal blindness often comes a long way before total blindness).

When Should I Get Cataract Surgery?

You’re probably already aware that the only way to remove cataracts is cataract surgery. But what you might not be aware of is when you need to have it done.

According to The American Academy of Ophthalmology, there are four questions you can ask yourself to help you determine whether you’re ready for cataract surgery:

  1. Are your cataracts impacting your daily or occupational activities?
  2. Are your cataracts affecting your ability to drive safely at night?
  3. Are your cataracts interfering with the outdoor activities you enjoy?
  4. Can you manage your cataracts in other ways?

As a final point, it’s important you understand that moving forward with cataract surgery is always your choice.

While a doctor can advise you based on your circumstances, the decision MUST always come from you.


Part IV. The Pre-Surgery Experience

The procedure may vary depending on your surgery center. At Milan Eye Center, our surgeons and staff prepare patients for cataract lens replacement surgery by providing them with all pertinent information about their procedure.

You and your eye doctor will discuss Traditional vs Bladeless cataract surgery options, as well as the different types of Intraocular Lens (IOL) implants available during a pre-surgery appointment.


The Night-Before and Day-Of Preparation Checklist:

Medication. Before surgery, patients are given a prescription for eye drops and should use the medicated eye drops exactly as written in the pre-op plan.

While aspirin may continue to be taken prior to surgery, patients who take anticoagulants such as Coumadin or Plavix should talk to their primary care physician or cardiologist to determine whether the anticoagulants should be stopped prior to surgery. Patients should never stop taking anticoagulant medication on their own!

And for diabetic patients, no insulin or other diabetic medication should be taken before the cataract surgery.

Heart or blood pressure medication can be taken that morning with a small sip of water.

Transportation. Patients should plan ahead for a family member or friend to drive them home following the procedure.

Diet. Beginning the night before the cataract procedure patients should not eat or drink anything after midnight, including water.

Contacts. On the morning of cataract surgery, patients should not wear any contact lenses.

Bathing/Makeup. Patients should shower the evening before surgery. Patients should not apply any makeup including blush, mascara, lipstick, eyeliner, or eye shadow. Patients should also avoid using any lotion on the face or chest.

Clothing. Patients should dress comfortably with a button or zipper top and leave all jewelry and other valuables at home.

Any other questions about medication or before surgery plans, should be asked well before the day before surgery. Milan Eye Center physicians can answer any questions about a specific pre procedure plan. And following the pre-op plan is the first step towards ensuring a cataract surgery procedure is successful and smooth.


Part V. What to Expect During Cataract Surgery

Check-in: 30 minutes

Once patients arrive at the Milan Eye Center surgery center for their cataract surgery, they must check in at the front desk.

Patients will then be directed to a surgical waiting room.

A nurse will bring the patient back to our Pre-Op area where blood pressure will be taken and an IV will be started.

Then an anesthetist will visit with the patient in order to go over the anesthesia plan in depth.

Surgery: 10-12 minutes per eye

Typically, cataract patients will have IV sedation along with a local anesthetic so the operation is not painful. But because patients will be conscious during the procedure, it is important that they always look toward the bright operating room lights.

Doctors will make a tiny incision to remove your lens and replace it with a new Intraocular Lens Implant (IOL). The type of IOL will be determined with your doctor beforehand.

Additionally, patients should not talk during the procedure in order to keep their head from shaking unnecessarily unless you have a pressing question or concern. For example, if you have to move, cough, or sneeze during the procedure alert the doctor before doing so.

Post-Op: 30 minutes

Once the short procedure has been completed, the patient will be taken to a post-operative area where they will be able to rest, relax, and watch television.

Due to the after-effects of local anesthesia, you’ll probably feel slightly groggy after the procedure, and for that reason, might need to rest in the recovery area for approximately 10 minutes before it wears off.

A nurse will bring the patient’s family back to the room in order to go over the post-operative plans for care.

Heading Home

After leaving the surgical center, you’ll want to continue to use the antibiotic, steroid and anti-inflammatory eye drops for four weeks to prevent infection and reduce inflammation.

Instructions for administering the eye drops will be explained at both your preoperative appointment as well as your follow-up appointments at your doctor’s office.

You’ll also be given a protective eye shield or a pair of sunglasses. This is to prevent you from accidentally rubbing your eye at night and to reduce any discomfort you may experience from bright light on your journey home.


Part VI: Life After Cataract Surgery

What Recovery Process Should I Expect?

Patients can expect blurry vision over the next few days following their cataract surgery.

Minor discomfort should be expected and the treated eye may feel scratchy and watery once the numbness dissipates.

Therefore, Tylenol or Advil should be adequate for treating any pain and any discomfort should improve within a few days. Patients can obtain new glasses when their vision has stabilized after 4-6 weeks.

How Long After Cataract Surgery Can I See?

Cataract surgery recovery time varies from person to person (or perhaps more fittingly, from eye to eye).

While many patients report noticeable improvements in their vision within a few hours or days (particularly with brightness in color), you may need as long as a week before your vision becomes very clear.

This is because the eye needs time to adjust to the removal of the cataract and adapt to the intraocular lens that has replaced it.

Don’t be alarmed if your eye is itchy or feels gritty for a couple of days after surgery—this is part of the healing process and will disappear after a few days.

Avoid rubbing or pushing on your eye and the discomfort will subside as your eye heals.

What Happens in Appointments That Follow?

After having cataract surgery, you will typically have three follow-up appointments with your optometrist. It’s important you attend all your appointments, even if you’re feeling well.

The First Follow-up Appointment

This will occur the day after your surgery. The purpose of this appointment is to check your vision and your eye pressure and to make sure there are no post-op complications.

At this appointment, your vision and eye pressure will be checked and your doctor will give you detailed instructions about your eye drops.

It is not uncommon to experience elevated eye pressure for the first few days after surgery, but if it is elevated, you may need to use additional eye drops to help lower the pressure.

As with any antibiotic, your eye drops are a crucial part of your recovery so make sure you use these eye drops exactly as prescribed.

If you don’t notice any improvement in your vision or you’re experiencing itchiness or discomfort in the days following this visit, report this to your doctor.

The Second Follow-up Appointment

This usually takes place about one week after surgery. At this appointment, your eye may be dilated again (to allow a thorough retinal examination) and checked for any symptoms of infection. Furthermore, the schedule for your eye drops will be reviewed with you.

The Third Follow-up Appointment

This happens around four weeks after the cataract surgery. At this appointment, you will be checked for a prescription for eyeglasses. Most patients at this appointment will be instructed to stop using all of the surgery-related eye drops as your eye will be completely healed.

Beyond These Appointments, When Should I Contact My Doctor?

Patients should call their doctor at any time if they have questions or experience any of the following:

  • Excessive pain that is unrelieved by Tylenol
  • Increasing redness or soreness of the eye
  • Flashes of light that persist
  • A veil coming over your vision
  • Grey or blackened vision
  • Fever over 101 degrees
  • Persistent nausea or vomiting

What Not to Do After Cataract Surgery

One day after surgery, you might find yourself returning to everyday activities such as bathing, showering, washing your face and hair, etc. While this is perfectly acceptable, it’s important not to partake in any activities that could potentially cause infection or derail the healing process.

To make sure you enjoy a safe and speedy recovery, avoid the following activities:

  • Heavy lifting or strenuous activity for approximately two weeks after surgery (this includes lifting your grandchildren)
  • Bending over for approximately 2 weeks after surgery (this puts extra pressure on the eye)
  • Swimming (including hot tubs and saunas)
  • Irritants such as grime and dust
  • Rubbing your eye (this is especially important as this can increase the chance of infection)
  • Wearing eye makeup
  • As always, if you have any concerns or questions, discuss them with your  ophthalmologist or optometrist at your follow-up appointment.

A Common Procedure for Better Vision

Cataract surgery is one of the most common and effective surgical procedures performed in the United States.

And because of it, millions of people are enjoying greater vision—and the many perks that come with such gift.

If you have a cataract and are looking to have surgery, but don’t know where to start, we would love to hear from you.

To learn more about how the Milan Eye Center can help you with cataracts, call and speak to an expert at (678) 681-9834 or Contact Us for more information.

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