Cataract Surgery

About half of the population develops a cataract by age 65, and nearly everyone over age 75 has at least one. But in rare cases, infants can have congenital cataracts. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited.

A cataract usually starts very small and is practically unnoticeable until it grows gradually larger and cloudier. Your doctor is probably waiting until the cataract interferes significantly with your vision and your lifestyle. Early steps to treat vision changes from a cataract include updating one’s glasses prescription.  

Continue to visit your eye doctor regularly so the cataract's progress can be monitored. Some cataracts never reach the stage where they should be removed. If your cataract is interfering with your vision to the point that it is unsafe to drive or makes doing everyday tasks difficult, it's time to discuss surgery with your doctor.

All surgery involves some risk, so yes, it is serious. However, cataract surgery is the most commonly performed type of surgery in the United States.

Traditionally, cataract surgery is performed with a specialized ultrasound machine called a phacoemulsification machine.  Depending on your specific case, your doctor may recommend using a laser to perform parts of the surgery. 

Determining the correct lens, or IOL, for you can be based on many factors, including the health of your eye, your lifestyle, and the fact that some IOL options incur out-of-pocket expenses. If you are interested in correcting astigmatism and/or presbyopia, which all people develop beginning at about age 40, there are options. You potentially can decrease your dependence on eyeglasses and restore your ability to see at all distances with a "lifestyle" IOL. However, you must consider that additional cataract surgery costs do occur with lifestyle IOLs, even though they may reduce or eliminate dependency on eyeglasses.

Before cataract surgery, your eye will be thoroughly measured in a preliminary examination to determine the proper power of the IOL that will be placed in your eye. If you choose a lifestyle IOL, you may need extra tests to make sure measurements are exact and that you do not have other vision problems that might hamper the performance of the IOL.
 

The average new patient appointment time is 2-3 hours. You will go through a number of tests, including non-invasive imaging of the eye. You will be dilated, so you may want to have someone to drive you home.

Please bring:

• A list of your current prescription medications and dosages (this includes vitamins over-the-counter medication and herbal medication).
• Prescription eye drop bottles
• Current glasses or the information for your current glasses prescription
• Your insurance card and co payment
• Valid ID (driver's license)
• Your referring Physician's name and phone number along with any paperwork they may have given to you.

You will receive a lot of important information at your cataract consultation, and it may be helpful to have a relative or friend by your side.

What do you love to do and what does your vision potentially prevent you from doing? What activities are most important to you? Answers to these questions will help you to decide your lens treatment option.

Dry eye is a common eye condition that affects almost everyone, though not necessarily all in the same way. Your eyes do not have to feel dry to have dry eye. Some common symptoms include blurriness that comes and goes, redness, grittiness, irritation, and excess tearing.

Treating dryness and improving the eye surface health prior to your appointment is important as it can impact the quality of the imaging used to determine the best lens implant. If you are not currently using any dry eye treatment regularly, we recommend at least using preservative-free artificial tears four times a day for at least two weeks prior to your appointment.

Our doctors may add additional dry eye treatments at your appointment. They may also request repeat testing after a few weeks of diligent dry eye therapy. It is important to also know that dry eye does not stop once you have cataract surgery.

Contact lenses can change the shape of the front surface of the eye, or cornea. Please stop wearing soft contact lenses at least two weeks prior to your evaluation for surgery. Hard contact lenses may change the shape of your cornea to a greater extent, and thus, you will need to be out of them for several weeks/months prior to your evaluation for surgery and the surgery itself. Please stop wearing them as far ahead of your appointment as possible and know that you may need to continue to be out of the lenses for a longer period of time to allow for repeat measurements to ensure stability.

Make sure to let your doctor know that you wear contact lenses. 

Yes, you will be asked to get a medical clearance prior to surgery. If you have a complicated medical history, we may ask you to be cleared by one of our Hospitalists.

We request that you bring someone with you on the day of your cataract surgery. You cannot drive yourself home nor can you use a ride service unless you have a responsible adult to accompany you.

The surgery will take place at the Gavin Herbert Eye Institute, Argyros Surgery Center, which is located in the garden level, or lower level, of the Gavin Herbert Eye Institute building on the UCI Campus.

Most patients should plan to be at the surgery center between 3-4 hours from registration to discharge.

We recommend that you bring the following to the surgery center:

•     Friend or family member (someone to help with paperwork, driving home, etc.)
•     Medicare or insurance cards
•     Medication – enough for the time you will be away from home
•     List of prescription medication including dosage and strength
•     Sweater or jacket
•     Reading material /something to do while you wait
•     Form of payment if you have opted for a service/IOL that is not covered by your insurance
   

Yes, take all prescription medications as you normally would with a sip of water, unless specifically instructed by your doctor to do otherwise. It is not necessary to stop blood thinners prior to cataract surgery, unless instructed to do so by your doctor.

No, fasting is required for all surgery patients. Please ensure that you have no solid foods (jello is a solid) after midnight the night before your surgery, regardless of the time of the surgery. Also included in the list of items not to consume after midnight are gum, candies, breath mints, any milk products, and juices with pulp.

You may have very small amounts of clear liquids up to 4 hours before surgery but do not add sugar or honey. Clear liquids are apple juice, water, black coffee, or plain tea.

If fasting guidelines are not followed, surgery will be cancelled and rescheduled.

Please do not wear any makeup on the day of surgery. 

Yes, bring more than enough oxygen for a 3 hour stay. While under our care, we will have oxygen available for you. 

Most patients feel only gentle pressure during cataract removal surgery. 

Most patients only see the bright lights of the microscope. 

Generally our anesthesia staff is present. A mild anti-anxiety medication will be administered as needed. 

Unlike the mouth, the eyes are very clean. You will not need to take oral antibiotics unless instructed by your doctor before the operation.

Most patients are able to leave within an hour of having cataract surgery. 

You may have your surgeries one to two weeks apart, unless there is a reason to wait longer or if you desire to wait longer. Your doctor will discuss the timing with you. 

Most patients’ vision is quite blurred immediately after the surgery from the dilating drops and bright microscope lights. 

After the surgery, you will be taken to the recovery room where we will assess your vital signs (pulse, blood pressure, etc). At this time, we will also explain your postoperative instructions and medications to you and a friend or family member. 

We will need you to lie down for surgery; however, our experienced OR team has worked virtually every medical condition that presents special needs. We will be able to work with you to make your experience as comfortable as possible.

The vast majority of patients require an implant to replace the natural lens or cataract. Only in very rare cases of extreme nearsightedness is an implant not required.

No, we require patients to bring a friend or family member to drive them home due to the medications given. 

If we are unable to manage your blood pressure with medication, your surgery may be postponed until you consult with your primary physician.

Intraocular lenses are required except in very rare cases of extreme nearsightedness.

Most of the implants used are made of either acrylic, silicone or PMMA (plastic).

The intraocular lens implant will remain in your eye permanently and will not “wear out."

No, since the intraocular lens is not made up of human tissue, your body cannot reject it.

Wearing your old glasses will not harm your eyes, but they will probably not give you optimal vision either. Most patients find it best to wear glasses only for reading. 

Your ability to see well at close range depends on the type of intraocular lens you received. For most IOLs, it is normal to require reading glasses after cataract surgery. 

• Strenuous activity and heavy lifting (nothing over 10 to 15 pounds).
• Bending, exercising and similar activities that might stress your eye while it is healing. 
• Water that might splash into your eye and cause infection. Keep your eyes closed while showering or bathing.
• Also, avoid swimming, hot tubs, and/or ocean water for at least two weeks. 
• Any activity (such as changing cat litter boxes) that would expose your healing eye to dust, grime or other infection-causing contaminants. 
   

For most cataract surgery patients, vision improves significantly in the first 24 hours after surgery. You may drive as soon as you feel comfortable. 

Flying after cataract removal surgery will not harm your eye. 

You may wear lipstick and powder immediately after surgery. However, you should avoid eye make-up for two weeks after surgery. 

Yes, as long as you take sensible precautions to avoid chemical contact with your eyes.

During cataract surgery, a microscopic incision was made on the surface of your eye. When you blink, you may feel a slightly scratchy sensation until the incision heals. After surgery, many patients find that using artificial tears helps to alleviate discomfort.

It is common for some eye drops to burn or sting. You should continue to use your eye drops as prescribed. However, if your discomfort seems to be worsening, or you experience a decrease in vision, call us immediately. Some patients find that using “preservative free artificial tears” five minutes before placing medicated drops in the eye decreases irritation. 

The white part of the eye (sclera) is covered by a clear layer of tissue (conjunctiva). When a tiny blood vessel breaks, the blood becomes trapped below the conjunctiva. Since the tissue is clear, the blood is clearly visible. If this were to happen on your arm, you would have a blue or purple bruise because the skin is not transparent. This will not affect your vision and will gradually resolve on its own. 

This dramatic glare was due to the fact that your pupil was still dilated from the surgery. After dilation wears off, vision should return to normal. 

There are many factors that can cause glare. A slight need for glasses (refractive error) is one of the most common reasons you may notice slight glare at night. Also, some patients experience minor corneal swelling after surgery that may cause temporary glare.

This pink tint is due to slight swelling in the retina and is not uncommon after surgery. It will gradually go away as you use your post-operative eye drops. However, always contact your eye doctor if you notice a change in your vision. Since sun exposure can aggravate this problem, it is also important to protect your eyes with sunglasses when outdoors.

Patients with cataracts see their work through a yellow tint. It’s just like wearing yellow-tinted (“blue-blocker”) sunglasses, which block colors from the lower end of the color spectrum (blues and violets). When the cataract is removed and replaced with a clear implant, you will see these unfamiliar colors again. This is much more dramatic for some patients than others. 

If you have additional questions about cataract removal surgery please ask your doctor.