Q:

Is there much pain?

A:

Most people report the sensation of an eyelash in the eye the first several hours, and are better the next morning. I do not routinely give a prescription for any pain medication after cataract surgery. If you do have more pain than a Tylenol will relieve, you will have my mobile phone number to call.

Q:

How long am I in the hospital?

A:

Three hours in the outpatient department.

Q:

What are my restrictions on activities after the surgery?

A:

You can’t drive home, due to the sedation you have had. You will need to have someone stay with you overnight, due to the sedatives administered during the surgery. Don’t rub your eye. You should not go underwater swimming for two weeks. You should wear the protective shield at night or when napping for three days afterward.

Q:

Don’t I have to avoid lifting or bending?

A:

No. The incisions are self sealing and your routine activities will not disrupt them.

Q:

When will my vision improve?

A:

Brightness and color is usually noticeably better the first evening. Your vision may be limited by other eye conditions present, which will be discussed before your surgery.  If you have fragile cells lining the cornea, such as with Fuchs’ dystrophy, I will let you know.  These corneas take longer to clear after surgery but often provide surprisingly good vision, once healed.  If you need glasses, they are prescribed about two weeks after surgery, unless we are going to operate on the fellow eye.

Q:

What are the possible complications?

A:

The complication I most worry about is infection, because the outcome is unpredictable in a given eye, even with aggressive measures. Infection can occur despite all the precautions, at the rate of 1 per 5,000 cases. The vision can return to near normal, but at least half the time there is some compromise, sometimes severe.  The eye can be lost from an infection.  Risks for infections include blepharitis, poor hand hygiene, the presence of a colostomy, immunosuppression, not taking the recommended antibiotic drops, prolonged or complicated surgery, and eye rubbing postoperatively.

Retinal detachment can occur, at the rate of 1.5%, on average. If you are young-ish (under 60, for a cataract patient), male and myopic you are at somewhat higher risk.

Corneal decompensation resulting in edema, or swelling, can be present after surgery if you have a delicate cornea (see Fuchs' corneal dystrophy).  Sometimes there can be more corneal swelling associated with cases where the cataract is very large or firm, and extra ultrasound power is needed to get it out.  The technique of removal is sometimes altered if the lens is loose, the iris is scarred or floppy, or other unexpected problems occur during surgery.  Usually difficult cases can be identified before surgery, so I can tell you what to expect.

Q:

I have glaucoma.  Can I still have cataract surgery, and are there more risks involved?

A:

Glaucoma may actually be easier to control after cataract surgery.  Usually the case proceeds like any other, but sometimes the prolonged use of medications makes the eye more irritable and healing is somewhat longer. Eyes that have glaucoma due to inflammation (iritis or uveitis) need to be quiescent before we proceed, and we have to watch for inflammation after the cataract is removed.  If there has been damage to the optic nerve from the glaucoma, the vision may not be perfect, but I would not recommend surgery if I did not think there was something to be gained.

There may be possible risks that are particular to your case, and a general review cannot substitute for an exam and thorough discussion with the doctor.

Q:

When should the cataract surgery be done?

A:

When your visual function demands it. If you are coping well, it's not broken and we don't need to fix it. But if you find you are giving up things you enjoy, getting depressed, or if you are having any safety issues, you may feel the time is right.

Q:

When is someone too old to have surgery? Can Alzheimer’s patients have cataract surgery?

A:

No particular age is too old.  More important is whether we can improve that person’s quality of life.   Sometimes, when a patient is nonverbal they cannot express their needs or satisfaction, but people who know them well can judge by their visual behavior whether surgery is appropriate.  The risks and benefits are weighed, the person’s capacities and function are considered.  General anesthesia can be used, if needed.

Q:

When is the other eye done?

A:

When your visual function demands it. That feeling of necessity varies for each individual. Some people feel unbalanced with only one cataract removed. Others happily go years between eye surgeries.

Q:

How much does the surgery cost?

A:

Medicare patients pay 20% of the allowable reimbursement for the Part B charges—the surgeon’s and anesthesiologist’s fees. The OR is under Part A and is fully covered.  For a translation and a better approximation of your cost, it is best to speak with my administrator, who can factor in your coinsurances, deductibles, etc.