By Dr. Jean E. Keamy
In last month’s article, I discussed what a cataract is. For those of you who may have missed the article, I will summarize. The lens in the eye acts much like a lens in a camera. It focuses images we see onto the retina that is analogous to film in a camera. When we are born, a healthy lens is clear. As we age or have different diseases, the lens becomes cloudy until it is opaque. The cataract or cloudy lens can make vision blurry, produce glare at night, cause double vision, make colors less distinguishable and decrease contrast sensitivity.
When the cataract decreases one’s quality of life, then the only way to improve vision is through cataract surgery. There are no medications nor supplements nor vitamins that will get rid of the cataract. Cataract surgery is one of the most common surgeries performed today. It has a success rate of approximately 90 percent. Many decades ago, cataract patients were hospitalized overnight. Now the procedure is performed on an outpatient basis. It takes approximately 10-30 minutes, depending on how mature or dense the cataract is.
Cataract surgery is always elective and usually routine. However, it is not without risk.
Risks include retinal detachment, macular edema, glaucoma, corneal edema, droopy eyelid, double vision and retained lens, but rarely loss of vision or life.
Before surgery, your surgeon will take measurements of the eye in the office. First the curvature of the cornea will be measured, and then the length of the eyeball will be determined. These important measurements help determine the power of the artificial lens to be placed in the eye.
All patients need a preoperative physical with blood tests and possibly an EKG and chest X-ray within 30 days of the surgery. Consents are signed prior to surgery with the surgeon.
On the day of surgery, a patient does not eat breakfast unless otherwise instructed. They usually have an IV placed for mild sedation. Dilating drops are placed in the surgical eye. Local anesthesia may be given around the eye in order to keep the eye frozen during surgery. Sometimes topical anesthesia may be the only numbing needed. Patients are usually awake but mildly sedated during surgery. Only in rare cases such as dementia or tremors would general anesthesia be required.
Once a patient is brought into the operating room, the eye to be operated on is prepped and draped in the usual sterile fashion. A small wire speculum opens the eye so the patient cannot close the lids. A small incision is made into the cornea.
The lens is then broken up into pieces and vacuumed out of the eye with the ultrasonic phacoemulsification hand piece. The aspirated fluid is replaced with an infusion of balanced salt solution to maintain the shape of the eye. Then a folded intraocular lens implant is placed into the eye. It then unfolds into position. If the wounds are water tight, no sutures will be necessary. There a number of choices for the lens implant. I will discuss these choices in my article Cataracts Part 3 next month.
After surgery, some doctors put a shield and/or patch on the operated eye overnight. The next day the surgeon takes it off, checks vision and pressure and examines the eye.
Several drops of eye medications are needed each day for approximately four weeks to prevent infection and inflammation. One month after surgery, a new glasses prescription may be given if needed.
Dr. Jean Keamy is a board certified ophthalmologist specializing in cataract surgery, refractive surgery, eyelid surgery and diseases of the eye. She owns Keamy Eye & Laser Centre on 24 Lyman St. in Westborough and can be reached at 508-836-8733. Learn more at www.seemedrkeamy.com.
