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Thread: Can Cataract Surgery provide better vision for a happier life?

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    Arrow Can Cataract Surgery provide better vision for a happier life?

    Can Cataract Surgery provide better vision for a happier life?

    Cataract Surgery - complications

    General Info:

    The word Cataract is derived from the Latin word “Cataracta” meaning “waterfall”. A cataract is simply a "clouding" of the natural lens in your eyes, it affects your vision, like looking through a “waterfall”.

    It is a natural process associated with age especially adults aged 55 years and above. As light passes through the cloudy lens, it is diffused or scattered. This results in blurred or defocused vision.

    A cataract generally should be removed to provide better and clearer vision.
    Most cataracts are highly treatable. Cataract surgery is one of the most common surgeries performed in Singapore with 100% of patients experiencing improved vision if there are no other eye conditions present.

    A cataract can occur in either or both eyes. It cannot spread from one eye to the other.


    Cataract Surgery can provide better vision for a happier life

    Being diagnosed with a cataract need not be alarming event. In fact, when you understand what a cataract is, how it will be removed, and the life-changing benefits cataract surgery can bring, you'll likely wish you'd had the procedure sooner.

    A cataract can progress until eventually there is a complete loss of vision in your eye, and neither diet nor laser treatment will make a cataract go away. LASIK eye surgery cannot treat a cataract.

    However, a cataract surgery can help restore your vision, long before you experience loss of vision significant enough to interfere with your daily activities.

    After successful cataract treatment, your vision will be clearer, brighter, and sharper than it’s been for long time.


    During the procedure

    Cataract surgery, usually an outpatient procedure, takes an hour or less to perform. Eyedrops placed in your eye dilate your pupil. You'll have local anesthetics to numb the area, and you may be given a sedative to help you relax. If you're given a sedative, you may be awake but groggy during surgery. Rarely does anyone require general anesthesia for cataract surgery.

    Typically, two things happen during cataract surgery — the clouded lens is removed, and a clear artificial lens is implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.


    Surgical methods used to remove cataracts include:


    •Phacoemulsification (fak-o-e-mul-sih-fih-KA-shun). In phacoemulsification, your surgeon removes the cataract but leaves most of the back layer of the lens (lens capsule) in place. To do this, your surgeon makes a small incision — about 1/8 inch, or 3 millimeters (mm), long — where the cornea meets the conjunctiva and inserts a needle-thin probe. Your surgeon then uses the probe, which transmits ultrasound waves, to break up (emulsify) the cataract and suction out the fragments. The lens capsule remains in place to provide support for the lens implant.


    •Extracapsular cataract extraction. If your cataract has advanced to the point where phacoemulsification can't break up the clouded lens, your surgeon may do an extracapsular cataract extraction. This procedure requires a larger incision, about 2/10 inch (10 mm), where the cornea and sclera meet. Through this incision your surgeon opens the lens capsule, removes the center (nucleus) of the lens in one piece and vacuums out the softer outer lens, leaving the capsule in place.

    Once the cataract has been removed by either phacoemulsification or extracapsular extraction, a clear artificial lens is implanted into the empty lens capsule. This implant, known as an intraocular lens (IOL), is made of plastic, acrylic or silicone. You won't be able to see or feel the lens; it requires no care and becomes a permanent part of your eye.

    Some IOLs are rigid plastic and implanted through an incision that requires several stitches (sutures) to close. However, many IOLs are flexible, allowing a smaller incision that requires no stitches. The surgeon folds this type of lens and inserts it into the empty capsule where the natural lens used to be. Once in place the lens unfolds to about 1/4 inch (6 mm) in diameter.

    Recent advances in IOLs include blue-blocking lenses, which filter out ultraviolet light. Other types of IOLs provide multifocal vision — being able to see things both near and at a distance. Multifocal lenses offer reasonably good near and distance vision. However, vision at the intermediate range is sometimes less than satisfactory. Glare is reportedly a problem with multifocal lenses, but design improvements are ongoing.

    After the procedure

    With phacoemulsification and foldable lens implants, surgical incisions are very small, and sutures may not be necessary. If all goes well, you'll heal fast and your vision will start to improve within a few days.

    You'll typically see your eye doctor the day after your surgery, the following week and then again after a month to monitor healing.

    It's normal to feel itching and mild discomfort for a couple of days after surgery. Avoid rubbing or pressing on your eye. Clean your eyelids with tissue or cotton balls to remove any crusty discharge. You may wear an eye patch or protective shield the day of surgery. Your doctor may prescribe eyedrops or other medication to prevent infection and control eye pressure. After a couple of days, all discomfort should disappear. Often, complete healing occurs within eight weeks.

    Contact your doctor immediately if you experience any of the following:

    •Vision loss
    •Pain that persists despite the use of over-the-counter pain medications
    •Increased eye redness
    •Light flashes or multiple spots (floaters) in front of your eye
    •Nausea, vomiting or excessive coughing

    You're likely to need glasses after cataract surgery, both for reading and to correct astigmatism, a focusing problem caused by uneven curving of the cornea. Although astigmatism is often unavoidable, it's not likely to be a significant problem if your surgeon is able to remove the cataract through a very small incision. Your doctor will let you know when your eyes have healed enough for you to get a final prescription for eyeglasses.

    If you have cataracts in both eyes, your doctor typically schedules a second surgery a month or two later to remove the cataract in your other eye. This allows time for the first eye to heal before the second eye surgery takes place.

    Results

    Cataract surgery successfully restores vision in the majority of people who have the procedure done.

    Months to years after cataract surgery, you have a 25 percent risk of developing a condition known as posterior capsule opacification (PCO), or second cataract. This happens when the back of the lens capsule — the part of the lens that wasn't removed during surgery and that now supports the lens implant — becomes cloudy and impairs your vision. The gradual clouding is the result of cell growth on the back of the capsule.

    To treat PCO, you need a painless, five-minute outpatient procedure called YAG (yttrium-aluminum-garnet) laser capsulotomy. In YAG laser capsulotomy, a laser beam is used to make a small opening in the clouded capsule to let light pass through.

    After the procedure, you typically stay in the doctor's office for about an hour to make sure your eye pressure doesn't increase — a potential complication if you have glaucoma or are extremely nearsighted. Other complications are rare but can include swelling of the macula and retinal detachment.

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    SYMPTOMS & DETECTION
    Cataract Surgery Complications
    Types of Cataract Surgery





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    Cataract Surgery - Frequently Asked Questions



    Pre Surgery FAQs

    Must someone accompany me on the day of surgery?

    It’s not absolutely necessary, but advisable. Our staff is more than happy to assist patients who are alone.

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    How long does the testing take for my surgery?

    The time requirement for pre-surgical testing may vary greatly, but most patients should plan to be at St. Luke’s between 8-10 hours from the beginning of testing to your discharge.


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    What should I bring with me the day of surgery?

    Here is a list of things that we recommend you bring when coming to St. Luke's for surgery.

    Friend or family member (someone to help with paperwork, driving home, etc.)

    Medicare or insurance cards

    Current prescription glasses (even if not worn presently)

    List of prescription medication including dosage and strength

    Medication – enough for the time you will be away from home

    Sweater or jacket (advised for those who chill easily)

    Lunch or snack (or visit the restaurant in our building)

    Reading material or busy work


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    I take a blood thinner and several other prescription medications. Should I continue this before surgery?

    Yes. Take all prescription medications as you normally would before surgery.


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    I am a contact lens wearer. May I wear my contacts until the day of surgery?

    No, your contact lenses may change some of the measurements we take before the surgery. Please remove soft contact lenses at least one week prior to surgery, and hard lenses two weeks prior to surgery.


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    May I eat before surgery?

    Yes. We recommend that you eat a good meal before arriving and bring a snack, bagged lunch, or each at the restaurant on the second floor.


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    May I wear makeup?

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


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    I’m on oxygen. Should I bring it along?

    Yes, bring more than enough oxygen to meet your needs for an 8-10 hour stay at the clinic.


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    I live a long distance from St. Luke’s. How long must I stay for follow up?

    Patients having routine cataract surgery may usually leave the area within one or two days after surgery. If you do plan on going home immediately after surgery, please make arrangements for a qualified doctor to provide follow-up care in your area.


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    Can St. Luke’s provide a list of local recommended hotels?

    Click here for a list.


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    Surgical - FQAs


    Will I feel anything during surgery?

    Dr. Gills has developed special solutions that numb the eye. Most patients feel only gentle pressure.


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    What do I see during surgery?

    Most patients only see the bright lights of the microscope.


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    Would a cough prevent me from having surgery?

    It is very important that you don’t cough unexpectedly during surgery. Before the operation, we can give you throat spray or a cough suppressant.


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    May I have medication for my nerves?

    It’s not required, but some patients do request medication to help them relax. If you do elect to take medication for your nerves, have someone accompany you if possible.


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    Will I need to have blood drawn before the surgery?

    We do not routinely draw blood unless there is a specific indication.


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    I was told that I need to take antibiotics before any dental work. Is this true for eye surgery also?

    Unlike dental surgery, Dr. Gills is working in an area that is very clean. It is very unlikely that you need antibiotics, however, if you have the medication available, you may take it as instructed by your doctor before the operation.


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    How soon may I leave after surgery?

    Most patients may leave within a few hours after the surgery.


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    I know I need surgery on both eyes. When may I have my second eye done?

    If surgery is recommended on both eyes, you may have them one day apart.


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    What will I be able to see right after the operation?

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


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    What happens before I’m discharged?

    After the surgery, you will be brought into the recovery room where we will assess your vital signs such as your pulse and blood pressure. We will also check your eye pressure and explain your postoperative instructions and medications to you and a friend or family member. Afterward, an attending eye surgeon will examine your eye or we will make arrangements to check you the following day.


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    My back keeps me from lying flat. What position must I be in for the surgery?

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


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    Does every patient need an implant?

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


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    May I drive myself home?

    It is not recommended, although some patients who see well out of their other eye and have not had any medication may drive.


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    Sometimes my blood pressure gets high when I’m nervous. What happens if it’s too high?

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


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    Do I need a physical before surgery?

    Yes. Your general health is assessed prior to surgery by a staff physician so we can grant medical clearance for your surgery.




    Post Operative FAQs



    Did I receive a lens implant?

    The cataract is actually the lens of your eye. Since the lens is responsible for 1/3 of the eye’s focusing power, it must be replaced with a lens implant for you to see clearly. Intraocular lenses are required except in very rare cases of extreme nearsightedness.


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    What is my implant made of?

    The implants used at St. Luke’s are made of either silicone or PMMA (plastic). Each lens has specific indications and the doctor determines which lens is best suited for you based on a number of factors.


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    How long will my implant last?

    The intraocular lens is placed permanently in your eye and will not "wear out".


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    Can my eye reject the lens implant?

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


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    Was laser used to remove my cataract?

    Your cataract was removed by ultrasound, not laser. In a process called phacoemulsification, sound waves gently break up the cataract and it is removed from the eye. However, lasers are presently being developed to remove cataracts.


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    Should I wear my old glasses after surgery?

    Wearing your old glasses will not harm your eyes, but since the prescription won't be optimal for your surgery eye, you will probably see best without them. Most patients find it easiest to only wear glasses for reading.


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    I see great at a distance, but why can’t I read without glasses?

    Your implant is a single-focus lens. If your lens was chosen for distance vision, you will need reading glasses for close range work. Some patients elect to have one eye focused for close vision so they can read without glasses. However, this may compromise distance vision. Patients who require precise distance vision do best with both eyes focused for distance and reading glasses for near.


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    Is it safe to resume activities I enjoy such as golf and reading?

    We encourage you to resume normal activities as soon as you wish. Routine activities such as bending and lifting will not harm your surgery.


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    How soon may I resume driving after surgery?

    Most cataract surgery patients enjoy a significant improvement in their vision within the first 24 hours. You may drive when you feel comfortable.


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    Is it safe to fly after cataract surgery?

    Flying will not harm your eye after cataract surgery.


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    When may I wear make-up again?

    You may wear make-up on your face such as lipstick and powder immediately after surgery, but eye make-up should be avoided for two weeks.


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    Is it safe to have my hair done or get a permanent?

    Just like before your cataract surgery, you should avoid any chemical contact with your eyes. Take sensible precautions.


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    Why does it feel like there is something in my eye after my surgery?

    You’ve had a microscopic incision on the surface of your eye. When you blink, you may feel a slightly scratchy sensation until the incision heals. Scratchiness is also a symptom of dry eyes. After surgery, our patients find that using artificial tears helps to alleviate the symptoms.


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    The eye drops, given to me to use after surgery, sting my eye. Is this normal?

    It is common for some eyedrops to burn or sting upon installation. You should continue to use your eyedrops as prescribed. However, if your discomfort seems to be worsening, or you experience a decrease in vision, call your doctor at St. Luke's. Burning may also be a symptom of dry eyes. Make sure you're using your "artificial tears" drops frequently. Some patients find using artificial tears 5 minutes before their medicated drops decreases their irritation.


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    After surgery, I noticed a spot of blood on the white of my eye, should I be concerned?

    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 underneath the conjunctiva. Since the tissue is clear, it’s easy to see the blood. 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.


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    On the way home from surgery I saw huge halos around all the lights. What causes this?

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


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    My glare problem has improved dramatically since the surgery, but I still occasionally notice halos or streaks on lights at night. What causes this?

    Glare may be caused by many factors. 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.


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    Since my surgery a few weeks ago, everything has a pink tint. What causes this?

    This pink tint is due to slight swelling in the retina and is not uncommon after surgery. It will gradually resolve as you take your postoperative eye drops. However, always contact your doctor at St. Luke's if you notice a change in your vision. It is also important to protect your eyes with sunglasses when outdoors since sun exposure can aggravate this problem.


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    Why does everything have a blue tint since surgery?

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


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    I can't read without glasses. Should I be able to?

    Your implant is a single-focus lens. If your lens was chosen for distance vision, you will need reading glasses for close range work. Some patients elect to have one eye focused for close vision so they can read without glasses. However, this may compromise distance vision. Patients who require precise distance vision do best with both eyes focused for distance and reading glasses for near.

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