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What to Expect When You Have Cataracts

As you may or may not know, cataracts are one of the leading causes of blindness worldwide. Fortunately, cataract surgery is a very effective treatment that can restore vision. In the United States, cataract surgery is one of the most frequently performed procedures in medicine and has an excellent success rate. With new technology and surgical advances, the experience of undergoing cataract surgery has become easy and painless. When we consider how important sight is in our daily life, restoring sight with cataract surgery is as miraculous as Ponce de Leon’s fountain of youth. The only difference is that cataract surgery is real and easily available.

A cataract is not a disease, but is a part of the natural aging process, like the graying of our hair. A cataract results when the lens inside our eye that was once clear becomes cloudy. Diabetes, excessive sunlight exposure, eye injuries, surgery, and inflammation or prolong use of corticosteroid medication can increase the risk or speed of cataract formation. The cataract interferes with light entering into the eye. As a result, vision becomes blurred, and colors fade. Other symptoms include glare, such as with on-coming headlights, difficulty with vision at night, with reading, seeing “halos” around lights, frequent changes in eyeglasses, or double vision in a single eye. When you notice these symptoms or any sudden changes in vision, it is important to consult your doctor for a full eye examination. Since age is also a risk factor for other serious eye diseases such as glaucoma, and age-related macular degeneration, the American Academy of Ophthalmology recommends that people over the age 65 get an annual eye examination.

Once you have an appointment with your eye doctor, a few preparations will make your visit go smoothly. You should write down a list of your symptoms, key eye and medical conditions, a list of medications you’re using including eye drops and over the counter medications, and your allergies. It will be useful to write down a list of questions that you may have, such as do I need cataract surgery now? How long can I wait?  Will I be awake during the surgery?  How long does it take to recover?  When can I return to work and what can’t I do after surgery?  Will I need glasses afterwards?

It is sometimes helpful to bring along a family member or friend. Since there can be an overwhelming amount of information given by your doctor during this appointment, a friend or family member can be helpful in remembering some things that you may miss or forget. Additionally, he/she can drive you home if your eyes become blurry after dilation, a test that is necessary to fully evaluate your cataract.

During your eye examination, your doctor will test your visual acuity by asking you to read a series of letters or numbers in the distance and at near. Your doctor will examine your eyes with a special microscope called a slit lamp. Your eye pressure will be measured to screen for glaucoma. Your pupils will be dilated with drops. This complete eye examination including dilation is important because it can correctly diagnose cataract, and other blinding eye diseases like glaucoma, age-related macular degeneration, diabetic retinopathy, etc. Like most diseases, early detection and treatment can help prevent blindness.

Once a cataract is diagnosed, the only effective treatment to restore vision is cataract surgery. Cataract surgery involves removal of your natural discolored lens, and replacing that with a new artificial lens, called an intraocular lens (IOL). However, surgery is not needed for all cataracts.

If you are diagnosed with cataracts, then your doctor will talk to you about whether cataract surgery is right for you. If the cataract is interfering with your activities of daily living, such as watching TV, reading, or driving at night, then cataract surgery may be a good treatment option. Once you and your doctor decides that cataract surgery will help improve your vision, then your doctor will discuss the details of cataract surgery, the types of intraocular lens options available, the risks, benefits and alternatives to surgery. Cataract surgery is a generally safe and highly successful surgery. Over 90% of patients undergoing this procedure have better vision after surgery compared to before surgery. More than 95% of patients report being satisfied with results of cataract surgery. However, like all surgical procedures, there are small risks associated with cataract surgery such as bleeding, infection, and second surgeries. The risk for loss of vision or eye is exceedingly rare.

Cataract surgery is a day surgery performed in either an ambulatory surgery center or in an operating room within a hospital. During the day of surgery, the patient will be asked by multiple staff members to confirm his/her identity and the correct eye for the surgery. The patient is usually awake with mild sedation during surgery. The eye is locally anesthetized. When surgery is completed, a shield is placed over the eye, and the patient can go home on the same day. A typical post-operative care plan entails follow-up at the doctor’s office on 1 day, 1 week, and 1 month after surgery.

Most patients can see on the very first day, and vision will improve as the eye heals. Healing usually takes 4 to 6 weeks. During the healing period, vision may fluctuate. A post-operative regimen of eye drops is given including an antibiotic, a steroid drop and sometimes an anti-inflammatory drop. Patients are also given instructions on a few activity restrictions, and early warning signs of infection. Once the eye heals, glasses are prescribed if necessary. For the overwhelming majority of patients undergoing cataract surgery, the process to visual recovery is miraculous.

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