Cataract Counseling

There are different types of cataract surgery and different intraocular lenses to choose from.

• • The goal of every cataract surgery is to remove the cataract and to replace it with an intraocular lens (lens implant). Every patient gets an intraocular lens.
  • When removing the cataract and replacing it with a lens implant is the only goal, this is referred to as “traditional surgery”. Patients will continue to wear glasses after traditional cataract surgery.
  • When patients also have the goal of becoming less dependent on glasses or contact lenses, they may choose to have laser-assisted cataract surgery and a specialty, or advanced technology lens implant.
    • Laser-assisted cataract surgery is used to surgically correct astigmatism. It also softens the cataract prior to removal and helps with centering the intraocular lens which is critical for certain types of lens implants. Other benefits include enhanced precision and predictability. (video link LenSX)
    • Specialty, or advanced technology lens implants can also correct astigmatism and can allow the eye to see at multiple distances (or zones of vision, there are 4) without glasses.
    • The 4 zones of vision are:
      • Zone 1 – Far distance: street signs, golf balls
      • Zone 2 – 8-10 feet distance: pictures, clocks, and tv’s on the wall
      • Zone 3 – Intermediate/arm’s length: computer, dashboard, grocery shelves, music stand, face in mirror
      • Zone 4 – Near or Reading: books, menus, phones, sewing

The most important things to consider when making these decisions are:

• • Does the patient mind wearing glasses after surgery, or would they like to wear them less often or possibly not at all?
  • What type of surgery is the patient a good candidate for? What is best for the patient’s eyes?
  • If the patient is interested in laser-assisted cataract surgery or an advanced technology lens implant to have less dependence on glasses, are they able and willing to pay for part of the surgery out of pocket? The cost of the laser and specialty lens implants is not covered by any insurance.

All of these options can seem confusing at first, but Dr. Landes will discuss the options with you and help you pick the one that is best for you and your goals.

If you are having both eyes done, they cannot be done on the same day due to insurance policies. Most patients schedule their eyes 2 weeks apart; however, you may discuss scheduling your surgeries further apart if desired.

• If you are on the one-drop protocol (all 3 of the drops mixed into one bottle) you do not need to pick up any prescriptions prior to surgery. You will receive one bottle of eye drops on the day of surgery at the surgery center.
• If you are not on the one-drop protocol, you will need to pick up your prescription eye drops at your pharmacy prior to surgery.
• The surgery center will call you at least 2 days before surgery to give you your arrival time. If they are not able to speak with you, they will ask that you call them back to confirm you have received the arrival time.
• The surgery center will call you up to 2 weeks before surgery to collect the cost of the specialty lens if chosen, their portion of the facility fee, and the fee for your eye drops if you are on the one-drop protocol.
• The week before surgery, Dr. Landes’ office will collect any portion of their surgical fee that is not covered by insurance. This only applies to surgeries that have an upgrade fee (does not apply to traditional surgery) or for patients who are self-pay.
• Do not eat any food after midnight the night before your surgery.
• You may have a total of 8 ounces of clear liquids up to 2 hours before you arrive. These clear liquids must be stopped 2 hours before you arrive.
• If you do not follow the instructions for eating and drinking, your surgery may need to be cancelled.
• We generally schedule diabetic patients near the beginning of Dr. Landes’ surgery time.
• Take your regularly scheduled medications except insulin, oral diabetic medications, and diuretics (“water pills” that would make you need to urinate).
• Generally, we do not stop any blood thinners prior to cataract surgery. If Dr. Landes is performing glaucoma surgery at the same time as your cataract surgery, please make sure you tell her if you are taking any blood thinners and discuss if the blood thinners should be stopped.
• If you wear contacts, you will need to remove them 2 days prior to surgery unless instructed otherwise.
• If you take glaucoma eye drops, you will continue them before and after surgery unless instructed otherwise.
• Our Surgical Coordinator/Patient Counselor will review your specific pre-operative instructions with you.

Dr. Landes performs her surgeries at The Center for Surgery, located on Graham Road in Cuyahoga Falls. (https://daviseyecenter.com/about-us/the-center-for-surgery/)

The Surgical Coordinator will provide you with further details including address, phone number, and a map.

• You will need a driver to and from the surgery center. You may not take a cab, Uber, or public transportation home without a friend or family member to accompany you. You may not drive on the day of surgery.
• If you are not prepared to follow the guidelines for your ride home after surgery, the surgery center will cancel your surgery.
• You will be at the surgery center for about 2 hours.
• Your driver is welcome to stay or may come back to pick you up.
• After checking in, you will receive several sets of eye drops to numb and dilate your eye as you sit in the waiting room.
• You will be called back to the pre-op area and after completing some paperwork, a nurse will place an IV in your arm so that you can receive “twilight sedation”. This means you will be awake during surgery and breathing on your own; however, the medicine will help you feel calmer and more relaxed. You may or may not remember having the surgery.
• If at any time during surgery you feel too anxious, are unable to lay still, or are in pain, please speak up so that more medication can be administered if needed.
• You will not need to change into a hospital gown; you will be placed on a bed to go into the OR suite.
• You will be in the operating room for about 15-20 minutes and the surgery usually takes around 10 minutes. It will take several minutes longer if you are having laser assisted surgery or cataract surgery combined with glaucoma surgery.
• Once you are brought into the operating room, your eyelashes, eyelids, and the area around your eye will be cleaned before the surgery to help reduce the risk of infection. Once this is done you cannot touch your face.
• A foam pillow with an oxygen supply tube at the end will be placed on your chest and your face will be covered by a sterile drape. You will be able to breathe very well due to the pillow tenting the drape away from your mouth and nose and the direct supply of oxygen available.
• An eyelid speculum will hold your eye open for you. You do not have to worry about blinking during the surgery.
• You will not see the surgery being performed. You will see very bright lights, colors, and shadows during surgery. Dr. Landes will ask you to look at the 3 bright lights because it will help keep your eye straight and still.
• You will feel some light pressure, some cool water, and perhaps the surgeon’s hands resting on your cheek. Rest assured that the vast majority of patients feel no pain.
• You cannot reach up and touch your face during surgery. You must keep your hands down at your sides and lay as still as possible. Any movement or talking can make your eye move and may disrupt the surgery.
• There will be a nurse at your bedside through the entire procedure, available to hold your hand, if needed.

• You will go to the recovery room where you will receive more eye drops and a drink. Your post-operative instructions will be reviewed with you before you go home.
• Before you leave the surgery center, your eye will be closed and taped shut. Please leave the tape on for 4 hours unless otherwise directed in your post-operative instructions. After 4 hours you may remove the tape and will not need any other bandages or eye patches, unless otherwise directed.
• Please follow the post-operative instructions carefully.

• No driving the day of your surgery.
• No eye rubbing or pushing on the eyes.
• Wash your hands each time before you put drops in your eyes.
• Don’t touch the tip of the eye drop bottle to your eye or any other surface.
• No pools, hot tubs, or lake water for 1 week after surgery.
• You may take a bath or shower and wash your face, just close your eyes and do not push on them or intentionally get water in them.
• It is best to avoid any particularly dirty or dusty activities or environments that might cause you to get something in your eye for the first week.
• No eye makeup for 2 days after surgery. It is recommended to purchase new eye liner and mascara and wash your makeup brushes.
• Average lifting and bending movements are allowed, but please ask about any extreme or unusual activities.

• Blurry vision – Your vision may seem better in some ways almost immediately (brighter, changes in color), but it may seem like a “blurry version of better”. It is normal for the vision to be blurry as you recover from surgery, but it will improve more and more each day. Most patients require 1-2 weeks before the vision is done improving. If glasses are needed after surgery, they will be the final step in improving your vision. You may be ready for new glasses as soon as 3-4 weeks after the second eye is done.
• Mild irritation/discomfort – Your eyes may feel scratchy, rough, gritty, or like something is in the eye. They may feel slightly tender. This is temporary and generally lasts from 1 day up to a few weeks.
• Dry eye – Dry eye is a very common problem (not everyone is aware of it) and tends to worsen after surgery. Signs of dryness include mild irritation and discomfort such as a scratchy or gritty sensation, burning or stinging, redness, tearing, and fluctuating vision. Keeping the eyes lubricated with artificial tears will help. We will give you some artificial tears to get started with on the day of your surgery and you may use them as often as you need for comfort.
• Floaters – You may see floaters in your vision after surgery. These could be old floaters that you had before surgery or new floaters that may develop after surgery. Please tell Dr. Landes if you see any new floaters in your vision after surgery.
• Light sensitivity – It is not uncommon to feel more sensitive to light after cataracts have been removed. You may feel more dependent on sunglasses and may adjust over time.
• You may see a dark line or crescent shaped shadow in the side periphery of your vision after cataract surgery. This is due to a shadow that is caused by the new lens implant. If you see this, know that nothing is wrong with you and that it usually goes away within a few weeks, especially if you try to ignore it.
• You may notice a shakiness or quivering in the vision in the first few days after surgery. It is also common for patients to report seeing streaks of light, flashes of light, or sparkling lights.

• You should not have pain (pain being anything more than a mild discomfort or irritation).
• You should not have worsening vision. We expect the vision will be the blurriest the first 1-2 days after surgery but it should only improve from that point forward.
• If you have pain or worsening vision, or any other concerns or questions, please contact our office immediately. If you urgently need to speak with Dr. Landes after hours, follow the prompts on the office voicemail.

• Dr. Landes will discuss these with you and any that may specifically apply to your situation.
• Cataract surgery is the most common surgery performed in the country with one of the highest success rates (over 95%). The odds are in our favor but it is important to consider what can go wrong.
• The following list includes the commonly known risks and complications of cataract surgery. Commonly known is not the same as frequently occurring. This list includes issues of varying frequency and severity.
• Generally the risks and complications of cataract surgery include (but are not limited to) swelling, inflammation, increased eye pressure, leaking wounds, corneal abrasions, corneal burns, corneal decompensation, bleeding, infection, droopy eye lid, retinal swelling, retinal holes or tears, retinal detachments, tears in the posterior capsule located behind the cataract, vitreous gel coming forward through a tear or defect into the front of the eye where it doesn’t belong, cataract falling into the back of the eye, retained fragments of cataract remaining inside of the eye, problems with the intraocular lens, decentering or dislocation of the intraocular lens, worsening of certain eye conditions, need for extra follow up, need for extra medication, need for additional treatment, need to consult with other eye specialists, need for extra procedures or surgeries, pain, vision loss, blindness, and loss of the eye.
• Most of the time, most of the above risks and complications can be successfully treated. One of the most concerning risks is the risk of infection. This occurs between 0.1% and 0.05% of the time, or 1 patient per 1000-2000 cataract surgeries. The risk of infection is greatest within the first week of surgery but does not develop within the first 24 hours. The signs of infection are pain in the eye, worsening of vision, and redness in the eye. Treatment for infection includes the injection of antibiotics into the eye and possibly surgery. If treated quickly, approximately 50% of these cases of infection are able to recover vision, and about 50% result in permanent vision loss which may be as severe as total blindness in the eye. If you develop signs of infection, it is critical that you contact Dr. Landes’ office immediately.
• No promises or guarantees can be made about the outcome of your surgery. Sometimes the unexpected happens. Dr. Landes will always keep you informed and will make sure you are getting whatever care you need.

• Follow your post-operative instructions for details on how to take your eye drops.
• Most patients will be on the eye drops for 3 weeks, sometimes longer.
• Your eye will be examined the day after surgery and then usually about 1 week after surgery.
• Sometimes additional exams are necessary.
• If you are having both eyes done, it is common to space the surgeries about 2 weeks apart, but other time frames can be discussed.
• If new glasses are needed, they are usually prescribed around 3-4 weeks after the second eye surgery.
• While you are waiting for both eye surgeries to be completed and for the eyes to heal, your glasses may not work as well as they used to. You may find that you see better without the glasses. You may either wear the glasses if they seem to help, or you may take them off. Whatever is most comfortable is what you should do. This may change from day to day and may depend on the activity. Many patients find that having a +250 over-the-counter pair of reading glasses (“cheaters”) can help them with their near activities during this transition period