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Must know facts about cataract surgery

Must know facts about cataract surgery

what is cataract surgery

Cataract Surgery Basics

In cataract surgery, the lens inside your eye that has become cloudy is removed and replaced with an artificial lens (called an intraocular lens, or IOL ) to restore clear vision.

The procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility.

Most modern cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction.

This procedure, called phacoemulsification or “phaco,” can be performed with smaller incisions than previous surgical techniques for cataract removal, promoting faster healing and reducing the risk of cataract surgery complications, such as a retinal detachment.

 

After all remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear intraocular lens, positioning it securely behind the iris and pupil, in the same location your natural lens occupied.

 

The surgeon then completes the cataract removal and IOL implantation procedure by closing the incision in your eye (a stitch may or may not be needed), and a protective shield is placed over the eye to keep it safe in the early stages of your cataract surgery recovery.

A video explaining what exactly is a cataract surgery

A video explaining  Cataract Surgery in Hindi.

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Useful blog giving a step-wise guide to a cataract patient.

A step-wise guide to a cataract patient.

 

Step one: Do not panic.

Cataract is a very common clinical condition and is treatable.

 

Step two: Confirm why you developed the cataract?

Consult an eye surgeon

 

Step three: Do you actually need surgery?

Ask your doctor why you can not see? 

 

Step four: Can it be postponed?

Ask you doctor , if you can safely postpone your surgery.

 

Laser Cataract Surgery

Recently, a number of femtosecond lasers — similar to the lasers used to create the corneal flap in all-laser LASIK — have been approved by the FDA for use in cataract surgery performed in the United States.

These lasers have gained approval for the following steps in cataract surgery, reducing the need for surgical blades and other hand-held tools:

Creating corneal incisions to allow the surgeon access to the lens

Removing the anterior capsule of the lens

Fragmenting the cataract (so less phaco energy is required to break it up and remove it)

Creating peripheral corneal incisions to reduce astigmatism (when needed)

While studies have shown that lasers can improve accuracy during certain steps of cataract surgery, they may not necessarily improve cataract surgery safety, recovery time and visual outcomes in every case.

A video explaining what exactly is Laser Cataract Surgery

HOW MUCH CATARACT SURGERY COST

Harithaapriyadarshini Chadalavada, Masters Ophthalmology, Jagadguru Jayadeva Murugarajendra Medical College (2017)

It depends on your location , surgeon , procedure and the kind of lens that is being implanted.

To give a rough idea, a basic procedure like SICS can cost something from 5k to 15k.

Phaco emulsification is an advanced , machine based procedure that can cost anywhere between 20 to 80k, depending on the intraocular lens being implanted .

Fematosecond laser is another kind of advanced procedure that uses a laser for cataract surgery. This will be around 60 to 90k.

Apart from these, there are free cataract surgeries being done under DBCS(District Blindness Control Society ) in various areas which are absolutely free.

So you can choose anyone one of then, but ignoring cataract for a long time can lead to permanent loss of vision. So please don’t neglect this condition even if you can see crystal clear with the other eye.

Good luck!

Ajay Gopal, works at Writers and Authors

Let me say my story. I live in chennai.

The experienced doctors in chennai who can provide optimum results charge around ₹40k to ₹50k for a procedure, while doctors with poor results in chennai charge lower. So for my grandparents, I flew down south to get quality eye care at affordable prices. I went to my native place tuticorin. There I found an eye hospital called Annai eye clinics,Thoothukudi.There a doctor with three decades of experience who has performed around 15,000 cataract surgeries performed phaco emulsification for ₹12000 on my grandma and she has perfect vision right now.In fact she is stitching and knitting with small needles with her precise eyesight. I even explored chains like vasan, agarwal- they were expensive with inexperienced doctors, even the doctor’s name was not disclosed. While some chains like shankar nethralaya sometimes perform the surgeries with trainee surgeons. So research is necessary.Most important point is cost of surgery is not proportional to better eyesight.Although the surgery may be done in a fancy hospital, the surgeon’s skill is important.

Cataract Surgery Packages

Cataract surgery Packages varies from, hospital to hospital, surgeon to surgeon, city to city, type of operation ( SICS> Phaco> Femto Laser), type of lens ( Indian Mono-Focal > Indian Multifocal> Multifocal )  and so on. Cost may vary from 10k -150k depending on the combination of doctor, hospital, surgery, the lens you have chosen for you.

What is included in cataract surgery packages?

The” Package” includes

Pre-operative examination

Surgeons fee

Surgery charges

Anesthesia charges

Medication given during and before surgery

Cost implant (Lens) and hospital stay.

What is not included in cataract surgery packages?

Cost of the post-operative drugs

Additional intervention after the surgery like Yag Laser,Vitrectomy.

Treatment of any complication arising after surgery

Coverage for cataract treatment

The terms of coverage for cataract may vary from one insurer to another.

There are many health insurance companies in the market that provide coverage for cataract.

However, there are some plans that exclude cataract from the list of covered illnesses. You must read the policy document carefully to know whether cataract coverage is offered by your health insurance plan.

Cataract surgery is likely to cost Rs.30,000 to Rs.50,000 for a single eye in a reputed hospital in a major city.

Before providing coverage for cataract treatment, a health insurer may set forth certain conditions.

Things to note in health insurance plans

As noted, more and more health insurers in the market have started providing coverage for cataract treatments. With the increase in lifestyle-related diseases, it is not uncommon for someone in their 40s or 50s to get cataract. Health insurers are aware of this fact. Hence, they provide coverage for cataract only upon satisfaction of certain terms and conditions.

  • Waiting period: Most of the health insurers in the market have disease-specific waiting periods for certain conditions. Typically, most insurance companies provide cataract coverage after a waiting period of 2 years. The waiting period clause is mainly used by insurers to discourage people from taking insurance just for the purpose of cataract surgery. If you enter a health insurance cover at a young age, you will not have any issues getting coverage for cataract surgery.
  • Sub-limit: For cataract treatments, the full sum insured amount of a health insurance policy may not be available. Specific sub-limits are set for cataract treatments in most health insurance covers. Any additional expenses incurred for cataract treatment must be paid from one’s own hand. Though not common, there are some health insurance plans that do not have any specific sub-limit for this treatment. If cataract treatment is a major requirement for you, you must choose your health insurance cover accordingly.
  • Extent of coverage: Cataract is not a disease that spreads from one eye to another. However, if you have cataract in one eye, there is an increased possibility of getting cataract in the other eye also. Hence, it is better to check whether the sub-limit available for cataract treatment is available for each eye. Also, check for any other provisions when it comes to getting treatment for both eyes.

Health insurance plans that offer cataract coverage

Some of the health insurance plans that offer cataract coverage can be listed as follows:

insurance coverage for cataract surgery in India

Where to get operated? : An accredited eye hospital

There are no rule of thumb to identify a good hospital from the rest, but certain general guidelines may be followed.

  1. Prefer a hospital/ facility which accredited by some accreditation agencies like NABH in India.
  2. Dedicated eye hospitals have better developed facilities for eye care that an eye department in a multi-specialty hospital.
  3. A facility with multiple eye surgeon practicing different eye specialties has better services than single surgeon facility.
  4. If you have personal acquaintance with the reputed individual surgeon, that’s the best choice.

Here are some steps to help you select an ophthalmologist for your cataract surgery.

Talk with your family doctor. if you know any doctor in your neighborhood,  he is the right person to talk to regarding selection of eye surgeon for you. He will  guide you in selecting the best ophthalmic surgeon.

Check with family and friends in your area who have had cataract surgery. If they had a positive experience with their own cataract surgery, they will be happy to recommend their ophthalmologist.

Go online to find eye surgeons in your area. Use sites like Practo or Lybrate to find the ophthalmologist around you.

Common Patient Concerns about Cataract Surgery Services.

Concerns about cataract surgery services

choice of suyrgey

If you have cataracts then the only treatment is surgery. However the time to have surgery is largely decided by its effect on the quality of your life.

Cataracts do not get worse overnight and generally do not cause any permanent damage. Hence the surgery is elective. You choose when to have it.

There are very few exceptions here and it is best to have it assessed by an ophthalmologist to ensure that it is just cataracts affecting the vision and that your eye does not have other risk factors.

Ask your doctor why you can not see?

 Just because you have the cataract, does not automatically means you immediately require surgery. Mostly it is because of  the poor  vision due to  cataract that people decide to have the surgery. Sometimes there are other  reasons for poor vision, which can only be  determined by your doctor . You should discuss with your doctor, the extent to which your vision is compromised due to cataract, in the affected eye and with both the eyes open . You should also discuss the  likely visual gain after cataract surgery in these situations.
An important reason for people to be unsatisfied with the surgical outcome is the lack of significant improvement in vision after surgery. You should also discuss what exactly is the room for improvement in your vision after surgery, in the affected eye and with both the eyes open.

is cataract surgery is safe

George Corrent, MD PhD Ophthalmology & Neurophysiology, Washington Univ/BPEI (1989)

In reply to question ” Is cataract surgery safe?” on Quora.com.

My concern in answering is: how truthful do I want to /need to be? Should I “soften” my answer? If I just answer directly without any further explanation, will I frighten people who “need” cataract surgery? Hell, some people are frightened enough about having anything done to their eyes, without reading something like this. Oh, What to do, what to do?

 

So, Yes. The answer is yes. Cataract surgery is quite safe. Is it perfectly safe? No. No surgery or medical treatment is “perfectly safe”. People (some people, not many) do have complications during or following cataract surgery.

 

Most patients, the vast majority, have successful, “uncomplicated” cataract surgery with improved vision. The percentage of serious complications (infections, bleeding, inflammation, swelling of the cornea or clinically significant macula edema {cystoid macular edema, CME}) is quite low. Endophthalmitis- infection inside the eye- occurs in only 1/1000 to 1/2000 patients, and even more than half of those patients regain good-useful vision (but not perfect vision). Retinal detachment can occur after cataract surgery. The risk is higher in highly myopic eyes, and eyes that have a ruptured posterior capsule during surgery. Another rare complication is a “dropped lens” in which a part, or rarely most of the cataract, falls into the vitreous gel in the back of the eye. This can lead to inflammation in the eye and/or elevated pressure (glaucoma). Sometimes these pieces of lens material require a second surgery to remove them.

If you have macular degeneration, especially wet macular degeneration, the condition can worsen after cataract surgery, although studies conflict on whether this is a statistically significant increased risk. Patients with diabetes and diabetic retinopathy, even if it is mild, are at a higher risk for developing macular edema after cataract surgery. Patients with Fuch’s corneal dystrophy can have their corneas swell or decompensate after cataract surgery. There are other things that could very rarely happen: wound leaks, displaced lens implants, worsening of dry eyes, damage to the Iris, choroidal hemorrhage, etc.

So that’s my answer. But here’s the catch that I tell all my patients who have reached the point where they really need cataract surgery, but are afraid. “You will have to do it sooner or later, and now that you have reached the point that you really need it, by waiting longer, you are just procrastinating. And you are probably increasing your chances of a more difficult surgery by waiting after the cataract reaches a certain point. And you will just worry about it longer. So waiting longer doesn’t help.

Mahaveer Eye Hospital, studied at Pune, Maharashtra, India.

In reply to question ” What kind of IOLs are recommended for a cataract surgery?on Quora.com.

Cataract is an eye condition which is characterized by the blurry vision that is caused by the very slow opacification of the eye lens. The cause of such a discrepancy in the lens has been traced to multiple reasons. It could be congenital or it could result from the traumatic injury to the eye. Cataract could also be due to exposure to toxic environments like the UV rays or other radiation or because of corticosteroid drugs; while diabetes is also a cause! The cataracttreatment generally involves replacement of the opaque lens with the new clear synthetic lens that is called as the IOL or the intraocular lens. Leading specialist offering cataract surgery says that while most patients are ignorant about the IOL, the same is a vital factor in determining the effectiveness of the treatment and surgery also. Unless the IOL is properly chosen, the desirable results would never be obtained.

The choice of IOL depends actually upon various factors that are intrinsic to every patient and thus a custom decision needs to be maintained. Additionally, the cost also emerges as the factor in this choice, says the Pune specialist. He offered the following information on the relevant factors and types of IOL choice in an individual case.

1. The monofocal lens

Ideally, the single vision lens or the monofocal lens has aspheric design and offers correction either for the near vision or the distant vision. In most cases, these are used for the near vision. Thus, it derives that after the use of this type of IOL, post-surgery many people not require to wear glasses for distance vision but for the near vision! People with a larger pupil are considered as the candidates suitable for such single vision lens. Eye specialist recommends premium segment single vision lens only for a better glare free and clear vision.

2. The multifocal lens

Multifocal lenses, also known as the presbyopic lenses offer vision adjustments for near, intermediate and long distance. This means that the person post surgery need not wear glasses at all. These are costlier than monofocal lenses and could be implanted only in the healthy eyes. People with macular degeneration, glaucoma or dry eye condition are not candidates for these lenses. These lenses, however, generate glare and blurred vision in the dim light conditions. Accommodative multifocal lenses are the premium types that generate a crystal clear vision that is devoid of glare and dim light blurriness.

3. The toric lens

The toric lenses offer spherical and cylindrical functions and are suited to persons with astigmatism of more than 1.00 D. These lenses provide high-quality distance vision in patients post surgery.

4. The tinted lens

Normal and healthy human eyes have natural protection mechanism against harmful blue light and this is strengthened with age as the age-related macular degeneration increases. However, the clear IOL that is put in the eye post cataract surgery does not offer such protection to the person. Yellow tinted IOL are now available that offer such protection apart from reducing glare, cyaniposia, and choroidal melanoma.

What type of lens should be implanted ?

 

Indian Mono -focal foldable lens

Posterior chamber lens are commonly used, unless it is not possible to implant that lens in eye due to medical reasons. They rigid and fold-able. Fold-able lens are better. They are available by different brands, and place of manufacturing (Indian /imported). Often the imported lens are expensive. I could not find a single scientific report which says that visual gain after surgery has any relation with the brand or the place of manufacturing of lens.

Foldable lens versus non foldable (rigid) lens?

Foldable lenses are more popular and expensive that their non-foldable (rigid) counterparts if all other parameters are the same (design, brand, country of origin). There are only two scientific studies (one from Thailand, other from France ) which were designed to see the difference  in the vision and other outcomes after the surgery, among these type of lenses. Neither of the two studies reported any difference among the two.

Indian versus imported lenses

In the eighties and nineties, when ophthalmologist began to switch to lens implantation (rather than leaving the eye without the lens and giving the patient thick glasses). At that time the lens needed to be imported from the US and Europe, as there were no lens manufacturers in India. Though the imported lenses were of good quality but were very expensive. In nineties some Indian companies started manufacturing lenses in India. The lens manufactured were quite cheap, but the quality was not as good as those of the imported once.

Now days there are many Indian companies who are manufacturing the lenses in India, and also exporting it to many other countries, which include the US and Europe. Since they have to meet stringent FDA and EC guidelines for that, overall quality of lens manufacturers in India matches with any of the manufacturers from abroad.

So in my view, it as far as the  quality  of the comparable lens (similar lens material and design) is concerned, there is no difference.  The imported Lens usually cost 3 to 5 times as much as an Indian lens. Various government bodies are raising concern of this pricing of the lens in India. Quite likely, we may have some government regulation on price control of lens, in day to come.

Imported: Alcon, AMO, Zeiss, Bausch & Lomb, Hoya.

Indian companies: Appasamy, Omni, Aurolabs, Biotech, Care,

Monofocal and a multifocal lens

 Another critical issue is to decide between monofocal and a multifocal lens. The latter is supposed to provide functional vision for both near and distance, but the lens is expensive. But that does not guarantee spectacle free life after the surgery. Some cases may still need glasses for a specific type of task, even after uneventful cataract surgery with a multi-focal lens. Moreover, it is associated with a particular kind of vision-related complications like glare and reduced contrast of images. An article by Dr. Evans appropriately explain the pros and cons. If you want to know more, there are many good scientific publications on this issue. Discussion with your doctor is the best way out. If you are still in doubt, gamble on the mono-focal lens.

Por Yong Ming, Ophthalmologist

In reply to question ” What is it like having premium IOLs that correct for near vision after cataract surgery?”on Quora.com

There are several different types of IOLs that give multifocality and good near vision as well as distance vision. I will base my answer on the most commonly used lenses-the diffractive multifocal lenses like the Alcon Restor and the Tecnis Multifocal.

These diffractive multifocal lenses have rings etched onto either their front or back surfaces, which split/diffract incoming light rays into two foci. Some newer ones can even split the light into 3 foci. This fact gives rise to several implications.

1. Vision will be clear mainly at 2 (or sometimes 3) distances. For the older +4 Restor and the Tecnis multifocal, the near focus is at about 1 foot. So reading material has to be held quite close. If it is held further away (say at 3 feet or so-intermediate distance), then it is not so clear anymore. Then things much farther away, say 15-20 feet away, start to become pretty clear again. Note: This is only the case if the surgeon has been very accurate in calculating the lens power/biometry.

2. Because of the light splitting, there is a drop in contrast compared with a monofocal lens. Patients with multifocal lenses tend to be more sensitive to low light conditions-ie when it starts to get a little dark, they start to feel the drop in vision faster than patients with monofocal lenses. A person with a monofocal lens and reading glasses could read in dimmer conditions than a person with a multifocal lens.

3. The rings on the IOL give rings of light (halos) around light sources. This can be an issue when driving at night because of the halos around car headlamps. Having said this, many patients get used to the halos and do not notice it as much after a time.

The above of course does not completely apply to the Crystalens or the Oculentis MPlus. The Crystalens is an accommodative lens, which gives somewhat unpredictable results-some patients don’t get any near effect at all. The MPlus (available in Europe/Asia) has a wedged shaped section on the lens to focus for near. Point 1 above applies to this lens as well. However, although this lens does not give rings around lights, it can still cause ‘halos’ of a different shape-it is more like a smearing effect in one direction. Occasionally if a patient’s pupil is small and not aligned with the lens, the patient may only have a far focus or a near focus and not both.

…@http://eyesurgerysingapore.blogs…

Mitul Mehta, Vitreoretinal (eye) surgeon

In reply to question ” What is it like having premium IOLs that correct for near vision after cataract surgery?”on Quora.com

It depends on the problem the patient has.

Often times there is something called refractive surprise, where the lens calculations were not accurate (usually despite the surgeon doing everything right) and the patient ends up having to wear glasses or contacts. In these patients typically I will repeat the lens calculations with an IOL master or LENStar machine, and corneal topography. I will re-measure the length of the eye as well.

An OCT scan is also done to make sure there is no swelling of the retina.

Of course the eye is examined thoroughly and sometimes there is no clear view and an ultrasound (B-scan) is performed as  well.

Specific circumstances can necessitate other tests.

What type of surgery should you have ?

Phaco-emulsification with posterior chamber lens implantation, commonly known as Phaco.

The most common surgical method for age-related cataract is Phaco-emulsification with posterior chamber lens implantation, commonly known as Phaco. It’s neither required nor possible in every patient. Certain conditions in a given patient may need other surgical methods. You should discuss with your doctor which surgery is best in your situation. You should never insist on a particular type of surgery with your doctor.

Robotic/Laser assisted cataract surgery

It’s a new technique in which some critical surgical steps are done using high precision laser. Other steps are common between laser assisted and traditional method. The downside is that it is more expensive that traditional method. The available scientific evidence by researchers (Popovic M, Day AC) does not document any significant difference in the visual outcome after either of these techniques ( Robotic/conventional Phaco ). 

AME DAY CATARACT SURGERY

Most of the hospitals offers the option of “same day surgery”.

It basically means that you get operated on the day you go for an consultation for the surgery. It offers and advantage to those patients who know that they have cataract and have made their mind to get operated.

Patients walks into the clinic /hospital and is operated ( often discharged ) on the same day of the surgery.

Patient comes for a follow-up visit on a scheduled data later on.

SAME DAT CATARACT SURGERY

If you have cataracts in both eyes, surgery typically is performed on one eye, and then a few days or a few weeks later, it’s performed on the second eye.

This approach allows the first eye to recover and your vision in that eye to stabilize before surgery is performed on the fellow eye.

That said, modern cataract surgery is very safe and effective, and the rate of cataract complications is very low. This has led to some surgeons to begin offering simultaneous (or sequential) bilateral cataract surgery (SBCS) — in other words, cataract surgery performed on both eyes on the same day.

Many cataract surgeons are reluctant to routinely perform cataract surgery on both eyes simultaneously.

The risk of eye infection and other serious complications from cataract surgery is very low. However, if both eyes were to become infected or experience other serious complications at the same time, the results could be visually devastating for a period of time and perhaps even permanently.

Win Marsh, Self-employed in anesthesia.

In reply to question “Why is my vision still hazy after cataract surgery?” on Quora.com

For a cataract extraction and inter ocular lens placement, there are various ways to nb the eye.

Often, numbing drops are placed in the eye. That numbs the eye so that pain cannot be felt. You might feel touch and a little pressure, but no pain.

Sometimes, an anesthetic block is placed. To do that, you are given medicine in an IV to have you go to sleep for 4–5 minutes. While you are asleep, numbing medicine is injected with a needle into the side space of your eye. It will numb your eye — very much like your mouth is numbed when a tooth is worked on.

Because people get stressed about their eye being worked on, it is typical to give a little bit of sedation through an IV whether the patient has eye drops or a block placed.

Most patients are surprised at how fast the procedure is and how little pain there is with it.

Anthony Lawson, MD Anesthesiology & Ambulatory Surgery Centers, University of Medicine and Dentistry of New Jersey (1999)

In reply to question ” Do they give anesthesia for cataract surgery? ” on Quora.com

Yes. The patient may have TOPICAL ANESTHESIA or a Retrobulbar/Peribulbar Block. IV Sedation may be administered. But if the patient has an illness that precludes them from staying still, General Anesthesia should be administered.

Nathaniel Hummel, ChFC, CLU, Studied on own and educatied by “Doc- Friends”

In reply to question ” Do they give anesthesia for cataract surgery? ” on Quora.com

Sven, these days cataract surgery, by a skilled ophthalmologist, (glad Quora corrects spelling, I always get “ophthalmologist” spelled incorrectly.) oh, anyway the first put a “numbing” solution in your eye so you really don’t feel anything. Then they make a small “Tri planar” incision (so the IOC, pressure in your eye will close it without any “stiches”) and put a small instrument in that sonically breaks up the cataract and “vacuums” it out. Again, no pain or sensation. The then, carefully, put a small “folded” new lens in and the natural fluids in your eye (or maybe that add some, I don’t recall) then “inflates” the new lens and it’s positioned in and held there by some tiny, what I call attachments, that keep it there.) The put a “protective patch/shield” on your eye and you usually go in the next day, they remove it and you can see pretty well, and then they probably tell you to only wear the “patch-shield” at night and to avoid any activities around your eye, and in my case and I assume most others, one then comes in again in about a week later and they examine your eyes again to make sure all is OK, and then no patch, normal activities and you’ve “got” an eye that sees well and you can’t tell anything is in your eye, and all is well with the world and you.

Disclaimer… This was my experience, which I thought was fairly “easy” and not my advice… as, again as posted earlier in other Quora stuff, I am not a doctor, “I only play one on TV.) [ again, just an expression so don’t look for me on TV ]

John Ruchak, IT professional with more than 25 years experience.

In reply to the question “What is the recovery process for a cataract surgery?”on Quora.com

I just had cataract surgery 4 weeks ago, today. My doctor gave me no restrictions post-op except no driving the day of surgery and no swimming for a week. Showers were OK as long as care was taken not to get soap and water in the operated eye. He said, otherwise, I could resume normal activities as I felt able, even immediately after surgery – lift, bend, run, jump, whatever.

Oh, no rubbing the eye!

The doctor gave me a clear plastic shield to wear over the eye while sleeping to prevent any accidental rubbing. I had to sleep with the shield for a week, but did not wear it during the day, not even immediately after surgery.

I had steroid and antibiotic eyedrops to use for a little while. The antibiotic was for a week, the steroid for 3 weeks.

I had light sensitivity until the second day after surgery – my wife said she could see that my eye was still dilated. I could also see it in the mirror.

My eye watered a lot more than usual and I had a mild sensation of something in my eye through the day following surgery. It was feeling normal by the 3rd day.

For the first two weeks, vision was “adjusting” – it wasn’t bad, but I could see better some times than other times. Even at its worst, though, it was orders of magnitude better than before surgery. Doctor said the variations in clarity are normal and could continue for about a month while the eye healed. As long as I wasn’t seeing floaters, dark spots, or flashes of light (all symptoms of a detached retina), or experiencing pain (possible infection or other complication), it was nothing to worry about.

Pre-surgery, the best possible correction (with glasses) we could get gave me 20/60 vision. I had “corrective lenses” and “daytime only” restrictions on my driver license. Now, un-corrected, I’m 20/25 and only need reading glasses for computer work or reading. I went and re-took the driving vision test. The restrictions on my license have been removed.

The doctor officially released me back to work on the 8th day after surgery, but I took a few days of vacation time to get used to my new sight and “dial in” the right strength of reading glasses for different situations. For example, I find +1.5 good for using a laptop computer on my lap. +2.5 is great for my desktop computer work. And +3.0 is perfect for reading fine print or using my phone. It just took some experimentation with various strengths. Fortunately, reading glasses are inexpensive, and you can do the experimentation and “dialing in” with readers from a dollar store before buying nicer / more comfortable / more stylish pairs.

If I could find +2.75 readers in a style I like, I could just use them instead of the separate 2.5 and 3.0 ones.

Anyway, having cataract surgery changed my life and is on the short-list for one of the best things I’ve ever done.

John Nakulski, M.B.A. Technology & Technology Management

In reply to the question “What is the recovery process for a cataract surgery?”on Quora.com

After cataract surgery, the recovery process is generally painless but there are many steps that you need to take. Before you leave the surgery or hospital, you will be given full instructions on how to help ensure a successful recovery. Your instructions are likely to include the following:

Ask a friend

  • Anesthesia recovery. During your recovery from the anesthetic, you may be asked to stay where staff, or your friend or family member, can observe you.
  • Don’t drive. Bring someone with you to take you home after surgery. Don’t try to drive until after the post-surgical consultation with your eye doctor, which will generally be the next day. At this point, your eye doctor will test your vision before giving you the OK to drive.
  • Avoid strain. No heavy lifting or strenuous activity for one week. Moreover, don’t exercise and be careful while bending to avoid stress on your healing eye.

This is definitely the time to ask your family and friends for help.

Protect your eyes

  • Eye shield. For about one week, you’ll use an eye shield to help protect your eyes while you sleep or take a nap.
  • Sun glasses. For protection against sunlight and strong indoor lighting, you’ll wear a pair of special post-operative sun glasses.
  • Avoid water. Water can increase the risk of infection. Therefore, shut your eye while bathing or showering during the first week. Avoid swimming pools and hot tubs for two weeks.
  • Keep it clean. Avoid dust, dirt and contaminants. This is your excuse to delay the gardening and cleaning, or ask the children for help.

If you’re an active person like the famous painter Claude Monet, you’re likely to become frustrated during recovery. Give yourself the time and space to allow your eyes to fully heal.

Cataracts effected Monet’s ability to paint colours and provoked depression

Prescriptions

  • Eye drops. For several weeks, you’ll use prescription eye drops, a few times each day.
  • Redness and blurry vision might be experienced for a few days or even a few weeks.
  • Wear glasses. You may need a new prescription or, in some cases, none at all. Your eye doctor may suggest you wear progressive lenses after surgery to get the best possible vision over all distances. Even if you don’t need lenses, you may wear glasses for additional protection.

George Corrent, MD PhD Ophthalmology & Neurophysiology, Washington Univ/BPEI (1989)

 

In reply to question “Can cataract surgery have side effects?” on Quora.com

Well, yeah. ANY Surgery has the risk of some negative outcomes. The thing is, one should always try to balance the risks against the projected benefits. So the risks of loss of vision after cataract surgery are:

  1. Endophthalmitis: Usually bacterial infection of the interior of the eye. Sterile endophthalmitis does occur, but is rarely as devastating. The risk runs from about 0.1% to 0.03% depending on the study, the population being studied, the surgeons, and the use of antibiotic prophylaxis. Corrected visual acuity of 20/200 or less is a result in about 30–40% of cases. About 50% of cases will recover to 20/40 or better[1].
  2. CME (cystoid macular edema): older studies show a high incidence (30–40%)[2]of angiographic CME. Many of these patients do not notice that their vision is affected by the swelling, and the fluid goes away without additional treatment. Other forms of CME following cataract surgery (associated with diabetes and diabetic macualr edema, or with inflammation/uveitis-iritis) can have more deleterious and long lasting effects on vision.
  3. Vitreous loss: If the posterior capsule is ruptured during surgery, there is a high chance that the posterior vitreous will prolapse, necessitating additional surgery (vitrectomy). This usually necessitates and change in the planned lens implant, and increases the risks of endophthalmitis, CME, inflammation, and retinal detachment.
  4. Retinal detachment: Risk is about 1.5% in the year following cataract surgery.[3] Remember, in this age group, there is a risk of retinal detachment even in patients who have not had cataract surgery, but the risk after cataract surgery in increased slightly.
  5. Corneal edema/corneal decompensation: The US Food and Drug Administration (FDA) premarket approval studies for intraocular lenses performed from 1978-1982 found an incidence of postoperative corneal edema of 0.06% for posterior chamber lenses, 1.2% for anterior chamber lenses, and 1.5% for iris fixated lenses.[4]

Certain styles of intraocular lenses introduced in the mid 1980s were reported to have an incidence as high as 5% (eg, Leiske and Hessburg closed loop anterior chamber intraocular lenses, ORC Stableflex, Azar model 91Z). Those lenses are no longer in use.

Pseudophakic corneal edema is a much smaller problem today than it was even 10–15 years ago due to a better understanding of the causes, and better technology including better viscoelastics and phaco-dynamics.

6. Choroidal or Expulsive hemorrhage: Can be a devastating complication if it occurs during cataract surgery, but is quite rare (incidence is given as 0.05% but I would say it’s much rarer rare in patients who do not have the risk factors -high myopia, atherosclerosis and HTN, poorly controlled glaucoma).

7) Retained lens particles, post-operative intraocular pressure rises, iris damage, post-operative wound leaks, are all usually temporary and fixable problems.

Footnotes

[1] https://www.healio.com/ophthalmo…

[2] Pseudophakic Cystoid Macular Edema

[3] Digital Journal of Ophthalmology

[4] Postoperative Corneal Edema

First of all ask your doctor. It could be lots of things (since you haven’t really given any information), but here’s a few common things.

  1. Refractive Error. While one of the goals of cataract surgery is to get you seeing well without having to wear glasses, that isn’t always the case. Often there will be some leftover nearsightedness, farsightedness, or astigmatism that could be causing the blur.
  2. Corneal Edema. If there’s swelling then light won’t focus like it needs to. The causes range from benign to pretty severe, but your doctor will be able to tell you that part.
  3. Intraocular Inflammation. Most patients will have “normal” inflammation that goes away pretty quickly and doesn’t really cause many symptoms (remember it’s normal to have inflammation following trauma…even voluntary trauma such as surgery). Abnormal inflammation can be from retained lens material or from an infection (drops are important!).
  4. Posterior Capsule Opacification. During surgery the cataract was replaced with an artificial intraocular lens (IOL). The lens is located within a very thin membrane ‘bag’ called the capsule. The front of the capsule must be opened to remove and insert the lenses. The back (posterior) of the bag (capsule) remains intact to support the new lens. In some patients the outer cells of the old lens remain, and grow on the capsule. This causes the capsule to become hazy (opacification), which results in blurred vision.
  5. Macular Edema. Doesn’t happen very often, but definitely possible after cataract surgery.
  6. Something else. I don’t know if it’s one day after or 1 year. I don’t know if there’s pain involved. Maybe you have diabetes or macular degeneration. Maybe it’s just dryness. But keep in mind, while not every surgery is perfect, some patients have way too high expectations and want to see 20/15 after surgery.. without glasses. And that’s really not realistic.

Long story short, ask your doctor. They should be seeing you pretty frequently after surgery.

Price cap may not benefit cataract patients

The Maharashtra government submitted a report recently to the Union health ministry to cap the prices of 18 medical devices that includes intra-ocular lenses (IOL).

Matthew Aldrich, Optometrist

In reply to question “Why is my vision still hazy after cataract surgery?” on Quora.com

18 lose vision after botched cataract operation

 

Price cap may not benefit cataract patients

The Maharashtra government submitted a report recently to the Union health ministry to cap the prices of 18 medical devices that includes intra-ocular lenses (IOL).

Cost of cataract surgery in India.

Researchers analyzed data on a sample of the 10,954 patients who visited Aravind’s facilities in the city of Madurai during July 2013 and found that total costs per operation were, on average, only U.S. $120, or $195 per quality-adjusted life-year gained.

Inappropriate cataract surgery: is it a myth or reality ?

There have been media reports in which the doctors and the hospitals have been accused of performing cataract surgeries when these are not actually required. The question is, are these really fake news or are actually happening?

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