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Cataract Surgery
Introduction
Dr. Shingleton's cataract surgery technique uses a tiny, sophisticated "phacoemulsification"
instrument to dissolve the hazy cataract lens within the eye and replace it with
a clear, artificial lens. This technique is called "small incision phacoemulsification
with intraocular lens implantation." A typical procedure is performed as follows:
- Anesthesia is achieved with eye drops and/or a small, painless injection near
the eye.
- A small incision (approximately 1/8") is made in the eye.
- The hazy cataract lens is gently dissolved by the tiny phacoemulsification
instrument, with high frequency ultrasound waves.
- The new, clear, artificial lens is folded and inserted through the small
incision and placed in the same position as the natural lens of the eye.
- No stitches are required but can be used if advantageous for a particular
patient. Often no patch is needed, but a tape and a shield may be placed
over the eye for several hours.
Surgery is performed on an outpatient basis and often takes less than 10 minutes.
Family members may watch the surgery via television monitors in the waiting area.
Dr. Shingleton's technique results in a rapid recovery allowing many patients
to return to near-normal activity the next day.
To receive more information about cataract surgery by mail, click here
.
Who Can Have Cataract Surgery?
Almost everyone with a visually significant cataract who is hampered in his
or her daily activities can undergo small incision phacoemulsification cataract
surgery with intraocular lens implantation with Dr. Shingleton. Age is not a
limiting factor, and general medical issues, such as diabetes, are rarely a
problem because surgery is quick, safe and performed on an outpatient basis.
Dr. Shingleton sees many patients with glaucoma and the vast majority of these
patients can also undergo cataract surgery with lens implantation.
If you are interested in determining if you, or a family member or friend
are a candidate for cataract surgery, use our Online
Cataract Surgery Evaluation or call 800-635-0489 or 617-314-2612
to schedule an appointment with Dr. Shingleton's clinical team.
Dr. Shingleton's Surgical Team
Dr. Shingleton has been teaching cataract surgery techniques for over 25 years.
Ophthalmologists travel from around the world to learn his technique of small
incision phacoemulsification cataract surgery with intraocular lens implantation.
He is supported by a superb team of optometrists, fellows-in-ophthalmology,
board certified anesthesiologists, nurse anesthetists, nurses, and ophthalmic
and surgical technicians.
Dr. Shingleton's Cataract Surgery Results
Cataract surgery results for Dr. Shingleton are almost overwhelmingly successful.
Dr. Shingleton has more up-to-date information on the cumulative results of
his surgery than almost any other ophthalmologist in the country. He has developed
one of the largest cataract surgery computer database files for an individual
surgeon. This database file now comprises over 15,000 surgical procedures. Highlights
are listed below.
Vision Improvement
A significant improvement in vision after surgery is reported by 95% of Dr.
Shingleton's patients. This is particularly impressive given the referral nature
of Dr. Shingleton's practice. Many complicated cataract cases are referred to
Dr. Shingleton and his overall results include these challenging cases, as well
as his routine procedures.
Capsule Tears
Posterior capsule tears can occur during cataract surgery. Published reports
often cite an incidence of 2.0% - 5.0% as acceptable. In a recent review
of over 400 eyes, Dr. Shingleton's rate of posterior capsule tears was <
0.25%, (less than one quarter of one percent).
Infection
Infection is a potentially serious complication of any surgical procedure.
Published reviews of eye infection (endophthalmitis) after cataract surgery
in the United States often cite an incidence of one per thousand or higher.
Dr. Shingleton's rate of endophthalmitis is significantly less.
You should know the surgical results of your cataract surgeon! Be sure
to ask! Dr. Shingleton is proud of his exemplary results and is pleased
to review them with you. For a list of additional questions to ask your cataract
surgeon, please click HERE .
Your Cataract Surgery Consultation
Preparing for your consultation
Please bring your current glasses and/or contacts to your examination.
Please complete and bring the patient registration form and medical history
form that will be mailed to you prior to your appointment.
Your eyes will be dilated during the examination. Therefore, bring sunglasses
or someone to assist you if you will be driving home after the examination.
Your consultation
Specially trained technicians and optometrists who are part of Dr. Shingleton's
team will perform a complete history and eye examination.
Microscopic measurement of the shape of your cornea (keratometry) will be
performed and supported by corneal topography, if needed.
A precise measurement of the length of your eye will be taken by ultrasound
and state-of-the-art IOLMaster techniques. .
Dr. Shingleton will review all tests, examine your eyes and determine if
cataract surgery is indicated. He will review all the findings with you and
answer any questions you may have.
The entire examination is painless and takes two to three hours.
Scheduling your cataract surgery
Dr. Shingleton's surgical coordinator will schedule your cataract surgery
and postoperative office examinations. All patients are provided a cataract
surgery information packet.
Dr. Shingleton works closely with many eye specialists in this country and
abroad to provide cataract surgical care. For most patients, Dr. Shingleton
and his team also provide postoperative care. For some patients, a portion of
follow-up care is provided by your primary eye care doctor to maximize convenience
for the patient. For certain patients of doctors who work regularly with Dr.
Shingleton, your local eye doctor will provide all preoperative and postoperative
care. For all patients , Dr. Shingleton does the entire cataract
surgical procedure.
Our goal is to provide you with the safest, highest quality and most convenient
cataract surgery. We strive to consolidate your care in your local area and
make your cataract surgery comfortable and convenient.
Your Cataract Surgery
Preparing for surgery
Eye drops are prescribed for use starting approximately 3 days prior to surgery.
Our staff provides you with the time approximate of surgery about a week
prior to surgery.
Consent forms and medical evaluation forms are completed prior to arrival
at the surgery center.
Patients should plan to spend approximately 4 hours at the surgery center.
Your cataract surgery
Surgical nurses and board certified anesthesiologists prepare you and your
eye for surgery.
In the operating room you will be on a comfortable, reclining stretcher bed.
After the eye is anesthetized it is cleaned and prepared for surgery in a
sterile manner.
Dr. Shingleton performs your surgery utilizing a microscope. Your family
and friends may watch the surgery via TV monitors in the waiting area.
After surgery, you will go to the recovery area where you will rest for 15-30
minutes enjoying a snack and coffee or tea. Family members can join you.
A nurse will review all postoperative instructions and you are given a medical
care kit for use at home.
After surgery, a friend or relative must assist you to your home or hotel
where you should relax quietly for the remainder of the day. Most patients feel
well and may go out for dinner, however, please devote the entire day to the
appropriate care of your eye.
No appointments or business meetings should be planned. After your cataract surgery
Depending on your anesthesia, you may not need an eye patch or you may require
tape and a shield for several hours.
A metal shield without a patch is used at bedtime for the first night. A
list of postoperative instructions is reviewed with you prior to your departure
from the surgery center.
Most patients experience little or no pain after their procedure, although
some patients experience low to moderate discomfort.
You will be seen for a postoperative checkup the day after your surgery.
Patients usually note improved vision, but there may be some blurring depending
on your particular cataract and eye situation. Your best vision is usually obtained
2 to 4 weeks after surgery.
A follow-up visit will be scheduled and postoperative instructions are
reviewed. Eye drops are typically used on a tapering schedule for approximately four weeks
postoperatively.
Routine activities may be resumed the day after
surgery including bending, lifting, stooping, driving (depending on your vision),
flying, golf, tennis, jogging, shopping and carrying bags. No mascara is allowed
for one week and no swimming for two weeks.
Possible side-effects and complications of cataract surgery
As with any type of surgery, complications are possible. Every effort is made
to minimize risk, but serious or long-term complications can never be fully
eliminated. No list of complications can be complete and a medical and surgical
procedure has potential risks, both foreseen and unforeseen. Each patient
is different in this regard and you should review any questions you have about
your particular situation with Dr. Shingleton's team.
Our goal is to provide patients with the safest and most successful cataract
surgery possible. The majority of our patients enjoy improvement of their
vision following cataract surgery with Dr. Shingleton. Please click if you
would like to schedule an appointment or receive
additional information about Dr. Shingleton's practice.
Medications
- HOW DO I TAKE MY PRE-OP EYE MEDICATIONS?
Antibiotic and anti-inflammation drops are used by most patients beginning
three days prior to surgery. Drops are taken four times each day. Eye make-up
(particularly eyeliner and mascara) should be stopped three days prior to
surgery.
- HOW DO I TAKE MY POST-OP EYE MEDICATIONS?
This varies among patients. You will receive specific written instructions
on the day of surgery, as well as samples, medication prescriptions and
a post-op kit.
- IF I TAKE ASPIRIN, DO I NEED TO STOP BEFORE MY SURGERY? IF SO, WHEN?
Generally, aspirin does not need to be stopped prior to surgery.
If you are asked to stop aspirin, this should be done 10 days prior
to surgery.
- WHEN DO I RESUME MY ASPIRIN AFTER SURGERY?
If aspirin is stopped preoperatively, it can generally be resumed
the day after surgery. Please confirm with the doctor on your first
post-operative visit.
- IF I TAKE COUMADIN, DO I NEED TO STOP BEFORE MY SURGERY? IF SO, WHEN?
Coumadin does not generally need to be stopped prior to cataract surgery,
but may be stopped prior to certain other surgeries. Check with Dr. Shingleton's
staff for recommendations regarding your particular situation. Your medical
doctor should determine the date to stop coumadin if cessation is required.
- WHEN DO I RESUME MY COUMADIN AFTER SURGERY?
If coumadin is stopped preoperatively, it can often be resumed the
day following surgery. Please confirm with the doctor on your first
post-operative visit.
- IF I AM USING EYE MEDICATIONS IN MY EYE TO BE OPERATED ON, DO I STOP
TAKING THEM?
Continue all eye medications up until the day before your surgery. Do
not use eye medications in the eye to be operated on the day of surgery.
Glaucoma patients undergoing cataract surgery who are on pilocarpine will
be asked to stop this medication approximately 7 days before surgery. Eye
drops for the fellow eye should be continued as usual.
- IF I AM TAKING MEDICATIONS FOR ANYTHING OTHER THAN MY EYES, DO I NEED
TO STOP THEM PRIOR TO MY SURGERY?
Use of most medications can be continued preoperatively.
- DO I TAKE ANY MEDICATION ON THE MORNING OF MY SURGERY?
Take all your usual systemic medications the morning of surgery with
a sip of water. Your medical doctor should direct insulin dosage.
Day of surgery
- WHAT TIME IS MY SURGERY?
Surgical starting times vary. Your arrival time for surgery could be
as early as 6:30 a.m. The day before surgery (Friday for Monday surgery,
Wednesday for Thursday surgery, or Thursday for Friday surgery) a nurse
from the Surgery Center will call you with your exact arrival time. If you
wish to call Dr. Shingleton's staff earlier during the week prior to surgery,
they will be able to give you an approximate arrival time.
- HOW LONG WILL I BE AT THE SURGERY CENTER THE DAY OF MY SURGERY?
Even though your operation itself may take less than 10 minutes, we
require extra time for proper preoperative and postoperative care. You should
plan to spend 3-4 hours at the Surgery Center. We are committed to providing
the finest surgical care. You should commit the full day to your surgery
and your recovery- all other activities should be postponed.
- ON THE DAY OF SURGERY, WHAT SHOULD I WEAR?
You should wear a loose shirt or a shirt that buttons in front. Do not
wear jewelry.
- WILL DR. SHINGLETON BE DOING MY CATARACT SURGERY?
Dr. Shingleton performs surgery on each and every patient. Surgical
technicians and board-eligible fellows in ophthalmology assist Dr. Shingleton
during surgery and visiting doctors from all around the world frequently
observe the surgery on TV monitors to learn from Dr. Shingleton. However,
all operations are done by Dr. Shingleton.
- WILL I HAVE PAIN WITH SURGERY?
No, eye surgery for the vast majority of Dr. Shingleton's patients is
pain-free. Most patients find the overall surgical experience to be pleasant.
- WILL STITCHES BE USED FOR MY SURGERY?
The vast majority of Dr. Shingleton's state-of-the-art cataract surgery
is accomplished without stitches. Certain types of cataracts are best treated
with the use of stitches and they are used when necessary. All glaucoma
surgery patients have stitches that dissolve by themselves.
- IS A LASER USED TO REMOVE MY CATARACT?
No. It is a misconception that a laser is used to remove cataracts.
Dr. Shingleton uses ultrasound (sound waves) -- the latest in cataract surgical
technology -- to gently dissolve the cataract and remove it from the eye
through a tiny incision.
A laser is occasionally used months or years after cataract surgery
to open the normal capsule of the eye that surrounds the implant. In about
25% of patients, this capsule gradually thickens through a normal healing
process and slightly blurs the vision. This slight blurring can be corrected
with a simple and painless laser procedure that takes only a few minutes.
- WHO HELPS WITH ANESTHESIA?
Board-certified anesthesiologists supervise your anesthesia. They have
some of the most extensive experience with eye surgery in the country. Your
surgery will be virtually pain-free.
- WILL MY FAMILY BE ABLE TO WATCH MY SURGERY?
Your surgery will be transmitted by television camera to a special viewing
area in the Surgery Center for your family to observe, if you and your family
desire. Videotapes of the surgery are not available.
Post-operative care
- WILL I BE WEARING A PATCH AFTER SURGERY?
Dr. Shingleton performs surgery for many patients using topical or light
block anesthesia. These patients do not require an eye patch after surgery,
but may have the eyelids taped closed for several hours to provide enhanced
protection. Patients who are best suited for other types of anesthesia may
require an eye patch for several hours. Occasionally patients require an
eye patch until they are seen the next day.
- WHEN WILL I BE SEEN FOLLOWING SURGERY?
All patients must be seen the day following surgery by Dr.
Shingleton, one of his associates or your referring doctor. This must be
incorporated into your schedule and transportation plans.
Patients scheduled to see Dr. Shingleton or one of his associates
the day after the surgery follow this schedule:
| SURGERY
|
POST-OP
APPOINTMENT |
| Day
|
Surgery Location
|
Day
|
Time
|
Office Location
|
| Monday |
Boston |
Tuesday |
7:30 - 3:00
PM |
Boston |
| Thursday |
Sandwich |
Friday |
8:00 - 3:00
PM |
Yarmouth |
| Friday |
Boston |
Saturday |
As scheduled
|
Boston |
| Saturday |
Boston |
Sunday |
As scheduled
|
Boston or MA Eye and
Ear Infirmary |
For patients seeing their referring doctor the day after surgery, your
appointment will be made by Dr. Shingleton's surgical coordinator. Dr. Shingleton
will personally speak with your doctor on the day of surgery after your
operation is completed.
For all patients, future appointments, with Dr. Shingleton, his associate
or your referring doctor, subsequent to your first post-operative visit
will be coordinated by Dr. Shingleton's surgical coordinator.
- WHAT SHOULD I BRING WITH ME TO MY POST-OPERATIVE VISITS?
Bring all medications, instruction sheets and supplies to every
post-operative visit. You will receive a convenient tote bag and medicine
kit at the Surgery Center. Bring all your surgery-related supplies and information
sheets in these bags to every visit.
- HOW LONG DO I HAVE TO WEAR A PROTECTIVE EYE SHIELD AFTER SURGERY?
You should wear your metal shield at bedtime the first night post operatively.
No eye pad should be used.
- WHEN WILL I SEE AFTER SURGERY?
It is remarkable how well many of Dr. Shingleton's cataract surgery
patients see immediately after surgery. You will experience your best vision
after cataract surgery 3-4 weeks post-operatively. Glaucoma surgery patients
need longer healing time before returning to maximum vision.
- WILL I REQUIRE GLASSES AFTER SURGERY?
Many of Dr. Shingleton's patients see very well and function well without
glasses. However, all patients must be prepared to wear glasses at certain
times for optimal vision. This applies to patients who receive multifocal
or monofocal intraocular lens implants. Visual needs vary greatly among
patients. As a result, Dr. Shingleton personalizes your surgery and strives
for the best surgical result to meet your needs and requirements.
- WILL I RECEIVE A MULTIFOCAL INTRAOCULAR LENS?
Dr. Shingleton has a great deal of expertise with multifocal lens implants
and uses them in patients well suited for them. For the right patient, multifocal
lenses can be a great success. However, there are limitations to their use
and potential visual "trade-offs" that must be appreciated by anyone receiving
multi-focal lenses. Dr. Shingleton's results with the newest FDA-approved
multifocal intraocular lenses, the ReSTOR and the ReZoom, are excellent. Dr. Shingleton will review the pros and cons of multifocal
lenses with you, if you are a suitable candidate. Do not hesitate to ask
Dr. Shingleton or any member of his staff about multifocal lenses and their
applicability to your situation.
- WILL I RECEIVE AN "ACCOMMODATING" INTRAOCULAR LENS?
Dr. Shingleton was one of the earliest ophthalmologists in the United
States to be trained in the implementation of accommodating intraocular
lenses. As with multifocal lenses, their applicability is limited, but may
represent a unique opportunity to certain patients. The Crystalens is the
only FDA-approved accommodating implant. Dr. Shingleton was the first
surgeon in Boston to be certified to implant it. His results with the
Crystalens are excellent. Do not hesitate to ask
Dr. Shingleton about the potential for the Crystalens accommodating implant
in your situation.
- WHEN CAN I RETURN TO WORK?
This varies among patients. Many patients return to work the following
day, although we often recommend the patient take a day off. Please ask
Dr. Shingleton or his associate on the day following your surgery for recommendations.
- WHAT TYPE OF PHYSICAL ACTIVITY AM I ALLOWED TO DO FOLLOWING MY SURGERY?
ALL PATIENTS
Most patients can return to 90% of activity the day after surgery. Of utmost
importance is to avoid physical trauma to the eye.
CATARACT PATIENTS
You may bend, stoop, lift, tie your shoe, shop, carry grocery bags, cook
and travel in cars, planes or trains. For 2 weeks, exercise should be
limited to low-impact activities such as treadmills, exercise bikes and
golf. No weight lifting, push-ups, sit-ups or swimming is permitted for
2 weeks.
GLAUCOMA PATIENTS
For 3 weeks, you should avoid strenuous physical activity or heavy lifting.
No swimming is permitted.
- WHEN AM I ALLOWED TO TAKE A SHOWER AND WASH MY HAIR?
You may shower and wash your hair the day following your surgery. Simply
hold a dry wash cloth over the operated eye to prevent water from contacting
the eye.
- CAN I WEAR EYE MAKE-UP AFTER MY SURGERY AND WHEN?
No eyeliner or mascara should be used for 1 week following surgery.
Other facial make-up is acceptable.
- WHEN CAN I DRIVE AFTER MY SURGERY?
Assuming vision is acceptable in your fellow eye, you may drive the
day following surgery.
If you have further questions, please call Dr. Shingleton's Boston office anytime
at 617-314-2614 or the Cape Cod office at 508-534-6082 anytime from 8:00 A.M.
- 5:00 P.M. After 5:00 P.M. and on weekends, please call 617-367-4800 and ask
to have the doctor-on-call paged.
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