Cataract surgery

A Patient's Perspective

Introduction
When the normally clear lens within the eye becomes cloudy and opaque it is called a cataract. Cataracts vary from extremely small areas of cloudiness to large opaque areas that cause a noticeable loss of vision. One method to treat cataracts is surgical removal with the use of ultrasound and intraocular lens implantation.

Many people preparing to have cataract surgery may be as apprehensive as I was when told that the procedure would be done under local anesthesia. While I could accept having a cyst removed from my face or finger under "local," I found it intimidating to be conscious during eye surgery. Despite being told by my primary eye care doctor and Dr. Shingleton that the surgery was short, painless and that I wouldn't see instruments or anything alarming---I was apprehensive. I wanted reassurance from another patient, so I asked my doctor to put me in touch with one of his past patients. The patient reassured me that the surgery would be as the doctors described. Therefore, to put everyone who is contemplating this procedure at ease, I have documented my cataract surgery experience.

Pre-operative Visit with Surgeon
At some point, a person with a cataract is told that cataract removal is required to improve vision. If the patient agrees, an eye examination is scheduled with a cataract surgeon, and, in my case, this was Dr. Shingleton. Dr. Shingleton confirmed that the cataract should be removed and determined the specifications of the intraocular lens to be implanted. Information about the surgery was provided and all my questions were answered. Surgery was scheduled with Dr. Shingleton's surgical coordinator. The date and time were determined by my sense of urgency and Dr. Shingleton's schedule. Most patients are accommodated within 4-6 weeks.

The Day of Surgery
Cataract surgery with Dr. Shingleton at the Boston Eye Surgery & Laser Center or the Cape Cod Eye Surgery and Laser Center  is a 3-step procedure which takes approximately 2 � hours.

1. Preparation - More data is gathered, an identification bracelet is attached and eye drops are administered for various purposes including dilating the pupil and anesthetizing the eye. Intravenous is started for safety purposes.

2. Surgery �My surgery suite had a large, cheery pastoral scene covering an entire wall---hardly a bleak, unfriendly environment!

   You are moved to a surgical chair and reclined to a comfortable position. The skin surrounding the eye is sterilized with a solution. It is then covered with what appeared to be a light gray piece of translucent plastic material with a hole around the eye. The junction of the sterile material with the hole over the eye is adhered to the face with medical tape. The plastic drape allows light in and is lifted away from your nose and mouth so that you can breathe easily and don't feel confined. The rest of the body is covered with a warm blanket.

   At this point you are ready for surgery. Dr. Shingleton greets and reassures you. He explains what you will experience. The anesthesia has made the area totally numb and the eyelids are held open with a lid holder. Throughout the 10-minute procedure you will see a broad bright light which is not uncomfortable (I saw three rather small blue lights). While conversation is minimal, you can ask questions and the doctor may ask you to "look up" or "look down" to reposition the eyeball a little differently. Some anesthesia does not allow mobility of the eye. In either case, an ultrasound/vacuum instrument removes the cloudy lens and the artificial intraocular lens is inserted. There is no pain or discomfort during the procedure.

   One of the things that fascinated me was how Dr. Shingleton inserted the �" diameter lens through a 1/8" opening. When my surgery was complete, Dr. Shingleton showed me the tool he used to insert the intraocular lens. It folds the lens into a "taco shape" and then the lens unfolds in the eye. This is often done without any stitches.

3. Recovery -- This phase lasts 30 to 45 minutes. The heart, lungs and blood pressure continue to be monitored. You are brought coffee, tea or juice and a muffin or cookie. If a friend or relative joined you, they can visit you in the recovery area. 

   There is one added, interesting feature in the waiting room. If someone accompanies you to surgery, they can watch your operation on a TV monitor in a sectioned off portion of the waiting room. There is no blood and it is not difficult to watch. On the 18" screen you see a 9" diameter eyeball and the various steps taking place. My wife declined to watch, but I watched several cases after mine. When I am at the Surgery Center for another medical checkup next year, I am actually planning to watch a procedure again!

1. Three different drops are placed in the eye four to six times a day for the first week, three to four times a day for the second week, two times a week for the third week, and once a day for the fourth week. The surgical facility provided samples and prescriptions for refills.
2. A. A shield is worn over the operated right eye for the first night while sleeping.
   B. Bending, kneeling and squatting are permissible.
   C. Lifting of normal weights can be done with full activity at two weeks following surgery.
   D. If there is minor discomfort in the eye, Tylenol may be taken. I took one tab on the first night because of a little scratchiness.
   E. The doctor said I could drive a car 24-hours after surgery. This decision obviously depends on the condition of the fellow eye.
   F. Showers can be taken immediately and your hair can be washed. It is important to cover to keep it dry. No restrictions in terms of water contact are present after three weeks.
   G. Swimming in a pool is not recommended until two weeks after surgery.
   H. Healing is complete at 4 weeks and all activity can be resumed at this time.
3. I consider the vision in my operative eye NORMAL for all intents and purposes, however, I do notice some light sensitivity when looking at a reasonably bright light. This is not a problem when using both eyes. Also, there is a difference in color appreciation between the two eyes. The operated eye sees brighter.
4. The need for new glasses depends on how quickly the eye stabilizes after surgery as measured by refraction. In my case, there was no effective change in prescription and no glasses were required. It should be noted that if a patient is over 65 and on Medicare, 80% of the cost of the lenses and new frames are covered by that insurance. The optician will fill out the necessary forms.
5. Surgery and anesthesia can affect blood counts for up to one week. I have adult onset diabetes type II and my sugar count increased for six days.

NOTE FROM DR. SHINGLETON
I thank Mr. Trethaway and all other patients who reviewed his text and added their comments. I hope this will make you feel more comfortable about your cataract surgery experience.