Are You or someone you know having Cataract Surgery?
Here's everything you need to know!
Whether you are about to have cataract surgery or have been diagnosed with cataracts but
do not yet need surgery, or are just wondering if you have cataracts, this is the video for
you.
For those who are new to the channel, I’m Dr Audrey Tai, board-certified and fellowship
trained Cataract and refractive surgeon, ophthalmologist and cornea specialist, welcome to my channel
- eye Channel by eye surgeon.
I am here to bring you the latest information on eye health and medicine.
In today’s video, I will review what are cataracts, and when do you need cataract surgery,
as well as what to expect before, during and after cataract surgery, and the risks of surgery.
So what Are cataracts?
Cataracts are the aging changes that happen to the crystalline lens of our eyes.
If you imagine the eyes are built like a camera, The crystalline lens in our eyes functions
like the lens of a camera, it has refractive power to focus the light rays onto the retina
to form clear images, just like the film that's used in a conventional camera.
The crystalline lens is made mostly of water and proteins, when we are young, the lens
is transparent due to the orderly arrangement of the protein fibers in the lens, those proteins
are called crystallins.
As we age, the accumulation of oxidative stress causes cross-linking of the lens proteins,
resulting in progressive clouding and loss of transparency, as well as increased stiffness
of the lens, and this process eventually forms cataracts.
How do you know if you have Cataracts?
Because cataract formation results in the loss of transparency of our natural crystalline
lens, the most common symptoms of cataracts are blurry vision and increased glare with
bright lights.
Usually people notice a gradual decrease in the overall clarity of their vision over time,
which affects viewing things far away as well as up near.
For example, you may find yourself needing more and more light when reading a book, or
having a harder time seeing the road signs when driving.
The symptoms of increased glare are typically seen during night driving.
People with cataracts often notice progressive difficulty with nighttime driving, the bright
lights from oncoming traffic seem more and more blinding.
In people who have advanced cataracts, even regular sunlight can be very bothersome.
So if you notice those symptoms, you may be developing cataracts.
If you would like to learn more about how to prevent and delay the progression of cataracts,
you can check out this video: five tips to prevent cataracts.
Most of the time, when we think about cataracts, we think it is a disease that exclusively
affects elderly people, but that's not always the case.
Typically cataracts start developing around age 40, by age 80, more than 70% of people
develop visually significant cataracts.
By 2050, the number of people in the US with cataracts is expected to double, from 24.4
million to about 50 million.
it is true that the most common form of cataracts is age-related, but this is not to say that
people younger than 40 do not develop cataracts.
As a cataract surgeon, I have removed cataracts in people in their 20s, 30s, 40s and older.
So when do you need cataract surgery?
Ophthalmologists typically recommend cataract surgery when you notice that your vision is
blurry even with new glasses or contact lenses, or when you're having trouble seeing objects
clearly with regular day to day tasks like driving, reading, or playing sports, or if
you have trouble with night vision, for example starting to avoid nighttime driving due to
blurry vision or significant glare from oncoming headlights.
So if you notice any of those symptoms, I would recommend you get a full dilated eye
exam with a qualified eye doctor to evaluate the size of your cataracts and see if cataract
surgery is right for you.
And of course there are other eye diseases, such as macular degeneration, diabetic retinopathy
etc. that can cause blurred vision.
Therefore a regular full eye exam at least once a year is what I recommend for all of
my patients.
What should you expect before you have cataract surgery?
For all of my patients, before scheduling cataract surgery, I typically perform a full
dilated eye exam.
A full cataract surgery evaluation with me usually involves measuring the curvature and
length of the eye, a full eye exam with pupil dilation, and examining the health of the
optic nerve and retina inside of the eye.
Also the strength of your glasses prescription for both distance and near vision will be
recorded during the exam.
Contact lenses can temporarily change the eye curvature, and affect the accuracy of
the curvature of the eye measured during the exam.
This can affect the accuracy of the implant chosen for the eye, and can ultimately affect
the vision outcome after cataract surgery.
For this reason, I give each of my patients specific instructions regarding discontinuing
contact lens wear for a period of time prior their visit.
For people who wear regular soft contact lenses, I typically ask them to be out of contact
lenses for 5 to 7 days prior to the visit.
For toric soft contact lenses I require patients to be out of contact lenses for two weeks,
and for hard contact lenses I will give each of my patients a customized contact lens discontinuation
schedule.
This is why it is important to bring your current glasses and contact lens prescription
with you for your cataract evaluation visit.
It is also very important to bring your records with you if you have had any refractive surgery,
such as LASIK, PRK, radial keratotomy also known as RK surgery, or any other prior eye
surgeries.
Refractive surgery changes the shape of the eye, and this can affect the accuracy of the
measurements of your eye curvature, and affect your vision after cataract surgery.
Also, please do not forget to bring a list of all of the medications that you are taking
to your cataract evaluation visit as well.
After the examination and testing, if you are a candidate for cataract surgery, I will
go over the testing results and implant choices, surgical steps as well as surgical risks with
you before scheduling you for cataract surgery.
We will formulate an individualized surgical plan for you to fit your personal vision needs.
With the advanced technology available for cataract surgery nowadays, I offer my patients
femtosecond laser assisted cataract surgery, as well as conventional manual cataract surgery.
To learn more about the differences between laser assisted cataract surgery and conventional
surgery as well as the steps of cataract surgery, you can check out this video:
During cataract surgery the cloudy crystalline lens is removed, and a permanent lens implant
is placed in the eye.
I offer my patients advanced astigmatism correcting implants as well as presbyopia or reading
glasses correcting implants, in addition to basic monofocal implants.
To learn more about the differences between each type of implant, and to help you choose
which implant will work best for you, you can check out this video:
And if you are enjoying this video so far, don’t forget to hit the like button and
subscribe to my channel!
What should you expect on the day of cataract surgery?
In the US, Cataract surgery is typically done at an outpatient surgery center, and typically
only one eye is operated on at a time.
The second eye is operated on a different date a few weeks or a month after the first
eye surgery.
If you are having cataract surgery with me, I typically will prescribe you a combination
eye drop to start four times a day 2 days before the surgery, and you will continue
to use it for about one month after the surgery.
For cataract surgery, patients are typically given conscious sedation anesthesia; therefore
patients are required to have an empty stomach without food or drink for at least six hours
prior to the surgery time to avoid any complication from anesthesia.
On the day of the surgery, you'll come to the surgery Center and check in for your surgery.
Cataract surgery typically takes less than 15 minutes, and you will go home the same
day.
You will be in the surgery center for a few hours, including preoperative care and postoperative
recovery.
As I mentioned before, during the surgery, patients are typically not under general anesthesia.
You will receive IV or local sedatives but will not be completely asleep.
The surgery itself is painless.
You will be in a very relaxed state, but will still be able to follow directions such as
looking up and down.
Right after surgery, there will be a clear plastic shield placed over your eye to protect
it.
After surgery, nurses will give you postoperative instructions before going home.
And you will be instructed to keep the shield on overnight, and you can remove it in the
morning.
I usually instruct my patients to apply their first postoperative dose of the eyedrop about
four hours after surgery, and apply them two more times before bedtime that evening.
You can remove the shield in order to put in the eyedrops, but tape it back on right
after putting in the drops.
The plastic shield needs to be maintained over the surgical eye at all-time except when
putting eyedrops in for the first 24 hours after surgery.
For my patients, I always emphasize that when you hold back your eyelid to put in eyedrops,
it is very important not to push on the eyeball, instead you can lean back on a reclining chair
or in your bed to provide your head with support, so you can squeeze the eye drop bottle, and
let the eyedrops fall into the eye with gravity, without touching or putting any pressure on
the eye.
Only one drop is needed to be applied in the eye each time.
And how do you care for your eyes after surgery?
I always tell my patients there are three things that are very important not to do for
1 week after surgery: the first one is to never touch the eye, the second one is to
not bend down with your head below the level of your heart, and the third is no heavy lifting
for the first week after surgery.
Especially during the first 24 hours after surgery.
The first week after surgery, I instruct my patients to avoid any strenuous activities,
such going to the gym, any competitive sports including golfing, swimming, etc.
You should also not wear any eye makeup, or lift any object heavier than 20 pounds, and
especially do not rub the eye.
I instruct my patients not to get their face wet, including in the shower for the first
24 hours after surgery, and afterwards they can shower but they need to avoid spraying
water straight into the eyes for one week after surgery.
The key is that you want to avoid anything, including water, dust or sweat getting into
your eyes.
My patients will typically continue the combination eye drop prescribed for one month after surgery,
using it four times a day the first week after surgery, three times a day the second week,
twice a day the third week, and once a day the fourth week after surgery.
If you have any other eye condition, such as diabetic retinopathy, or a history of eye
inflammation such as iritis, etc, or a non-routine complex cataract surgery, you may need to
use prescription eye drops for more than one month after surgery.
What should you expect in terms of vision recovery after cataract surgery?
In general, your vision will be blurry on the day of surgery.
With a successful cataract surgery, your vision should be much clearer the day after surgery,
and you should be able to resume most of your visual tasks within a few days after surgery,
such as watching TV, or light reading.
You may feel very mild irritation or foreign body sensation in your eyes, and may have
some tearing and light sensitivity for about a week after the surgery.
The majority of vision recovery occurs during the first week after surgery, but it is not
unusual to experience small fluctuations in your vision during the first month after surgery.
Although mild irritation and vision fluctuations are expected shortly after surgery, significant
eye pain or sudden significant vision changes are unusual and can be signs of potential
serious complications.
If you experience those changes or any other concerning symptoms, you should contact your
eye surgeon right away.
For most cataract surgery patients, their vision stabilizes after about one month after
surgery.
However, a small percentage of patients may take a few months to fully recover their vision
after cataract surgery.
Your vision recovery after cataract surgery may be longer if your surgery was complex,
or if you have any other eye diseases that may interfere with vision recovery after surgery.
Usually patients will be following up with their eye surgeon or eye doctor a few times
during the postoperative period.
Please discuss with your eye surgeon what to expect after your cataract surgery during
your individual consultation.
So what are the risks of cataract surgery?
I always tell my patients that cataract surgery is one of the most commonly performed surgeries
in the US with one of the highest success rates.
In general, for a routine cataract surgery, minor complications that do not result in
permanent vision loss occur in less than 1% of cases, this includes complications such
as infection, bleeding, swelling, retina tears or retinal detachment, incomplete cataract
removal etc.
Those complications can be treated with additional medications or surgeries.
Serious complications that can result in permanent vision loss occur in between one in 10,000
to 100,000 surgeries.
Even though cataract surgery is one of the safest surgeries, just like any other eye
surgery, the risk of vision loss with cataract surgery is not zero.
If you have any other eye conditions, such as diabetic retinopathy, macular degeneration,
poorly dilated pupil, etc, or if your cataracts are very dense, your individual surgical risks
can be higher.
If you need cataract surgery, it is very important for you to have an individual consultation
with your eye surgeon to discuss your specific surgical risk.
Let me know in the comments below if you or anyone you know had cataract surgery, and
how was your experience?
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Thank you again for watching and I will see you in my next video.