Cataract

Cataract Surgery Day – A Journal III

Surgery Day. Must admit, I’m a bit anxious. Tossed and turned all night.

No coffee or breakfast this morning. Just a couple meds with a sip of water. Brushed my teeth and rinsed my mouth out, being careful to not swallow any of that tasty toothpaste!

My co-workers learned I’m not as perky when I am caffeine deprived! But I took a couple Tylenol with my meds to keep the headache minimized and made it through to admission time.

The staff are fantastic! I don’t think I was ever alone. Super supportive, keeping me informed of what was happening along the way. There were a bunch of eye drops that got easier each batch because there was always a numbing drop first. IV, monitors placed for heart rhythm, SAT and a blood pressure cuff. You know, surgery stuff! I was a bit chilly and a hand warmer and the heated chair were perfect. Even got a bit of a massage from the chair.

Seemed like no time at all and I was fitted with O2 tubing and being escorted into the Operating Room. Normally there are 4 folks in the OR with a patient: the Surgeon, Anesthesia, Scrub Tech and Circulator. As I said, never alone.

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There was a little shuffling around to get comfortable in the chair and after that I really don’t remember much! I do remember seeing a really cool pattern (like a beautiful wallpaper), some colored lights, the surgeon saying we were going to do a final test, doing that and then being told the lens was in. Then the slight sensation of the medication being placed in my eye and we’re done!

Out to the post op area with another great staff member who recorded vitals while I had a cup of coffee and a “continental breakfast.” With strong vitals and me feeling good, time to disconnect the IV and head home.

Now this dropless medicine manifests differently for everyone. For me it’s like oil on top of a bowl of water being swirled around. At first it looked like mountain ranges, later it was bubbles, and even later just a patch of black dots! I was told to go home and rest in an upright position for a couple hours so that the medicine could settle to the bottom of the eye.

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Headed home, noticing my eye felt a bit scratchy as the numbing wore off. Laid down with a bunch of pillows to keep my head elevated and took a short nap, woke up feeling great. My husband and I picked up our grandson and went to Taekwondo; back to normal except no driving today.

What a great experience! From checking in to checking out, the staff are very caring, friendly and professional. Yes, I work with them every day, and from a patient perspective, I’m proud to say GREAT JOB!

Tomorrow, back to work and I’ll see the doctor for my first follow up visit and I’ll keep you posted as I continue this journey and the second surgery next week.

My biggest WOW right now it how bright white is with my new eye! The old eye looks like someone turned the dimmer switch down. This is exciting!

Tap here to read A Journal IV

Cataract Surgery Patient Workbook is here!

Cataract Surgery Patient Workbook (dragged)Download the most recent copy of our Cataract Surgery Patient Workbook.

We hope this workbook will assist you up to the day of surgery and beyond.  We understand how nervous people can be when they anticipate their first eye surgery. We encourage you to enter into this event with a clear and relaxed attitude.  The more you know, the more you can participate in the success of this surgery.  The American Academy of Ophthalmology estimates that cataracts affect 22 million people in the US.  Know you are not alone and you are in good hands. This Workbook is created to help organize and convey what you will need to know.

We’ve been performing cataract surgery for over 30 years.  You can rest assured we know our stuff.  Now it’s you we wish to bring into our practice and share what we know so that you will move forward with confidence.

In this workbook you will find what we call the Cataract Process.  We will discuss the big picture so you will know where you are going.

We will look at the procedures leading up to the day of surgery.

We will also take a look at Medicare policies that create a safe environment for you.

And, in the back of this booklet is the paperwork that you will need at various points of your journey.

So, are you ready?  We will be with you all along the way.  Congratulations on finding a way to rejuvenate your eyesight.  We hope for the best outcome for you!

— the Doctors and Staff at The Harman Eye Clinic

 

Current Treatment For Cataracts

What are the treatments for cataracts?What Is The Current Treatment For Cataracts?

Cataract surgery is a simple, relatively painless procedure. This surgery is the most frequently performed procedure in the United States, and also one of the most successful.  During surgery, a small incision is made in the eye to remove the cloudy lens and replace it with a clear silicone lens, called an implant. Once the opaque lens is removed by your surgeon, there is now opportunity to replace it with a variety of lenses.  Before cataract surgery, an intraocular lens implant (IOL) measurement is made to determine  the lens power.  This measurement will incorporate your glasses prescription. Without an implant, you would need to wear very strong glasses or contact lenses.

Are there different types of lens implants?

Yes, there are standard lens implants and special custom lens implants.  Careful discussions with your surgeons lead to a recommendation that best fits your vision needs.

Who is a good candidate for multifocal and accommodative lens implants?

Patients who are highly motivated to be functionally free of glasses for reading, computer work and driving are good candidates. A multifocal lens compensates for the eye’s inability to change shape by allowing the eye to see at distance and near simultaneously through the same optic.  A good candidate has realistic expectations and understands that these lenses are not the same as the natural lens of a young person.

Description of Available Lenses

Will you see 20/20 after surgery?

We hope so, but there is no guarantee.  You are paying for the service and the implant and not for a guaranteed result.  We counsel each patient that they should expect to use glasses on occasions where they wish very fine detail.

If you receives a multifocal lens there is a good chance you won’t need glasses. Eighty percent of patients implanted with the diffractive and refractive lenses in their respective FDA clinical trials did not need glasses after surgery for distance or near vision. Of course, not every patient in the trial was spectacle independent.

ORA Optiwave Refractive Analysis System

The ORA System gives your surgeon an analysis of your eye during your procedure, enhancing the outcome of your premium cataract procedure. ORA measurements are taken after the clouded cataract is removed, when the surgeon has a clear view of your eye.  It is at that time that a final determination of the best lens implant is made.  An ORA-guided cataract procedure offers fully customized premium lens placement, helping ensure you have great vision for life.

The use of the ORA is included in the global fee for premium lens upgrades.  However, patients who wish to use this feature during surgery may opt to pay a nominal fee to assure they will receive the best implant outcome for distance.

How Fast Will I Recover From Surgery?

Your vision may be blurry up to 24 hours following your surgery since your eye will still be dilated. Most patients leave without a patch. Clear Cornea Cataract Surgery involves no stitches or sutures. Because topical anesthesia is used, fast restoration of vision is possible. The incision required is very small and is made through clear corneal tissue which has no areas of blood vessels.  A safer, topical anesthesia is used in place of the traditional injection block of days past. These differences allow our surgeons to perform surgery on patients with preexisting medical conditions without interfering with those conditions.

Postoperatively you will be asked to avoid swimming and makeup for two weeks, free to enjoy your restored vision.

We are here to help answer your questions.  Please feel welcome to call our staff at 360.435.8595.

The Harman Eye Clinic

903 Medical Center Drive, Arlington WA 98223

360-474-2561  360-435-8595  FAX 360-435-5233

http://www.20Better.com

Beginning To Think About Cataracts? Here’s A Good Starting Place.

What are cataracts?

What are cataracts? How do I know if I am ready for surgery?

What are cataracts?

The human eye is like a camera, your eye has a clear lens through which light passes for you to see. Like a camera, when the lens of the eye is cloudy, not as much light can pass through the lens. Clouding of the human eye lens is called a cataract, a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision. Cataracts cause a progressive, painless loss of vision.

What Causes Cataracts?

The most common cause of cataract is more candles on the cake.   The lens inside of our eyes naturally become cloudy over time.  Cataracts can also be cause by UV light exposure, diet, eye trauma, previous eye surgeries and certain types of medications.  It is said that if you live long enough everyone will get cataracts.

How Do I Know If A Cataract Is Developing? 

One of the first noticeable symptoms of cataracts is a bothersome glare that makes night driving difficult. Other symptoms include halos around lights, light sensitivity, double vision in one eye or temporarily improved near vision.

You may be ready for surgery when you can no longer do the things you enjoy in your everyday life.  These might include driving at night, reading, painting, sewing, golfing, reduced socializing. Things you normally like to do, you now avoid because they are more difficult.

If you are still unsure, take the Cataract Self-Evaluation Test:

Cataract Self-Evaluation

Please circle all that applies to your situation.

Does your vision make it a challenge for you to:

  • read the newspaper?
  • read a book?
  • read a traffic sign?
  • drive in the rain?
  • drive in bright sunshine?
  • drive in the fog?
  • see a road sign at a distance?
  • recognize a face from across the room?
  • read the television menu?
  • enjoy your hobbies?

Do you have difficulty in judging distances:

  • seeing steps?
  • walking down stairs?
  • while driving?

Do you have trouble

  • transitioning from bright light to dark?
  • driving through a tunnel?
  • seeing objects in the shade when you are in the sunshine?

Are you bothered by

  • poor night vision?
  • seeing star-bursting or rings around lights?
  • glare from headlights?
  • glare from sunshine?
  • blurry vision?
  • eyes are fighting each other?
  • Do you find that you need brighter light to read?
  • Does your vision cause you to be fearful during the daytime?
  • Does your vision cause you to be fearful during the night or dusk?
  • Do you avoid driving due to your vision?

How do you feel your vision is affecting your life on a scale of 1-10

(1 is no problem, my vision is fine and 10 is my vision is impacting my life.)

Circle one:        1 2        3 4       5         6         7        8        9       10

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The above is taken from the Patient Guide to Successful Cataract Surgery.  It can be downloaded for free to your computer.  If you are still unsure as to how or when to proceed to improve your vision, feel free to call us at 360.435.8595.

The Harman Eye Clinic

903 Medical Center Drive, Arlington WA 98223

360-474-2561  360-435-8595  FAX 360-435-5233

http://www.20Better.com

Astigmatism

Correcting Astigmatism with Cataract Surgery

Astigmatism:  What is it?  How can it be corrected?

Most of us have probably been told we have some degree of astigmatism.  Symptoms can include blurred vision and monocular double vision, but what exactly is astigmatism?

The term astigmatism is used to describe a cornea that is not round. It is shaped more like a football instead of a basketball.  Like a football, the astigmatic cornea has two curves: a steeper one and a flatter one 90 degrees away. These two curves bend light entering the eye, causing two images to form in the back of the eye on the retina.

As a comparison:

  • A person with standard myopia or hyperopia (farsightedness) may see a dot as a blurred circle;
  • A person with astigmatism may see the same dot as a blurred oval or a frankfurter-shaped blur. The variation depends on the how much astigmatism is present.

What are the treatments for astigmatism for patients with cataracts?

Our doctors will determine if a visually significant cataract is present. Astigmatism will be corrected with the cataract surgery, if the astigmatism is in the lens.

However, if the astigmatism is in the cornea, the astigmatism remains when the cloudy opaque  lens is removed.  If good, uncorrected vision is desired, the astigmatism needs to be addressed in addition to the standard lens implant surgery.

How can Astigmatism be corrected?

Astigmatism can be corrected with eyeglasses, toric (astigmatic) soft contact lenses and gas permeable (rigid) contact lenses.  Surgically, astigmatism can be corrected with laser vision correction (99% accurate), or for small amounts (less than 1.5 diopters) of astigmatism, Limbal Relaxing Incisions LRI (80% accurate), and Toric Intraocular Lenses in conjunction with cataract surgery  (95% accurate).

Several intraocular lenses are approved by the FDA for the surgical correction of astigmatism during cataract surgery.  The most commonly recommended are:

Typically, a patient’s eye is marked while sitting upright as the eye may rotate (cyclotorsion) when they lay supine for surgery.   Surgery is painless and takes about 15 to 20 minutes.  If the lens rotates more than 5 degrees it may be necessary to return to the operating room weeks later to rotate the lens to the desired axis.

If no cataract is present, LASER vision correction is an excellent modality to treat astigmatism.

Special Cases:

The usual type of astigmatism is symmetric regular astigmatism.  In case of asymmetric or irregular astigmatism other treatments are necessary.

Keratoconus is a progressive non-inflammatory (usually) bilateral thinning of the cornea associated with asymmetric or irregular astigmatism.

It typically is a contraindication for LASIK as well as any of the advanced technology lenses used in cataract surgery such as Crystalalens AO, Tecnis Multifocal or ReSTOR lenses which treat presbyopia (inability to read up close after age 40).

Sometimes keratoconus can be treated with a toric intraocular lens (Off-label) if the astigmatism is stable and the patient is not expected to ever wear gas permeable contact lenses.  Collagen cross linking is a new treatment worldwide for keratoconus, but it is not yet approved by the FDA.  It uses ultraviolet light to cure or harden the cornea after it has been pre-treated with riboflavin.

Pterygium is an abnormal growth from the conjunctiva (white part of the eye) onto the cornea (clear windshield-like dome in the front of the eye).  It can cause asymmetric astigmatism and can be cured surgically.  Small pterygia may be safely observed, whereas larger pterygia are best cured by surgical excision, typically with a conjunctival auto-graft secured with tissue glue (Tisseel) instead of stitches.

Tags: astigmatism, LASIK, PRK, cataract surgery, pterygium