Common Cataract Questions
Learn More About Cataracts
Your Eyes with Cataracts
The eye’s natural lens is the clear lens inside the eye that helps focus incoming light rays on to the retina to form an image. As this lens becomes cloudy less light enters and vision becomes blurry and hazy. Vision gradually becomes impaired. The clouding of the lens usually happens over time, but it can occur quickly as well. Cataracts are common with age and can occur in one or both eyes. It is important to visit your optometrist regularly to monitor the progression of cataracts. Once you feel your vision has decreased to where your quality of life is affected, you will be referred to our office for further evaluation and surgery.
Symptoms of Cataracts
Cataracts are often difficult to detect at first, because they develop slowly and without pain. However, these are some symptoms to watch for:
- Blurred or hazy vision
- Washed out greens and blues
- Difficulty reading small print
- Increased sensitivity to light and glare
- Ghost images
- Double vision in one eye
- Poor night vision
- Spots in your vision
- Difficulty driving at night
- Halos around lights
Be sure to inform your doctor if you notice any of these symptoms or your vision becomes impaired to the point where it is dangerous to drive, or your quality of life is compromised by your impaired vision. As the cataract matures, life can become difficult and you will know that the time has come to remove them. Together with Dr. Boyd, you will make your vision plan to reset your vision.
The above symptoms may indicate a need for cataract eye surgery or they may signal other serious vision problems. If you suffer from any of these symptoms, you should contact your doctor.
Diagnosis of Cataracts
When you are referred to our office for an evaluation, you will be asked questions about your health, medications, and family history. You will have your vision tested and a variety of tests performed to assess the need for surgery and how the cataract is affecting your vision and quality of life. A typical exam includes testing visual acuity, glare sensitivity, measuring the curvature of your cornea, measuring the length of your eye, and a thorough examination of all other parts of the eye. Drops are used to dilate your pupils, which allow the doctor to better evaluate your cataracts. Be sure to bring any glasses and contact lenses you wear to your appointment. Please allow a minimum of two hours for this comprehensive evaluation and consultation.
Your cataract should be removed when you decide that enhanced vision will improve your quality of life. In many people, the symptoms listed above develop slowly and the early stages of cataract development do not prevent normal activities. As the cataract matures, life can become more difficult and you will know that the time has come to remove them from your eyes. If, after the examination, you and Dr. Boyd feel that removing the cataract will improve your vision and be the best decision for your eyes, you will then meet with the surgical coordinator to schedule your surgery.
What is Involved in Cataract Surgery
How Cataracts are Treated
This is not your grandmother’s cataract surgery. Fortunately, due to advances in cataract eye surgery, Dr. Boyd can treat cataracts at the Cataract and Laser Center, LLC (Center) as a routine out-patient surgical procedure to restore clear vision by replacing the cloudy lens with a clear one. Patients no longer have to wait until a cataract ‘ripens’ or accelerates to a certain point before it can be removed. No hospital stay, needles, or IV anesthesia are involved. There is no need to stop any medications or skips meals the day of your surgery. We now even offer patients the option of dropless cataract surgery which eliminates the need for pre- and post-operative eye drops.
In most instances of cataract surgery, patients with otherwise healthy eyes have improved vision after the lens replacement procedure. Many patients’ vision improves so dramatically that they are now able to pass the vision test to renew their driver’s license!
Surgery is the only way to remove a cataract and restore clear vision. When you have made the decision to proceed with surgery you will meet with the surgical coordinator. She will explain all of the benefits and risks associated with any type of eye surgery and give you a date for your procedure. One benefit of the Cataract and Laser Center is that we do have the option to offer patients the convenience of same day surgery. If your optometrist feels you are ready for the procedure, he/she may make an appointment for you to come to our office and have your evaluation and surgery all in the same day. You will spend about 3-4 hours here, but it will eliminate the need to make multiple visits to our office prior to your surgery. You will be seen one day post-operatively at the Eye Care of Delaware.
Patients who elect the same day surgery option will not be a candidate for dropless cataract surgery since the medication needs to be ordered in advance.
Benefits of the Cataract and Laser Center
- Convenient scheduling allows for examinations and cataract surgery the same day
- The procedure itself is typically over in only a few minutes
- No need to skip medications or meals the day of surgery
- No need to undress or remove dentures for surgery
- No needles or stitches are required; only eye drops are used to numb the eye
- No extra costs for anesthesia, laboratory testing, or x-rays
- Professional and courteous staff dedicated to your eye.
The Center is fully accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). The AAAHC is an independent, not-for-profit organization and is the gold standard for excellence and quality in ambulatory outpatient surgical centers. Their mark is a symbol of quality that we are proud to provide to you.
Risks of Cataract Surgery
Cataract surgery has become one of the most common and well-perfected surgeries performed in North America. Its success rate is extremely high and side effects and risks extremely low. However, as with all invasive procedures, there will always be potential for problems.
- Infection of the eye
- High pressure in the eye
- Detachment of the retina or swelling of the retina
- Bleeding that occurs behind the retina
- Small fragments of lens which can become lodged in the vitreous or back cavity of the eye
- Potential for loss of sight
Because contact lenses can slightly change the shape of your eye, they should be removed and not worn for a number of days prior to any vision surgery. Soft contact lenses should be out for a minimum of 7 days, and gas permeable (hard) contact lenses for 3 weeks before the evaluation and procedure .
You will be given a time for your arrival at either Eye Care of Delaware (same day evaluation and surgery) or the Cataract and Laser Center (surgery only). Plan to spend about 2 to 4 hours at our facility for preparation, surgery, and post-operative care.
Please be sure to bring with you the following:
- A driver
- Insurance cards (medical insurance, not vision plans)
- Photo identification
- Medical Power of Attorney (if applicable)
- Advance directive or living will (if applicable)
- List of medications, with doses, that you are currently taking
- Inhalers or Nitroglycerine pills (if applicable)
Please take your medications as you normally would, including any blood thinners, unless otherwise instructed.
You are encouraged to eat prior to your procedure and to take all medications, including eye drops, unless otherwise instructed. If you are diabetic you may want to bring a small snack.
The temperature at the surgery center is a little chilly at times, we recommend you bring a sweater that buttons or zips so we can check your blood pressure.
Please, no lotions, makeup, or perfume.
Same Day Surgery
If you wish to have your cataract evaluation and surgery on the same day, you must inform our office of your intention when you call to schedule your appointment. Please be advised that not every patient is a candidate for same-day surgery. Some patients may require special lenses that need to be ordered.
Prior to your appointment date, you will receive a telephone call from our surgical coordinate to discuss your procedure. If you are scheduled for same-day surgery and have not heard from us at least 2 days before your surgery, please call us at (302) 454-8802. We must speak with you no less than 24 hours prior to your surgery. If we do not speak with you there is a chance we will have to postpone your cataract surgery.
The day of your appointment, you will be asked to come to the Eye Care of Delaware for a full examination and several calculations will be made to determine the appropriate power of the intraocular lens to implant. A specific artificial lens is chosen based on the length of the eye and corneal curvature (the clear portion of the front of the eye). If you are interested in an advanced technology lens, such as the extended focus IOL or a Toric lens to correct astigmatism, please inform a technician so the options can also be discussed with you during your evaluation.
After your doctor examines your eyes and determines that cataract surgery is indicated, you will meet with our surgical coordinator. She will discuss the risks that are associated with any type of eye surgery and sign all of the necessary paperwork. You will have another opportunity to ask any questions you may have about the procedure.
History and Physical: Medicare guidelines state that all patients must have a history and physical and be cleared for surgery no more than 30 days prior to surgery. There is no need for patients to get any blood work, chest x-rays, or EKG’s to have cataract surgery. To download the H&P form, click here.
Cataract Evaluation With Surgery at a Later Date
If you see Dr. Boyd at Eye Care of Delaware for an evaluation and schedule a later date for your surgery, you will report directly to the Cataract and Laser Center on the day of surgery since all of the paperwork and calculations were performed during your evaluation.
Surgical Procedure at the Cataract and Laser Center
After checking in at the Cataract and Laser Center you will meet with a nurse who will ensure that you are fully prepared for your surgery by confirming the operative eye, reviewing your medical history, medications, paperwork, and post-operative instructions. She will perform a short physical exam (checking your temperature and blood pressure) and provide you with a medication for anxiety, if requested. At this time, she will also begin to administer a series of eye drops that will dilate and numb your eyes. Once you are fully prepped (completely numbed and pupils fully dilated and non-reactive to light) for the surgery, she will escort you back to the operating room. If you are unable to walk, you will be taken in the operating room by wheelchair.
In the OR you will be seated in a reclining chair and made comfortable. Your eye area will be cleaned with an antiseptic solution and sterile drape will be placed over the eye to ensure sterility. A lift is placed under the drape so that you are able to breathe comfortably.
As the surgery begins, your eyelid will be held open with an eyelid holder to prevent blinking. Next, using state-of-the-art techniques, the surgeon makes a microscopic incision into the eye and removes the cataract. He then inserts a new lens through the same opening, and the incision automatically seals itself and heals without needles or stitches.
Cataract surgery is not considered by most patients to be painful. However, you may feel some mild discomfort and a little bit of pressure from the various instruments used during the removal of the cataract. You can also expect to feel some discomfort/irritation following surgery.
What Happens Following Surgery
Immediately following the surgery, you will be escorted back to a recovery room where the nurses will monitor you for a short time before you are discharged and able to leave with your driver. If you need to use eye drops post operatively your nurse will review the instructions.
For patients who have elected dropless catarct surgery your nurse will review with you what you can expect in the days following your surgery. Most patients will experience some haze in their vision for the first 8-12 hours following surgery. Please keep in mind that some patients may need to be prescribed an eye drop if their eye doesn’t heal as quickly as the doctor would like it to.
You will also be given a protective eye shield to wear so you do not accidentally rub or bump your eye. You will wear the plastic shield the day of surgery and while sleeping for two weeks. Avoid pressing or touching your eye and practice good hygiene. Dark glasses are provided for you and may help with any light sensitivity.
The morning following your surgery you will have an appointment for a short post-operative exam at Eye Care of Delaware. After that appointment, most patients are able to resume their normal activities. However, every patient recovers differently, so it is best to keep your schedule flexible for the first few days following your surgery.
While you may notice some mild discomfort, such as scratching, tearing, or burning, most patients do not experience significant pain following surgery. You should call our office immediately if you experience any of the following:
- Decreasing vision
- Double vision
- Light flashes or floaters
- Increasing redness in the eye
- Significant or persistent pain
Co-Management of Care
To the doctors in the Eye Care of Delaware network, co-management means “teamwork” and we like to serve as an extension of your optometrist when it comes to medical and surgical conditions of your eyes. Ongoing and clear communication between our office and your referring optometrist ensure safe and convenient follow-up care for you.
Once you are released by your doctor, you may continue to receive follow-up care from your referring optometrist. Most patients find it very convenient to return to their optometrist for post-operative care and services. Your optometrist is also the vision specialist who will examine and fit you for glasses, if necessary, after cataract surgery. If you develop any complications during the post-surgery follow-up period your optometrist will be in communication with our office regarding your care until the problem is resolved.
For patients who were self-referred to our office, your post-operative care will be handled by our office.
Cataract Lens Replacement Options
Throughout the United States and around the world, more than 1.4 million people have cataract eye surgery each year, and a high percentage of those treated regain useful vision.
The most common type of cataract eye surgery performed in the U.S. today is an outpatient procedure using a process called phacoemulsification. During this surgery, the surgeon makes a tiny incision and uses high-speed ultrasound waves to break the cataract into tiny pieces that are then removed.
The surgeon will then replace the lens with a clear intraocular lens (IOL) implant. IOLs are designed to perform most of the functions of the natural lens. They are made of special materials that require no care and will not be rejected by the eye. Cataract lens replacement options vary in material type and strength and are selected to improve the eye’s focusing ability.
Extended Focus Lenses
Intraoular lens technology has progressed and extended-focus lenses are now an option for Eye Care of Delaware patients. Traditionally, the replacement lens used for cataract surgery is a monofocal lens which restores functional distance vision, but patients typically still need to wear reading glasses. For patients who wish to improve their vision in an extendedfocus Tecnis Symfony® and full the AcrySof® IQ ReSTOR® is an available option. Not all patients completely eliminate the need for glasses. Some patients experience glare and halos at night and there is a period of adjustment, especially for the intermediate range of vision. It is important to discuss with your doctor your expectations when selecting an extended focus advanced technology lens. The Tecnis Symfony® are the only lenses that provide a full range of continuous vision.
Most AcrySof® IQ ReSTOR® lens patients find they can read a book, work on the computer, drive a car, and play sports with increased freedom from glasses. Four out of five AcrySof® IQ ReSTOR® lens recipients reported never wearing glasses after having the lens placed in both eyes.
If you have cataracts and are interested in multi-focal lens implants, contact our office for an evaulation and see if you can benefit from the AcrySof® IQ ReSTOR®. A comprehensive evaluation and additional testing is required for patients interested in advanced technology lenses, since not all patients are a candidate for this type of lens. Financing is available with Care Credit.
Click here to view the Tecnis Symfony® ( NEED TO PUT IN THE HYPERLINK)
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Click here to view the ReSTOR Patient Video.
Visit the AcrySof® IQ ReSTOR® website for more information about this lens option.
The STAAR Elastimide® Lens (3-piece silicone IOL) and the STAAR Elastic Lens® (single piece silicone IOL) are available in various diopter powers in the United States and abroad. STAAR Surgical Company was the first company to receive pre-market approval for a foldable single piece silicone IOL. The lens’s ability to be folded allows for a small “no stitch” incision during cataract eye surgery, resulting in a quicker recovery time.
Acrysof IQ Toric Astigmatism Correcting IOL
Some eyes have an abnormal shape called astigmatism which makes objects look out of focus or blurry and many patients wear glasses or contact lenses to decrease this condition. There is an IOL, called Acrysof Toric IOL, which will reduce astigmatism at the time of cataract surgery and may be recommended for patients with corneal astigmatism.
Tecnis Toric Symfony IOL
Toric version of the extended focus IOL is now available for patients who have astigmatism but want a vision plan to free themselves for glasses.
Please be sure to discuss the lens options during your cataract evaluation. Our goal to is help you find your vision plan.
Please note: This video is has been produced by the manufacturer of the Toric lens. Dr. Boyd does not use an IV during cataract surgery. Click here to view the Toric Patient Video.
What is a cataract?
Cataract formation is a natural aging process in which the lens of the eye turns cloudy. Some patients describe their vision with a cataract as if they are looking through a dirty windshield of a car.
What causes a cataract?
Factors that can contribute to cataract development include genetics, excessive UV exposure, diabetes, tobacco use, and some medications (such as steroids). However, it is generally an aging process.
Is surgery the only treatment?
Sometimes, in the early stages, a change of glasses will help for some time. Once the cataract has progressed to the point where your glasses no longer improve your vision to your satisfaction, surgery is the only way to remove a cataract.
How do I know if I should have cataract surgery?
In many people, cataract symptoms develop slowly, and the early stages of cataracts do not interfere with your normal activities. As the cataract matures and your vision worsens, life can become more difficult. When you have difficulty performing ordinary activities, are frustrated with your decreased eyesight, or your glasses no longer improve your vision, you will then know the time is right for surgery. Our goal is to restore your vision so you can see and do the things you enjoy.
Once your cataract has reached the point when it needs to be removed, surgery is the only way to remove it.
Can I wear my contact lenses until I am ready for surgery?
Because contact lenses can slightly change the shape of your eye, they should be removed and not worn for a number of days prior to cataract surgery and your evaluation. Soft lenses should be out for a minimum of 7 days and gas permeable (hard) lenses should be out for 3 weeks before your surgery and evaluation.
Are cataracts removed with a laser?
Laser-assisted cataract surgery is now available for some patients. During your consultation, your doctor will discuss options for your post-cataract vision plan. Depending on the type of lens implant you choose, part of the surgery may be done with the femtosecond laser. Be sure to discuss your options with your doctor to determine if you are a candidate for this breakthrough technology in cataract surgery.
How is the cataract removed?
The cataract is removed using a procedure called phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear dome-shaped surface that covers the front of the eye. The surgeon then inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. All cataract surgery done at the Cataract and Laser Center is done by phacoemulsification, also called “small incision cataract surgery.”
Can I have both eyes operated on at the same time?
Generally, cataract surgery is performed on one eye at a time, and your surgeon will typically do “worst first”. If necessary, the second eye can be operated on within 1-2 weeks.
Is cataract surgery always successful?
No surgery can be guaranteed, but cataract surgery is considered one of the safest and most successful surgeries. The few complications that do occur are usually cared for without any permanent effects. However, this is a surgical procedure, and there is always the very slight chance that a complication could result in loss of vision.
Do I need to stop my regular medications before surgery?
There is no need to stop medications before surgery. You can even take them the day of surgery. It is important to tell the nurses what your prescriptions are and to inform them of any existing medical conditions.
Can I eat and drink before surgery?
Yes, you are encouraged to eat prior to your surgery. If you are diabetic, you may even want to bring a small snack with you.
What should I wear the day of surgery?
You will not need to change out of your clothes for your surgery, so it is best to wear something comfortable. The temperature in the Cataract and Laser Center is a little cool, so you may want to bring a light sweater. Please make sure it can easily be removed for the nurses to take your blood pressure.
Does the surgery hurt?
Most patients feel no pain during surgery, only some pressure. Topical anesthetic drops are used to numb the eye prior to surgery. After surgery, you may feel some minor discomfort, such as scratching or tearing as the numbing drops wear off.
How can I keep my eye from moving and blinking during surgery?
We have a special instrument, called an eyelid speculum, to prevent you from blinking.
What if I have to cough?
If for some reason during surgery you need to cough or sneeze, you must simply inform us so your surgeon can be prepared.
How long will the surgery take?
The surgery itself is typically very short, just 5 to 10 minutes. However, the preparations before surgery can take 1 to 1.5 hours. Be prepared to spend up to 2 to 3 hours at the Cataract and Laser Center for preparation, surgery, and post-operative care.
Am I put to sleep for surgery?
Due to advances in cataract surgery, there is no need for general anesthesia, needles, or stitches. Topical anesthetic drops are used to numb the eye, and we can provide you with a medication for anxiety, if needed.
Will I feel the lens implant inside my eye?
Since there are no nerve cells in the capsule where the lens is implanted, you will not feel the lens.
Why do I need an implant in my eye?
Cataract surgery removes your eye’s natural lens, which accounts for about 40% of the eye’s focusing power. Without a replacement lens, you would need a very thick pair of glasses, which would distort your vision. The artificial lens implant replaces the focusing power of your original lens.
Will the implant need to be cleaned, removed, or replaced?
Because the lens is placed inside the eye, the implant requires no maintenance and will last for your lifetime.
Will I wear an eye patch?
You will leave the OR with a clear plastic shield over your eye, which prevents you from rubbing or touching your eye. You will be able to see through the shield, which is attached with tape, and you will wear the shield until your post-operative appointment the next morning. You will continue to use the shield while sleeping two weeks post-operatively.
When will I be able to see?
Vision after cataract surgery varies from person to person and from eye to eye. Soon after your operation you may see noticeable improvement or your vision may be a little blurry. Both can be normal.
When can I resume normal activities?
You will be able to resume your normal activities right away. When you shower, just be careful to pat the eye dry; do not rub your eye. It is also safe for you to bend over.
How soon can I drive?
When you are able to see clearly and are comfortable with your new vision, you may drive and return to work. If you are able to see 20/40 or better without glasses, you may want to have the corrective lenses restriction removed from your driver’s license.
How soon can I get new glasses?
If after surgery you still need corrective lenses, you will be able to get a new prescription from your optometrist at your 2 week post-operative checkup.
Can my cataract come back?
The cataract cannot return once it has been removed. However, the lens capsule (the part of the eye that holds the lens in place) sometimes becomes cloudy several months or years after the original cataract operation. If the cloudy capsule blurs your vision, your surgeon can perform a second procedure using a laser, called a posterior capsulotomy (YAG), to make an opening in the cloudy lens capsule, restoring normal vision. This laser procedure is done at the Cataract and Laser Center.
How soon can I have the second eye done?
Because they are so thrilled with their vision, most patients schedule a date for surgery for their second eye within one week of the first eye. The date for the second eye can be scheduled when you return for your post-operative exam.
What if I have more questions?
If you have more questions, call our office at 302-454-8800 and ask to speak with one of the nurses or our surgical coordinator.