What is a cataract?

The clouding of the eye's naturally clear lens is called a cataract. A cloudy lens interferes with light passing into the eye. Having a cataract can be compared to looking at the world through a foggy window.

How is a cataract removed?

Cataracts are now removed by a revolutionary surgical technology called phacoemulsification. A small hole is cut into the eye, and another into the capsule that surrounds the cataract. The cataract is then cut up and vacuumed out of the eye in tiny pieces using phacoemulsification technology. The artificial lens that must replace the cataract (in order to restore vision after surgery) is then placed inside the capsule. All of this is done as day surgery at the hospital.

Is cataract surgery done by laser?

Cataract surgery is performed safely and expertly by the experienced hands of your eye surgeon. Although there are certain lasers which can be used to do parts of the surgery, this a very expensive technology that is not currently available at Misericordia Health Centre or deemed necessary.

What is an intraocular (IOL) lens?

An intraocular lens (IOL) is an artificial lens implant, which is made of an inert substance such as silicone or acrylic. This lens is placed permanently inside the eye at the time of cataract surgery right after the cataract is removed. An artificial lens is required to see properly after the surgery. Without an artificial lens implant, you will need very thick glasses to see and focus light. All patients with provincial health insurance are covered for single distance intraocular lenses. These lenses are soft and are folded into a small, thin shape, and then inserted into the eye through a very small hole. Once inside the eye, the intraocular lens unfolds and is positioned neatly into the capsular bag to replace the cataract. The cloudy window is now all clear.

Are there stitches with cataract surgery?

Cataract surgery is done through a very small incision (hole) in the eye. Most of the time, this incision is self-sealing and does not require any stitches. However, if it is leaky, it will be sealed closed with either a dissolvable or a semi-permanent stitch that may or may not need to be removed after surgery. Occasionally, people feel a bit of foreign body sensation or eye irritation when this stitch becomes loose several weeks later, in the case of a dissolvable stitch, or months or even years later, in the case of a semi-permanent stitch. If this happens, contact your surgeon to check your eye and pull out the stitch. This is a simple, painless office procedure that can be done when you visit your surgeon.

Where will the surgery be done?

GEM Clinic surgeons perform all their surgeries at the Misericordia Health Centre.

Will I still need glasses after cataract surgery?

The intraocular lens (covered by Manitoba Health) will correct your vision for one distance only. Therefore, most people who get these lenses can see well in the far distance, but will still need glasses to read after surgery (usually over the counter glasses are good enough unless you have significant astigmatism).

If you are a candidate and opt for a premium intraocular lens (explained below), you will be less dependant on glasses for most activities.

Are there intraocular lenses that correct for near and intermediate distances and astigmatism?

Yes, there are some premium intraocular lens options which can allow you to see at different distances without glasses. These lenses are NOT covered by Manitoba Health and are an extra cost to you. You may or may not be a candidate for these lenses. If you are interested in any of these options, please contact our office.

Please note that outcomes with these lenses may vary depending on various factors. The goal of premium lenses is to obtain the best post-surgery vision and reduce dependence on glasses. This means that for most activities, you would not have to wear glasses to see clearly. However, you may still need glasses to refine your focus, since it is not possible to guarantee perfect 20/20 vision at all distances.

1. Toric Lenses

Astigmatism is an irregular curvature of the cornea (front "window" of the eye). It is as if the eye is shaped like a football instead of like a soccer ball. Uncorrected astigmatism causes blurred vision. You will still have to use glasses to correct astigmatism after surgery if you get the regular intraocular lens. However, if you are a candidate for a TORIC lens, this will correct your astigmatism and far distance vision. Although, you will still need glasses for reading at near and intermediate distances, your distance vision will be a lot clearer without glasses. These lenses are not usually recommended for glaucoma patients getting combined glaucoma and cataract surgery, or glaucoma patients who have a condition called pseudoexfoliation (which may cause looseness of the capsular bag holding the lens in place, though some exceptions may apply). If you would like to have better vision at various distances as well as astigmatism correction, you may be able to opt for an ENHANCED MONOFOCAL TORIC, EDOF TORIC, or a MULTIFOCAL TORIC lens.

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2. Enhanced Monofocal Lenses

These lenses can correct astigmatism, and distance vision, and also provide better intermediate vision. With these lenses you would be able to see into the far distance while driving and also see your dashboard clearly without glasses. There is a chance that you may need glasses for refining your intermediate and far distance vision, and you definitely will need glasses to read. However, for most other activities, you should be able to function without glasses. These lenses do not decrease contrast and do not cause a haloing effect around lights at night, making them an ideal choice for patients with glaucoma or early to moderate macular degeneration who would not be good candidates for EDOF or multifocal lenses.

 

3. Extended Depth of Focus (EDOF / EDOF Toric) Lenses

These lenses provide good distance and intermediate vision, as well as some functional near vision. They can also correct astigmatism. You will not need glasses for most activities. However, if you need to read for a long time, reading glasses are recommended. You may also prefer some refining of your vision for intermediate and far distances with glasses. These lenses can cause some mild haloing effect around lights at night which can be undesirable for night driving. However, the halos are much less prominent compared to those experienced with multifocal lenses. Patients with mild or early eye disease such as glaucoma and macular degeneration may be considered for these lenses.

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4. Multifocal / Multifocal Toric Lenses

These lenses (also known as "TRIFOCAL" lenses) can give your clearer vision at all distances and can also correct astigmatism, so that most of the time you will not need glasses, even for reading. In fact, out of all the available options, they offer the best option for near vision without glasses. These lenses work very well in good lighting conditions, however you may still need reading glasses for low lighting conditions (eg reading a menu in a dimly lit restaurant). These lenses cause a haloing effect around lights at night which can be undesirable for night driving. They are generally not recommended for patients with pre-existing vision problems from conditions such as glaucoma and macular degeneration because they can slightly decrease contrast.

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What type of anaesthesia will I be getting? Will I feel anything?

Cataract surgery is done under topical anaesthetic (anaesthetic gel and drops) with intravenous (IV) sedation. This means that you are awake during surgery, but will not feel anything during the surgery. At the beginning of the surgery, you will feel your surgeon preparing the area by putting a drape over your face and placing a clip under your lids to hold your eye open. You will be able to see light and colours during the surgery. Cataract surgery will take about 15 to 30 minutes (depending on the maturity of the cataract and/or other challenging factors).

(If you are having cataract surgery as well as glaucoma surgery, the combined procedure usually takes about 1 hour or so and extra freezing will be used around the eye for the glaucoma surgery. The experience will be similar except a bit longer.)

If I am taking blood thinners, will I have to stop them?

If you are having cataract surgery alone, there is no need to stop your blood thinners.

If you are having cataract surgery combined with a glaucoma surgery, you WILL need to stop your blood thinners before surgery in consultation with your family doctor or specialist (1 week for aspirin or Plavix® (clopidogrel); 3 days for Coumadin® (warfarin) or Xarelto® (rivaroxaban). You will be able to restart them about 3 days after surgery, unless otherwise stated.

Are there any medications that are injected into my eye at the time of eye surgery? Why does Flomax (tamsulosin) have a potential influence on cataract surgery?

Routinely, non-preserved lidocaine anaesthetic is injected into the eye to ensure that the surgery is comfortable.

Flomax (tamsulosin), used for benign prostate hypertrophy, can cause IFIS or "intraoperative floppy iris syndrome". This causes some difficulty in removing the cataract and dilating the pupil. Usually, non-preserved 2.5% phenylephrine (an adrenaline-like drug) is used to help dilate the pupil and keep the iris from billowing into the instruments that are used to take out the cataract. Sometimes, tiny hooks or devices are used to stretch the pupil to make sure the iris is kept out of the way. Overall, problems with Flomax are easily overcome with these maneuvres. Stopping Flomax before surgery will not prevent this problem from occurring, therefore there is no need to stop Flomax. Similar drugs that can also cause IFIS are alfuzosin (Uroxatral) and finasteride (Proscar).

Non-preserved phenylephrine 2.5% may also be used to dilate the pupil more fully by injecting it directly into the eye.

Diluted Moxifloxacin drops (Vigamox®) are injected into the eye at the end of all eye surgeries (except if there is an allergy to this drug). This has been shown to be a safe and effective way to prevent infection.

If you have had a previous surgery for glaucoma called trabeculectomy, or a XEN® or PreserFlo™ implant, you will likely have a superficial or "subconjunctival" injection of Avastin® (bevacizumab 2.5mg) at the end of the surgery. This will sting a bit. This prevents closure of the filtration site, which helps drain fluid out of the eye to lower eye pressure in glaucoma patients. Often, after cataract surgery, particles get flushed through this site and promote scarring and eventual failure of the filter. Avastin® helps prevent this by inhibiting growth of new blood vessels that support newly growing tissue, like scar tissue. This medication is used for chemotherapy in colorectal cancer and also in other eye conditions like proliferative diabetic retinopathy and wet macular degeneration. It rarely can cause closure of blood vessels and compromise oxygen flow causing tiny "strokes" to the area it is used. This is a very rare, potential complication. If this happened, your vision would be much blurrier than expected after cataract surgery. You should call your surgeon's office for a follow-up check as soon as possible or visit Misericordia Health Centre or an emergency department after office hours.

What are the possible complications of cataract surgery?

Complications are rare during and after cataract surgery, but can occur. The most common complication during surgery is rupture of the capsule that holds the cataract, possibly causing spillage of cataract material to the back of the eye. If this happens, your surgery may be prolonged, or you may require another surgery afterwards. Also, you may need an anteriorly placed lens, which will require a larger incision, which must be stitched up. If promptly and effectively managed, you should still have a good visual outcome with this complication, although it will take longer to recover.

Capsule rupture can happen more commonly with an eye condition called "pseudoexfoliation" . In this condition, which is often associated with glaucoma, small particles can collect on the fibres (called "zonules"), which hold the capsule in place. This can cause the capsule and cataract to be wobbly and break easily during surgery. You will be advised if you have this condition. Surgery can still be done in this case, but it often takes longer due to special precautions that need to be taken to prevent problems. Sometimes, if the capsule is too floppy and loose, a capsular tension ring is inserted into the capsular bag as well. This helps stent the capsule and provides more support for the capsule and lens. The capsular tension ring and artificial lens are permanently implanted. You will receive a card with information on these implants at the end of the surgery.

Pseudoexfoliation can also prevent proper dilation of the pupil for cataract surgery. If the pupil is not dilated widely enough for various reasons, it may become necessary to use "iris hooks" or a similar iris- stretching device during surgery. After cataract surgery, the pupil may still look slightly stretched and irregular for some time, however this will not affect the vision.

Sometimes after cataract surgery, especially if a patient has glaucoma of any type, the eye pressures can become very high and may require extra medication by mouth or by intravenous to control. Occasionally, a second surgery is required to control the eye pressure.

Other possible complications which could cause problems with your vision or even loss of vision include chronic swelling of the cornea, prolonged inflammation, elevated eye pressure, infection, retinal detachment and hemorrhage (bleeding). These could occur during or days, weeks, months or years after the surgery. Thankfully, these complications are rare. We try our best to identify these problems and treat them as quickly as possible. It is important for anyone who has cataract surgery to get checked promptly (same day) if he/she is experiencing severe pain or headache, worsening redness, decreasing vision, sudden onset of flashing lights (lasting seconds) or new onset floaters. If the problem occurs on an evening or weekend, your surgeon may not be available. For post-surgical emergencies after- hours, call the Misericordia Hospital switchboard at 204-774-6581 and ask for the on call Ophthalmologist or visit Misericordia Health Centre or your nearest emergency room.

What are the potential risks of local anaesthesia?

Anaesthetic complications are extremely rare but can happen even with the small amount of intravenous medications and local anaesthetics that are used. Most of the time, if a patient is comfortable, no drugs are used. However, if a patient is nervous and needs something to stay relaxed, a small amount of sedatives and painkillers are used in the intravenous. In some patients, use of local anaesthetics in and around the eye can cause decreased vision, bleeding and nerve changes. These effects are usually temporary and resolve with time. Rarely, there can be permanent damage. In rare patients with multiple medical problems, these drugs can potentially cause cardiac or neurological problems, resulting in serious illness or even death. We are certainly vigilant of any concerns with the use of medications in our patients and are prepared to deal with these kinds of emergencies. However, we cannot always predict when a serious drug reaction will occur. Fortunately, these complications are extremely rare with local procedures.

How do I prepare for eye surgery?

Read more here

What happens after the surgery?

After the surgery, you will be seen in the office (or Misericordia Health Centre on weekends) later that day or the next day, and sometimes 1 week later. You should see your Optometrist 4 to 6 weeks after (the second eye) surgery to update your glasses. You will need to use 3 different types of eye drops for 4 weeks.

If you are taking eye drops for glaucoma, you will need to continue these in addition to the extra post-operative drops, unless otherwise instructed. If you are having glaucoma surgery combined with your cataract surgery, the glaucoma eye drops will be stopped after the surgery in your operated eye only. Full instructions will be given at the time of surgery. You will also receive a card with information about the implanted lens to keep for your records. Your eye will be covered with a shield when you leave the hospital. You can take the shield off when you get home, and then tape it over your eye at night for 1 week to protect your eye while sleeping. We recommend 3M Transpore® tape available at any drugstore to tape on the shield (hypoallergenic and latex free).

Will I be able to see clearly immediately after surgery?

Since we do not use a freezing needle injection around your eye, you will be able to see right after surgery. However, because your eye has been exposed to the bright shining microscope light, phacoemulsification energy and lots of fluid for the duration of the surgery, there will likely be some temporary swelling and inflammation. Expect your immediate post-operative vision to be blurry. Over the course of the next few days, your vision will improve as the swelling and inflammation clears up. It is not usual for your vision to get worse. If you have worsening vision or pain, call your surgeon's office or the Misericordia Health Centre at 204-774-6581.

Will I be more light-sensitive after cataract surgery?

After cataract surgery, many people notice that they are more sensitive to bright lights. This is common, since the clear implanted lens allows more light into your eye than the cloudy cataract that was removed. Overtime, you will get used to the change in brightness after cataract surgery. The implantable lenses have built-in UV protection. You should routinely wear sunglasses in bright light to protect your eyes and keep them comfortable.

Will I have to stay overnight in the hospital?

If you do not have anyone who can stay at home with you, we will arrange for you to stay overnight in the hospital. It is important to have someone stay with you the night of your surgery, because any sedatives used may make you may feel drowsy after the surgery.

Will Homecare be arranged for me, in case I cannot manage all the drops myself?

Please let us know if you require help with your drops and we can arrange this prior to your surgery. If you already have homecare, please let us know and we will forward all the necessary updated orders to your homecare nurse prior to the surgery.

How long will I be off work?

With uncomplicated surgery, vision returns quickly and one can resume normal activities within a short period of time (usually a few days to a week). If you need short-term disability forms filled out, please present these to us PRIOR to your surgery, as the surgeon cannot fill these out on the day of surgery.

What restrictions do I have after cataract surgery?

After uncomplicated cataract surgery, healing is usually reasonably fast. It is important to avoid getting direct water into your newly operated eye for 2-3 days. It is also important to avoid very strenuous activities and exercise for the first week. Wear the plastic shield provided over your eye at night for the first week. Avoid any appointments to the dentist the first 2 weeks after surgery (as dirty matter can spray into your eye and cause an infection).

Do not plan to fly right after cataract surgery. It is best to plan your trips at least 3-4 weeks after cataract surgery in case of unforeseen circumstances. If you are having glaucoma surgery combined with cataract surgery, please see the Glaucoma Surgery section to review further additional restrictions that may apply (depending on the type of glaucoma surgery planned).

B221-2025 Corydon Avenue, Winnipeg, Manitoba, Canada, R3P 0N5

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