At Worcester Ophthalmology Associates, we are proud to offer the latest in modern, small-incision, minimally invasive cataract surgery.
What are cataracts?
The Academy of Ophthalmology has an excellent patient portal with information about eye health.
Video in Spanish below:
How do I know if I have cataracts?
As we age, the natural lens in the eye that helps focus light gets cloudy. The clouded lens is called a cataract. This can occur slowly over time, or in some conditions like trauma or diabetes, can develop more rapidly. When the cloudy lens starts to affect vision or quality of life, then we may decide that it is time for cataract surgery. Symptoms of cataract may include glare with nighttime driving or difficulty reading despite best glasses correction.
What should I expect for my evaluation?
You will have a complete eye exam including a glasses check, dilating drops, special measurements, and thorough discussion of risks and benefits of surgery and lens implant options with your surgeon. You should plan on being in the office for at least 2 hours for your consultation. Since you will be dilated, you should bring someone with you to drive you home or have alternate transportation plans as you may be light sensitive or blurry for 4-6 hours after the dilating drops.
What are my lens options?
There are basically 3 types of intraocular lenses (IOLs) on the market. Alcon, one of the major lens companies, makes a neat vision simulator to help you get a better idea of the vision from different types of lenses. The American Academy of Ophthalmology also has some good information about your lens options here. A new addition to our lens options is the Light Adjustable Lens by RxSight, which is the only one that can be modified AFTER lens implantation. You can find more information on your options below:
1. Monofocal IOL: The most common type of lens, and the one that insurance will pay for. This is designed to provide clear vision at one distance, but does not correct astigmatism or presbyopia. You and your physician will discuss what the target distance will be. For instance, if you elect to be able to see objects far away, you will most likely need glasses for computer work, reading, and any type of “up-close” detail work.
2. Astigmatism Correcting (Toric) IOL: This lens corrects astigmatism, which is a measurement of the curvature of the cornea (front part of the eye). There is a good explanation of astigmatism here at the American Academy of Ophthalmology web site. Astigmatism can be corrected by corneal surgery (including femtosecond laser assisted cataract surgery), glasses, contact lenses or an astigmatism correcting intraocular lens. The astigmatism correcting IOL can provide high quality vision in patients with significant astigmatism. Your doctor will let you know if you would benefit from this type of lens. Insurance does not cover the additional cost of astigmatism correction.
3. Presbyopia Correcting IOL: Presbyopia is the normal loss of near focusing ability that generally occurs as we age. There are different technologies for this type of lens. The two main types of presbyopia correcting intraocular lenses are extended-depth-of-focus lenses (EDOF) and multifocal lenses (MFIOL). The appropriate lens will be recommended for you based on measurements taken during your visit in combination with your goals and requirements for vision. The goal is to be less dependent on glasses for daily tasks, though you may still need low-prescription readers for fine detail work. In achieving more glasses independence, there may be a trade off. You may lose some of the sharpness of your vision or you may see some rings or circles around lights (halos) at night. For most patients, this is not an issue, but for a minority of patients these visual phenomena can be very symptomatic and disturbing. Insurance does not cover the additional cost for this type of lens.
What are Light Adjustable Lenses?
We are proud to be the first practice in Worcester to offer the RxSight Light Adjustable Lens. It is the only lens implant that can actually be customized after lens implantation using specially focused UV light in the office. This allows your surgeon to work with you to tailor and test drive your vision to you specifications after your cataract surgery. Many people elect to have blended vision in order to get the best distance vision as well as some degree of reading. There is a wonderful patient portal on the RxSight company website which can be found by clicking on this link.
What is Femtosecond Laser Assisted Cataract Surgery (FLACS)?
We are proud to be the first practice in Worcester to offer FLACS. When used, the laser is the first step of cataract surgery, and helps to make corneal incisions including astigmatism-correcting incisions, to create the opening in the lens capsule, and to soften the cataract. The laser can be used to reduce the amount of ultrasound energy used in traditional cataract surgery. We do not believe that FLACS is appropriate for all patients, but will make recommendations based on your exam and visual requirements. This technology is not covered by your insurance. More information about astigmatism can be found here.
What about drops?
We have moved to a (mostly) drop-free cataract surgery protocol for eligible patients. You can learn more about this technique here.
If you have glaucoma, significant optic neuropathy, or known elevated eye pressures in response to steroids, you will have a more traditional cataract drop regimen.
If you have an increased tendency to have inflammation or swelling in the back of the eye (for example, diabetic retinopathy with macular edema or macular degeneration with edema), you will likely need to be on additional drops for 4 weeks after surgery.
How should I prepare for surgery?
1-3 weeks ahead: See your primary care doctor for a physical exam to determine if you can safely have cataract surgery. Your primary care doctor will need to fill out a physical exam form for the surgery center and send it to our office. They can also send a copy of your most recent exam instead of filling out the physical exam form. It is important to get that information to our office as soon as possible to make sure the anesthesia team can review this information to assess safety for surgery.
1 day ahead: The surgical center will call you to confirm arrival time. If you have not heard from them by early afternoon around 2PM, please feel free to call and confirm at 508-754-0700 (Worcester Surgical Center) or 508-381-6040 (Cataract Surgical Center of Milford).
Night before: No eating or drinking after midnight. You may have a sip of water with any pills the morning of surgery, but that’s it!
Obviously, each patient is unique. You may have some extra things to do in order to prepare for surgery. This will be covered during your consultation.
What is recovery like?
Normal cataract surgery is performed at an outpatient surgery center. It is a day surgery, meaning that you will go home the same day. Surgery itself usually takes less than 20 minutes. You should plan to be at the surgery center for a couple of hours. The surgery center will call you the day before to let you know what time to come in for surgery. You will need a ride home, as you will likely receive some intravenous medications and cannot drive for at least 24 hours after surgery. You will leave the surgery center with a shield over the operated eye, which needs to stay on until your follow-up appointment the next day. It is normal to feel a bit scratchy after surgery and for your vision to be blurry. You may still be dilated for 1-2 days after surgery. Most people feel mostly back to normal by 1 week after surgery. You may be using eye drops for 4 weeks after surgery.