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Cataract FAQ’s 

“It’s all minor surgery unless it’s on me, then it’s all major surgery.”

J. Stanford Shelby, M.D. 

Pioneering Cardiovascular Surgeon 

Heart Surgeon JS Shelby, M.D.

That is a quote from my father, a pioneering Cardiovascular and Thoracic surgeon.  It’s easy for someone NOT going through surgery to tell you how easy it is and not to worry about it.  When we are faced with surgery, no matter how minor or major, we all get a little apprehensive about it.

This is a list of the most common questions we are asked before and after the procedure.  We, as surgeons, sometimes assume that everyone understands what is going on as well as we do and fail to realize that you, as a patient, have no idea what is normal and what is not.

If YOU have any questions that aren’t covered here, feel free to contact me at doc@seebetter.com and I will do my best to answer your questions.

As always, when you See Better, you Live Better.

Christopher L. Shelby, M.D.

What is a cataract made of? – It’s densely packed protein and collagen.  A cataract IS your lens, just no longer clear and transparent.  As you age, the lens continues to grow and insoluble high molecular weight proteins continue to increase which slowly causes the changes we call a “cataract”.

What are the causes of a cataract? – Birthdays….  The most common cause of a cataract is aging.  As we get older, cataract development is a normal change of the lens we were born with.  The most common age for cataract surgery is around 70.  This is when the symptoms get bad enough to warrant cataract surgery.  The other common causes of cataracts, especially in younger patients, are:

  • Diabetes
  • Trauma
  • Steroids, injected or oral
  • Other eye surgeries

Can I prevent cataracts with sunglasses? – Short answer, NO.  Sun exposure may be a minor cause of cataract development but it hasn’t been proven.

Will vitamins help prevent cataracts? – Once again, NO.  Numerous vitamins and supplements have been well document in helping slow the progression of macular degeneration and also help with dry eye syndrome but nothing has shown to be effective against cataract formation.

Do I need to stop my Aspirin before cataract surgery? – No, or at least not in our practice.  Cataract surgery now a days is a simple outpatient procedure that only requires minimal sedation with an IV.  We perform clear corneal surgery so we bypass any blood vessels on the surface of the eye.  Your lens (the cataract) has no blood supply so the risks of bleeding  are close to non-existent.  Even patients who take more powerful blood thinners do not need to stop them before hand.

clear cornea cataract surgery no need to stop blood thinners
There are no blood vessel on the cornea so no bleeding

Do I need to stop my Flomax or other prostate medicine before cataract surgery? – No.  Flomax and the other medications in its class, cause what we call “Intra-operative Floppy Iris Syndrome” or IFIS.  IFIS is when the pupil rapidly shrinks and the iris (colored part of your eye) billows (gets floppy) during cataract surgery.  This effect happens even years after you have stopped the medication so it does not help for patients to hold off before.  We have special medications and instruments that help during surgery if we run into any problems, which are few and far between.

Does Medicare pay for cataract surgery?– Yes.  Cataract surgery is a covered procedure by Medicare and here’s how it works.  When you come to the office and we find that you indeed have Visually Significant Cataracts that are causing you to have a poor quality of life then Medicare will pay.  The entire procedure is usually covered (standard lens, anesthesia, etc..) and Medicare then will pay for 80% of the allowable charge.  Either you or your supplemental insurance is responsible for the other 20%.  Medicare DOES NOT however pay the extra fee for premium lenses such as multifocals and torics, nor do they pay the extra for the Laser when used at the time of cataract surgery.  They DO pay for the cost of a standard lens.

What’s the allowable charge?  It is the fee that we have agreed to accept from Medicare.  Let’s say I decided to charge $1,000,000 for cataract surgery, (which by the way is worth it, in my humble opinion), as a Medicare provider, I signed a contract with them saying that no matter what I decided to charge I have agreed to accept X amount for my surgical services.

What does Medicare pay for cataract surgery? – Not enough….  

Is there any pain during cataract surgery? – Cataract surgery is a painless procedure.  The eye is a very sensitive organ and is covered by thousands of sensory nerve fibers.  Because of that, topical anesthetics work amazingly well at completely numbing the eye.  We also inject a small amount of anesthesia inside the eye to provide even further comfort.  Because of the mild sedation, most patients do not remember anything from the surgery anyway.  

Is there any pain AFTER cataract surgery? – No, or at least there shouldn’t be.  Because of the 2 tiny incisions required for surgery, most patients will feel a little gritty or scratchy sensation for a few hours after the surgery.  The eye heals so fast that those sensations go away by the next day.  Severe pain is ABNORMAL and should be addressed immediately. 

Is LASER Cataract Surgery better than normal? – In a word, Yes.  Our primary goal with cataract surgery is to get you, the patient, seeing better.  The closer we are to our predicted outcomes, the better you will see.  We have found that in our practice, patients who have the Laser plus the ORA are within 94% of predicted while those that have routine surgery are within 70% of predicted.  The Laser improves our accuracy, reduces the amount of time and energy required to remove the cataract and helps to reduce post operative healing time.

Do cataracts ever grow back? – NO, they can’t.  Remember a cataract is simply a color change of your natural lens.  Cataract surgery is removal of your lens and replacing it with a new one.  Your natural lens is held in place by a bag, when we remove your lens we leave that bag intact so we can place the new lens in it.  Sometimes that bag that we put your lens in can become hazy.  When that happens, we call it a “secondary cataract”.  The lens is a living structure so those little fiber continue to migrate along the back of the bag and create some fibrosis (scarring).  When this happens, the vision can get blurry and seem like  the cataract has returned.  It happens about 50% of the time after surgery and can happen any where from 6 weeks to 10 years.  If it does happen, we simply use a YAG laser in the clinic to remove it.  It is painless, takes less than a minute and you notice an improvement in your vision within an hour or so.

Secondary cataract after cataract surgery is very common and happens 50% of the time
“secondary cataract” is a clouding of the bag that holds your lens.

I have some flashing and flickering off to the sides after cataract surgery.  What is that? – Flashing and flickering is caused by the jelly (vitreous) inside the eye tugging and pulling on your retina.  This does not happen with everyone after surgery but is not uncommon.  Your natural lens is fairly thick compared to the lens we put back in, so something has to make up the space.  Imagine taking a pumpkin out of a grocery bag and putting in a  frisbee.  As that lens is healing in, the vitreous jelly tends to move forward and tug on the retina.  The flickering is usually seen at dusk, dawn and lower light conditions and resolves after a few weeks.  If the flashing and flickering worsens especially if it’s associated with new floaters it could be a tear in the retina which requires urgent intervention.  

flickering and flashing lights after cataract surgery are caused by the vitreous jelly tugging on the retina.
Tugging on the retina by the vitreous jelly causes flashes after surgery

I sometimes see a line or Crescent Shadow off to one side or the other or both.  What is that? – We call that a negative dysphotopsia or ND.  An ND is an optical phenomenon caused by the optic of the new lens, the physics being fairly complex.  Your natural lens is 12-13 mm in diameter, the optic (central portion) of the lens we put in is only 6 mm in diameter.  The new lens must be smaller in order for us to get it through such a tiny incision.  Most patients will experience this during the initial healing phase periodically.  Over time, usually 4-6 weeks, most patients notice they don’t see it anymore.  Some patients however can notice it up to 6 months or even longer.  If an ND becomes problematic for patients and interferes with their daily activities, it can be treated in a number of different ways but most times resolves on its own. 

Does the lens ever need to be replaced? – Not usually.  Once you’ve had cataract surgery your eyes and vision should remain fairly stable.  After the initial healing period, your lens  is pretty well healed in.  Sometimes you will need a YAG laser like we discussed before but even after that, your vision should get back to where it was right after surgery.  RARELY can something happen to the lens that would require it to be replaced.

Will my vision continue to change after cataract surgery? – Not like it did before.  Most of the vision change you’ve had (or you will have) over your lifetime happened because of cataract development.  Once the cataract is out and a new lens placed, your vision remains surprisingly stable.  There are some subtle changes to the cornea (front clear part of the eye) that continue over your lifetime but these changes are very slow.  This is assuming there are no other issues with your eyes such as glaucoma, diabetes or macular degeneration.  

Can I have surgery again if my vision gets blurry after cataract surgery? – It depends on what is causing the blurry vision.  If you develop blurry vision after cataract surgery or your vision was never quite as clear as it should have been, then we look for reasons why.  If your blurry vision is caused by residual nearsightedness, farsightedness or astigmatism, then you may be a candidate for LASIK or some other vision correction surgery to sharpen your vision.

Will I need glasses after cataract surgery? – This all depends on what you were trying to achieve after surgery.  If you elected for multifocal lenses or for mono vision correction, then you should NOT need glasses for most things.  If you decided to go with the standard lens then  you will at least need glasses for reading if not bifocals for distance and near.

What about my Dry Eye after cataract surgery? – Most patients will notice a slight worsening in dry eye symptoms for a few months after cataract surgery.  If you’ve never had dry eye symptoms before, don’t be surprised if you have some after.  The inflammation associated with healing decreases the quality of your tear film.  This causes some of the symptoms to worsen slightly.  We generally see it last for about 3 months then it returns to baseline.  Lubricating drops will alleviate most of the symptoms during that interim period.  If Dry Eye continues to worsen after the 3 months, the we treat it more aggressively.

Will my Floaters go away after cataract surgery? – No, sorry they will not.  Floaters are simply debris floating around in that vitreous jelly that sits behind your lens.  When that debris passes in the light coming through your lens, you see the shadow it casts onto your retina.  Because cataract surgery is in the front of the eye, we don’t get into the space  where the floaters live.  Most patients will notice the floaters seem different after surgery.  This is due to the fact that the light coming in is much sharper and not scattered.  Because of this, most floaters seem smaller and more defined and a lot of patients will then adapt to them.  If floaters are still bothering patients after surgery there are some options to help minimize them.

floaters are still present after cataract surgery
Floaters are BEHIND the lens so cataract surgery does not remove them.

How long does it take to heal after cataract surgery? – It will take 5-7 days for the small incisions from the surgery to be healed.  During that time, you want to minimize bending at the waist and try not to pick up anything heavier than 10 pounds or so.  You can get back to walking the next day but weightlifting you need to give it a full week.

When can I drive after cataract surgery? – You can drive the next day.  IV sedation is like getting a bunch of margaritas directly in your veins so no driving the day of.  Most people just go home and sleep. 

When will I be able to see after cataract surgery? – Immediately!  Most patients will notice an immediate improvement in brightness and colors.  There is some foggy hazy vision for a few days from the pupillary dilation and the wound swelling.  Some patients see perfect the next day others may take a few days depending on the severity of the cataract and any other coexisting conditions such as diabetes or retina issues.  The day of surgery you can read (may have to use reading glasses), watch tv and get on your computer.

When can I fly after cataract surgery? – Immediately after.  There is no issue at all with flying even right after surgery.  It is dry on an airplane so don’t be surprised if you need to use lubricating drops when flying.

Can cataracts cause headaches? – Not really.  Some people can get a “brow ache” from squinting too much trying to focus but as a general rule, cataracts don’t cause chronic headaches.

Are there any eye drops that dissolve cataracts? – Not yet.  No matter what anyone tells you there are NO DROPS that will STOP or REVERSE cataracts. 

Can you wear contact lenses after cataract surgery? – Sure.  Sometimes dry eye can make contact lenses a little more uncomfortable but as long as you can tolerate them it’s fine.

Is there light sensitivity after cataract surgery? – Yes, initially.  If you can imagine having this brown cloudy lens has been in your eyes for the last 10-20 years and suddenly the lens is now clear, your eye takes some time to adjust to ALL that light coming in.  Most patients notice an increase in light sensitivity for 4-6 weeks then it slowly improves.  

When can I exercise after cataract surgery? – You can do light exercise such as walking almost immediately after.  We recommend waiting at least a week before getting back to strenuous weight lifting and/or aerobics.For more information on all Eye and Vision issues please visit

www.SeeBetter.com

doc@seebetter.com

seebetter

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