How Do I Behave When I Am Undergoing Cataract Surgery?

Cataract Surgery nowadays is usually performed under 'topical anaesthesia' that involves instillation of drops of the anaesthetic agent on the eye surface. The patient retains the power to close the lids and move the eyeball during surgery, feel no pain but touch and pressure sensations are unaffected. A peribulbar block anaesthesia may be used at times on surgeon's discretion that involves an injection of anaesthetic agent around the eyeball with a short needle. This takes away lid and eye movements to a large extent but some control may remain with the patient.

Operating Surgeon expects the patient to follow the instructions for a smooth surgery. It is important to have a surgical counselling session with the doctor to understand the procedure and expected sounds/conversation during the operative procedure. The sequence of events should be understood and played in your mind while you move through the surgical suite.

  • You should be wearing loose, comfortable hospital pyjama suit. Do not hesitate to change it if it is tight around your neck. Some hospitals have the policy to allow you to wear your own loose clothes and give you a hospital gown over them. Please ensure you are not wearing tight fitting clothes and your neck is free. Ladies to tie their hair in a ponytail with a band or a soft bun with no clips or clasps
  • Sit quietly in the pre-operative area and use the washrooms before going to the OR. You may take sips of water if your mouth feels dry but do not hydrate yourself too much.
  • You may be given a cap and eye marked for surgery. The antiseptic solution will be painted around the eye. Let the solution dry and do not touch your eye.
  • OR assistant will help you lie down on the OT table with a rubber ring under the head to prevent rolling from side to side. You should be comfortable and be able to breathe rhythmically while lying down. Ask for a head raise if neck extension is hurting you and get the ring adjusted to your comfort and if it is hard for you to ask for a softer ring.
  • When you are comfortable allow the staff to put monitoring devices which could be a pulse oxygen meter alone or additional cardiac electrodes. Breath rhythmically and try to relax.
  • Sterile Drapes will be placed around your head and an adhesive eye drape on the eye to be operated upon. Please maintain your head in a position as required and adjusted by the surgeon. Do not move your head or lower your chin. The surgeon works under a microscope and any movement shifts the focus and obstructs in smooth surgery.
  • There will be several sounds in the OR that you should ignore-beep of monitors, hum of air circulation unit, trolley wheels, the doctor would be giving instructions to staff and asking for instruments etc. Try to keep your attention focused towards surgery only.
  • Coughing and snorting during surgery can create complications, always ask the surgeon to stop the surgery if you feel like doing so. Do not try to suppress a cough or sneeze by holding breath. Do not bear down or move.
  • Follow instructions of a surgeon and do not start a conversation. Answer only when a question is directed towards you. The surgeon may ask you to look in a particular direction. You have to follow the command by moving your eyes and not head unless the specific instruction is made.
  • The first touch of the instrument will increase your confidence. Do not wince, squeeze your lids or make a jerky movement if you feel some pain. Inform the doctor, who will reinforce anaesthesia.
  • Cataract Surgery machines also produce different types of sounds during different phases of surgery and also have synthesised verbal outputs. Do not get distracted by the same.
  • You will see movements in front of the eye during surgery and also perceive vibrations. Light intensity will increase towards the end of surgery.
  • A calm patient who is having a regular rhythmic breathing and a regular normal pulse rate makes a surgeon's job easy.
    (In case of specific problems additional monitoring and specialised anaesthetic cover may be required which the operating surgeon will discuss before hand).

    "Oh God! I Have Been Diagnosed with Cataract!"

    When a patient is diagnosed to have cataract the following questions pop up immediately:

    1. Is it unusual at this age?
    2. Can it be cured with medication of any sort?
    3. Is the surgery a must? What if I do not get operated?
    4. How long can the surgery be avoided?

    Cataract is the commonest cause of gradual, painless, progressive diminution of vision in middle-aged and old people. The reaction of a patient varies from utter shock, disbelief to acceptance and discussion of further treatment.

    Why Me?

    While cataract is known to occur at all ages and even congenitally, it is the senile, age-related, a cataract that is the commonest in prevalence. People get cataract at different ages depending upon familial trends and associated systemic illnesses and exposure to certain light frequencies. Diabetes (and other metabolic afflictions), steroid intake and exposure to Ultra Violet light cause early cataract formation. Trauma to the eye also causes cataract formation.

    Why does vision decrease?

    The normally transparent crystalline lens of the eye becomes translucent and some areas turn opaque, thus causing scattering of light as well as a blockage. Location of opaque areas also matters as central changes affect vision much earlier than those in the periphery. Opaque areas close to the nodal point of the lens will affect vision profoundly even if small in size.

    Is there a medical cure available?

    In spite of tall claims no medical treatment has been established scientifically beyond doubt till now. Anecdotal claims do not satisfy scientific hypothesis. Use of antioxidants may retard the progression of cataract as a general anti ageing effect. Avoid using eye drops of unknown composition and dubious sources in the name of magical cures! They may cause more harm than benefit.

    What is the "Right Time" for surgery?

    It depends on upon the lifestyle, profession and visual needs of a patient. It is ordinarily an elective surgery and a patient should discuss all the elements of procedure and care with the surgeon and decide on the timing of surgery. Surgery is aimed at improving "quality of life". Glare, difficulty in driving and reading are some of the things that can affect the quality of life of a person and surgery is expected to alleviate them. A driver, an IT professional, an avid golfer may choose to undergo surgery at an earlier stage than a person who does not drive and read much.

    Gone are the days when patients used to wait for the cataract to mature! Surgery time is decided after a mutual discussion on outcomes and QOL targets. Surgery should not be postponed for long in case of advanced cataracts as they turn harder with time and surgery becomes more challenging. There are situations when surgery can not be postponed such as a swollen lens causing a rise in pressure or a leaky lens causing inflammation.

    Cataract surgery is one of the most gratifying surgical procedures and safest as well. Do not get scared, discuss the goals of surgery and take a cool decision.

    I Am Undergoing Cataract Surgery, Which Is the Suitable IOL for Me?

    Cataract surgery is the one of most commonly performed eye surgery. It has got high levels of safety and predictability of outcomes.

    IOLs are manufactured mostly from Hydrophilic or Hydrophobic clinical quality plastic polymers. Hydrophilic polymers create highly pliable lenses that are relatively easier to introduce in the eye. However ,the incidence of lens capsule becoming opaque is higher, though eminently treatable with YAG laser capsulotomy. This kind of material may also be avoided in diabetic patients as it binds to silicone oil, in case patient undergoes VR surgery in future (the chances are low though for this kind of surgery). Hydrophobic Polymers are increasingly the choice of material for eye surgeons across the world. The polymer research is continuing in various directions to make the IOLs behave as close to the natural lens as possible.

    IOLs are available in different refractive options as well; mainly mono focal and multi-focal. Mono- focal lenses have a fixed focus and necessitate use of reading glasses after surgery. Multi-focal lenses are designed to work at all distances and obviate reliance on corrective lenses post surgery for most of the daily activities. There are advantages as well as limitation of multi-focal lenses which you must discuss with your doctor. Current knowledge discourages use of multi focal lenses in diabetics.

    Toric lenses are also available to take care of of cylindrical power as well as Toric Multifocal lenses which also help in assisting in near vision.

    There is a fiscal impact for each lens that a patient should know and discuss probable outcomes as well as challenges that may arise in the post operative period peculiar to a lens design such as glares, halos, floaters etc.

    It is important to discuss with your surgeon about the material, design, probable visual outcomes and limitations of an IOL that is selected for insertion in your eye.

    Please obtain the bar code of the IOL inserted in the eye from the hospital and keep it safe for future reference.

    An informed decision is always important to match expectations in outcome of a surgery.

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