Frequently Asked Questions  

Understanding Cataracts
What is a cataract?

A cataract is the natural clouding and yellowing of the lens that exists inside of your eyes. When you are born, this lens is typically clear, and with age, it naturally evolves into a cataract. 

How do I know if I have a cataract?

Most people will start to develop the start of cataracts in their 50s to early 60s. However, early cataracts have minimal impact on your vision. Over time as the cataracts worsen, you may notice vision becoming more hazy or blurry. You may have difficulty reading small print or seeing words on the television. Glare can become more bothersome when driving at night, or with bright sunlight during the day. 

 

What can be done to treat cataracts?

Cataract surgery removes the cataract from your eye and replaces it with a lens implant that restores your vision. There is no other way to treat cataracts. Without surgery, cataracts continue to grow and vision will continue to worsen. Once a cataract is removed, it will never come back. Learn more about cataract surgery in the section below.

What causes cataracts?

Cataracts occur in all individuals as a natural aging process of the eye. In some, cataracts can occur as early as birth. Other causes include trauma or surgery to the eye, certain inflammatory conditions, diabetes, and long-term use of oral, topical, or nasally inhaled steroid medications. 

 

How can I prevent cataracts?

While there are no known methods or medications to prevent the formation of cataracts, you can follow these tips to slow down and reduce your risk of early cataracts: avoid smoking, use sunglasses with UV protection when exposed to sun, keep your blood sugar well-controlled, and eat a healthy diet with vitamins and antioxidants. 

 

When should I have cataract surgery?

The decision to have cataract surgery is a very personal one that is made based on a number of factors. Ask yourself whether your vision is affecting your ability to comfortably do normal day-to-day tasks such as your work activities, reading, watching TV, and driving. If so, it may be time to consider cataract surgery. You will need to have an eye exam for your eye surgeon to determine the extent of the cataract and whether there are other causes for your vision changes. Cataract surgery should not be performed too early (before any vision symptoms are noticed), but should also not be delayed until vision is extremely poor as surgery carries a greater risk when the cataracts are very mature.

Cataract Surgery 
How is cataract surgery done?

With great advancements in modern technology, cataract surgery is now one of the safest and most common surgeries performed. Cataract surgery is done as an outpatient procedure, and typically takes less than 20 minutes. At Bay Area Eye Specialists, we perform sutureless, clear cornea small incision cataract surgery. The procedure involves making a tiny incision on the eye only 2.4mm in size (less than 1/10 of an inch), and using microinstruments with ultrasonic phacoemulsification energy to break down your cataract and remove it from the eye. A new intraocular lens implant with a power customized to your eye is inserted through the same tiny incision and positioned to provide vision correction (read more about your different intraocular lens implant options down below). At this point, the surgery is complete, and typically no sutures are required as the incision is self-healing. 

What kind of anesthesia will I get?

Cataract surgery can typically be performed under local anesthesia with topical numbing eye drops, along with a mild sedative given intravenously to help you feel relaxed. Surgery is monitored by an anesthesiologist, who will adjust your IV sedation as needed to keep you completely comfortable. For individuals that are unable to tolerate the procedure with the typical anesthesia given, stronger sedation may be given, up to general anesthesia if absolutely required in certain circumstances. Our goal is to keep you completely comfortable and pain-free at all times. 

 

Will I have both eyes operated on at the same time?

No, we do not operate on both eyes at the same time. The reason is to allow you to have your normal vision in one eye while the other eye is healing, and also to avoid exposure of both eyes to any infection that could occur following surgery. We typically schedule to operate on your second eye approximately 2-4 weeks following the first eye. 

What can I expect during surgery?

You will be laid flat on the operating bed with your head positioned flat and facing the ceiling. The operating room staff will position your body so that you are comfortable for the duration of the surgery. During surgery, a holder will be placed to keep your eyelids open, and a bright light will be shone above you. You will hear sounds and see colors and shapes, but you will not see the surgery itself. Some people may feel drowsy and fall asleep, and some people have no recollection of the surgery at all, depending on how you react to the sedation. Although you may feel some pressure during surgery, there should be no pain. An eye patch is placed over the operated eye for the day of surgery, to be removed the next day at your first post-operative visit. 

What preparation is need for surgery?

Prior to surgery, you will need to have a pre-operative visit with your eye surgeon, during which special measurements are taken to evaluate your eye. These measurements are important to allow your surgeon to customize the intraocular lens implant that will be placed in your eye during surgery. You will also need to have a physical performed by your primary care doctor within the 30 days prior to surgery to ensure that you are medically cleared for surgery. This workup usually includes getting some bloodwork and possibly also an EKG (electrocardiogram of the heart). 

 

What do I need to do the night before surgery?

At your pre-operative visit, you will be given eye drops that are to be started the day before surgery (3 times that day, at breakfast, lunch, and dinnertime). You will also place the eye drops once on the morning of surgery. It is crucially important that you do NOT eat anything after midnight at night. In the morning when you wake up, do not eat or drink anything (this includes black coffee or juice). You may have a sip of water for your morning medications only. 

 

What is the process on the day of surgery?

You will arrive at the hospital surgery center on the morning of surgery at the time given to you in advance. There will be time given for paperwork and for you to change into a gown. You will be asked to remove your shirt only, but you may keep your undergarments on as well as anything below your waist. The nursing staff will administer dilating eye drops and medications to prepare you for surgery. An IV will be placed so that you can receive sedation at the time of surgery. You will be brought to the operating room, and when surgery is done you will be transferred to the recovery area where you are given food and drink while you recover. You are typically discharged from the hospital within 30-40 minutes after surgery. You can expect the whole process to take a few hours. You will be given your post-operative care instructions upon discharge. You must be accompanied home by a family member or friend (you may not go home by cab or by yourself).

What are the risks of cataract surgery?

There is no surgery that is performed without any risk. Luckily, cataract surgery is one of the safest surgeries available with a success rate of greater than 95%. Less than 5% of the time you may develop bleeding, infection, a retinal tear or retinal detachment, or have the need for additional surgery. Other risks include swelling in the front or back part of the eye, elevated eye pressure, and prolonged inflammation during the healing process. These potential issues are treatable and infrequent. Extremely rarely, there may be loss of vision or loss of the eye. The decision to have cataract surgery should be made when the benefits of surgery outweigh the risks, and the good news is that this conclusion is typically the case. 

Post-Operative Healing
How long does it take to heal?

The typical healing course for cataract surgery is 1 month. Your body may heal faster or slower depending on how it responds to the surgery. 

What will I feel right after surgery?

Following cataract surgery, you may feel groggy from the sedation. You will have a patch on the eye and will not need to use any eye drops that first day. Most people will not have any discomfort. If you feel any pain or irritation, try taking some extra strength Tylenol. Some people may feel tired that day, and it is recommended that you take it easy and sleep as much as needed. Feel free to use your non-patched eye to watch TV or read if you feel up to it. Avoid taking a shower or getting your eye patch wet. You may resume your normal medications. 

 

What restrictions are there after surgery and for how long?

After surgery, avoid showering or washing your face the first night to keep your patch dry. After the patch has been removed at your first post-operative visit the next day, you may resume showering and washing your face as long as you keep your eyes closed and avoid splashing water in your eyes. During the first two weeks of healing, you are to avoid any straining, heavy lifting (not more than 20 lbs), or bending past the waist. Straining may cause your cataract incision to open (as no stitches are placed), so time must be given for the incision to heal properly. Avoid getting any water in the eyes, and do not go swimming or go to the beach or pool. Throughout the entire month, avoid rubbing the eye at all. If you are placing eye drops, be sure not to press on the eye itself or touch the eye with the bottle. Dab gently around the eye with a tissue if needed. To ensure that you do not accidentally rub the eye or bump it while sleeping, you must tape an eye shield (provided to you at the time of surgery) over the operative eye at bedtime for one week. While you are out during the day, we recommend wearing sunglasses to protect your eyes from the sun. 

What daily activities may I do?

During the first few days, try to take it easy. Avoid any strenuous activities. You may read or watch TV, do light household chores, and go for walks. After the first week, you may do some light jogging, gentle cycling, and resume any daily activities that are not strenuous or cause straining. Avoid any gardening for the first two weeks. For makeup, do not use any powders or creams near the eye the first week, and do not use any mascara or eyeliner.  You may resume all makeup after 1 month. Most people can resume work after a few days to a week. Consult with your eye surgeon to determine when you should return to work. If your work involves heavy lifting or bending, you will need to be on modified light duty to avoid doing so. You may start driving when you are comfortable doing so with your new vision. For some individuals, vision will be excellent within the first few days to a week, and for some, vision will be blurred until a new pair of glasses can be prescribed. 

What is the typical post-operative timeline?

We typically schedule you for a post-operative follow up at 1 day after surgery, 1 week, and 1 month. At the 1 month visit, most people have completed healing and their vision should be stabilized. At the month 1 visit after both eyes have had surgery, you will be checked for your residual glasses prescription (if you have an outside optometrist you may have this done by your optometrist). Even if we expect to have minimal need for glasses after surgery, we will obtain the residual measurement by refraction to understand your visual outcome after surgery. 

How should I use my post-operative eye drops?

Your post-operative eye drops are the same eye drops that were given to you (or ordered from a pharmacy) prior to surgery. Once your eye patch has been removed at the doctor's office the day following surgery, you are to resume using the eye drops 3 times a day (spread evenly throughout the day) until the bottle runs out. Be sure to shake the bottle prior to each use, and administer one drop each time. If you are not sure if you got the eye drop in the eye, you may place an additional drop. The bottle is expected to last approximately 3-4 weeks depending on how you use them. If you are using multiple eye drop bottles, wait 5 minutes between each medicine to avoid washing the previous one out of the eye. Your doctor may ask you to use your eye drops on a different schedule or add additional medications during your follow up visits, depending on how you are healing.

 

How will my vision change following surgery?

Your vision may be clear on the day after surgery, but often you may have blurred vision caused by swelling that is typical after surgery, which improves over the first week or two. You should notice vision getting better day by day initially. Your final vision is achieved by 1 month after surgery. Depending on the type of intraocular lens implant you chose for your eye, you may find that you need some glasses for reading, and sometimes even for distance. While our pre-operative predictions on outcomes are excellent using advanced mathematical formulas, we cannot know exactly how your vision will respond to surgery until after the eye has healed and adjusted to your intraocular lens implant. Sometimes a glasses prescription is still required to provide you with the clearest vision. This need will be determined at the 1 month post-operative visit. 

What problems should I look out for?

It is normal for vision to be somewhat blurry initially after surgery, and the eye may feel scratchy, irritated, or teary during the healing process. However, if you experience sudden worsening of vision, or a sudden increase in pain, eye redness, light sensitivity, or flashes of light and many new floaters, please call our office immediately to find out if you may need to be seen. 

Intraocular Lens Options
Why do I need an intraocular lens placed during cataract surgery?

The eye has a natural crystalline lens which helps you see. With age, this lens becomes cloudy and turns into a cataract. Cataract surgery removes this natural lens and it must be replaced with an intraocular lens implant which has a prescription to help you see better again.

Does the lens implant ever stop working?

No, the intraocular lens implant never stops working and is safe to stay in your eye the rest of your life. The cataract itself will also never return once it has been removed.

Can I disturb the lens implant by accident?

Generally, no. You may resume all normal activities after full post-operative healing. The lens implant resides inside the eye and cannot be disturbed by routine activity. In cases of extreme trauma to the eye area, the lens may become dislodged and affect vision. If this occurs you should be seen right away for an exam. 

What is a secondary cataract?

You may hear about "secondary cataracts" that form after cataract surgery has been done. It is a film-like scar tissue that the body makes around your lens implant and occurs in about 1/3 of patients who have had cataract surgery. It may make your vision slowly become cloudy again and you may wonder if your cataract is returning (it is not). This scar tissue is called a posterior capsular opacification, and can be easily removed in the office with a quick and painless laser procedure. After it has been removed, this scar tissue will no longer return. Your ophthalmologist will evaluate you and discuss whether you need this laser procedure done. It is covered by insurance. 

What is a basic monofocal lens?

A basic monofocal lens is a lens implant that provides vision focused at a certain distance from you. Most people prefer to have this distance be far away, so that you can see clearly for driving or looking across the room at your TV. It cannot focus vision for up close reading or for things like your computer or tablet. Therefore you will need a pair of reading glasses to focus your vision up close. 

What are premium intraocular lenses?

Premium intraocular lenses such as toric lenses, multifocal lenses, extended depth of focus lenses, and trifocals lenses, all use different technology to help you see. These lenses work to give you more range of vision without the need for glasses. With the right lens implants we can try to achieve good distance vision (driving/TV), mid-range vision (computers, grocery shopping), and near vision (reading). Not all patients are candidates for these types of lens implants and not all patients have the same outcomes as our eyes are unique. Your surgeon will discuss the options with you to find the best fit for your vision needs. The goal of these implants is to give you as much glasses independence as possible. Insurances will still cover the cost of surgery if you choose a premium lens, however there will be additional out of pocket costs that are not covered by insurance. The additional fee goes toward the cost of the premium lens technology itself as well as special testing that is done prior to and during surgery. Scroll down to read more about the different lens types.

How should I choose my intraocular lens implant?

Every individual has different visual needs in day to day activities that would determine what lens implant is the best choice to meet those needs. Each lens implant type has pros and cons. In general, the basic monofocal lens gives great quality vision but may require you to wear distance and reading glasses. The premium lens options can be chosen to decrease dependence on glasses wear. It is important to have a complete and thorough eye exam with your eye surgeon to determine if you are a candidate for the different lens implants. It is also important to think about how your vision matters to you.

 

A few questions to ask yourself:

- What do you spend most of your time doing at work? At home?

- What are your hobbies?

- How important is distance vision to you? (driving, golf, skiing, etc) 

- How important is mid-range vision to you? (computers, cooking, grocery shopping) 

- How important is near vision to you? (reading, smartphones, sewing)

- Do you mind wearing glasses after surgery for either distance, mid-range, or near vision?

- Would it bother you if you saw some starbursts, glare, or halos around lights at night?

- Are you easy-going? A perfectionist? Or somewhere in between?

 

These are all questions your surgeon will discuss with you. It is good to come to your consultation appointment prepared with the answers to these questions. 

Basic

(Monofocal)

The basic lens implant is called a "monofocal" intraocular lens. As the name suggests, it provides clearest vision at one distance, which is typically set for far away. This lens gives great vision at distance but does not correct for any astigmatism in the eye (see below to learn more about astigmatism). You will also find that vision up close is blurred unless you put on a pair of reading glasses. This blurring applies for activities such as reading, using your cell phone, or the computer. This lens implant is a great choice for you if you intend to wear glasses after surgery to give you the best possible vision.  

Before Surgery
Scenic Road
After Surgery
Scenic Road
Near Vision without Glasses
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Near Vision with Reading Glasses
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Astigmatism Correction

(Toric)

Astigmatism is a cause of blurred vision due to the shape of the eye. See the difference between uncorrected and corrected astigmatism in the photos to the right. Many individuals have astigmatism correction in their glasses or contacts prescription, which helps sharpen the vision. We can now build the astigmatism correction right into your lens implant. This type of lens implant is called a "toric" lens. A toric lens gives you clear vision by correcting your astigmatism so you do not have to rely on your glasses as much for distance vision. You will still need to wear reading glasses for all activities up close such as reading or computer work. The toric lens implant is a great option for you if you would like to wear glasses less for distance, and use them mostly just for reading.

Uncorrected Astigmatism
Girl Hiking in Mountains
Corrected Astigmatism
Girl Hiking in Mountains
Near Vision without Glasses
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Near Vision with Reading Glasses
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Premium

(Multifocal & Extended Depth of Focus)

We are excited to offer the newest technology in intraocular lens options, our portfolio of premium lens implants. These lenses are specially designed to give you great vision for far away (driving and watching TV), mid-range (computer), and near (reading, cell phone). There are premium lens options that also correct any astigmatism you may have. The majority of people find that they no longer need to wear glasses for most activities after surgery. You may see some starbursts, glare and halos around lights especially at night (see example at right). There are a number of different premium lens types, including multifocal, trifocal, and extended depth of focus lenses. Your surgeon will work with you to determine the right lens implant choices based on your lifestyle and vision needs. The premium lens implant is a great choice if you desire glasses independence for most activities. 

No Glasses Needed for Most Distances
New York Office
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Summary of Lens Implant Choices