Four Questions for Your Cataract Surgeon

It can be a scary thing to face cataract surgery. In fact, most eye doctors need a lesson in bedside manner. Eye doctors get in a big a hurry and tell patients they need cataract surgery to improve their vision without really explaining what a cataract is and what cataract surgery is all about. 

A cataract is a clouding of the eye's lens. Cataracts are the leading cause of blindness among people older than 55. Most older people have some degree of lens clouding, which is a normal part of aging. A cataract is similar to looking through a foggy window. Cataracts usually grow so slow that you will not notice the decrease in your vision. Cataracts can cause you to need a lot more light to read. People with cataracts often complain about glares and halos around lights while driving at night. Sometimes night  driving becomes almost impossible.

If you are considering cataract surgery, be sure to do your research so you know what to expect. Following are five questions to ask your doctor before he or she performs your cataract surgery.

1
Will I know when it's time for cataract surgery?

Patient counseling is a priority. Dan Dalton

The answer to this question in some ways is simple: when you feel that your vision is not as good as you would like it to be. In the real world, it is sometimes difficult to tell when that is. Cataracts usually grow slowly so it's not always easy to tell. Ask your doctor what the quantity and the quality of your vision is. One way to measure quantity of vision is to find out what your best corrected visual acuity is. This means exactly how good your vision can be with corrective glasses or contact lenses. This will give you an idea of how bad your cataracts are. Normal eyes see 20/20. If your vision is 20/60, that is several times worse than normal. The quality of your vision can be measured by a BAT test. A BAT will simulate how your vision is when faced with headlights while driving at night. You may have 20/25 best corrected vision, but when measured by a BAT test, your vision may drop to 20/100.

2
What type of surgery will I have?

A picture of a cataract
A.D.A.M.

A few years ago, this was a simple question. Traditionally, most people had cataract surgery by phacoemulsification. The procedure was completed using a small blade for an initial incision, followed by a procedure conducted with a phacoemulsifier. A phacoemulsifier is an ultrasound device that vibrates at such a high speed that the cataract is emulsified or dissolved into tiny fragments and gently suctioned out of the eye. Fast forward to 2011 when the FDA approved "laser cataract surgery" or more precisely, "femtosecond laser cataract surgery." In laser cataract surgery, a surgeon can view a magnified, high-resolution image given to him or her by a built-in OCT device.  A peripheral incision can then be made strategically without taking the surgeon's experience into account. This laser-designed incision is safer and seals better than a surgeon-made incision. 

There is no question that in the hands of a highly trained cataract surgeon, laser cataract surgery is an excellent and advanced option. However, due to anatomy, some people cannot have laser cataract surgery. Phacoemulsification is still a very high quality way to perform cataract surgery. Part of your decision will be based on cost, as Medicare and commercial insurance companies do not cover laser cataract surgery.

3
What type of lens implant will be placed in my eye?

ADAM

This is one area where a lot of discussion should take place between patient and surgeon. The question really is centered more on your lifestyle than optics. How do you use your eyes on a daily basis? What special interests do you have? Are you a type-A personality where detail is super important to you? It is important because your surgeon can basically set your vision where you want it. Do you want to have perfect, glasses-free distance vision and then wear reading glasses for near vision, or the opposite? 

Once again, times have changed. Now people have the option of having the surgeon insert a multifocal intraocular lens implant. This means that the implant will attempt to deliver high quality distance vision, intermediate vision and near vision with no glasses. While the multifocal technology is indeed advanced, most surgeons will make sure the patient understands that there is no guarantee that they will have totally glasses-free vision.

4
What is my risk of possible complications?

LASIK Candidate
Antonio M. Rosario / Getty Images

All cataract surgery carries the risks of infection, bleeding and retinal detachment. However, some people may have a higher risk of these complications than others. For example, people that are highly nearsighted have a higher risk of having a retinal detachment during their lifetime than someone who is not nearsighted. When surgeons have a patient that is high risk, they may take special precautions or have a retinal specialist on call if problems occurr. Another example may be a patient who is taking a blood thinner or anti-coagulant for heart problems. These patients are sometimes asked to discontinue these medications for a couple of days before surgery. 

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