Cataract surgery . . . [Archive]

bargainguy

02-20-2012, 07:38 PM

Used to work in the medical field. Here goes.

The most common type is intracapsular cataract extraction (ICCE) in which an ultrasound device is inserted into the lens and high frequency is used to dissolve it, then the debris is slurped out. The other (older) type is extracapsular (ECCE) where the lens is excised rather than whipped and slurped. Either way, the old lens is removed and then a new lens placed. A choice is made between ICCE and ECCE depending on the type of cataract involved. There are many: senile, juvenile, diabetic, etc.

The first type (ICCE) is one of the most common surgeries performed. I think only transurethral resection of the prostate is more common, but it's been a couple years so this may have changed.

The complication rate is extremely low. Really the biggest thing I saw is if the ICCE procedure left any fragments behind, then another surgery was required to remove them.

Both surgeries can be done under monitored anesthesia care (MONAC) where you are in light sedation and your vitals monitored.

You'll be amazed how your vision improves. Good luck and let us know how it went.

Don

C5 Snowboarder

02-20-2012, 07:50 PM

I'm having it in May. They will be putting in a single focal intra-ocular lens.

Anybody have this surgery and can tell me anything about it and rehab? did it interfere with your riding?

Sadly, I've already checked into the prices for the Steve Austin zoom lens implant and $6 million isn't in my budget right now. :D

BBD

Dave -- I had both eyes done about 8 months ago. also single focal lens. I love it. Dunno what your reason for the cat surgery, mine was I could not get my vision corrected to 20/20 anymore. the good stuff is everything is so bright and clear now, I used to think my SUV was painted a light dirty white color, now I see it as a brilliant white color. I can see road signs 1/4 mile away with my new 20/15 vision. Golf game is better than ever. no more contacts which I was wearing before were -3.50 power. I do need reading glasses now which is ok - for me it is a great trade off to not need any vision wear except close up. it is a whole new brilliant and bright world out there now. Absolutly amazing the difference.

does not interfer with my riding a bike or my snowboard. My golf buddies want me to tell them where their golf ball lands now.

Re: -- rehab... takes a little while for the new eyes to stabilize. but I could see fairly well the next day and drive for my 1 day check up, but within a week I had 20/20 vision and in 3 weeks 20/15 vsion. 2 weeks after the first eye they did the 2nd eye. I had them video the surgery which is only about 10 min long, so I could see them do the lens implant... but I caution you --- if you do that do not -- I say do not watch the video until both eys are done.. It is by far the scariest movie I have ever seen. so what I am saying you may not go back for the second eye if you watch the 1st eye get done. pretty invasive the way they suck the old lens out of your eye and stick the new lens in.

RE: sedation.. they numb your eye muscle with a squirt out of a long needle down along the eye so it can't move... otherwise I was totally awake and talked with the doc as he did it.

Good luck and it is a good thing. plus I think my vision will not change ever again... no worry about cataracts ever again... they can't come back. :hello: :hello:

gasman

02-20-2012, 08:06 PM

Still in the medical field. Cataract extraction is far and any the most common surgical procedure done. Every doc here uses topical anesthesia with light IV sedation. A small incision is made, the cataract is removed by busting it up with ultrasound and suction to remove the pieces.Have never seen a re-operation for pieces left behind in 23 years. A new lens is inserted and you may or may not have a single suture placed to close the tiny incision. Most surgeons here don't put in a stitch these days.

A single-focal lens is a good choice. Over the last 15 years there have been multiple attempts at making a lens that will change focus-they have all had problems. Don't know how well the newer bifocal lenses work. You will need to choose whether you want to have the new lens give you close , intermediate or distance vision. You can be sometimes corrected to 20/20 if you were nearsighted before but if your other eye needs a lot of correction with glasses this not may be possible as the image your brain receives from each eye is too different to be able to fuse into one image.

I had a retinal detachement 15 years ago. After 5 surgeries, including cataract surgery, I can tell that it is an easy recovery. You'll be putting in a ton of eyedrops fora week or so and I expect your doc will not want you to ride for a week, but they all vary in their recommendations. The only hard part was letting my eye heal enough so I could get a new lens for my glasses. Your vision changes over a couple weeks as the swelling subsides.

The main complication besides infection is development of a membrane in the posterior capsule left in place behind the lens. The cure is a 3-5 minute laser zapping of the membrane. I had it done and it was the easiest of the surgeries, well not even a surgery really.

Good luck. PM me if you have other questions.

gasman

02-20-2012, 08:14 PM

Dave --.

RE: sedation.. they numb your eye muscle with a squirt out of a long needle down along the eye so it can't move... otherwise I was totally awake and talked with the doc as he did it.
:hello: :hello:

This is very old school, doing a retrobulbar block or peri-bulbar block. I don't know of any ophthalmologist in Eugene that doesn't use just topical anesthesia with sedation.

C5-I think you're brave to have it done for vision correction alone-or were you developing early cataracts ?

C5 Snowboarder

02-20-2012, 08:22 PM

This is very old school, doing a retrobulbar block or peri-bulbar block. I don't know of any ophthalmologist in Eugene that doesn't use just topical anesthesia with sedation.

C5-I think you're brave to have it done for vision correction alone-or were you developing early cataracts ?

I had cataracts which is why they could not correct my vision anymore. but I dont know what "early" cataracts mean to you... I am 65 yr young. :beer:

Dunno about the topical anesthesia vs. the needle in the eye muscle.-- It is just the way Pacific Cataract and laser institute did it on me. I liked being awake.

you will be awake throughout the procedure. Eye drops will numb the surface of your eye to allow anesthesia to be gently administered to the surrounding tissue. You may feel a slight warmth as the anesthesia is given.
http://www.pcli.com/cataract/surgery_works.html

BumbleBeeDave

02-20-2012, 08:32 PM

C5 Snowboarder

02-20-2012, 08:39 PM

. . . the whip and slurp.

My vision in both eyes is awful--nearsighted. So I'm looking forward to having at least one of them be better.

But . . . I've read they build a prescription into the lens, but what do they use as a baseline? I got new glasses last October and my vision in that eye had deteriorated by over a diopter in the previous 12 months. Now it's lost another full diopter in the past 4 months. So how does the doc know what to build into the new lens to correct it to? Whatever he does, I'm gonna have a pretty weird Rx after it's all over. My left eye may be near 20/20, but my right eye will still be at least -6.

I also have pretty bad floaters the last couple of years, but apparently the solution for that is pretty extreme. :eek:

BBD

They measure your eye ball with a pretty amazing machine... so when they get your lens for that eye it is pretty much "dead nuts on".

My eyes changed the same way as you -- in 6 months my prescription changed a -1.0 diopter.. so I knew something was going wrong. Plus I could not see my golf ball after about 75 yrds. 2 years ago that was not a problem.

Re: Floaters -- yea what a pain in the butt... I had a detached retina in my one eye a little while ago and they had to drain the fluid to laser weld/fix it so my floaters in that eye now gone but it is not a very nice thing to do. best to live with them if you can.

Louis

02-20-2012, 08:42 PM

Best of luck Dave.

Happily it sounds like cataracts are a pretty low risk surgery.

Random comment: my ophthalmologist has told me that I'm at a higher risk than usual for retinal detachment (due to lattice degeneration) so eye-related issues are always a concern for me.

Take care.

Edit: Just a matter of time until we all get one of these:

http://erthstationone.files.wordpress.com/2012/02/geordilaforge2367.jpg

Elefantino

02-20-2012, 08:43 PM

I've had an IOL for the last 21 years. Focused to arm length, or computer distance. Was blind in my right eye from an accident and secondary glaucoma.

I was also awake. It was cool to finally see again.

You'll do fine.

C5 Snowboarder

02-20-2012, 08:45 PM

This is very old school, doing a retrobulbar block or peri-bulbar block. I don't know of any ophthalmologist in Eugene that doesn't use just topical anesthesia with sedation.

Not sure what you call it - medically -- but I am darn glad my eye muscle was totally dumb when they poked all those tools in my eyeball.. I would doubt if just sedation could hold that sucker still... :beer:

they do use topical sedation but that just helps put that long needle into the muscle.

DfCas

02-20-2012, 08:45 PM

I had both eyes done in December. 1 at the beginning of the month and 1 in the middle.

They give you some calming medication through the IV, and though you are awake you have trouble remembering what they did. The procedure takes about 10 minutes. My eyes felt slightly irritated afterwards, but it was not a problem. Recovery was taking antibacterial drops for 1 week, and steroid drops for 1 month. The steroid dosage tapered from 4 drops per day, reduced by 1 drop per day each week, so the last week you take 1 drop per day. Within 2-3 days my vision was much improved in each eye, and after 1 month I was able to get a new eyeglass presciption.

I chose not to have my distance vision corrected.-because- due to my astigmatism, the doc said that I would still need a pair of glasses to BEST correct my distance vision. If they corrected my distance vision as best they could with the implant, I would still need glasses to tweak distance vision, and I would need glasses for close up reading also.

They made a moderate correction of my distance vision, leaving me -3.75 diopters in each eye. I can read and work closeup without glasses, and I prefer this due to the type of work I do and the need to fill insulin syringes. I am happy with my decision to remain nearsighted.

I have had vision problems for 10 years, due to diabetes. I have had a vitrechtomy/membranechtomy, and the recovery from that was awful. I had to lie face down for a week. My eyes have been "messed" with a lot, meatball surgeries and steroid injections, and they think the cataracts were a result of that. 1 was slow growing and 1 was fast. I was pretty much blind in the fast growing side in 2 months.

The cataract surgery and recovery were very mild and uneventful. I was told not to ride for a week. My vision is so much better-blacks are black,whites are white, and contrast is excellent, and I don't need sunglasses all the time. Highly recommended.

Hope this helps.

Dan

scooter

02-20-2012, 08:46 PM

I had it done back in 2002 for my left eye by Dr. Marwa Adi in Bethesda at Washington Eye Physicians & Surgeons. This medical practice has excellent doctors, so if you live in the area you might want to consider them for your surgery. I was having difficulty seeing at night, especially when lights were shining in my face, blinding me in my left eye. Driving a car or riding my bike after dark were getting to be too dangerous. After the surgery I was stunned by how much better my eyesight was. About six months after the surgery I had a very minor post op procedure to clear up an opacification, which can occur after the original surgery. The newer, more advanced interocular lenses (multifocal and UV protective) were not on the market at the time so I can't comment on their benefits. Cataracts diminish your quality of life. By all means, have the surgery done. I have not experienced negatives with regard to the monofocal interocular lens, quite the contrary.

DfCas

02-20-2012, 08:51 PM

[QUOTE=BumbleBeeDave]. . . the whip and slurp.

My vision in both eyes is awful--nearsighted. So I'm looking forward to having at least one of them be better.

But . . . I've read they build a prescription into the lens, but what do they use as a baseline? I got new glasses last October and my vision in that eye had deteriorated by over a diopter in the previous 12 months. Now it's lost another full diopter in the past 4 months. So how does the doc know what to build into the new lens to correct it to? Whatever he does, I'm gonna have a pretty weird Rx after it's all over. My left eye may be near 20/20, but my right eye will still be at least -6.

I also have pretty bad floaters the last couple of years, but apparently the solution for that is pretty extreme. :eek:

To determine the corrective lens, they have you look into a machine. It measures the size and shape of your eye, and they then figure out the corrective lens to get you to where you want to end up. They told me the basic single lens implants only come in 1/2 diopter steps, where eyeglasses can be ground in 1/4 diopter increments.

You can also get custom implants, but you are talking heavy dough.

bargainguy

02-20-2012, 08:52 PM

Have never seen a re-operation for pieces left behind in 23 years. The main complication besides infection is development of a membrane in the posterior capsule left in place behind the lens.

Unfortunately, I did see reoperations for cataract fragments, but I'm probably in a different boat than you. I was working as a web-based coding auditor and saw op reports from facilities all over the country, anything from tiny clinics to large health care systems (Kaiser, Mayo etc.).

And interestingly, I rarely saw infection of the IOL, but did see the pseudomembranes on occasion. I think much depends on the skill of your surgeons and the level of postop care, with the wild card being patient noncompliance.

Don

palincss

02-20-2012, 09:10 PM

I'm having it in May. They will be putting in a single focal intra-ocular lens.

Anybody have this surgery and can tell me anything about it and rehab? did it interfere with your riding?

I had both eyes done a year ago. First eye was more challenging because as soon as the surgery was done I no longer had a working pair of sun glasses and the two things they told me you need to do immediately post surgery are 1) protect from excess sunlight and 2) avoid exertion that would raise blood pressure. It took me a week to get used to things and get sunglasses sorted out. When the second eye was done, I went on a ride a couple of days later, took a short cut and skipped the hilly section.

The hardest thing about it all was keeping to the schedule of eye drops. Bad enough I can't put in eye drops myself without spilling half the meds down my face, but the shifting intervals for the different eye drops made Dave Brubeck's polyrhythmic music seem as simple as the ticking of a metronome.

BCS

02-20-2012, 09:10 PM

[QUOTE=bargainguy] I was working as a web-based coding auditor and saw op reports from facilities all over the country...

Did you also sleep at a holiday inn last night? :cool:

bargainguy

02-20-2012, 09:17 PM

Nope, although in the days before electronic medical records, we had to go on location to audit, so you might have seen me at a local hotel.

Don

palincss

02-20-2012, 09:20 PM

But . . . I've read they build a prescription into the lens, but what do they use as a baseline?

Literally dozens of measurements of the shape of your eyes. Remember this isn't like corrective lenses that act on top of the lenses in your eyes: this will replace the lenses in your eyes.

Don't sweat the details. Even more than you would do in the case of a frame builder, you leave it to the professionals. You bring your head with you when you go to the opthalmologist, you look where they tell you while they measure you and figure out what's needed - and that's several appointments leading up to the Big Day - and you basically decide what kind of vision you want.

I had one eye corrected for long distance, the other for intermediate distance. End result: I can read cue sheets without glasses, and can see distance without glasses. I need reading glasses for close work.

A friend of mine chose to have one eye set for reading, the other for distance. Others choose to see perfectly for reading w/o glasses, need glasses for distance. Up to a point, your brain can integrate the two images and make sense of them, depending on how much difference. Prior to the surgery I had >5 diopter diff in the prescriptions in left and right eye (had a hell of a time adjusting to that prescription!) and the diff now is much less.

Here, too, they'll guide you as to what your options are but ultimately you have to make a choice.

Good news is, once it's done your prescription won't ever change again.

palincss

02-20-2012, 09:24 PM

Incidentally -- and this is VERY important -- if you take meds for BPH (e.g., Flomax) be damned sure you let them know. BPH meds can produce a surgical problem called "floppy iris," easily worked around during surgery if they know about it but if precautionary measures aren't taken (like, because you forgot to mention it) you can be in deep doo doo.

Ken Robb

02-20-2012, 09:58 PM

I had both eyes done a year ago. First eye was more challenging because as soon as the surgery was done I no longer had a working pair of sun glasses and the two things they told me you need to do immediately post surgery are 1) protect from excess sunlight and 2) avoid exertion that would raise blood pressure. It took me a week to get used to things and get sunglasses sorted out. When the second eye was done, I went on a ride a couple of days later, took a short cut and skipped the hilly section.

e Dave Brubeck's polyrhythmic music seem as simple as the ticking of a metronome.
Blue Rondo ala Turk?

gasman

02-20-2012, 10:33 PM

gasman

02-20-2012, 10:46 PM

I had cataracts which is why they could not correct my vision anymore. but I dont know what "early" cataracts mean to you... I am 65 yr young. :beer:

Dunno about the topical anesthesia vs. the needle in the eye muscle.-- It is just the way Pacific Cataract and laser institute did it on me. I liked being awake.

you will be awake throughout the procedure. Eye drops will numb the surface of your eye to allow anesthesia to be gently administered to the surrounding tissue. You may feel a slight warmth as the anesthesia is given.
http://www.pcli.com/cataract/surgery_works.html

I also liked being awake but calm. Looking at the website they give you topical eyedrops but not sure which type of block they gave you to immobilize your eye.

Hey -65 is early !!! Don't you feel better ?
Sounds like it was time for you to have it done and I'm glad you had a good result. It is really rare for someone to not be glad they had the surgery, in fact, I can't think of one person who wasn't happy.

Dave you'll be fine. I did have surgery for floaters- a vitrectomy, but only after several years had passed after my retinal detachment. (nearsighted with lattice degeneration and maybe, just maybe from the bungy-jump 6 weeks earlier) A vitrectomy is quite a bit more involved than a cataract.

slowgoing

02-21-2012, 12:56 AM

my ophthalmologist has told me that I'm at a higher risk than usual for retinal detachment (due to lattice degeneration) so eye-related issues are always a concern for me.

Same here. Developed a partial tear after MTB riding with a rigid fork, won't do that again. Tacked down by laser surgery, not invasive at all but does carry risks. Note that the laser pulses can induce sneezing if you have photic sneeze reflex, I spent most of the procedure sneezing and trying to fight off the urge to sneeze.

PaMtbRider

02-21-2012, 09:31 AM

If you need this surgery done don't hesitate. My wife had it done last year, not for cataracts but to correct her vision. She has worn glasses since she was 8 years old and her last contact prescription was something like +12. She had lenses that have both near and far correction in each eye implanted. Like others have said, she was back to work the following day, and a week later her vision normal. She no longer needs reading glasses or correction of any kind. It was expensive since insurance considered it elective surgery, but well worth the money for the improvement in the quality of life. My 80 year old mother also had cataract surgery last year, and her biggest complaint was putting eye drops in her eyes for the 2 weeks following surgery.

biker72

02-21-2012, 10:50 AM

I'm having it in May. They will be putting in a single focal intra-ocular lens.

Anybody have this surgery and can tell me anything about it and rehab? did it interfere with your riding?

BBD
Had the left eye done in late December. Maybe 15 minutes for the surgery and had to wear an eyepatch overnight. Rode the day following surgery. Other than a dramatic improvement in vision, I couldn't tell I'd had surgery. No discomfort whatsoever. I did have to to put eye drops in the eye for a few weeks.

Right eye was done two weeks ago. Had some cornea abrasion with this one. This was due to my eyelid coming loose under the patch and rubbing on the cornea. Some discomfort for three days. Rode two days after surgery. It's going to be another week before the cornea totally heals up.

BumbleBeeDave

02-21-2012, 10:52 AM

I like that!

ARRRRRR, matey!

BBD

palincss

02-21-2012, 01:41 PM

I like that!

ARRRRRR, matey!

No, it's more like a tea strainer you tape onto your face than a real eye patch. And it was a bloody pain in the a$$, too. Trust me, you won't like it. Especially not if you get a reaction to the adhesive in tape.

And you probably won't like the regimen with the eye drops. But those two are most likely going to be the only things you won't like about the whole process. You are almost certainly going to be ecstatic about the results.