Just when you thought technology couldn’t get any better, Virginia Eye Center is pleased to offer the latest equipment available for cataract surgery. Our doctors are the first ophthalmologists to offer laser cataract surgery in Loudoun County. Used in conjunction with the most advanced measurement tools, bladeless, laser surgery provides more gentle, accurate and precise results than traditional cataract surgery.
Intraoperative Aberrometry System
The Intraoperative Aberrometry System is some of the latest technology Virginia Eye Center utilizes in customizing your vision even further during cataract surgery. It provides real-time analysis of your eye during surgery.
Prior to cataract surgery, measurements are taken to help determine the proper intraocular lens (IOL) selection. Although these measurements are precise, there is a margin of error. In addition, the surgeon needs to wait several weeks after surgery in order to assess the effectiveness of the IOL and determine whether the best type of IOL was selected.
This new technology reduces the uncertainty and gives our surgeons the ability to verify proper selection of IOLs during the cataract surgery procedure. They are able to get a precise assessment of the IOL and, if needed, the surgeon can instantly make any adjustments, such as refining the incisions, fine-tuning the power of the IOL implant or even performing a lens exchange if the pre-selected IOL isn’t an ideal fit.
This technology is especially useful for cataract surgery in post-LASIK or PRK patients, in whom IOL formulas tend to be less accurate, as well as patients having astigmatic correction with either toric lenses or limbal relaxing incisions.
The laser provides the surgeon an even more precise, and blade-free, method of removing cataracts. Using focused femtosecond laser pulses, it creates incisions in the lens capsule, crystalline lens and the cornea. This allows for treatments that are tailored to your specifications and delivers a high degree of accuracy. It automates the most challenging steps of cataract surgery by eliminating the need for surgical blades. When compared to traditional cataract surgery, the femtosecond laser technique has also proven to better manage astigmatism after the procedure. There is an additional cost for laser surgery which is not covered by any private insurance or Medicare.
What to Expect on the Day of Surgery
Cataract surgery is performed at outpatient surgery centers, with no overnight hospital stay. Our physicians perform cataract surgery at Reston Surgery Center in Reston, Virginia and Loudoun Ambulatory Surgery Center in Leesburg, Virginia. If you have a preference of which location you would like surgery performed, please inform us at the time you make your initial appointment in our office.
On the day of surgery, we ask you to keep an empty stomach (don’t eat or drink), and arrive 1 to 2 hours before surgery so we can get you ready for the procedure. The surgery itself lasts about 30 minutes. You will be discharged (leave the surgery center) within 1 hour after surgery. The eye that had surgery is usually dilated, and you may feel a little more drowsy than usual from the anesthesia, so you need someone to drive you home after surgery.
Cataract surgery is done with local anesthesia (numbing drops in your eye) and a light sedative (we don’t have to put you fully to sleep). You are generally very relaxed and comfortable. An anesthesiologist will be with you during the procedure to help ensure your safety and comfort.
During traditional cataract surgery, your doctor makes a tiny incision at the side of your eye. A small probe with ultrasound (sound waves) is used to break up the cataract. The cloudy tissue is removed with suction. The lens sac is left in place, and the new artificial intraocular lens (IOL) rests in that lens sac. You usually wear a protective shield over your eye, at night only, for a few nights after surgery.
When to Have Cataract Surgery
To determine whether or not cataract surgery is the right treatment, you must take into account several factors, including:
- Your needs and preferences
- Your doctor’s evaluation
- Any risks or other eye conditions
- When your insurance covers surgery
After considering these factors, you and your doctor will make the decision together. The right treatment for you is one that fits your eyes, your health and your life.
It could be time to have cataract surgery if vision changes are making it difficult to:
- Do activities you enjoy
- Do everyday activities such as shopping, cooking or yard work
- Drive, read or watch TV
At Virginia Eye Center, we’re here to help you meet your personal needs and goals. We know that everyone is different and that some activities require sharper vision than others. For example, if you are a pilot, you will probably need cataract surgery earlier than someone with another job or hobby.
If a cataract is preventing treatment for another eye condition, such as age-related macular degeneration (AMD) or diabetic retinopathy, you might have cataract surgery. The cloudy lens caused by a cataract can make it difficult for your doctor to treat these conditions.
In general, insurance pays for cataract surgery when it is medically necessary (needed to restore vision). For example, Medicare standards for medically necessary cataract surgery include:
- Seeing 20/40 or less with glasses or contacts
- Being less able to do daily activities such as reading, driving, watching TV or doing work tasks
- Having cataracts that lessen your doctor’s ability to treat another eye disease
These are just some of the standards Medicare uses to determine if cataract surgery is medically necessary. Your doctor can tell you if your eye condition meets them, or if surgery is medically necessary for other reasons. To determine if surgery is right for you, call 703-858-9800 to schedule your cataract consultation in our office.
Other insurance companies may have similar or different standards for cataract surgery. If you have any questions, please talk to our insurance and billing staff as well as your doctor. We’ll work with you to help you understand what your insurance covers and create a treatment plan. Because cataract surgery does involve a small risk, your doctor will probably recommend waiting to have surgery if your cataracts are minor and you can tolerate any vision changes. Changing your glasses prescription and using brighter light for reading can help you see better in the meantime. Talk to your doctor about how to make the most of your vision before surgery.
Results of Cataract Surgery
About 95 percent of people who have cataract surgery see better after the procedure. But if another eye condition affects your vision, such as glaucoma or macular degeneration, you might not have good vision even after cataract surgery. Talk with your doctor about:
- How much cataract surgery could improve your vision
- Surgery risks if you have another eye condition
- If the benefits of cataract surgery are greater than the risks
Risks of Cataract Surgery
Cataract surgery is very common, and is a safe procedure for most people. Complications (problems) with cataract surgery are rare, but every surgery has some risk.
More serious risks of cataract surgery include:
- Retinal detachment
- Natural lens material left inside the eye
- Reaction to sedative or anesthesia used in surgery
- Vision loss
Less serious risks include:
- Needing glasses or contacts after cataract surgery
- Droopy eyelid
- Dry eye or eye irritation
- More floaters (small spots in your vision)
- Double vision
- Seeing abnormal light reflections
You might have other risks depending on your health, eye condition, or other factors. If you have any questions or concerns, raise them with your doctor.
Recovering from Cataract Surgery
On the day of your surgery, please plan to rest after the procedure. We’ll send you home with care instructions.
Recovering from cataract surgery usually takes just a few days. Most activities such as walking, cooking, grocery shopping, watching tv, showering or bathing can be done the same day as surgery. It is recommended to hold off on reading or light computer work until the day after surgery. Other activities, including exercise, can usually be resumed within three days. Things to avoid within the first week include: deep bending in a way that your head is below your heart; heavy lifting, and impact aerobics/running.
Some additional frequently asked questions are:
When Can I Return to Work? Although this can vary between patients, most patients are able to return to work the following day. In planning your return to work, please keep in mind that you will need to be seen for follow up appointments the first day after surgery, as well as at regular intervals per below.
When will my follow up appointments be? You will be scheduled an appointment the first day after your surgery, as well as one week after surgery and one month after surgery. If you need cataract surgery on your other eye, you will usually have this done anywhere from a week to a month after the first surgery, so the first eye has time to heal. Unless you have other specific issues, a quick vision check is recommended six months after surgery and a routine eye exam once per year. Your routine eye exam can be performed by your regular optometrist or ophthalmologist, or, if you don’t have a regular doctor, you can see one our doctors here at Virginia Eye Center.
Is It Normal For My Eyes to Feel Scratchy After Surgery? You may experience mild grittiness. Continue to use your drops, as well as artificial tears as needed. The most common side effect after eye surgery is dry eye which causes grittiness and mild blurriness. If this occurs, tear lubricants need to be used frequently to help your eye regain its normal moisture. This may take a few weeks.
How long is the recovery period? Total recovery time after cataract surgery is usually about six weeks, but most discomfort should subside after a day or two. Immediately following surgery, you may experience peripheral flickering or crescent images, grittiness and dryness, some residual haloes/glare, as well as some peripheral blurriness for the first few days. It is also possible to experience increased light sensitivity and a small amount of fluid discharge. Continue to use your drops to promote healing and regulate the pressure inside the eye. Call the office at 703.858.9800 immediately if you experience eye pain, decreased vision or yellow/green discharge.
How Soon Can I Wear Make-Up? For the first two days, it is best to keep some makeups away from the eyelid margin. Therefore, refrain from using mascara, eye shadow or eyeliners until the third day. Since powders and foundations can make their way into the eye, it is best to refrain from using those for two days as well. Lipsticks are fine to be worn the day after surgery.
Your New Eyeglass Prescription
If you will wear glasses after cataract surgery for distance vision or reading, your doctor will give you a new prescription after your eyes heal. Your old glasses won’t be as comfortable as before, but you can use them until you get the new prescription.
A common complication after cataract surgery is clouding of the back of the eye’s natural lens – the part that was left in your eye to support your new artificial lens. This is called posterior capsule opacification (PCO) or secondary cataract.
If this happens, your doctor treats it with a short, painless procedure in the office called a YAG Capsulotomy. Using a specialized laser, the doctor makes a small opening in the cloudy tissue. This restores your vision and the opacification can’t recur.
Glaucoma Surgery During Cataract Surgery
There are multiple types of glaucoma treatments to control your glaucoma.
For patients with combined cataract and mild to moderate open-angle glaucoma, we are pleased to offer the latest technology in glaucoma treatment. The iStent is the smallest medical device ever approved by the FDA. It is placed in your eye during cataract surgery and is so small that you won’t be able to see or feel it after the procedure is over. iStent is designed to improve aqueous outflow of fluid from your eyes to help control eye pressure and may reduce your medication burden. Only your doctor can determine if iStent is right for you.
Kahook Dual Blade
The Kahook Dual Blade is a safe and effective glaucoma treatment that allows the surgeon to make precise incisions within the eye. In a normal and healthy eye, fluid moves through the "trabecular meshwork," a pathway that eventually travels out of the eye and into the bloodstream. For patients with open-angle glaucoma, fluid does not drain efficiently from the eye, causing pressure to build up to dangerous levels (high IOP). The Kahook Dual Blade makes targeted incisions within the mesh-work to alleviate pressure.