Cataract in Adults. with Otherwise Healthy Eyes. Information for Patients. What is a cataract? Cataracts:

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1 Information for Patients Cataract in Adults with Otherwise Healthy Eyes What is a cataract? A cataract is a cloudy area in the lens of the eye. A normal lens is clear. The lens is located behind the iris - the coloured part of the eye. The lens focuses light passing to the retina at the back of the eye. When a cataract forms, the lens becomes cloudy, like a frosted window, and the light is not clearly focussed on the retina at the back of the eye. Sometimes, only a small part of the lens becomes cloudy. If this happens, a person s eyesight may not be affected too badly. If a large part of the lens becomes cloudy with a cataract, sight may be partially or totally lost until it is removed. Cataracts: are not films which cover the front of the eye are not caused by overuse of your eyes are not cancer do not mean that you will go permanently blind are not life threatening 1

2 What are the symptoms of cataracts? Cloudy, blurry, fuzzy or foggyvision. Double vision or ghosting. Changes to the way you see colours. Need for brighter lights when you read. Problems with glare from lamps or the sun. Poor night vision. Problems driving at night because headlights seem too bright. Frequent changes in your eyeglass prescription. Problems with falls because of poor eyesight. Who do you check with? The symptoms of cataracts can also be signs of other eye problems. It is always important to first visit your family physician if you have any problems with your vision. Your family physician may refer you to an eye care professional if your problems are eye related. Eye care professionals include ophthalmologists (medically trained doctors specializing in diseases and surgery of the eye) and optometrists (eye care professionals trained in vision assessment). The ophthalmologist, optometrist or your family doctor can tell you if you have a cataract. How does your eye doctor know if you have cataracts? A regular eye exam is all that is needed to find a cataract. You will probably get eye drops to enlarge your pupils (the round black centres of your eyes). This enables your doctor to see inside your eyes. Afterwards, your eyes may be sensitive to light and you may need someone else to drive you home. The doctor will use a bright light to see whether your lenses are clear and to check for any other problems in your eyes. How are cataracts treated? You may not need any treatment for a cataract if your vision is only a little blurry. A change in your glasses may also help you to see better. The use of stronger bifocals or magnifying lenses may help to improve your eyesight. Sometimes, tinted glasses are prescribed by your eye doctor to reduce the glare from lights that bother people who have cataracts. There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. Cataracts may be prevented or slowed down by protecting your eyes from sunlight. Consider using regular tinted glasses or sunglasses that screen out ultraviolet (UV) light. When your eyesight prevents you from working or doing the things you like to do, you may wish to consider cataract surgery. Surgery is the only way to remove a cataract. How do I decide whether to have cataract surgery? Most people have plenty of time to decide if they want to have cataract surgery. Your eye doctor cannot make this decision for you. However, talking with your doctor can help you decide if surgery is best for you. 2

3 Talk to your ophthalmologist about how cataracts have affected your life. Check ( ) the statements below that apply to you and share this list with your eye doctor: I need an unrestricted driver slicence so I can work. I need to drive but there is too much glare from the sun or headlights. I do not see well enough to do my best at work. I do not see well enough to do the things I need to do at home. I do not see well enough to do the things that I like to do (for example, read, sew, play cards, watch TV, hike, or go out with friends). I am afraid that I will bump into something or fall because of my poor eyesight. Because of my cataract, I am not as independent as I would like to be. My glasses do not help me to see well enough. I need to change my eyeglasses more than once a year. My eyesight bothers me. What should I know about surgery? Removal of cataracts is performed by the ophthalmologist a medical doctor who has special training in eye surgery and diseases of the eye. The doctor will discuss the type of operation you should have to remove your cataracts and will also explain how to prepare for surgery and what you should do after your operation. There are two types of surgery to remove lenses that have cataracts: 1) extracapsular surgery, and 2) phacoemulsification. With extracapsular surgery, the eye surgeon, makes a tiny incision and removes the lens. The lens capsule is left behind. With phacoemulsification, (pronounced FAY-co-ee-mul-sih-fih-CAY-shun), the doctor softens the lens with ultrasonic waves and removes it through a small tube. The lens capsule is left behind. A person who has cataract surgery usually gets an artificial lens implanted at the same time. The artificial lens is called an intraocular lens (IOL). The IOL is placed in the lens capsule inside the eye. At the present time, there are a large number of intraocular lens available and you may wish to discuss this with your eye care professional. You may have other problems that you want to discuss with your eye doctor. Speak with your eye doctor about any of your concerns. Your eye doctor is there to help you, but you must be the one to decide whether to have cataract surgery. 3

4 Your operation may be done in an outpatient clinic or a hospital. Most people do not need to stay overnight in a hospital either before or after the operation to have cataract surgery. However, it will be necessary for you to see your eye surgeon the day after your operation. If you live a long distance from the city where you are having your surgery, you may need to make arrangements to stay overnight. Normally, you have your surgery and go home when the eye doctor says you are well enough to leave the outpatient clinic or hospital. You will need someone to take you home. Someone should also be able stay with you and help you for at least a day after your cataract surgery to help you follow your doctor s instructions. This may include a administering eye drops. The vast majority of people see better after cataract surgery. It takes a few months for your eye to heal completely. After you have seen your eye doctor the day after your operation, you will need to see him or her one to two times in the next eight weeks. If you have any problems, you may need to see your eye surgeon more often. If your eye becomes sore, you have increasing discharge, or if your vision is not as good as it was immediately after your operation, you should contact your ophthalmologist. You will be able to tell if your vision is getting worse if your sight is blurry, if you are generally unable to see well, or if you have decreased side or peripheral vision. Be sure to ask your ophthalmologist the best way to contact him or her for after hours care or if complications arise. Your doctor may delegate portions of your follow-up care to a qualified health provider in your community. If you have any questions, ask your eye surgeon. After your surgery, you may experience some mild discomfort in your eye for a day or two. Some people have a feeling that there is something in their eye after their cataract surgery. This feeling also goes away in a few days. Some people with cataracts in both eyes may experience visual disorientation after they have had cataract surgery on one eye. This happens because one eye can see much better than the other eye. If you have dense cataracts in both your eyes, it is normal to have surgery on the second eye as soon as the first eye has healed enough. Once you have had cataract surgery on the second eye, the visual disorientation usually goes away. 4

5 Is cataract surgery right for me? Most people who have cataract surgery recover from their operation with few problems and have improved eyesight after surgery. There have been dramatic improvements in the success rate of cataract surgery which is currently 95% in patients with otherwise healthy eyes. But no surgery is risk free. Although rare, possible complications of cataract surgery include high pressure in the eye, infection inside the eye, artificial lens dislocation, drooping eyelid, retinal detachment, bleeding inside the eye, swelling or clouding of the cornea, blindness in the operated eye, or loss of the operated eye. There are several benefits of cataract surgery including those impacting normal activities such as: driving, reading, hobbies, moving around, working, safety, social activities, self-confidence independence. If you have cataracts in both eyes, experts say it is best to wait until your first eye heals enough before having surgery on your other eye. If the eye that has a cataract is the only eye with vision, then you and your doctor should very carefully discuss the benefits and risks of cataract surgery because of the possibility of a complete loss of all vision. You will be able to make the right decision if you know the facts. Ask your doctor to explain anything that you do not understand. There is no such thing as a foolish question when it comes to your health. Do not be afraid to ask for a second opinion from another eye doctor if you think it would help you decide whether or not to have cataract surgery. Here are some questions you might ask: Do I need to have my cataract removed right away? How long can I wait to have cataract surgery? What are the risks of having cataract surgery? Should I have a particular type of lens implant, and what would it cost? Will my eyesight get worse again after I have had my cataract surgery? How long will I need to wait before I have surgery? You may want to write down some other questions for your eye doctor to help you get all the facts. Talk to your surgeon about the variety of anesthetic choices. There are a number of techniques which include local or topical (eye drops), nerve blocks (using a needle to inject a local anesthesia around the eye), and general anesthesia. 5

6 What should I tell my eye doctor before surgery? Before most people have an operation for cataracts, they will first need to see their family doctor. The doctor will check them and will either talk or write to the eye doctor to give him or her any important health information. It is important to tell the eye doctor if you have been taking any blood thinners or any other pills. Tell the doctor if you have any existing medical problems such as heart disease, diabetes, trouble breathing, seizures, high blood pressure, or current infections. If you cannot lie quietly and comfortably on your back for 30 to 60 minutes for any reason at all, be sure to tell your eye doctor. How much will it cost to have cataract surgery? Alberta Health will pay the ophthalmologist who performs your cataract surgery. Effective July 1, 1996, the Regional Health Authorities assumed responsibility for paying private clinics a facility fee. Therefore, you should not be charged a facility fee if you have your cataract surgery in a private clinic. You should ask your ophthalmologist if there are any costs for services not covered by Alberta Health or the Regional Health Authorities and the reasons for the extra charges as currently, there may be an additional charge for the lens implant. Additionally, due to ongoing health care reform, it is important to be aware that practices may vary between the different health regions. Be sure to ask your ophthalmologist if you have any questions. You may also wish to contact your Regional Health Authority for additional information. Other costs associated with having cataracts removed include the cost for eye drops not covered by your medical plan. You may also need to have your eyeglass prescription changed after your cataract surgery. Currently, persons aged 65 and over and their spouses are eligible to receive vision care benefits once every three years under Alberta s Extended Health Benefits Program. It is best to check how much financial assistance you are eligible to receive for purchasing new glasses. Will my cataract return? No, your cataract will not return. However, in some people, the membrane behind the lens implant may get cloudy after cataract surgery. Cloudy membranes cause the same eyesight problems as cataracts and are commonly called secondary cataracts. If the membrane behind your lens gets cloudy, your eye doctor can use a laser (light) beam and make a tiny hole in the lens membrane to let light pass through. This procedure is called a YAG capsulotomy. It does not hurt and does not require that you stay in hospital. Most people see better after YAG capsulotomy. However, there are risks and benefits of having the YAG capsulotomy which your eye doctor can discuss with you. 6

7 Terms which you may hear your doctor use You may hear your eye doctor use technical terms and may wonder what they mean. The following are some definitions that might help explain what is happening. 6/6 Vision: 6/6 vision is when a person can see at 6 metres what a normal sighted person can see at 6 metres. When 6/6 vision is expressed in feet instead of metres, it is referred to as 20/20 vision. 6/12 Vision: 6/12 vision is when a person can see at 6 metres what a normal sighted person can see at 12 metres. When 6/12 vision is expressed in feet instead of metres, it is referred to as 20/40 vision. IOL: Intraocular Lens - the artificial lens put inside your eye during cataract surgery which replaces the lens that was removed. Rigid - hard plastic lenses that require an incision about 6 millimeteres long. Foldable - newer intraocular lenses are softer and can be folded, allowing insertion through an incision about 3 millimeters long. Multifocal - any lens that provides near and distance vision. Intraocular Pressure: The pressure inside the eye. Ocular: Anything relating to the eye. Ophthalmologist: A medical doctor trained in the specialty of ophthalmology, the branch of medicine dealing with structure, function and diseases of the eye. Ophthalmologists may also be called eye surgeons. Ophthalmoscope: An instrument which is used to look inside the eye. Optometrist: An eye-care professional trained in the measurement, assessment, detection and treatment of disease of the human eye and the prescribing and dispensing of glasses and lenses. Postoperative Care: The care a patient receives after they have had some type of surgery (or operation). Postoperative care continues until a patient has fully healed from the operation. Slit Lamp: A special lamp used to help an eye doctor to see inside the eye. Visual Acuity: Visual acuity refers to how well a person can see, e.g., 6/6 or 6/12 vision. 7

8 Additional Information Where can I get more information? The information contained in this handout was based on the Clinical Practice Guideline, Surgical and Non-Surgical Management of the Cataract in the Otherwise Healthy Adult Eye, prepared by the Toward Optimized Pracitce (TOP) Program administered by the Alberta Medical Association. The guideline was developed by an expert panel of doctors, optometrists, and representatives from the government, public, and universities. For more information about cataracts contact: The Alberta Council on Aging Suite 401, Avenue Edmonton, Alberta T5J 3M1 Telephone: (780) Fax: (780) Ophthalmological Society of Alberta Suite 560, Jasper Avenue, NW Edmonton, Alberta T5J 3S9 Telephone: (780) Fax: (780) Alberta Association of Optometrists Suite 902, Kingsway Avenue, NW Edmonton, Alberta T5G 0X5 Telephone: (780) Fax: (780) August 1996 Reviewed 2007

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