CATARACT SURGERY INFORMATON

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1 CATARACT SURGERY INFORMATON Please read through the following information package before you come for your cataract surgery. This information package will provide you with some general information about your Advanced Refractive Cataract Surgery and provide you with instructions for your pre and post operative care. If you have questions about any information please call Dr. Nichols office at What is a cataract? Inside your eye is a natural lens that helps your eye focus on objects. As people age, the lens can become less clear, harder and even cloudy. This cloudiness in the lens is called a cataract. If you have a cataract, surgical removal of this cloudy lens is the only way to improve your vision. Your doctor has already or will discuss the surgery and answer any questions that you have. What is cataract surgery? To improve your vision, your surgeon will remove the cloudy lens and replace it with a clear artificial lens. This is called an intraocular lens implant (IOL) and it will provide you with the most natural vision possible. Your doctor has already or will discuss with you the various types of lenses available and work with you to determine which lens is best suited for you. Will I need to wear glasses after my cataract surgery? You may have friends or relatives who after cataract surgery no longer needed to wear their glasses for distance even though they had worn them most of their lives. The artificial lens implant used in cataract surgery can correct for nearsightedness and farsightedness often leaving patients less dependant on their glasses. However, artificial lens technology used today can not adequately correct for or astigmatism, leaving you still needing glasses for your astigmatism correction. Astigmatism occurs when the front of the eye (cornea) is more oval shaped than round, causing light to focus improperly on your retina. As a result, vision may be double or blurred when uncorrected. If your doctor has identified that you have a significant amount of astigmatism that will require you to wear glasses after your cataract surgery he will correct your astigmatism by a refractive procedure called a Limbal Relaxing Incision or LRI. What is an LRI procedure? Limbal Relaxing Incisions (LRI) are small incisions made at the very edge of cornea (called the limbus). These incisions allow the cornea to relax and become more round, thereby reducing the astigmatism and generally improving the patient s vision. The LRI procedure is done the same time as your cataract procedure. What is included in the Advanced Refractive Cataract Package I have elected for? The refractive package includes an upgraded lens implant that is specifically designed and approved by the FDA to improve your functional vision while driving at night. It also includes IOL Master testing. The IOL Master is an instrument that is used during your pre-operative examination to measure the power of your natural lens. This laser

2 instrument provides your surgeon with the most reliable and accurate information available, allowing him to implant the lens best suited for your eyes. The package also includes the Limbal Relaxing Incision discussed above, and an Orbscan measurement to again provide you with the best refractive result. These tests, lenses and treatments are deemed to be not medically necessary and as a result are not covered by OHIP. There is a charge of $1,500 - $2500 per eye for refractive package depending on lens selection. Where am I having my procedure? You will be having your surgery at TLC Laser Eye Centers. TLC is an ambulatory surgical centre outside of the hospital. Dr. Nichols will be performing your surgery at TLC. You will be required to go to TLC prior to your scheduled surgery day to have the IOL Master and Orbscan tests completed. These tests will take approximately 30 minutes. TLC is located in downtown London, at 142 Fullarton Street, at the corner of Richmond and Fullarton in the Talbot Centre Mall. They are located on the ground floor of the building beside the food court. There is metered parking on Fullarton and Talbot Street or there are several flat rate parking lots in the area. If you choose to park in the metered parking please ensure to bring adequate change for the meter. You will pay TLC Laser Eye Centers on the day of your procedure for the refractive package. TLC accepts Certified Checks, Debit, Visa, Mastercard and American Express credit cards. Should you have any questions about payment options please contact us at (519) What are the risks associated with cataract and the LRI surgery? Your surgeon will outline all of the specific risks associated with the surgeries. In addition, you will find two informed consent documents included in this information package. One will outline the cataract procedure risks and the other will outline the LRI procedure risks. Please read through these thoroughly prior to your procedure day. Call our office if you have any questions. You will also have an opportunity on the day of your procedure to meet with Dr. Nichols to discuss any final concerns you may have. Complete and bring both forms with you to the surgical centre on the day of the procedure. When can I have my other eye treated? Most patients will have their 2 nd eye treated 1-2 weeks after the first. What do I need to do to get ready for my procedures? We have enclosed a prescription for eye drops. Please have this prescription filled at least three days prior to your surgery day. You will be using all of these drops starting three days prior to your surgery and on the morning of your procedure. You will also use these drops for some time after your procedure. You will be given specific post operative instructions on the day of your surgery. It is important to shake the drops prior to use. Do not store the drops in a very cold or hot environment.

3 You will also find enclosed a pink form Surgical Day Care Physician History and Physical Form. You will need to make an appointment with your family doctor to complete this form. Please bring the form with you on the day of your surgery. Other surgery day instructions Wear comfortable clothes. Wear short-sleeved button front shirt or blouse. Ladies are asked not to wear pantyhose. Do not use highly scented perfumes, after shave lotions or creams. Leave rings, jewelry and valuables at home If you are diabetic, bring your diabetic medications with you If you have asthma or a lung condition, bring your inhaler (puffer) with you. Take all of your medications as normal Eat before you come to the centre for your procedure. Bring all medications in original containers or an up-to-date list. Bring a list of all of your allergies and sensitivities Glasses if you need them for reading. Your completed informed consent documents A family member or friend to assist you as well as to drive you home after your procedure. One person will be permitted to wait with you during the pre and post operative period. You will be at the center approximately 2-4 hours. Make sure to have filled your prescription for your eye drops prior to your surgery. Remember to start taking all of your drops three days prior to your surgery and remember to take them on the morning of your surgery. What is involved on the procedure day? On the day of your surgery you will arrive at the center and be taken to the preoperative area. You will receive a mild sedative prior to your procedure. Drops will be place in your eye to dilate your pupil and then to numb your eye. You will walk into the surgical suite and lie on a surgical bed. An eyelid holder will be place in your eye to prevent you from blinking. Throughout the procedure, you simply look straight ahead into a white target light. If required, your surgeon will do the Limbal Relaxing Incision Procedure first to treat your astigmatism. He will make 1-2 small incisions in the limbal area of your eye placed precisely to correct for your astigmatism. Once completed, the surgeon will begin your cataract procedure. A tiny 3mm incision will be made in your cornea as your eye is being held steady by the surgeon. A lubricating material will then be inserted into the eye. The surgeon will then remove your natural lens and insert the artificial lens. The small incision will close and heal naturally, usually requiring no stitches. You will not feel pain during the procedure. The entire procedure will take between minutes to complete. It is not uncommon for you to move your eye during the procedure. While this will not affect the end result, you should try to remain as still as possible.

4 What will my recovery be like? After your procedure is completed, you will remain at the centre for a short while. During this time, additional drops will be placed in your eye. We will place a protective shield over your eye. You may wear your sunglasses during the day and the protective shield at night. This eye shield will protect your eye and keep you from rubbing your eye while sleeping. Once you are given your post-operative instructions you may then return home. You will return to TLC later the same day to check your progress and monitor your healing. You will be given your appointment time on the day of your surgery. It is normal to feel a scratchy, sand-like feeling in the eye for the first few days. You may also find you feel tired for the first 24 hours after the procedure. You may find that your eye is bruised or bloodshot for about 1 week. Should you have any of the symptoms listed below or another concern or emergency use the following guidelines: Your operated eye becomes very painful or swollen There is an increase in mucous discharge There is a decrease in your vision in your operated eye During normal office hours (Monday Friday 8:00am to 4:00pm) contact Dr. Nichols office directly at: (519) After normal office hours page Dr. Nichols directly. The pager number will be given to you at the time of your surgery. Dr. Nichols will return your call. When you are back at home. Continue your eye drops today as instructed. You should take them at noon, supper and bedtime. We strongly recommend that you have someone stay with you the night after the surgery. There will be some mucous and tears from the eye. Rest during the evening following your surgery. You may read or watch TV. Take Tylenol (acetaminophen) for pain, if needed, provided your are not allergic to it. Use Gravol for nausea / vomiting. You may eat anything you normally would eat. You may take your regular medications. Wear the eye shield or sunglasses for 24 hours after the surgery and then use the shield while sleeping for the next week. Contact your surgeon s office if you experience severe pain in the eye, nausea or vomiting within the 2 weeks of your surgery. If it is after normal business hours you can page Dr. Nichols.

5 Other Instructions for Patients Following Surgery Post-operative care is very important. Carefully following your recovery regimen and attending all follow-up appointments is crucial to achieving the very best visual result. While complications are rare, proper post-operative care ensures that any problems will be identified and treated quickly. Some things to DO: Use your prescribed eye drops as instructed. Wear glasses or eye shield while sleeping for 1 week after surgery to prevent your eye from injury. Wait 1 full day before taking a shower. For the next week, wear the eye shield when showering or bathing. Let the water hit your back not your face. Some things to AVOID: Do not drive until your doctor advises you that it is OK. Do not rub or press on your operated eye Do not get water or soap in the eye. Do not lift anything heavier than 10lbs. for the first week after surgery. Avoid swimming, hot tubs, whirlpools and saunas for 2 weeks Avoid gardening and dirty, dusty, smoky environments for 2 weeks. Avoid wearing eye makeup for 1 week. Do not play contact sports for 1 month For 2-3 days do not put your head down below your waist when bending over. Once again, if you are experiencing increased pain, increased mucous discharge or a reduction in your vision. Contact Dr. Nichols office or if it is after hours page Dr. Nichols. If you have any further questions please contact our office. Best Regards, Dr. Bruce Nichols