Before Cataract and Lens Implant Surgery
HOW DO I TAKE MY PRE-OP EYE MEDICATIONS?
Antibiotic (Zymar) and anti-inflammation (Xibrom or Acular) drops are used by most patients beginning three days prior to surgery. Drops are taken two to four times each day: Zymar and Acular are 4 times daily medications. If you are given Xibrom instead of Acular, it is used only twice daily (the Zymar is still 4 times daily). Wait 5 minutes between drops. Be sure to take them on the morning of surgery, and to resume them immediately after surgery.
CAN I EAT OR DRINK BEFORE SURGERY?
We encourage you to take clear liquids, NO MILK up until 2 hours before surgery. We want you to be well hydrated when you arrive for your surgery. YOU CAN EAT AND TAKE MILK up until 6 hours before surgery. NO FOOD OR MILK AFTER THAT!
CAN I WEAR EYE MAKEUP BEFORE SURGERY?
Eye make-up can contain particles and bacteria (particularly eyeliner and mascara) so we stop them three days prior to surgery and week after.
IF I AM USING EYE MEDICATIONS IN MY EYE TO BE OPERATED ON, DO I STOP TAKING THEM?
Continue all eye medications through the day before your surgery. Do not use eye medications in the eye to be operated on the day of surgery. Eye drops for the fellow eye should be continued as usual.
CAN TAKE ASPIRIN (or Plavix) BEFORE AND AFTER MY SURGERY?
Modern cataract surgery rarely causes any bleeding. Topical anesthesia removes the risk of bleeding behind the eye from local anesthetic injections. So, continue your aspirin unless you are specifically instructed to stop. (Patients who will be having glaucoma surgery please do stop aspirin 10 days ahead of time. Glaucoma surgery is often better performed under local anesthetic, and the nature of the incision does result in some bleeding during surgery. Inform your primary care doctor if you do this. Also, if you are on coumadin you will be asked to stop 3-7 days ahead, and this you must discuss with your primary care physician.) Ask your surgeon when you can restart.
DO I NEED TO STOP COUMADIN (WARFARIN) BEFORE MY SURGERY?
Coumadin does not generally need to be stopped prior to cataract surgery. Patients ALSO having glaucoma surgery may need to stop several days ahead, please ask your surgeon and inform your primary care doctor.
NOTE: PATIENTS SCHEDULED FOR CATARACT SURGERY combined with GLAUCOMA SURGERY Patients who will be having glaucoma surgery please stop aspirin 10 days ahead of time. Glaucoma surgery is often better performed under local anesthetic, and the nature of the incision does result in some bleeding during surgery. Inform your primary care doctor if you do this. Also, if you are on coumadin you will be asked to stop 3-7 days ahead, and this you must discuss with your primary care physician. Ask your surgeon when you can restart.
IF I AM TAKING ORAL MEDICATIONS FOR ANYTHING OTHER THAN MY EYES, DO I NEED TO STOP THEM PRIOR TO SURGERY?
Use of most medications can be continued preoperatively. Ask our staff or your doctor. An exception is male patients taking FLOMAX® (tamsulosin) for urinary frequency. You MUST report using this to your surgeon. Special measures will be necessary to compensate for ocular effects of Flomax® If your surgeon asks you to stop 2 weeks pre-operatively, that may be helpful. If you can’t reasonably do without it, inform your surgeon and special measures will be taken to compensate. Surprisingly, this usually causes little distress from urinary symptoms. The complications that FLOMAX can cause with cataract surgery were discovered at Marin Ophthalmic Surgery Center.
DO I TAKE MY PILLS ON THE MORNING OF SURGERY?
Yes. Take all your usual medications the morning of surgery with a sip of water.
DO I TAKE MY INSULIN?
Your medical doctor should direct insulin dosage. We’ll try to schedule you early so you can take your insulin with a snack right after surgery.
CAN I WEAR MY CONTACT LENSES RIGHT UP TO SURGERY DAY?
Depending on what kind of contacts you wear, you will need to go without them prior to the Intraocular Lens power measurements. Contact lenses distort the cornea, and might cause a “surprise” result from our IOL power calculations. You will receive specific instructions on this.
Day of Surgery
HOW LONG WILL I BE AT THE SURGERY CENTER THE DAY OF MY SURGERY?
Even though your operation itself usually takes less than 20 minutes, you should plan to spend 2 hours at the Surgery Center. Preparation and post-operative observation and instruction take time. We are committed to providing the finest surgical care.
ON THE DAY OF SURGERY, WHAT SHOULD I WEAR?
Wear a loose shirt or a shirt that buttons in front. Do not wear jewelry.
WILL SURGERY HURT?
That would be unusual. Most patients are surprised when we tell them “Your surgery is over!” You are typically very relaxed from the sedation we use and may even doze during the operation.
WILL I BE AWAKE DURING SURGERY?
You may doze off, but many of our patients are awake and very relaxed for the surgery. Most times, patients recall very little from the actual surgery itself. The effects from the anesthesia are the reason why you must have somebody to drive you home from the surgery.
HOW DO I KEEP FROM BLINKING DURING THE SURGERY?
We will gently prop your eyelids open for surgery. If you are awake, your only task is to relax. That will be easy, we’ll be giving you a very pleasant relaxing medication just before surgery.
DO I SEE MY SURGERY?
No, all you will see (if you happen to be awake at any point) is a beautiful, random swirl of colors.
WILL IT HURT AFTERWARD?
While there is sometimes minor pain after surgery, plain Tylenol nearly always relieves it. If this is ineffective, call our office. It is very common to have some “sandy” or “scratchy” feelings mostly the first day and decreasing thereafter.
WILL I GET STITCHES?
Usually no. The vast majority of cataract surgery at MarinEyes is accomplished with such a small incision that stitches are unnecessary. Just the same, your surgeon will use stitches if he believes it is indicated.
IS IT LASER SURGERY?
No. Lasers have not gained widespread acceptance for this use. Cataract surgery uses ultrasound (sound waves) – the current standard in cataract surgical technology – to soften the cataract so it can be vacuumed out through a very small incision. The use of sound waves to soften and remove a cataract is called phacoemulsification. A laser may be used months or years after cataract surgery for a different purpose. In about 5-15% of patients who have had cataract surgery, a thin film of cloudy tissue develops behind the lens implant. The vision clouds and progressively blurs, causing symptoms very like those of the cataract! Because the symptoms are like the cataract symptoms you had before surgery, this is called “Secondary Cataract.” This blurring can be corrected with a simple and painless laser procedure called YAG laser Capsulotomy.
WHO ADMINISTERS ANESTHESIA?
For most “Routine” cataract surgeries, board-certified anesthesiologists supervise your anesthesia. For some surgeries, your surgeon and his nurse administer “Conscious Sedation,” along with topical or local anesthetics. It would be unusual for the surgery to hurt. Most patients are surprised when we tell them “Your surgery is over!” You are typically very relaxed from the sedation we use and may even doze during the operation.
WHAT IF I COUGH?
If you have chronic respiratory problems, bring your usual medications and inhalers. We can give cough suppressants if we need to. If you have a “cold,” and are coughing, call and let us reschedule your surgery!
Cataract Postoperative Care
Restart your preop drops and other meds unless otherwise instructed!
HOW DO I TAKE MY POST-OP EYE MEDICATIONS?
You will receive specific written instructions on the day of surgery, as well as samples, medication prescriptions and a post-op kit. In general, you will continue pre-operative eye drops, and additionally use Pred Forte 4 times daily.
WHAT CAN I DO WHEN I GO HOME AFTERWARD?
Take it easy, rest and don’t plan on doing any important paperwork or making any decisions. You’ll probably feel like taking a nap at some point.
SHOULD THE DROPS STING?
Ideally, no, but they often do! Acular is the most common cause of irritation. We currently prescribe the “less stinging” form of Acular, called “Acular LS.” The initial discomfort will diminish rapidly after the first day. The drops will sting momentarily after you have put them in the eye. After the first day, if it gets wors again please call and we will evaluate the situation.
IS IT NORMAL FOR MY EYES TO FEELS SCRATCHY AFTER SURGERY?
Expect this the first day, diminishing thereafter. Artificial tears can be soothing. Use them as often as you like.
WILL I BE WEARING A PATCH AFTER SURGERY?
Generally, no. Most patients do not require an eye patch after surgery.
MONOFOCAL AND TORICLENS IMPLANTS: WHY DO I SEE HALOES THE FIRST FEW DAYS AFTER SURGERY?
The best cataract surgery lens implants today have special edge treatments to reduce the chance of “Secondary Cataract” formation. This edge often produces a halo effect or arc of light in the peripheral vision for a few days after surgery. For some patients the symptom takes longer (weeks) to resolve, but rarely is a permanent serious problem. Occasionally, under particular lighting conditions, glare may be noticeable permanently but this is rarely bothersome to the patient. Proper corrective glasses with anti-reflective coating are helpful.
MULTIFOCAL LENS IMPLANT: WHY DO I SEE HALOES THE FIRST FEW DAYS AFTER SURGERY?
With these lenses, the reasons are the same as for the monofocal lenses (above) and also because of the nature of the multifocal optic itself. These symptoms may be pronounced for a day after surgery, but typically rapidly improve after the pupil dilation from surgery wears off. When closely questioned, more people withmultifocal lens implants will observe haloes at night compared with the monofocal focus lens, but they generlly are not very bothered by it.
HOW SOON WILL I SEE AFTER SURGERY?
Vision on the day of surgery is quite variable from one eye to the next, even for the same patient. It is usually blurry in all patients on and off during the first day. You usually experience your best vision after cataract surgery 2-4 weeks post-operatively. Glaucoma surgery patients need longer healing time before returning to maximum vision. For patients with multifocal lens implants, the near vision may not be clear at first, but will continue improving for months after surgery.
WILL I NEED GLASSES AFTER SURGERY?
Many of our patients see very well and function well without glasses. However, all patients must be prepared to wear glasses for optimal vision. Visual needs vary greatly among patients. As a result, our surgeons personalize your surgery and strive for the best surgical result to meet your needs and requirements. More detailed information is available. If there is a large difference between the glasses required before surgery and the desired goal of your surgery, you may be inconvenienced for the two weeks between the first and second eye surgery because it is hard to please both eyes with very different eyeglass prescriptions. The problem will be resolved when the second eye is done.
WHEN CAN I RETURN TO WORK?
This varies among patients. Many patients return to work the following day, although we often recommend the patient take a day off. Please ask your surgeon or his associate on the day following your surgery for recommendations.
WHAT TYPE OF PHYSICAL ACTIVITY AM I ALLOWED TO DO FOLLOWING MY SURGERY?
This depends on how long since surgery, and any special circumstances you might have. The Instructions Book, and the web page on Instructions for Cataract Surgery have this information.
WHEN CAN I RESUME MY NORMAL ACTIVITIES?
This depends on how long since surgery, and any special circumstances you might have. The Instructions Book, and the web page on Instructions for Cataract Surgery have this information.
WHEN CAN I DRIVE AFTER MY SURGERY?
Be prepared to have someone else drive if your vision is not sufficiently clear to drive safely and confidently! If your vision is good the morning after surgery, you may drive that day. Use good judgment, and if you have any question, don’t drive!
HOW SOON CAN I GO TO THE MOUNTAINS OR RIDE IN AN AIRPLANE?
High altitude and air travel pose no problems after cataract or glaucoma surgery.
IF I STOPPED COUMADIN, WHEN DO I RESUME IT AFTER SURGERY?
If coumadin is stopped preoperatively, ask your surgeon when to restart.
IF I STOPPED ASPIRIN OR PLAVIX, WHEN DO I RESUME IT AFTER SURGERY?
Ask your surgeon when to restart.
HOW SOON CAN I WEAR MAKEUP?
For the first week, keep makeup away from the eyelid margin. Lipstick, eyebrow pencil, etc are OK. Powders and foundations often make their way into the eye, as does eyeliner and mascara and should not be used until the second week. After that makeup is OK.