CATARACT SURGERY - Eye Consult

CATARACT SURGERYWHAT TO EXPECTEYE CONSULTANTSOF NORTHERN VIRGINIA, PCAdult/Pediatric Ophthalmology

CATARACT SURGERYThank you for choosing Eye Consultants of NorthernVirginia (ECNV) for your cataract surgery. We strive toprovide all the essential information required so thatyou can make an informed decision regarding surgeryand the lens implant that best suits your lifestyleneeds.WHAT IS A CATARACT?A cataract is a clouding of the natural lens of theeye. The natural lens is solid and round with a clearcovering like a piece of plastic wrap. Light entersthe eye and is focused through the front structures(cornea and lens) onto the retina, which is the seeingtissue lining the back of the eye. The natural lens canbecome cloudy causing blurring, glare or halos aroundlights. The change of the lens from clear to cloudy is acataract. The first treatment for a cataract is a change

in glasses. When glasses are no longer able to provideadequate vision for your daily activities such as driving,reading or watching television, the cataract can besurgically removed and replaced with an artificial lenscalled an intraocular lens implant (IOL).YOUR CATARACT SURGERY EXPERIENCE:Where is surgery performed?Cataract surgery is performed at an outpatient surgicalcenter. We use two surgical centers located in FairfaxCounty: Fairfax Surgical Center10730 Main Street, Fairfax, VA 22030Northern Virginia Eye Surgery Center2710 Prosperity Avenue #150, Fairfax, VA 22031Your total time at the surgical center on the day ofsurgery is about 2 ½ - 3 hours. The surgical coordinatorand surgical center will advise you of the arrival timefor your surgery.You will need someone to drive you to andfrom the surgery center on the day of surgery.You cannot drive yourself home. Your ridemust remain present for your entire procedure.In many cases, you can drive the day after surgery.Most patients can return to work one to two daysfollowing surgery, unless you work in an area where

you are exposed to dust, dirt or fumes. In that case, youshould be off from work for one week.What do I have to do to prepare for surgery?We want you to have the best surgical experience andoutcome, so make sure you follow all of the pre- andpost-operative instructions, and read all materialsthoroughly and well in advance of your surgery. Youwill receive a surgical folder about one month prior tosurgery with a list of items to be completed prior tosurgery. Below is a summary of these items:After your cataract evaluation with the doctor,our surgical coordinator will call you toschedule the cataract surgery. At that time,an additional pre-operative appointment for surgicalmeasurements may be scheduled. Once scheduledfor surgery, you will receive a surgical folder withconfirmation dates and additional information aboutyour surgery.On the day of your measurements, a postoperative supply kit is given. The cost of the kitis 25 and contains sunglasses, temporary over-thecounter reading glasses, an eye shield and tape for useafter the surgery. You can use one kit for both eyes.Within 30 days prior to surgery, you need to seeyour primary doctor for a medical clearance.You should schedule this appointment as soonas you know your surgical date(s) so there is plentyof time to get your clearance for surgery. In yoursurgical folder, you will find a letter to your doctorand a medical clearance form. Be sure to take bothof these to your doctor. Please have your doctor FAXthe clearance form and your lab results to the surgicalcenter AND to our office when completed.

Approximately 2 weeks before surgery, our officewill send your eye drop prescriptions electronically toyour pharmacy. Be sure to pick up your prescriptionsand start your medications as directed three daysbefore surgery! Continue using the drops after surgeryas instructed on the surgical drops sheet provided toyou. Prior to surgery, you should continue using all yourregular medications. There is NO need to stop anymedication including aspirin, Plavix, Coumadinor Flomax. On the day of surgery, take your regularmorning medications with small sips of water unlessyou have been advised to defer them. If you takeinsulin or any oral hypoglycemic medication, be sureto follow your medical doctor’s instructions for themon the day of surgery. Here is what you need to remember on the day ofsurgery: First, do not have anything to eat or drinkafter midnight if your surgery is in the morning.If your surgery is in the afternoon, the surgical centerwill advise you when to discontinue eating anddrinking.IMPORTANT! Take your surgical kit with thesunglasses and all three of your eye dropswith you to the surgical center on the dayof surgery, and give them to your doctor.Your doctor will use the drops after yoursurgery and will return the kit to you.

What Happens During & After TheSurgery?At the surgical center, you will receive anIV and pre-operative drops to prepare youfor surgery. Your eye will be numbed with a topical(eyedrop) anesthetic and you will be given a twilightsedative so that you are very relaxed for the procedure.You will be directed to focus on a fixation light, duringwhich time you will see a colored light show while thesurgeon performs the surgery.The surgery takes 12 to 15 minutes and there is usuallyno stitching or patching of the eye.You will be able to see when you leave the operatingroom although the vision will be blurry and hazy. Yourpupil will be dilated and you will wear sunglasses toreduce glare when you leave the surgical center. Youcannot drive the day of surgery but you may drive theday after surgery if you feel the vision is adequate.You will come back for a post-operative visit at oneof our offices within 1-2 days after surgery and 2-4weeks later. You will be using eye drops according tothe instructions for one month after surgery unlessotherwise directed by your surgeon.What is the success rate and risk of cataract surgery?In most cases, the surgery has a 99% success rate.Ninety-nine out of 100 patients have recovery of theirvision with no complications. There is a 1% complication rate which can include many things – bleedingin the eye at the time of surgery, retinal detachment,infection, dropping a piece of lens material in the backof the eye and drooping of the eyelid. Fortunately,complications occur very infrequently. There is a small

but real risk of an unsuccessful outcome.At the time of surgery, the cataract is removed and anew IOL is put in its place. The membrane surroundingthe cataract is called the lens capsule. It is left intactto support the new IOL. Months or years after surgery,this lens capsule can develop a haziness that causesblurring, glare and halos or a decrease in vision. Thisis NOT a complication of cataract surgery. It occursin approximately 50% of patients and can be treatedin the office using the YAG laser. The laser treatmentis a painless procedure and takes just a few minutes.The YAG laser treatment is a covered benefit for mostinsurance plans.WHAT ARE MY INTRAOCULARLENS (IOL) OPTIONS:There are various lens options that can be implantedat the time of cataract surgery. A standard monofocalIOL is a single focus lens and generally improvesthe vision in the distance (far away). All patients willneed glasses for reading and computer while somemay need bifocals or progressive glasses to correctastigmatism or residual retractive error. This lens is acovered benefit for most insurance companies.We also offer custom cataract surgery utilizingadvanced technology IOL’s and laser cataract surgery

to decrease glasses dependence after surgery. Theseadvanced options can customize your vision based onyour lifestyle needs and are not covered services. Youwould be responsible for the costs of the non-coveredservices if you choose any of these options. The out-ofpocket patient expense for each advanced technologyintraocular lens or advanced refractive option is listedin the sections below.After completion of your examination, the doctorwill advise you which options would be availableand recommended for you.OPTIONS TO IMPROVE DISTANCE VISIONMonofocal intraocular lens (Standard IOL)This implant is a single focus lens, which means itfocuses your vision at one distance. Most often, theimplant power is selected to give the best vision forfar away. It is necessary to use glasses for reading,computer and other close activities. Some patientswith astigmatism, nearsightedness or farsightednessafter surgery may need bifocals or progressive glassesto improve both distance and near vision. All patientsare candidates for this lens.There is no extra charge for this lens.OPTIONS TO IMPROVE DISTANCE VISIONWHEN YOU HAVE ASTIGMATISMAstigmatism is when the cornea is oval instead ofround and has to be corrected to improve the vision.

Toric Intraocular Lens (Toric IOL)This IOL has correction for astigmatism built into thelens, making the patient more independent of glassesfor seeing in the distance (far away). It is also a singlefocus implant; therefore, glasses are required forreading and for other near focusing activities. The extracost of a Toric IOL is approximately 1500 per eye.Femtosecond Laser Assisted Cataract SurgeryFemtosecond Laser performs several steps of cataractsurgery and can treat smaller amounts of cornealastigmatism. This improves uncorrected distancevision and decreases dependence on glasses aftersurgery by reducing astigmatism. Glasses are requiredfor reading and other near activities after surgery.The extra cost of laser assisted cataract surgery isapproximately 1400 per eye.OPTIONS TO IMPROVE DISTANCEAND NEAR VISIONMultifocal Intraocular LensesMultifocal intraocular lenses have correction fordistance and near built into the same lens. A portionof the lens brings distance light rays into focus anda portion of the lens brings near light rays into focus.Among multifocal intraocular lenses, some are bettersuited for distance-dominant activities and othersfor near-dominant activities. Your doctor will helpyou decide which lens best suits your visual needs.Multifocal lenses may be associated with mild halosand glare at night in a small group of patients. Theselenses can also be used in patients who have cornealastigmatism.

The extra cost of a multifocal intraocular lens isapproximately 2400 per eye.Monovision OptionMonovision is when the dominant eye is focused fordistance and the non-dominant eye is focused for closer activities. Using both eyes, you can see many activities without glasses. Monovision can be achieved withcataract surgery by implanting a lens for distance inone eye and a lens for closer activities in the other eye.There are limitations to monovision and glasses maybe required for some functions for both distance andnear. In addition, if the patient has astigmatism, thenastigmatism correction with a Toric IOL or laser isrecommended.The cost for Monovision is approximately 925 extra(one charge for two eyes).Thank you for choosing ECNV for youreye care needs!

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EDWARD S. PARELHOFF, M.D.Pediatric OphthalmologyStrabismus SurgeryHARESH AILANI, M.D.Cornea / Cataract SurgeryPremium Intraocular LensesJUDITH GADOL, M.DComprehensive OphthalmologyMARISSA L. ALBANO, M.D.Glaucoma / Glaucoma SurgeryComprehensive OphthalmologyJENNIFER B. DAO, M.D.Pediatric OphthalmologyStrabismus SurgeryBENJAMIN D. ABRAMOWITZ, M.D.Glaucoma / Glaucoma SurgeryComprehensive OphthalmologyJESSICA VAN LOOVEREN, M.D.GlaucomaComprehensive OphthalmologySpecializing In:Cataract/ Implant SurgeryPremium Intraocular LensesLaser Assisted Cataract Surgery Cornea ConsultationPediatric/ Adult Strabismus SurgeryCorneal Transplant Surgery Glaucoma Surgery /LasersPediatric OphthalmologyComprehensive Ophthalmology

Pediatric Ophthalmology Strabismus Surgery HARESH AILANI, M.D. Cornea / Cataract Surgery Premium Intraocular Lenses JESSICA VAN LOOVEREN, M.D. Glaucoma Comprehensive Ophthalmology JUDITH GADOL, M.D Comprehensive Ophthalmology MARISSA L. ALBANO, M.D. Glaucoma / Glaucoma Surgery Comprehensive Ophthalmology JENNIFER B. DAO, M.D. Pediatric .