Background Information:

What are the other Names for the Procedure?

• Cataract Removal
• Cataract Surgery
• Phakectomy

What is the Cataract Extraction surgical procedure?

• Cataract Extraction is a surgical procedure involving the removal or extraction of a cataract
• A cataract is the clouding or opacity of the lens in the eye(s)
• The lens that is removed is replaced with a synthetic lens implant

What part of the Body does the Procedure involve?

The body parts involved during a Cataract Extraction is the eye, cornea, lens, and eyelid membrane lining.

Why is the Cataract Extraction surgical procedure Performed?

A Cataract Extraction procedure is performed for the restoration of vision.

What are some Alternative Choices for the Procedure?

To restore vision in case of a clouded or opaque cataract, a Cataract Extraction procedure remains the gold standard technique.

What are the Recent Advances in the Procedure?

The recent advances to the procedure are the use of intraocular lens implant and phacoemulsification techniques for Cataract Extraction.

What is the Cost of performing the Cataract Extraction surgical procedure?

The cost of Cataract Extraction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Cataract Extraction procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002957.htm

http://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.html#b

http://www.ncbi.nlm.nih.gov/pubmed/19570151

Prior to Cataract Extraction surgical procedure:

How is the Cataract Extraction surgical procedure Performed?

• During the Cataract Extraction procedure, the eyelids are moved and kept apart using a special instrument
• A small incision is made in the cornea and the clouded lens removed; either by emulsifying the lens through fragmentation with ultrasound and aspirating the debris, or the lens is manually removed
• An intraocular lens made of silicone or acrylic material is inserted in the eye, replacing the cataractous lens
• Depending on the size of the incision, the surgeon may close the incision, with or without any sutures
• A solution of pilocarpine, or atropine eye drops solution is used to keep the pupil open during the period of surgery, and then the eye bandaged

Where is the Procedure Performed?

Cataract Extraction procedure is performed in an out-patient facility or a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The procedure is performed by an ophthalmologist.

How long will the Procedure take?

The procedure may take anywhere between 1-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is used; hence do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Cataract Extraction procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Cataract Extraction procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Cataract Extraction surgical procedure?

Prior to the surgery, the patient may be advised the following tests:

• Complete eye examination
• Snellen test; to check the visible accuracy for both nearsightedness and farsightedness
• Eye examination with stilt lamp
• Imaging study of the eye (Ultrasound, MRI, CT Scan)
• Routine blood and urine analysis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Cataract Extraction procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Will it restore clear and complete vision?
• Who are the medical personnel involved in this procedure?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Cataract Extraction surgical procedure:

In a majority of the cases local anesthesia, or topical eye drops is given. Medication to relax the patient may be used. General anesthesia may be given under some special circumstances, which include:

• Surgery in children
• Individuals, who are allergic to local anesthetic medication
• Individuals with very high anxiety levels
• Your surgeon will recommend an anesthesia method based upon your specific situation.

How much Blood will you lose, during the Procedure?

Since the procedure requires only a small surgical incision, the amount of blood loss is minimal.

What are the possible Risks and Complications during the Cataract Extraction surgical procedure?

The possible risks or complications that may arise during a Cataract Removal surgery are:

• Excessive bleeding
• Infection
• Accidental injury to the neighboring tissue

It must be noted that the risks and complications during surgery increase if the patient suffers from obesity, uncontrolled diabetes, or any other chronic ailment.

What Post-Operative Care is needed at the Healthcare Facility after the Cataract Extraction surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Cataract Extraction surgical procedure:

What are the possible Risks and Complications after the Cataract Extraction surgical procedure?

The possible risks and complications that may arise after a Cataract Extraction surgery are:

• Surgical wound infection
• Post-operative inflammation
• Thickening of the lens capsule causing hazy or cloudy vision
• Dislocation of the intraocular lens implant
• Astigmatism
• Retinal detachment
• Increased pressure within the eye ball, causing a condition termed glaucoma

What is the Prognosis after the Surgery?

The post-surgical prognosis is usually excellent with 95% of the patients experiencing better and improved vision.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Change in vision
• Pain, swelling, and redness of the eye(s)
• Bleeding and drainage in the eye, or at the incision site
• Signs of infection
• Dizziness
• Fever
• Nausea or vomiting

What Post-Operative Care is needed at Home after the Cataract Extraction surgical procedure?

At home, the following post-operative care is recommended, after a Cataract Extraction procedure:

• Keep the wound clean and dry
• Gently clean the eye using a warm, wet washcloth while changing bandages
• Complete the course of prescribed medication
• Use antibiotic eye drops or anti-inflammatory ointments, as suggested by physician to prevent infection
• Eat a well-balanced diet
• Do not press, or rub, or apply any pressure on the eye
• Avoid bending, straining, or lying flat on the bed, to avoid a pressure build-up inside the eye

How long does it normally take to fully recover, from the Procedure?

It takes about 3-4 days for recovery from the Cataract Extraction surgery and anywhere between 4-10 weeks to regain better vision.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Cataract Extraction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital or outpatient facility
• The ophthalmologist
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Cataract Extraction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA