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Cataract Surgery

Evolution of Cataract Surgery

Cataract SurgeryCataract surgery has continued to progressively improve over the past five decades. Initial procedures often involved general anesthesia and extended recuperation, including eight day hospital stays and surrounding the patient’s head with sand bags to promote proper healing. In contrast, Dr. Walter is now able to perform cataract surgery in a six to seven minute outpatient procedure, utilizing topical anesthesia, no stitch, and no patch. Cataract surgery is now is the most popular and safest of all surgeries.

Approximately three million cataracts are performed in the United States annually, with a projected increase to 4.5 million by 2030 as the baby boomer population ages in the next two decades. Currently, the standard for cataract removal is phacoemulsification with lens implantation. This technique was developed by Charles Kelman in the 1970s and has gained popularity over the last several decades due to quick recovery and excellent visual results. The method used to remove the lens nucleus has traditionally been through the tip of a needle with the assistance of ultrasonic sound waves, vacuum and irrigation. This method has enabled surgeons to make smaller incisions in the cornea that no longer require stitches.

Advances In Technology

Laser assisted surgery

Recently, femtosecond laser technology has been FDA approved for making the initial incisions into the eye. Traditionally, many phases of cataract surgery required the surgeon to utilize manual techniques, including the use of a surgical blade, a bent needle or forceps. The recent development and use of the femtosecond laser allows surgeons to replace the aforementioned manual techniques with the laser, which can result in even greater precision and improved visual acuity for the patient. The femtosecond laser can also make special incisions that reduce or eliminate astigmatism, therefore improving the chances for spectacle free vision after surgery.

Electing to use the femtosecond laser during your cataract procedure requires an additional fee since it is not covered by insurance or Medicare. To see more about femtosecond laser click here.

Premium Lens implants

Every patient receives a lens implant as part of cataract surgery; it replaces the cloudy lens that is removed, and is what allows the patient to “see” or “focus” on objects around them. The standard lens implant, which is covered by both Medicare and most insurance carriers, is safe and effective, but will require the patient to wear glasses to achieve the best vision possible post-surgery. While this is a vast improvement over vision with a cataract, there are premium lens implants available that can completely eliminate the need for glasses.

Not every patient is a candidate for these premium lenses, and Dr. Walter and his staff will discuss all lens options with you at the time of your evaluation. Should you ultimately select one of these premium lens options, an additional payment will be required prior to your scheduled surgery date since neither Medicare nor insurance currently covers them.

For more information on premium lens implants, please click here.

What is Required to Schedule My Cataract Surgery?

After you have had your initial appointment with Dr. Walter confirming that you have cataracts and that surgery is a good option for you, you will then schedule your surgery date as well as an appointment for a pre-surgical workup. At the pre-surgical work-up (typically within a week before your scheduled surgery date) you will meet with the Physician’s Assistant (“PA”) to discuss your current medications and medical history, and to measure your eye for the lens implant. The PA will also prescribe eye drops that you will begin using two (2) days prior to your scheduled surgery date. We suggest you begin the process of getting this prescription filled as soon as possible after your workup, because certain drops may require prior authorization from your insurance carrier, depending on your policy. If you have cataracts in both eyes, the second procedure will most likely be scheduled within about two weeks of the first procedure.

If you elect to have a premium lens implant and/or femtosecond laser assisted cataract surgery, the additional payment for these non-covered services will be due at the time of your pre-surgical work-up, regardless of your insurance status. For specific questions regarding your insurance deductible/copay please contact your insurance company and/or our insurance verification department at (336) 716-4091.

When scheduling your surgery date, you will also need to determine where you would like your surgery performed. Dr. Walter operates at Wake Forest Baptist Hospital in Winston-Salem, at Northern Hospital in Mt. Airy, and at Wake Forest Baptist’s newest surgical center in Davie County. You will receive top quality care and service at each of these locations. Dr. Walter is happy to discuss the advantages of selecting a particular location with you when you come in for your surgical evaluation.

What Should I Expect During Surgery?

Fortunately, cataract surgery is very easy for the patient and has one of the highest success rates of any type of surgery currently performed. Furthermore, the patient does not experience pain during or after surgery. Cataract removal is an outpatient procedure. The surgery itself takes Dr. Walter approximately 7-8 minutes. The eye is numbed topically with Lidocaine gel, therefore no needle is needed to inject a numbing agent into the eye. Once numb, a small spring is used to hold the eye open. Although you are awake during the surgery, you will feel very relaxed due to the administration of IV medicine (Versed). This medicine not only causes profound relaxation, but also may cause temporary amnesia, which causes you forget most things that happen during surgery. You will not see Dr. Walter operate on your eye, but instead will see brightly colored lights, often described by my patients as looking through a kaleidoscope. Before you know it, the seven minute operation will be completed, and thanks to Dr. Walter’s no stitch technique, the surgical wound self seals.

Cataract Surgery

What is Involved in Recovery, and How Long Does it Take?

The First 24-48 Hours

Most patients are concerned about the cataract surgery recovery process, but are delighted to learn that recovery is generally very quick, including markedly better vision within 24 hours after the procedure. While it is common to experience minor itching, mild discomfort, tearing, and/or sensitivity to light and touch after surgery, these symptoms typically disappear within a day or two. In fact, most patients are able to return to everyday activities within this time period. However, it is important realize that everyone heals at different rates (whether from cataract surgery, a broken bone, or a cut finger). Factors influencing a patient’s recovery after cataract surgery can include age, the presence of diabetes, and the amount of cataract present, among other things. Discussing the specifics of your situation with Dr. Walter can help to successfully manage your recovery expectations.

Eye Shield/Eyeglasses

Dr. Walter will recommend that you wear an eye shield or sunglasses for approximately one week after surgery. This is to help protect your eye from debris and to discourage rubbing or pressing on your eye during recovery. If you’ve elected to continue wearing glasses for vision correction post-surgery, a prescription will be written approximately four to six weeks after surgery is completed on your second eye. This time lapse is necessary in order for your vision to stabilize, ensuring that you receive an accurate prescription.

Eye Drops

ProlensaUsing eye drops is an essential part of the healing process, as they are necessary to decrease the risk of infection. Dr. Walter has researched and published several articles on the cataract drop regimen that will give you the greatest chance for a quick, painless and optimal outcome.

Many surgeons recommend a steroid eye drop that has to be administered four to six times a day initially, followed by a complicated tapering schedule that lasts over a month post-surgery. In addition to this complicated dosing schedule, steroids have been found to increase eye pressure, delay healing and have proven inadequate in preventing a serious complication known as cystoids macular edema (CME). In order to avoid these complications and to relieve patients of a complicated dosing regimen, Dr. Walter recommends that his patients use Prolensa, a non-steroidal anti-inflammatory (NSAID). Not only is Prolensa safer than a steroid, it is far easier for the patient to administer because it only needs to be used once a day. Dr. Walter recognizes that it is difficult for many patients to administer drops on their own, and by utilizing a once-a-day drop, recovering patients often find themselves less dependent upon loved ones to aid in their recovery.

What is a Laser Capsulotomy and When is it Recommended?

A laser capsulotomy is a simple, painless procedure that is sometimes necessary after cataract surgery. This procedure does not require an operating room or incisions into the eye. If you have had cataract surgery and are experiencing blurred vision, it could be because the lens implant developed a “film” behind it, causing blurry vision. The laser capsulotomy procedure is performed to create an opening in the film that can restore normal vision. You will be given anesthetic eye drops and the procedure only takes a few minutes.