Mann-Grandstaff VA Medical Center
In the fall of 2009, the Mann-Grandstaff (Spokane) VA Medical Center started to perform cataract surgery. Since the fall of 2009 we have completed several hundred successful surgeries per year.
Did you know?
Cataracts are the leading cause of vision loss in adults age 55 and older and the leading cause of blindness worldwide. By age 65, about half the population has a cataract, and by age 75 almost everyone has a cataract. Luckily, cataracts are highly treatable, and through advances in both cataract surgery and intraocular lenses, most people are experiencing full restoration of their vision (if no other ocular disease is present).
What is a cataract?
A cataract is a clouding of the eye’s natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens is mainly made up of water and protein. As we age, the proteins start to breakdown, clump together and start to cloud up. This is a cataract. Over time this continues to occur involving more of the natural lens to a point you can no longer see through it properly. Now, it is time to consider cataract surgery.
What Causes Cataracts?
No one knows for sure why the eye’s natural lens changes as we age, forming cataracts. Research continues on the exact cause. Some research suggests exposure to ultraviolet light can cause cataract formation. We do know that certain health conditions cause the development of cataracts. A prime example is diabetes. Certain medications also contribute to the development of cataracts. Examples include steroids, diuretics, and tranquilizers. Additional risk factors include cigarette smoke, air pollution and heavy alcohol consumption.
The earliest sign of a cataract is blurred vision. It can also make light from the sun or a lamp seem too bright or glaring. You can also notice difficulty with night driving with oncoming headlights having more glare than before. Colors may also not appear as bright or vibrant as they once were.
What is the treatment for Cataracts?
The only treatment for cataracts is surgery. Once a cataract reaches a certain level, new glasses will no longer improve your vision. When vision impairment reaches a point that you can no longer complete the activities you enjoy, it is time for surgery. Examples include inability to read and to safely drive a car. Cataract surgery is very successful in restoring vision. In fact, it is the most common surgery performed in the United States. More than 3 million Americans undergo cataract surgery each year.
Intraocular lenses may in fact be the most important advancement in cataract surgery. An intraocular lens is an implanted lens in the eye replacing the existing natural lens in cataract surgery. It consists of a small acrylic lens with side struts, called haptics, to hold the lens in place. At the Mann-Grandstaff VAMC, we use fixed mono-focal lenses. Most patients choose to correct their distance vision, knowing they will need glasses for reading. Multifocal lenses are not available at the Mann-Grandstaff VAMC.
Mann-Grandstaff VA Medical Center Cataract Surgery
All veterans enrolled at the Mann-Grandstaff VA Medical Center are eligible to have cataract surgery.
Prior to cataract surgery, a complete eye exam must be performed. Once completed and you are found to have visually significant cataracts, a consult for surgery is initiated. Visually Significant cataracts are determined by one of the staff optometrists. A visually significant cataract, at the Mann-Grandstaff VA Medical Center, is a cataract causing a decrease in vision to 20/50 vision best corrected. If your vision is better than 20/50 but glare (bright light) drops your vision to 20/50, you are still eligible for cataract surgery.
Cataract Surgery Pre-Operative Exam
At this appointment an extensive review of symptoms is completed, measurement of the length of your eye is completed to determine the power of intraocular lens to place into your eye, and an additional thorough exam is completed of your eye and retina to ensure it can tolerate surgery.
History and Physical
Once your pre-operative exam is completed you will be sent to have a history and physical to ensure your body can tolerate surgery. This physical is completed by one of our surgical Nurse Practitioners or Physician Assistant. At this exam the provider will review your pre-operative eye exam and review your general health and medications to be sure you can tolerate surgery.
As part of the History and Physical, the eye care provider will order the following tests prior to your physical:
1. Electrocardiogram (EKG)
Most people can tolerate cataract surgery. Once a history and physical is completed and you are determined fit for surgery your next step is the surgery itself:
Medications for Surgery
Patients are to continue ALL current medications. We do not stop any prior or after surgery. As a matter of fact, we start all patients on 3 additional eye drops for cataract surgery. These medications are used to prevent infection and inflammation. The medications are:
· Non-Steroidal Anti-inflammatory (NSAID): Ketorolac
· Antibiotic: Ofloxacin
· Steroid: Prednisolone Acetate
All patients will start the Ketorolac and Ofloxacin 3 days prior to surgery. You will take the medication 4 times per day and also each medication the morning of surgery. Both medications will be restarted the day after surgery. The Prednisolone Acetate will be started the day after surgery.
Day of Surgery
Prior to surgery you must make arrangements for transportation. Patients are required to have someone escort them home after surgery. It is Mann-Grandstaff VA Medical Center policy that you have a friend or a family member check you in and pick you up after surgery. This individual cannot be a taxi driver, a bus driver or one of our DAV volunteer drivers. If you show up for surgery without an escort your surgery will be cancelled, so PLEASE be sure to bring one with you.
On the day of surgery you cannot eat or drink anything by mouth after midnight. The morning of surgery when you wake we want you to take your medications like you normally do but with a very small drink of water. Just enough to get the medication down.
On the day of surgery you will check in at the Same Day Surgery clerk counter on the 6th floor of the hospital. Although your surgery only takes 15 to 20 minutes to complete, you will be at the facility for several hours. Please be sure to bring something to keep you and your escort entertained.
After you check in for surgery you will be asked to wait in the patient waiting room. Once they are ready for you one of our Same Day Surgery Registered Nurses will come for you and have you put on a gown for surgery. Once you are changed you will be sit in an eye chair/bed and an IV will be started. A constant drip saline will be initiated to keep you hydrated. During this time your blood pressure and oxygen saturation will be closely monitored.
Anesthesia of the eye will be completed by a staff Nurse Anesthetist. Each patient will be given a cocktail of medication with Midazolam (Versed) prior to local anesthesia of the eye. Midazolam is provided prior to anesthesia to cause drowsiness, relieve anxiety and prevent memory of the event. Once this is completed a local injection of lidocaine is injected around the surgical eye. Once anesthesia is obtained you will be wheeled to the Operating Room for Surgery.
In the Operating Room you will be laid down in the same eye chair/bed you started in. You will be lying on your back for approximately 20-30 minutes for surgery. A sterile sheet will be placed over your face and a constant stream of oxygen will be piped to you under that sheet. Once you are stable the surgeon will initiate surgery.
To start surgery the surgeon makes a very small incision into your cornea to reach the inside of the eye. Once in the eye she will add medications into your eye for surgery and commence by completing a capsulorhexis. A capsulorhexis is a procedure where the surgeon cuts a hole into the anterior capsule that holds your lens in place. Once the lens is exposed the surgeon will start phacoemulsification. Phacoemulsification chops the cataract into pieces then suctions the pieces out of your eye. Once your lens / cataract is removed the intraocular lens will be placed into your eye. Once this is completed all surgical instruments will be removed out of your eye, ensures the wounds seals shut (without sutures) and inspects the eye. After the surgery is complete, your eye is taped shut and a large shield is placed over your eye. You are then wheeled back down to the 6th floor recovery. Once you are stable, the IV is removed and you are sent home.
On the day of surgery the patch and shield stay on your eye until you are seen in the eye clinic the following day. You can complete any visual task you would like, such as reading a book or watching T.V. You cannot work or drive that day or complete any type of strenuous activities. Most patients report that itching is the only discomfort they experience on the day of surgery. This is likely due to the anesthesia wearing off.
Post Operative Exams
The 1-day post-op is completed at the eye clinic. At this appointment we take the patch and shield off of your operative eye. Once off we flush the eye with sterile saline to wash out any residual ointment that was placed after surgery. Vision is then checked and the eye is evaluated to ensure it tolerated surgery well.
AFTER your one day follow up appointment, you are to restart your pre-operative drops (Ketorolac and Ofloxacin). In addition, you will start your post-op medication prednisolone acetate. You will also need to wear your shield whenever you are sleeping. You will have a long discussion with your doctor about the surgery, expectations and final outcomes.
Post surgically you are placed on restrictions to ensure a successful surgery. This includes no bending over, no straining, or lifting anything more than 5 lbs. This restriction is enforced till your next appointment in 1 week
The 1-week post-op is completed in the eye clinic. The eye is again evaluated. If everything looks good your doctor will discontinue your Ketorolac and Ofloxacin drops. You will begin a taper of the Prednisolone acetate cutting the frequency of drop instillation for the next 3 weeks.
This is your final post-op exam. At this appointment your doctor will complete a thorough eye exam on you including dilating your pupil and checking your eyes for new glasses. Majority of patients will need reading glasses after cataract surgery.
You are done with cataract surgery. Congratulations. You will continue to receive comprehensive eye exams in the clinic on a regular basis. You and your eye doctor will determine when your next appointment will occur.