Cataract Surgery

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Cataract Surgery

May 3, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Geetha Vedula, MD

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Cataract Surgery" with Geetha Vedula, MD. We are thrilled to have her here today for this chat. Let’s begin with the questions.

einvests: What precautions should be taken before cataract surgery for a person who has Fuchs dystrophy?

Dr_Vedula: The same precautions are taken during any cataract surgery to prevent damage to the cornea while extracting the cataract, but even with all precautions sometimes Fuch's can deteriorate after cataract surgery and the patient may need a second surgery.

fedbac: Can Lasik surgery be done during cataract surgery?

Dr_Vedula: No. It is always done at a separate time with a special laser.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Geetha Vedula, MD, who is taking your questions about Cataract Surgery. To ask a question, type in the box below and then click 'Ask'

bklyn: Thank you for your time Dr. Vedula. I am a 73 year old male. My eye doctor believes that I will be ready to have my left eye operated for cataracts, then he said after a short time - three weeks or so - he will operate on the other eye however, my insurance will only cover the surgery if the second eye operation is done after 90 days. How will this insurance window affect my vision?

Dr_Vedula: The insurance window should not affect vision if both eyes have a low refractive error. If one eye is more near or far sighted than the other eye, after surgery it may be hard to focus initially until both eyes are done.

Dr_Vedula: Macular degeneration affects your central vision so taking out your cataracts may or may not improve your vision as much as you think depending on the amount of vision distortion macular degeneration. You need to speak with your doctor but it is hard to predict how much of your vision problem is from cataracts and how much is from macular degeneration.

bklyn: Is there a big difference in the quality of vision between the first cataract operation and the second one?

Dr_Vedula: Every eye is different but our goal is always to optimize the best vision possible in both eyes. You can only have cataract surgery once in your lifetime. Once it is taken out it does not come back.

readlist: What is the complication frequency using the crystal lenses or equivalent? Please break down by serious complications versus minor complications and by correctable versus non correctable.

Dr_Vedula: We do not use the crystal lens here.

rickjensen: What is the typical recovery time for cataract surgery?

Dr_Vedula: Full recovery and best vision is achieved 4-6 weeks after surgery. On average people start to see better in the first couple weeks as long they don’t have any other complicating factors.

klyn: My left eye has very limited vision, that is the one to be operated on first. Is it possible that after the operation I will not need to wear eyeglasses?

Dr_Vedula: It is possible that you may not need glasses after surgery.

bklyn: I was under the impression that macular degeneration affects older people as they age. I have had my vision problems since I was 6 years old.

Dr_Vedula: You may have other complex issues and need to be evaluated in the office.

bklyn: My concern is the unbalanced vision between the first operation and the second one. What remedies are available for the interim to be able to read, computer use, driving, etc?

Dr_Vedula: One option is to wear a contact lens between surgeries.

bklyn: Back in the mid 1940's a cataract patient was required to rest on bed and remain immobile, etc. compared to now, which is the process of recovery?

Dr_Vedula: We recommend light activity for the first week.

rickjensen: Is cataract surgery done on an outpatient basis?

Dr_Vedula: Yes, cataract surgery is done on an outpatient basis.

ceinvests: For an 80 year old woman with mid level Fuch's, is a 3 week interval between cataract surgery for each eye an optimal plan?

Dr_Vedula: That sounds okay. We usually see how the first eye recovers and then do the next.

readlist: Do you use the flexible lenses that permit multi focus usage?

Dr_Vedula: Yes, for the patients who prefer the multifocal lens we do offer them.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Geetha Vedula, MD, who is taking your questions about Cataract Surgery. To ask a question, type in the box below and then click 'Ask'

bklyn: I understand that all surgeries have an element of risk. What are the risks in the operation of cataracts?

Dr_Vedula: Although the risks are very low, there is a risk of bleeding, infection, re-operation amongst many others. Complete vision loss is a risk of any eye surgery.

bklyn: I apologize for many questions, but I am really concerned. How soon will one be able to read, watch TV, or do close work?

Dr_Vedula: Close work requires reading glasses but the time for recovery can vary from patient to patient and depending on their prescription before surgery. Some can read as early as the first week with over the counter reading glasses but we do not give a prescription until at least one month after surgery.

nance: What is the reason doctors wait to remove cataracts? The word "ripe" is no longer used so if cataracts are present in an elderly person, why not simply get them removed? In other words, what is the reason for an ophthalmologist to put off the cataract surgery?

Dr_Vedula: We wait to do surgery because we want the benefits to outweigh the risks.

JanL: I am 62 years old and have cataracts developing in both eyes but they do not interfere with my vision much at this point. My Ophthalmologist said I may need cataract surgery in the future (say 5 years) when and if they move. How will I know when it's time? Also when they are removed, is it possible for them to redevelop?

Dr_Vedula: When you are having trouble doing daily activities such as driving and reading is usually the time we like to take them out. They cannot grow back after they have been removed.

ssrangerthedog: How common is it that a cataract is caused by medication?

Dr_Vedula: That depends on the medication, dose, and duration of use.

bklyn: How long can one postpone a cataract operation before it can really get bad? The postponement would be due to insurance coverage or my own fear.

Dr_Vedula: That varies significantly between patients. We cannot predict.

cbirds5: Do cataracts ever interfere with laser treatments for retinopathy?

Dr_Vedula: Sometimes, in which case we remove the cataracts and then treat the retina with laser.

StevieD: Can you continue to wear contact lenses after cataract surgery?

Dr_Vedula: Yes, if you need to.

bklyn: To ignore cataracts, or the lack of attention to it, will that produce an irreversible blindness, or any other permanent damage?

Dr_Vedula: No. They can be removed later but they can be harder to remove.

nance: Can a doctor determine when cataracts should be removed during the eye exam, whether they appear one way or the other or do patients need to decide?

Dr_Vedula: As physicians we can see the degree of cataract that is present and based on the patient symptoms we can come to a mutual decision.

bklyn: From the early stage of cataract, it was recently found and no action is taken on it, what would be the worst result down the road of not doing anything about it?

Dr_Vedula: You can have a slow decline in vision.

ceinvests: From what I have read, recovery is longer for a person with Fuch's. Why would I schedule both eyes 3 weeks apart? Is there any good reason for that?

Dr_Vedula: You should do one eye and after your recover schedule the other eye.

PilotPete: Do cataracts progress at the same rate in both eyes?

Dr_Vedula: Not always.

fedbac: Are there any medications that can cause cataracts?

Dr_Vedula: Yes. Long term steroids are a well known cause of cataracts.

JanL: Does getting changes in prescription help in postponing surgery?

Dr_Vedula: If you can see well with new glasses and your vision is satisfactorily improved you may not need surgery immediately.

bklyn: Dr. Vedula, do you practice in the Weston, FL location?

Dr_Vedula: Yes, at Cleveland Clinic Florida.

Cleveland_Clinic_Host: We have approximately 10 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

ceinvests: Is there any time that you would not perform cataract surgery on a healthy 80 year old woman with Fuch's? Is there anything that would concern you?

Dr_Vedula: If the degree of Fuch's is severe there is a chance that the patient may need a second corneal transplant surgery but not doing surgery at all will also not improve vision.

nance: After the removal of cataracts a patient will need to continue epidural nerve blocks in the spine which contain steroids. What is the affect on the eyes when one needs to continue the nerve blocks?

Dr_Vedula: Even if cataracts are removed steroids can increase eye pressure, so periodic eye exams are necessary.

gabbyG: Can you still have cataract surgery if you have glaucoma and/or macular degeneration?

Dr_Vedula: Yes. But if the macular degeneration or glaucoma is very advanced then cataract surgery may not improve vision.

Cleveland_Clinic_Host: I'm sorry to say that our time with Geetha Vedula, MD is now over. Thank you again, Dr. Vedula, for taking the time to answer our questions today about Cataract Surgery. To make an appointment with Dr. Vedula, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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