About to have Cataract Surgery - A Few Quick Questions

Eye care
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The plan is right eye on 12/11 and left eye a week later. Alcon monodical lenses will be used. The targeted diopters after surgery is -1.00D(right eye) and -1.75D(left), or mini-monovision for near/intermediate. Before surgery, I'm 6.0/6.5 myopic and very slight astigmatism. Questions:

1. The surgeon said if I can stay motionless well, she may just apply topical anesthesia. How difficult is it to stay motionless during surgery? Do you sit down or lay down during surgery? Is recovery easier if applying only topical anesthesia?

2. The surgeon said I could change my mind to monovision for distance/intermediate after first eye is done(right eye). This is because I'm quite myopic and the resulting diopter may vary quite a bit from the targeted -1.00D(even though ORA will be used). My dominant eye is right eye. In monovision, does it matter which eye is which for vision length?

 

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1. I just had a topical anesthesia and had no issue with keeping my head motionless at the appropriate time. One is not completely motionless during all phases. In my case, actually, the laser used to make the incision was actually in one room while the insertion of the lens was in another room and therefore, I walked from one room to the other.

2. Use of a topical anesthesia does not make any difference in the recovery process from the cataract surgery. I just like to be aware of what is going on.

3. It is usually considered better to have the dominant eye used for distance for monovision. That is the way I have had it for the last 30 years, with contact lenses before the cataract surgeries and then with the IOLs. However, I don't think that it is that important to have it that way.

4. My only suggestion is that you may want to give yourself more than 1 week between the 2 surgeries. You should give the right eye at least a week to know  where you end up in that eye (it will probably still change a little after that) and then take another week for you and your doctor to make a better selection for the left eye to meet your overall objective.

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First off wish you the very best of outcomes Robert.

I was very nervous about the surgeries.  In a waiting room with 10 others I was the only one that took a prescribed Ativan.  The others just had their eye numbed.   That being said there really was no pain during the surgery.  They had me lie down on a low cot.  They draped me with surgical sheets and there was a pipe bringing in oxygen under the sheets.  It is over in about 10 mins with 5 mins to prep and put an eye patch on afterwards. 

The 2nd surgery I had to go earlier than expected as the person in front of me wasn’t cooperating (elderly man with some issues) so nurse took me in and I had barely just taken the Ativan.  Found Ativan helped me sleep later when I was home.  

But you won’t feel any pain and it wasn’t hard to lie stil.  You will see 3 round pinkish red lights that you’ll stare at - they won’t change. For 1st surgery I could see the rings of the Symfony Lens as it unfolded in my eye and asked the surgeon if that is what and he said it was.  My surgeon talked to whole time which I found calming.

I will let others better with numbers weigh in on that.  With dominant eye better eye for distance not all surgeons agree on that.  My own surgeon said he didn’t matter.  In my case I thought my left was dominant based on home testing but turns out after surgeries for cataracts home testing has my right eye as dominant.  Cataract was worse in dominant eye and also my prescription was always stronger for that eye anyways.  Left eye learned to take over.  But I am sure everyone will give you a different opinion on that.

Try not to worry - I kept myself busy.  There is a high success rate.  The balance of those on forums start posting because they had a complication.  The odds are definitely in your favour this will be a success.

Oh and following surgery everyone heals differently.  I seemed to see well within 24 hours after surgery - sooner after first where some others take weeks but still wind up with a great outcome.

Best of luck to you Robert.  Will pray for you on the 11th.  

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Yes I would agree with 201a about waiting between surgeries.  Most provinces here in Canada have a mandatory wait if 4 weeks.   I think that would especially be more important if you are wanting a bit of mini monovision.  You’ll want first eye to heal and know what that prescription is.

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I had it done without IV sedation.  I didn't want to be groggy after the procedure if I didn't have to be.  It was required that I have an IV ready so that they could quickly administer sedation if I needed it.  I'd like to be clear about the topical as it was not only numbing drops, but also a numbing gel.  I was able to use my small mp3 player and I just listened to meditation.  I never needed any IV sedation and it the entire process was painless.

The only thing I would do differently was when they did the surgery on my second (left) eye a few weeks later, there were times the light was so bright that the brightness was bothering the eye they were not operating on and I kept trying to close it.  It was quite distracting (hard to focus on my mp3 player/meditate).  I kept trying to close the eye they were not operating on as it was tearing profusely.  Try shining a really bright light in your eye and you just want to close it.  It was not bothering the eye they were operating on perhaps because it was numb.  In hindsight, I would have preferred a dark patch over my other eye so as to block out the light  (it's not easy to have one eye open while constantly trying to close the other eye and causes you to squint).  It was just distracting but I had already been through the procedure a few weeks earlier so I wasn't concerned and otherwise knew what to expect.  I'm not sure why I didn't have a problem with that when they did my right eye three weeks earlier and my left eye was not bothered by the bright lights.  Maybe it was because of the angle of the lights or something.

Normally the dominant eye is set to distance.  My eyes are set about 1/2 diopter apart with Alcon mono focal lens and it's been great.  I wouldn't go more than 1 diopter.  My dominant eye was actually not the one set to distance because originally I was going to have both set to distance. We did the non-dominant eye first and when I realized I could lose my near vision we set the second dominant eye in slightly and as a result both eyes now see great at all distances.

Good luck with your surgery.

 

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That is interesting that they prepped you for IV just in case.  Were you at the hospital or private clinic.  No one with me was prepped with an IV - would take too much time.  Plus they would have to keep you under observation after procedure.  Hospital I was at have you lined up like cattle - one surgery after another - about 15 mins apart.  The surgeon must do easily 25 of these a day.  

I don’t think your operated eye can close - numbing gel/liquid poured into your eye and then they put a spring in to keep it propped open.

It is quite amazing it doesn’t hurt though.  I was told cow ting to feel something.  Only at one point surgeon said I was going to feel a bit of pressure but that was it.  No pain.

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Sue - like your situation it was a "mill" where they do a lot everyday and a well run situation.  But, it was not a hospital, rather a "surgicenter" and there was an anesthesiologist and the IV prep is all standard procedure.  That is how my doctor does all his cataract procedures.  He doesn't want to be in the middle of a procedure (or even at the start) where someone might "freak out."  They want you to be comfortable and be able to provide you what you need.  From what they said, almost everyone gets the IV with a minor sedative but you can "opt out" as I did and it's there anytime if you need it.

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They used an anethesiologist and an IV for my cataract surgery, didn't seem to be optional, but they explained it wasn't strong it was supposed to be mild to keep you relaxed. But I think I dowsed off for most of the <10min surgery, I didn't see what happened after they started and only remember when the doctor said "Its all done, went OK" at the end!

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Find it interesting how different it is place to place.  Lol maybe Canada goes cheaonon the drugs!   

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I was quite surprised I was only patient in my grouping that took the Ativan.   

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Interestingly, the anethesia bill total ended up $600! Luckily my insurance cut that down to $450 and my part was 10% of that, so about $45 for it.

Compares to about $350 for my part after insurance for the basic cataract surgery and the basic lens costs.  Then my premium toric IOL added $1300 out of pocket cost for the lens and surgery.

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Well that confirms for me that since Canada pays for cataract surgery they keep the expense to a minimum so no IV.   Lol

When I asked my surgeon about the surgery and my nervousness he gave me a prescription for Ativan which my medical plan through work covered.

Surgeon said only in extreme situations would hospital sedate a patient - mostly for patients with dementia etc where they would understand procedure or couldn’t lie still.

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Yep, they don't fully sedate patients for cataract surgery unless its an extreme case.

The IV was just supposed to be for a calming effect, but I think a pill would be easier for that!

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I’ve had both cataract surgery and emergency retinal surgery while awake, and was shocked that it actually wasn’t difficult to hold still.  The cataract surgery was less than 10 minutes (the retinal laser was much longer) and while I can’t say it was pleasant, it wasn’t painful, either.  I only had a little achiness the first day then virtually no discomfort after that.  Both were done under local anesthetic but there was brief additional sedation (Versed) via I.V. for the cataract. If you are really anxious about it talk to your doctor.  You may be able to get an additional medication for anxiety.

2) While I think the dominant eye is typically set for distance, I’ve heard it doesn’t really matter that much and that your brain will ultimately adjust.  

Your target vision is similar to mine; my right monofocal result from September is -1.25D; with the other eye (small asymptomatic cataract) at -1.50D.  Immediately post-op the surgical eye was -1.0, and I felt the .5D difference was not very noticeable.  Further comparisons with contacts suggest that for me a .75D difference like you’re planning would also be pretty good; though many people do successfully adjust to monovision differences of -1D and greater..  As you are also considering, I suppose I could also go the other direction with my 2nd (non-dominant ) eye when the time comes; making it more for distance, but I’m pretty happy with the way things are.  I’d much rather wear glasses for driving, etc. than for everything up close.

Although it might be inconvenient to live with the vision discrepancy between surgeries, I would highly recommend waiting a bit longer as others have suggested, if you can.  My vision changed a bit (-1 to -1.25) sometime between 2 and 8 weeks.  (It wasn’t measurement error; I was really aware it had changed).

Sounds like you have a good plan, with some flexibility built into your refraction options.  Best of luck with your surgery!

 

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The Ativan I took was 2 mg - I think I should have been asked to take it an hour before surgery.  15 min not enough for it to have much effect.  But I did have a good nap afterwards.

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Thank y'all so much for the replies. Good to know what to expect during surgery. I'll talk with my surgeon after first eye post-op about waiting a little longer for my second eye. 

To BellaD, I also had retinal laser treatment two weeks ago after my surgeon finding that I had horseshoe tears which makes me a high risk having retina detachment during surgery. The other two surgeons and my regular optician missed it. I was wondering why I've been seeing floaters. Now I know why. I'm happy to have it done before surgery.  

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So glad someone detected your retinal tears.  I had a couple of "missed" diagnoses as well; not good.  Just FYI I did notice floaters for a day or so post-op which really concerned me with my history of PVD and retinal detachment, but I think it was due to suddenly seeing them through the new lens since they dissipated fairly quickly. Please post an update when you can.

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Hi Robert,

Be reassured. Your plan is exactly what I had. -1.75 and -1.0. First op one month ago. Second op just two days ago. Your myopia is also near identical to what I started with.

As others have said, it’s no problem staying still unless perhaps you suffer from a condition that makes this difficult. I was a little nervous before my first op but that was largely because I wasn’t sure what to expect. The second one, yesterday, I breezed through without a care in the world.

There was no "pain" at all, just a little mild discomfort — perhaps a bit like wearing a contact lens with a tiny kink in it.  A really minor sensation. Frankly, I’m not sure what anaesthesia I had. I had a small jab on the back of my hand but I was not 'knocked out'. After the procedure I got up and walked to the recovery room, ate loads of chocolate, then 30 mins later walked 500 metres to my tram, and later got my train and bus home, without ever feeling woozy.

The only moment of worry was walking out of the hospital with one eye bandaged up, into a dense snowstorm. (I live in Switzerland.) But I made it home — and people were very kind on public transport (or perhaps a bit nervous to see me bandaged up like that).

Regarding the one week between ops, I envy you. In my inexpert opinion, the one-month-apart thing is more a hangover from the cautious early days of such surgery, when they couldn’t be certain of success, and so wouldn’t do both eyes at the same time. I’d heard this view expressed a few times, and also heard it at the optician, when I went for some temporary glasses. When I asked the surgeon himself why I had to wait a month, he just sort of shrugged and smiled. "It's how we like to do things here", he said, like a Central American dictator might if asked about imprisonment without trial.

The month between the two surgeries were inconvenient as my eyes were so mismatched. After a few failed experiments I went to the optician and had some temporary glasses made with a slightly adjusted lens to sharpen up distance in the new eye, and had a blank lens put in the old eye, on which I wore a contact lens. Doing this for a month was annoying, but it worked well enough

I’m thrilled with the results so far. Yesterday, after returning from my checkup I drove to the local supermarket and realised, once there, that I hadn’t worn my glasses! This wasn’t the right decision, and I got them out for the return journey, but my point is that I drove without noticing, and that gives you an idea of how good the result seems to be.

So it’s near + intermediate monovision. It still feels a bit weird without glasses, and I'm getting a little double vision. Will this smooth itself out over time? I don’t know but of course I hope so. Even if it doesn’t change, it will perfectly ok for mooching round the house, cooking, casually watching a bit of TV, going for a walk, etc. But for anything that requires more attention, like driving, watching a nature documentary on TV, extended computer work, I will have to wear glasses. That’s fine for me.

The advice I’ve been given is that the eyes will take a few weeks to really settle down, so I should wait about 4 weeks, or just after my final check up, before having my eyes tested for some ‘final’ glasses. My makeshift temporary pair are doing a fine job, so that’s OK with me.

Sorry, I’ve rattled on a bit more than intended. The main message is not to worry, that it was a very quick, painless procedure, and that afterwards you will almost certainly be delighted.

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Hoping your surgery scheduled today went well Robert.

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Sounds like both your surgeries were a success.  Yes it does take several weeks for eyes to heal which is one of the main reasons one should wait between surgeries.  Once first eye settles adjustments can be made to target 2nd eye if need be.   Although inconvenient and a pain to wait a month between surgeries - I think one has better chance of good outcome.  I don’t know what Switzerland’s policy is for covering the expense under a national health program but Canada does cover it and depending on province you live in there is a minimum wait time too.  

Congratulations on a successful outcome.