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What is Cataract?

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The human eye is similar to a camera.  It has a lens at the front which focuses the light rays on the film at the back called the retina. When we are born the lens is clear.  As we age, the lens becomes cloudy reducing the light rays reaching the retina. This causes blurred vision. A cataract is the natural human lens that has become cloudy with time.

                               Like wrinkles in our skin, cataracts are a normal aging change of the eye.  Certain things can cause cataracts to appear earlier including diabetes and steroid use.  Some cataracts are genetic and may be present from birth or childhood.  Cataracts can also be caused by trauma. However, most cataracts are due to age.

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When should my cataract be removed?

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Just because a cataract is present, it does not mean you should have surgery to remove it. Initially, your vision can be corrected by updating your glasses.  Over time, this will no longer improve your vision and you can start to consider surgery if you are not satisfied with your vision. Some early symptoms of cataracts include loss of fine detail, glare around headlights, difficulty driving at night, and blurred vision. 

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How is a cataract treated?

Cataracts can only be treated by surgery. There is no medicine or eyedrop that can safely reverse a cataract.  Surgery is performed to remove the clouded lens and replace it with a new acrylic lens called an intraocular lens (IOL) implant.

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Cataracts are treated with an outpatient surgical procedure. Typically, this procedure takes 5-15 minutes.  You are awake for the surgery and a drop is administered to freeze the eye. You will be offered a mild sedative pill to ensure you are pain-free and relaxed throughout the procedure.

 

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A small 2.2mm incision is made in the cornea. The ultrasound handpiece is inserted and breaks the cataract into microscopic fragments which are removed.

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The lens implant is positioned in the eye in place of the cataract

 

 

 

 

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The new lens is in place.  The incision heals naturally without stitches.  The vision is restored.

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What is an intraocular lens/lens implant?

An intraocular lens (IOL) is the replacement lens that is surgically implanted in the eye to replace the clouded lens that is removed during cataract surgery.  The IOL is necessary to focus light on the back of your eye and will stay in place for the rest of your life.

 

All IOLs are of high quality and will provide good, long-term stable vision.  At your pre-operative assessment, we will discuss the IOLs for which you are a candidate and answer any questions you have.

 

Intraocular Lens (IOL)

Monofocal lens:  This is the most commonly used lens and is covered by the provincial health plan. There is no charge to the patient for this lens. It provides excellent vision.  With this lens, you will be required to wear glasses after surgery.  If you do not have astigmatism you may only require glasses for near or distance (not both).  If you have astigmatism, you will need to wear glasses for near, intermediate, and distance vision, but the vision will be brighter and sharper than with your current glasses, due to the removal of the cloudy cataract.

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• Corrects one focal point (distance or up-close)

• Does not correct Astigmatism

 

 

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Toric lens:  This lens is an excellent option if you have astigmatism.  Astigmatism is when the front of the eye is shaped more like a   football than a baseball.  After surgery glasses will be required for near and intermediate tasks only, but your distance vision should be fairly clear.  The toric lens is designed to work with the natural shape of your eye to correct astigmatism.  It will reduce your dependence on glasses; however, you will still require glasses for near tasks.  The cost of this lens is not covered by the provincial health plan.  

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PREOPERATIVE INSTRUCTIONS

• A prescription for eye drops will be faxed to your pharmacy. 

• There will be a refill for your second eye. You will need to start the eye drops one day prior to surgery and continue the day of surgery. If you are on any other eye drops (such as glaucoma drops) you may continue these as usual even on the day of surgery.

• Please shower/bathe the morning of/night before surgery.

• Do not wear a contact lens in the eye having surgery for 24 hours prior to surgery.  A contact lens can be worn in the other eye.

• Do not bring valuables or jewelry to the hospital.

• Take your usual medications the morning of surgery.

• If your surgery is at the Pasqua Hospital, do not eat anything after midnight.  You can drink clear fluids only (water) until 4 hours prior to your arrival at the hospital.

• If your surgery is at the Regina Surgical Center, you may eat a light breakfast prior to arriving at the center. 

• Bring a complete list of medications with you.

• Do not wear perfume, make-up, or face cream.

• Hearing aids should be worn to the surgical center.  The hearing aid on the side of your surgery will be removed during the surgery so it does not get wet or soiled.  They can be worn immediately after surgery is complete.

• You may wear wigs or dentures for your surgery as these do not need to be removed.

• Normally you can bring a maximum of one family member or friend with you to all appointments as waiting room space is limited.  This may not be allowed due to pandemic (COVID) related restrictions at the time of your surgery. 

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ON THE DAY OF SURGERY

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• YOU MUST HAVE SOMEONE DRIVE YOU HOME (or you must take a Taxi).  You will not be allowed to drive yourself home.  

• You will be at the Pasqua Hospital for approximately 3 hours. Your surgery is performed in an operating room.  You are lying down with a sterile drape covering your face and body.  Only your eye is exposed.  Your eye will be held open with a speculum so you cannot blink during surgery. 

• It is normal to feel light touch, pressure, and water running on your eye during surgery.  You will not feel anything sharp during the surgery.

• After surgery, you will have a clear protective shield taped over the eye.  You will wear this for 3 hours after surgery and then it can be removed.  It should be re-applied whenever you are sleeping for the first 5 days.  Your eye may water and the eye drops may sting.  You may have discomfort or even eye pain or headache on the day of surgery.  You may take Tylenol or Advil for discomfort.

• You will be able to see but your vision will be blurry and may have a red hue.  You may see light reflections off the lens implant and it is normal to see big halos around lights for the first few nights.  It is also normal to have a few floaters.

• You may be able to see a crescent-shaped shadow on the edge of your peripheral vision. This resolves over a few weeks.

 

               

                          Mild irritation after surgery is normal.  If your eye becomes very red and

                          painful, or if you experience a sudden increase in floaters, flashing lights,

                          or a curtain in your vision this could represent an emergency. 

                          Please call:

                                       - The office at 306-522-1092 (Monday-Friday 8 AM - 4:30 PM)

                                       - Outside of office hours call 306-450-4441 (for emergencies only)

                                           (this emergency number will not be answered during business hours)

 

POST-OPERATIVE INSTRUCTIONS

Eye protection for the first week

• DO NOT RUB your eyes – you may use a newly opened bottle of artificial tears to relieve irritation.

• Wash your hands with soap before touching your eyes.

• You may sleep on either side.  The protective eye shield should be worn when sleeping for the first week (with no padding under the shield).

• When awake, you may wear glasses/sunglasses instead of a shield.

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Activities within the first week

• No heavy lifting (over 25lbs) for 1 week.

• Lightly wipe lids with a clean tissue to remove debris/crusting.

• Showering/bathing and washing your hair is permitted but do not get water in your eye for the first week (wash so that the water runs off the back of your head and not in your face).

• Walking, reading, watching television, eating, and drinking as before surgery is permitted.

• No swimming, sauna, or hot tub use for 2 weeks following surgery.

• Do not wear eye make-up for one week.

• Do not drive a vehicle for 24 hours after surgery.

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When can I update my glasses?

After your cataract surgery, the lenses in your old glasses will no longer work for you.

 

After your first eye surgery, you may find it helpful to remove the lens on that side of your glasses and wear the glasses with only one lens (for the eye that has not had surgery).  However, if you have a high prescription this may cause you to be dizzy/disoriented.  If so, you can wear your old glasses even though the freshly operated eye will be blurry.

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Once both eyes have had the surgery you may prefer not to wear your old glasses at all.  You should follow up with your optometrist in 4 to 6 weeks for a new prescription.  It is often helpful to use a pair of over-the-counter readers until you see your optometrist for your new glasses.

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What can I expect long-term after cataract surgery?

Months to years after surgery some people may develop blurry vision or increasing glare and may feel that the cataract is returning.  This may be caused by posterior capsule opacification (PCO) and is sometimes referred to as a “secondary cataract”.  PCO is a cloudy membrane that forms behind the artificial lens inside your eye.  It occurs in up to 20% of people.

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How is Posterior Capsule Opacification treated?

PCO can be easily treated with a special laser procedure called YAG capsulotomy.  The procedure is quick, painless, and performed in the office.  The cost is covered by the provincial health plan.  The laser is used to open a window through the cloudy membrane, clearing the back of the lens and improving your vision again.  If you develop the above symptoms it is advisable you make an appointment to see Dr. Varma or your optometrist to decide whether PCO has formed and if so, to have it treated.

 

What are the potential side effects and risks of surgery?

The great majority (more than 99%) of patients are satisfied with their surgery.  However, like every other surgery, there are potential permanent negative effects on the body.  Fortunately, these are rare.  These may include but are not limited to:

• dry eyes

• foreign body sensation

• reflections off the implant

• negative dysphotopsias – 20% of patients see a crescent-shaped shadow in the outer side of the visual field initially.  This generally resolves with time.  About 1% of patients see this shadow permanently, but it is usually well-tolerated.

• light sensitivity

• infection (endophthalmitis) – occurs in approximately 1 in 5000 cases and can potentially cause blindness if not treated promptly.  Fortunately, it is rare.

• detached retina – rare, more risk in young, nearsighted individuals

• loss of vision

• loss of the eye – can be caused by untreated infection or retinal detachment.  It is exceedingly rare and occurs in less than 1 in 10,000 patients.

 

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Surgery and Post-Op Appointment Dates

 

Your surgery may be performed at the Regina Surgical Center on 2060 Halifax Street or the Pasqua Hospital 4101 Dewdney Avenue.  You may have a post-op appointment the same or the next day at Dr. Varma’s office (4000 Dewdney Avenue).  You will usually have a second post-op appointment approximately 1-3 weeks later.  If you are pleased with the results of the first eye and you are having the second eye done, it will be scheduled a few weeks later. 

 

Surgery locations:

                             REGINA SURGICAL CENTRE                           PASQUA HOSPITAL                                                               2060 Halifax Street South of Victoria Ave.          DAY SURGERY (2nd Floor)                                                     (between Victoria and 13th Avenue)                   4101 Dewdney Avenue

                             Admitting opens at 7:10 AM                                Admitting opens at 6:30 AM

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