In general, patients experience no pain, no patching, and no sutures. We numb the eye with a local anesthetic, dilate the pupil, and give patients medication, usually Versed (midazolam, Roche), under the tongue to relax them.
I use an eye model while explaining the procedure and point out the structures as I talk. Patients will typically better understand the procedure if they see the structures of the eye. I have found that the biggest misconception of cataract surgery is that patients believe they no longer have to wear eyeglasses or contact lenses. This is very important to clarify with your patients.
Patients having cataract surgery need to be informed that they will be seeing you again during the postoperative period if you comanage cataract surgery or they will be seeing you after their postoperative care for a new eyeglass prescription.
Preop clinical concerns
During your preoperative exam, be sure to examine the lids and tear film. Starting patients on warm compresses and lid scrubs twice a day and artificial tears four times a day before the surgical consult helps to ensure accurate measurements. This is very important for patients interested in advanced technology lenses along with femtosecond laser surgery.
Patients with significant map-dot-fingerprint corneal dystrophy may not be ideal candidates for laser surgery. Patients with corneal dystrophy, age-related macular degeneration, previous refractive surgery, or other ocular conditions (such as keratoconus or a history of retinal detachments) may not be candidates for multifocal IOLs.
Watch for large or small pupils and iris atrophy. Patients with large pupils are at a greater risk for experiencing glare postoperatively. Small pupils can cause concerns regarding a centered capsulorrhexis. Patients with iris atrophy are at risk for glare, light sensitivity, and weak zonules.
After your exam and patient discussion, it is up to you to offer the cataract surgery options that best fit your patient and his lifestyle.
Regardless of which surgery the patient receives, both options begin with IOLMaster (Zeiss) data. It is the gold standard in optical biometry. It will show IOL power selections, keratometry, anterior chamber depth, and axial length. Its Haigis-L formula helps determine surgical parameters for patients with a history of myopic/hyperopic LASIK. The newer 700 model incorporates swept-source OCT technology into biometry, allowing it to detect tilt or decentration of the crystalline lens.1 It eliminates the need for A-scans because it is able to scan through dense cataracts. It also performs toric IOL calculations.