Cataract surgery is by far the most common surgery performed in the United States. With advanced technology and highly skilled surgeons, modern cataract surgery should be a rather quick outpatient and a minimal risk procedure. If you are considering cataract surgery, your expectations should not only be to improve your vision, reduce glare at night, see brighter and more vivid colors and improve your day to day activities, but you should also be given an opportunity to reduce your dependence on glasses or contacts and in many cases eliminate this need. In 2017, many choices exist on where to have the surgery and by whom. What is confusing and potentially misleading is that many providers claim they are or provide “the best” without defining what their “best” means or even worse, creating their own definition of the same. Here are the specific questions to ask when you are trying to select the ideal surgical centers, resources, experience, skills and outcomes as you make the critical decision of who will perform your cataract surgery.
1 What type of anesthesia am I going to get? With modern cataract surgery, most surgeries should be completed under topical anesthesia and local sedation. Local sedation means that the anesthesiologist will give you minimal sedation, allowing you to recover your activities after surgery almost immediately with little or no health risk. Topical anesthesia means that the surgery eye becomes numb with drops. No need for injections and shots around or behind the eye. No shots translates into no risk of bleeding and serious complications from the shots. Although rare, this has unfortunately happened recently, when five patients became blind in Western Massachusetts, all in one day, after receiving shots behind their eyes prior to cataract surgery. Ask your surgeon about his techniques and how your procedure will be performed. If or not a shot will be done around or behind your eye and who will do it should be discussed with you before the procedure and you should be able to say yes or no.
2 What are the risks? One of the most dreaded risks of cataract surgery is accidental damage to the posterior capsule, which is the back wall of the bag holding your lens. The best practices have a rupture rate of 2 to 4 per thousand cases. The source of this information should be credible, and ideally made available by an independent review committee in a surgery center. Ask your surgeon about his/ her complication rate and how is this monitored. Does the surgeon have an independent review committee in his/ her center to validate this rate?
3 What is the rate of infections in your center? Another potentially devastating risk of cataract surgery is an infection inside the eye called “endophthalmitis.” Ask about the percentage of patients getting this infection in the center you chose for your operation. The source of this information, again, should be credible, and ideally made available by an independent review committee inside the surgery center.
4 Where will the surgery be performed? Different centers have different equipment and resources. For instance, Massachusetts has only few centers offering bladeless cataract surgery. Bladeless laser assisted surgery should be an option if you want to reduce dependence on glasses and treat low grades of astigmatism at the same time as your cataract surgery. This technology can also soften the cataract if it is dense and thick, allowing a safer and better outcome as it is the case in a specific eye disease called Fuch’s dystrophy. Ask your Ophthalmologist if he/ she is able to offer this technology.
5 What type of advanced technology is available at the center? Larger centers can often times afford better technology. For instance, a new technology called ORA can allow the surgeon to adjust the power of the lens implant placed in the eye while you are having the surgery. This is critical if you had LASIK before. This technology has the added benefit to reduce errors in the implant power calculations and improve chances of reducing your need for glasses after surgery. Ask your surgeon is this technology is available in his/ her center.
6 What type of implant am I going to get? Different lens implants can be used during cataract surgery with different materials, quality and ability to reduce your need for glasses. A lower cost does not always translate into savings as cost depends not only on the implant used, but also the technology used to measure your eye before the surgery. Ask your surgeon what type of implants he/ she uses and what technology is used to accurately measure your eye.
7 Will my need to wear glasses be reduced? Cataract surgery is a wonderful opportunity to limit or eliminate your need for glasses. As the surgeon removes the cataract, there is an opportunity to replace the cloudy lens with a special high tech implant able to achieve this goal. The new bladeless laser assisted surgery offers the opportunity to correct astigmatism at the same time as the surgery, allowing the lens implants to correct for distance, near and everything in between. This is now even easier to achieve with the new state-of-the-art Symfony Toric implants. Ask your surgeon if he/ she is able to access those implants, achieve this goal and how often is this achieved.
8 Will I have stitches? It is ideal to eliminate the need of stitches such as the surgery is a no-stitch surgery. Placing a stitch can be complicated by stitch induced astigmatism, a foreign body sensation and a broken and irritating stitch. Ask your surgeon if he or she is still using stitches.
9 What will be my vision on day 1 after the surgery? One of the measurements defining quality of outcomes after cataract surgery is the quality of vision on day 1 after the surgery. Surgeons should strive to make the vision correct to as close to best as possible on day 1. Ask your surgeon how often is he/ she achieving this outcome.
Cataract surgery is all about better precision, more safety and excellent outcomes. At Milford Franklin Eye Center, Dr. Kaldawy is proud to have been the first surgeon in the area and among the first in Massachusetts to offer bladeless laser assisted cataract surgery. We are happy to bring this technology to the area and are available for second opinions. The top 5 teaching hospitals in the Nation offer bladeless laser cataract surgery. We offer the same. We use one of the 2 femtosecond lasers currently used by Mass Eye and Ear Infirmary. The same laser used by the best of the best. We perform the procedure in a state-of-the-art center where 70 other Boston surgeons operate. This is also one of few centers in Massachusetts offering bladeless cataract surgery. We implant high quality premium lenses only, with correction for distance, near and everything in between. With the new Symfony implants, astigmatism is no longer a problem. The new Symfony implant is music to your eyes. Our percentage of posterior capsule complications and infections is one of the lowest in the Nation and is measured by independent sources. 100% of the surgeries are performed under topical anesthesia, so only drops, no need for shots and their risks and no need for stitches. Yes, we are in 2017, and we are proud to offer 2017 world class outcomes closer to home.
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Issue Date:
January, 2017
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