visioneyeinstitute.com.au VISION EYE INSTITUTE CATARACT SURGERY GENERAL INFORMATION

visioneyeinstitute.com.au VISION EYE INSTITUTE CATARACT SURGERY GENERAL INFORMATION

CATARACT Cataract surgery: the most common eye procedure in the Western world. In Australia alone, over 200,000 cataract procedures are performed every year and it is becoming even more common as people live longer. At Vision Eye Institute, our specialist cataract surgeons perform over 10,000 cataract procedures per year throughout Queensland, New South Wales and Victoria that s about 200 cataract operations every week. Cataract surgery is also one of the most successful procedures in modern medicine. Over 97% of patients undergoing cataract surgery without any other diseases of the eye will achieve sufficient vision to drive a car. 1 All eye surgery has the potential for complications that may affect your vision. However, cataract is one of the safest operations that can be undertaken and most complications, while rare, can be remedied with further treatment. Page 2

Vision Eye Institute Transforming lives. That s our vision What is a cataract? A cataract is a cloudiness of the normally transparent lens within your eye. This cloudiness reduces your quality of vision even when glasses are worn. Your lens is a small, transparent, jellylike disc that sits just behind your iris (the coloured part of your eye). All the light entering your eye passes through your lens so if the lens becomes cloudy, vision becomes blurred. cloudy lens (cataract) normal lens Page 3

Who is at risk of cataracts? Cataracts develop as a normal part of the ageing process due to metabolic changes within the lens of your eye. The risk of developing a cataract increases with age so while 30% of people over 50 have cataracts, about half of those over 80 either have a cataract or have had cataract surgery. Exposure to UV light is also a risk factor in developing cataracts, which is why it is important to wear sunglasses and a wide-brimmed hat when outdoors.

Vision Eye Institute Transforming lives. That s our vision Cataract development can also be influenced by eye injuries, smoking, poor diet, medical conditions (such as diabetes) and taking certain medications (such as corticosteroids or anti-inflammatories). How do cataracts affect you? Symptoms vary from person to person and in the early stages you may not be aware that a cataract is developing. Some of the common visual symptoms include: Blurred or hazy vision, affecting both distance and near vision, making it difficult to read road signs or small print for example, even with glasses. Glare, which can cause hazy vision in bright light conditions or haloes around small lights at night. Increased need for more light to see clearly. Frequent changes in glasses prescription and increasingly becoming more short-sighted. Double vision or ghosting can occur, even when one eye is closed. Page 5

Colours can appear faded, or white objects can have a yellow tinge. However, cataracts can have a negative effect on more than just your vision. Long-term studies show that reduced vision (from cataract and/or other causes) is ranked only third behind arthritis and heart disease as a cause of impaired function in older people. 2 When cataracts are small and in their early stages, you may be able to see well enough around the clouded areas to function normally in your day to day life. If cataracts are more advanced, they can result in a more noticeable reduction in your vision. They may then affect your ability to earn a living, read, drive, or live independently and can interfere with daily activities. 3 Reduced vision from more advanced cataracts and/or other causes is also associated with higher risks of falls, hip fractures and car accidents. 4 Your surgeon will discuss with you your particular cataracts and any impact they are having on your life in deciding if cataract surgery would benefit you. Page 6

Vision Eye Institute Transforming lives. That s our vision How are cataracts treated? Once the natural lens inside your eye has lost transparency due to cataract, there is only one cure. Your cloudy lens is removed during cataract surgery and replaced with an artificial lens which restores transparency. During cataract surgery, your specialist cataract surgeon creates a tiny opening in your eye less than 3mm wide.

A narrow instrument is inserted through this tiny incision into your eye to gently break up the cataract into smaller pieces which allows them to be removed easily. While the lens is removed, the elastic capsule that surrounds it is left intact to allow for the placement of the new artificial lens. This artificial lens is inserted through the same incision and stays in your eye permanently. Page 8

Vision Eye Institute Transforming lives. That s our vision Although surgery is the only cure for cataracts it is very rarely an emergency. If you have been diagnosed with cataract, the decision to have surgery should be based on your unique visual difficulties and needs, and the effect of vision loss on your day-to-day life. What are the latest cataract surgery techniques? Cataract surgery is common but it is also very complex. Until very recently, most aspects of cataract surgery, including the initial incision, opening the lens capsule and the breakup of the cloudy lens, were performed manually by the surgeon. Technology is constantly improving and with the introduction of the latest Laser Cataract technique, these steps can now be done with a special high-precision laser. Laser Cataract surgery was first performed in Australia in April 2011 by Vision Eye Institute s specialist cataract surgeons. Page 9

The advent of Laser Cataract surgery promises to make one of the safest surgical procedures in the world even safer. While there is no doubt that the Laser Cataract technique improves surgical control and precision, it is a young technology and it is not yet clear if its use will result in even better patient outcomes for a procedure that already has such a high success and low complication rate. However, there is emerging clinical evidence that it may be a safer way to perform cataract surgery. 5

Vision Eye Institute Transforming lives. That s our vision Will I still need glasses? An added bonus of cataract surgery for many people is that they are far less dependent on glasses to see well after surgery especially for distance vision. Why? The latest artificial lenses can not only replace your cloudy lens with a clear one but can also compensate for your glasses prescription. The right artificial lens for you will be carefully chosen by your surgeon to ensure that your dependence on glasses after surgery is minimised. Most people still use glasses for some activities after cataract surgery; however, their ability to see without their glasses is usually much better especially in the distance. Page 11

Your cataract procedure at Vision Eye Institute Your first appointment Your initial consultation with one of our specialist cataract surgeons will take about 1 to 2 hours. It is strongly advised that you bring a referral from your doctor or optometrist to your initial consultation as it will not only inform our specialists of your particular visual symptoms but it will also enable you to claim part of your fees (for both the initial consultation and the surgery) as a rebate from Medicare. Several in-depth diagnostic tests will be performed to confirm the presence of a cataract and to determine if you are suitable for cataract surgery. One of these tests involves a precise measurement of the size of your eye using ultrasound and laser techniques and often requires a return visit at a time that is convenient for you. Page 12

Vision Eye Institute Transforming lives. That s our vision Your eyes will be thoroughly examined to detect the presence of any other eye disease that you may have, such as age-related macular degeneration or glaucoma, so that the cataract specialist can give you a realistic picture of what to expect from a cataract procedure. Cataract surgery can still be performed in the presence of other eye disease but you may not get as much improvement in your vision as someone with an otherwise healthy eye. Your cataract specialist will also discuss your glasses prescription and how your cataract surgery can minimise your dependence on glasses, especially for distance vision. At the end of your consultation your cataract surgery may be scheduled for as early as the following week. If you are having cataract surgery on both eyes, they will typically be scheduled about a week apart. You will also be given an exact quote for all costs involved including the out-of-pocket costs not covered by Medicare and private health insurance. You should leave your consultation with a thorough understanding of the costs and potential risks and benefits of cataract surgery for your particular situation. Page 13

Your surgery On the day of your cataract procedure you will need to allow about 2 to 3 hours. Your cataract procedure will take place in one of our specialised day surgery facilities, or less commonly, a hospital which is fully equipped for eye care and meets the highest accreditation standards. Modern cataract microsurgery is performed under local anaesthesia to numb your eye so there is no need for a general anaesthetic or an overnight hospital stay. You will be made very comfortable for your procedure with a gentle sedative and there is rarely any discomfort or pain during the procedure. Sutureless incisions are standard, which means that in most cases the incision heals without any stitches, resulting in excellent outcomes and a very low risk of complications. Occasionally you may need a tiny stitch if the surgeon feels that it is safer for your eye; however, this stitch is very simply and painlessly removed at your follow-up visit a week or two after your procedure. Page 14

Vision Eye Institute Transforming lives. That s our vision After your procedure you will be provided with refreshments and your eye may be gently covered with an eye shield (or eye pad) to allow safe healing overnight. You will return to our centre the next day to have your vision assessed. You will be given special medicated eye drops to use according to your surgeon s instructions for a few weeks after your procedure.

These antibiotic and anti-inflammatory eye drops protect the eye during the important healing process. You will be advised to avoid strenuous activities and water in your eyes for the first few days after surgery. Most normal daily activities can be resumed within a day or two and your surgeon will instruct you on when you may resume contact sports etc. You should always advise your surgeon or the clinic promptly if there is pain, redness of the eye or blurring of vision during the early days or weeks after surgery. Cataract surgery, where clinically indicated, can be more than a sight-restoring procedure. It can bring several benefits, such as: Being able to see, with an almost immediate return to normal, pre-cataract, vision for more than 98% of patients. In most cases, returning to a normal lifestyle within a few days, including driving, reading, outdoor activities and independent living. Depending on the overall improvement in your vision, you may be at lower risk of falls, hip fractures and having a car accident. 6 Page 16

Vision Eye Institute Transforming lives. That s our vision Costs Cataract surgery is covered in part by Medicare and in part by private health insurance. There will be a gap payment that is not covered by either. This gap varies significantly due to several factors including your level of private health cover and excess as well as the particular artificial lens that will be used during your procedure. Charges for your cataract surgery and any associated gap not covered by Medicare and your health fund will be unique to you and will be discussed prior to your surgery. If you have any questions concerning your surgery, the risks, costs, benefits, likely outcomes or complications, please contact our friendly and helpful staff. Page 17

1. Evidence-based guidelines for cataract surgery: Guidelines based on data in the European Registry Of Quality Outcomes for Cataract and Refractive Surgery database. Lundström M, Barry P, Henry Y, Rosen P, Stenevi U (March 2012) 2. Blue Mountains Eye Study 1992-2009 3. Variation in cataract surgery practice and clinical outcomes. Schein OD, Steinberg EP, Javitt JC, et al. Ophthalmology 1994 4. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Harwood RH, Foss AJ, Osborn F, et al. Br J Ophthalmol 2005 5. Surgical Outcomes and Safety of Femtosecond Laser Cataract Surgery A Prospective Study of 1500 Consecutive Cases Timothy V. Roberts, MBBS, MMed, 1,2 Michael Lawless, MBBS, FRANZCO, 1,2 Shveta J. Bali, MBBS, MD, 1 Chris Hodge, BAppSc(Orth), 1 Gerard Sutton, MBBS, MD Ophthalmology Review Dec 2012 6. Improved visual function and attenuation of declines in healthrelated quality of life after cataract extraction. Mangione CM, Phillips RS, Lawrence MG, et al. Arch Ophthalmol 1994. Page 18

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