Cataract Surgery

Effective Cataract Removal from Green Apple Eye Care

When glasses and contacts aren’t enough to reduce your symptoms, cataract surgery may be necessary.

What is Cataract Surgery?

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In cataract surgery, under an operating microscope, Dr. Memmen uses tiny surgical instruments to make a small incision and remove the natural cloudy lens from your eye. He then replaces that lens with a permanent, clear intraocular lens (IOL) implant.

Dr. Memmen will discuss which lens is right for you in your appointment before surgery.

Think of your lens as an M&M. It is the same shape and size of the chocolate candy and also has the same outer shell. Dr. Memmen removes the cloudy chocolate center and leaves the outer shell (called the posterior capsule). He then replaces the cloudy chocolate with a new clear center so that light can pass through again.

Is a laser used during cataract surgery?

Laser Cataract Surgery (LCS) was approved for use by the FDA in 2010.  The laser is based on extremely short duration near infra-red laser which was originally used to machine nuclear war heads for the Department of Defense in the 1980’s.  The laser was first used in Ophthalmology for the correction of refractive errors (LASIK) in 2003. 
The laser only does a small part of the overall cataract operation.  This part of the procedure is easily performed manually and does not eliminate the need for Microkeratomes (small scalpels) during surgery. 
Currently, only 5% of cataract surgeries in the United States are performed with the laser.  Why are Ophthalmologists, who pride themselves on being on the cutting edge of new technology, not using the laser?  Existing technologies using high frequency ultrasound to disrupt the lens are still required after the laser softening of the lens and can do a great job without the laser. 
The laser was supposed to make surgery safer and more precise.  Two recent studies {Ewe, Shawn Y.P., MBBS, et al. “A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery.” Ophthalmology vol. 123, issue 1 (2016): 178-182, AND Stodola, Ellen, “Update on the ESCRS FLACS Study.” Eye World vol. 20 (2015): 33-34} concluded that “Laser Cataract Surgery does not demonstrate meaningful improvements in visual outcomes over conventional surgery.”  These studies were done over several years with 1,876 eyes and 2,814 eyes in each study respectively.  Some studies indicate slightly worse visual outcomes with more complications using LCS.
A common misconception is that the laser reduces the need for glasses after surgery.  The reduction in the need of glasses after surgery is dependent on the quality of pre-operative measurements and the type of intraocular lens used to replace the cataract.  It is not provided by the laser.
So why are 95% of cataracts surgeries still done without the laser?

  1. LSC is expensive! Minimum $2,000.00 per eye, which is not covered by insurance.
  2. LCS is not safer or more precise.
  3. LCS takes longer to perform.
  4. Substantial equipment costs for the surgery facility: The laser has an initial purchase price $500,000 with $100,000 minimum in annual maintenance. Plus, an additional $200 per use fee paid to the manufacturer.

Why so many ads on TV?

  1. Lasers are sexy, so it must be better.
  2. Advertising requires something new and cool to present.
  3. The facility needs enough patients interested in the procedure to cover the cost of the equipment.

 In conclusion: Dr. Memmen can provide his patients Laser Cataract Surgery.  However, it is expensive and does not offer the patient any distinguishable benefits or increased safety.

In addition, the lens capsule (the part of the eye that holds the lens in place) sometimes becomes cloudy several months or years after the original cataract operation. If the cloudy capsule blurs your vision, Dr. Memmen can perform a second procedure using a laser.

This procedure, called a posterior capsulotomy (YAG Cap), uses a laser to make an opening in the cloudy lens capsule, restoring normal vision. Dr. Memmen performs the YAG Cap in his Appleton eye clinic or his Green Bay eye clinic.

What can you Expect During Cataract Surgery?

Our cataract surgeon, Dr. Memmen, usually performs cataract surgery on an outpatient basis, either in a local hospital or surgery center.

When you arrive for surgery, you will be given eye drops and perhaps a mild sedative to help make you comfortable. A local anesthetic will numb your eye. The skin around your eye will be thoroughly cleansed and sterile coverings will be placed around your head. During the surgery you may see light and movement, but you will not be able to see the surgery itself.

After surgery is completed, you will receive a shield to place over your eye. Only a short stay in the outpatient recovery area is needed before you will be ready to go home. You will be unable to drive after surgery and will need to make arrangements for transportation home.

Following surgery you will need to:

  • Use the eye drops as prescribed to prevent infection.
  • Only blot your eye, DO NOT rub or press on your eye! Remember, Dr. Memmen made an incision that is now trying to heal.
  • Only resume driving and strenuous activities after Dr. Memmen advises you are able.
  • Wear eyeglasses or protective eyewear as advised.

Recovery time after surgery is different for every patient. Usually your eye will heal within three to four weeks.

When your surgery is scheduled, our staff will also schedule a follow-up appointment. Dr. Memmen wants to verify that no complications have occured and that you are comfortable. You will then schedule another follow-up appointment in one week and another in one month so that Dr. Memmen can confirm you are healing properly. [All follow-up appointments up to 90 days after surgery are characterized as “post-op” examinations, and they are usually covered by insurance as part of the surgical cost (see Insurance Questions).]

 

What is ‘Dropless’ Cataract Surgery?

Historically, antibiotic and anti-inflammatory eye drops have been used in conjunction with cataract surgery. The antibiotic drops are used to prevent infection, which is one of the most devastating complications of any surgery. The anti-inflammatory medications are used to reduce inflammation and promote healing.

Using antibiotic and anti-inflammatory medications injected at the time of surgery is not a new development in medicine.  It was widely done over 40 years ago, especially before small incision cataract surgery became popular in the 1980’s.

James Gills, M.D. introduced injecting steroids directly into the eye and reported good results in 2005.  This never got much traction with the ophthalmology community because the surgeons had to make up the solutions themselves.

In 2013, Imprimis Pharmaceuticals was given FDA approval for two products for intraocular injection.  With some experience, I feel the time for “dropless” or 1-drop daily cataract surgery has arrived.

Why?

  1. Cost of eye drops has increased 400% over the last 10 years.
  2. No Hassle. Many patients don’t like administering eye drops and other patients find it a challenge to comply with their surgeon’s instructions.
  3. Good results with dropless surgery in our patients.

In conclusion: Not all patients are candidates, but there are a number of good reasons to do dropless cataract surgery for many patients.

What are possible risks due to cataract surgery?

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Complications due to cataract surgery are extremely rare. However, just as with any surgery, there are possible risks. These include:
  • Infection
  • Bleeding
  • Swelling of the retina
  • Retinal detachment

Call Dr. Memmen immediately if you have any of the following symptoms after surgery:

  • Pain not relieved by non-prescription pain medication
  • Loss of vision
  • Nausea, vomiting, or excessive coughing
  • Injury to the eye

Will cataract surgery improve my vision?

The success rate of cataract surgery is excellent! Improved vision is achieved in the majority of patients if other vision problems are not present.

 

“My cataract surgery was incredibly simple. I was relaxed and excited about regaining my vision because I knew I was in good hands. Because of the quality of care and knowledge, it was always a reassuring, positive experience. The staff members are NICE people – competent, courteous, and ready to answer my questions. Follow-up care was encouraging, well explained, and thorough. Surgery was nothing to be anxious or worried about, and the results are gifts beyond words. I can see the stars again!
– Susan, Luxemburg, WI
“My improved vision is a miracle! After they removed my cataract, I can see definitions of greens in trees; sunlight is radiant, and I can differentiate between white and yellow. It’s like having high definition TV all the time. It’s a whole new world. Dr. Memmen and his very professional staff put me at ease throughout my first visit. They were reassuring, felt cared for as an individual. I couldn’t have asked for anything better. The outcome exceeded my expectations.”
– Jerry Metz, WI

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