What to Expect From Cataract Surgery
When my mother mentioned having had cataract surgery in the mid-1990s, I never bothered to find out what a cataract was and what the procedure was to get it removed. All I remember is that mom said she could see much better after the operation. I guess I had more important things to worry about at that time of life when I was in the early 50s.
Twenty years later, my vision started to fail. I couldn't read signs clearly even while wearing glasses. Everything seemed dimmer and the glare from lights made it almost impossible for me to drive at night.
An ophthalmologist in Bangkok diagnosed me with cataracts in both eyes in November of 2015. I waited, however, until mid-October of 2017 to have cataract surgery in my right eye in Udonthani, Thailand. On April 28, 2018, I finally had the cataract in the left eye removed.
After defining cataract and cataract surgery, I share my experience of what to expect during cataract surgery and the post-op care needed for at least one month.
What Is a Cataract and Cataract Surgery?
A cataract is a condition of the eye causing its lens to become cloudy thus affecting vision. When an ophthalmologist diagnosed my cataract condition, he showed me a picture of the lens of my eye. I was shocked to see that the lower part of the lens had a dirty yellow to brown color.
Cataract surgery is simply a procedure to remove the lens of the eye and replace it with an artificial lens usually of acrylic material. This procedure takes place in an outpatient clinic most of the time. It is usually done without sedation and lasts about fifteen minutes.
Cataracts Explained A to Z
How Do You Know if You Need Cataract Surgery?
I never thought I would need cataract surgery until the quality of my life was affected. At the age of 71, my vision started to deteriorate. I could no longer read signs easily at a distance and everything started to appear dimmer. Constantly I was cleaning my glasses but this really didn't help. A change in the prescription of my glasses helped for a very short time but soon I was afraid to drive at night. Glare from bright lights was causing occasional blurred vision. When I couldn't watch TV easily and enjoy it, I knew it was time to have cataract surgery.
Deciding on an Ophthamologist and Place for Cataract Surgery
It was no easy matter deciding on an ophthalmologist and place for my cataract surgery. When I lived in Bangkok, I had seen eye doctors at Rutnin Eye Hospital considered to be one of the best in Thailand. Now that I had lived in Udon Thani 570 kilometers since 2014, it would be very inconvenient and expensive to have cataract surgery and follow-up visits at Rutnin.
By word of mouth from a British expat friend and a Thai neighbor, I learned about two ophthalmologists in Udon Thani who did cataract surgery in their clinics. I never could make an appointment with the eye doctor introduced by my British friend; however, I got to see Dr. Panuwat introduced by my Thai neighbor without an appointment. My neighbor highly recommended Dr. Panuwat because he had recently done successful laser surgery to improve her vision.
At my first meeting with Panuwat, he confirmed the existence of cataracts in both of my eyes, explained the surgery procedure, and told me that he could fix my right and worst eye in one week. The doctor was about 40 years of age and could speak English well.
Dr. Panuwat also said he could do surgery on one eye for 32,000 Thai baht (about $1000) which was 3,000 less than what he usually charges. Prior to seeing this Udon Thani doctor, I had checked Rutnin's charge on the internet and found it to be twice as much as what Panuwat wanted. This made it very easy for me to decide to allow Dr. Panuwat to do my procedure.
Preparing for Cataract Surgery
After deciding to have my cataract surgery with Dr. Panuwat in Udon Thani in October of 2017, I immediately made the necessary preparations during this first visit to the doctor. The doctor's assistant first checked the vision in both of my eyes and then the pressure in both eyes. Since I was having the surgery in the right eye first, Dr. Panuwat measured the size and shape of my eye for the correct type of lens implant or IOL (intraocular lens.) I then had the choice of getting either monofocal or multifocal lens implanted. The monofocal lens would focus on objects at a distance and for reading or close-up work, I would have to wear glasses. The multifocal lens would focus on object both at a distance and near. There was a big difference in price. Since I had no insurance covering my eyes, I chose the monofocal lens which most people elect to have implanted.
The doctor then asked if I was taking any prescription medication. When I mentioned that I was taking Harnal for my enlarged prostate, Dr. Panuwat said that I would have to discontinue the use of this drug for one week prior to the surgery. Harnal which is tamsulosin is sold under the trade name of Flomax in the United States. One of the side effects of tamsulosin is that it causes difficulty in dilating the eye. During the surgery, my eye had to be dilated. I had no restrictions on my hypertension medication and other prostate medicine Avodart which is dutasteride.
I would be awake during the procedure, and no anesthetic was needed. Thus I would not have to fast prior to the surgery.
My surgery was scheduled for one week later at 6:00 pm but I would have to report to the clinic at 4:30.
My Cataract Surgery Procedure
My cataract surgery procedure was non-laser-assisted. According to the Mayo Clinic, during this procedure, an ultrasound probe is used to break up the lens in the eye. Utilizing phacoemulsification, tiny incisions are made in the cornea. A needle-thin probe is then inserted into the lens substance where a cataract has formed. This probe is used to break up (emulsify) the cataract. After the cataract in the lens is broken up, the fragments of cataract and lens are suctioned out leaving the lens capsule intact for an implanted artificial lens to rest.
After arriving at Dr. Panuwat's clinic at 4:30 on October 18, 2017, an assistant started putting drops into my eye to dilate it in preparation for surgery. Following 70 minutes and several drops, my eye was finally dilated. Before going down to the operating room on the second floor, an assistant washed my face.
At a few minutes before 6:00, I was met at the entrance of the operating room by a male attendant who assisted me in putting on a hospital gown top after I had removed my shirt and shoes. He also put a plastic cap on my head.
I then entered the operating theater and was told to lie down on a narrow operating table. A female assistant then proceeded to wash my face again and then put more drops into my eye to "freeze" or numb it for the upcoming surgery. After 10-15 minutes when it was time to begin the surgery, my right eye did not feel like it was "frozen" or numb.
After a cover was placed over my face exposing only the right eye, the assistant inserted a clamp on both sides of the eye to ensure that it stayed open. Dr. Panuwat then announced that the surgery was beginning. He instructed me not to move and to look at a bright white light above my eye. I could sense when the incision was made and the probe inserted into the lens substance. There was no pain, however, and I observed an absence of bright white light after the lens and cornea was broken up.
Following maybe 10 minutes, the doctor announced that he was inserting the artificial IOL. This procedure took probably no more than five minutes. My surgery was now completed but before I could get up, a see-through patch was placed over my eye. No stitches were required to close the incision in my eye. Before leaving the clinic, I was instructed to see the doctor the next day at 4:00 pm.
My cataract surgery was a very positive experience, and I got through it with no pain. There was a little discomfort in having to lie still and then having the clamp removed from my eye. Other than that, my surgery was "a piece of cake."
Post-Cataract Surgery Care
Immediately following cataract surgery, my doctor's assistant gave me three kinds of medication. The first was antibiotic tablets for infection. I was instructed to take two tablets daily—one in the morning and one in the evening for three or four days. The second medication was tablets to prevent inflammation and control eye pressure. I had to take half of a tablet four times a day for three days. The third was paracetamol (Tylenol) tablets for pain which I never needed to use. Before leaving the clinic, I was told to see Dr. Panuwat the next morning at 10:00. As I left the clinic wearing a cover over the eye, I felt great and could see a lot of light through the cover which had small perforations. I then celebrated at a restaurant with my family.
At 10:00 on a Sunday morning, I visited Dr. Panuwat at his clinic. After an assistant checked my vision and eye pressure, which were both very good, I saw my doctor. He examined my eye and asked how I was feeling. I replied having no pain but that my eye itched very much. This was common and then the doctor gave me the following instructions: no water or dust should go into the eye; no touching or rubbing of the eye; no heavy lifting; cover my eye when sleeping for one month, and use two kinds of eyedrops for infection and inflammation four times daily for one month. If I experienced any pain, redness in the eye, or blurry vision, I was to see Dr. Panuwat immediately. My next appointment was set for one week later.
After I arrived for my next appointment, my vision and eye pressure were checked again and found to be excellent. The doctor examined my eye again and said the wound had healed nicely. I was to continue with my previous instructions and see the doctor again in three weeks which would be one month after the surgery.
One month after the surgery, I saw Dr. Panuwat again and he was happy to say that my eye was completely healed. I could now get clean water in the eye and sleep at night without a cover over the eye. I had to continue use of my eyedrops, however, for two more weeks.
My far vision in the right eye was now excellent, and I did not have to wear glasses. My near vision was barely passable since my left eye had not yet been fixed.
On April 28, 2018, I had cataract surgery for my left eye. As I go through the previously mentioned post-cataract surgery care, my vision is now a lot brighter and clearer. I can easily drive at night and now use magnifying glasses for reading and computer screen work.
Cataract surgery is nothing to fear. It is painless and well-worth the little inconvenience experienced for only one month following surgery.
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© 2018 Paul Richard Kuehn