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Preparing for cataract surgery:
Before the operation, you and your eye will be carefully checked to decide the details of the operation. This may require a separate visit before the operation. Usually routine blood tests (sugar levels, ESR, haemoglobin levels etc.) as well as ECG are required before the surgeon clears you for surgery. If you have diabetes or other systemic diseases you may need more tests.
Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery.
The measurement of the eye is also taken (a test called Biometry) to determine the power of the IOL to be put in your eye. Biometry measures the length of your eye from the front to the back and also the curvature of the cornea and then uses this data to determine the power of the IOL using statistical formulae. Usually these calculations are very accurate and the surgeon has an opportunity to correct your post-operative refractive error (i.e. the power of the glasses after the operation) to near zero and you may enjoy clear vision for distance without needing glasses. However, you will still need reading glasses. See the section on recent advances in IOL technology to know how you can avoid glasses altogether after cataract surgery.
You may also be asked to undergo some other eye tests depending on specific disease conditions that you may have.
Anaesthesia for cataract surgery:
The usual method of anaesthesia is ‘local’ i.e. injections are given near your eye (not into it) to numb the nerves carrying pain sensation from the eye to the brain. This also paralyses the muscles that move the eye around – temporarily. This gives your surgeon a steady, painless eye to operate upon.
General anaesthesia (making you fully unconscious) is also another option although GA is rarely required for cataract surgery and is reserved for small children, mentally unsound patients and the very apprehensive patients.
The latest technique is called ‘Topical Anaesthesia’ in which anaesthetic eye drops are put in your eye to make it completely numb. You will not feel any pain during the surgery although some people feel a dragging sensation. However, your eye movements are not neutralised and you must keep your eye steady during surgery. Usually the steady fixation is maintained by asking the patient to look at the light of the operating microscope and most, if not all, patients can maintain a steady gaze. You may vaguely see some movement but no details of the operation.
The choice of anaesthesia is a mutual decision of the surgeon and the patient – the surgeon will assess if you are suitable candidate for topical anaesthesia – and you should not go with any preconceived notion about the method of anaesthesia. A normal clean phaco surgery can be done safely under topical but if the surgeon anticipates any deviation due to any co-existing eye disease he may advise you against topical.
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