It's a normal aging process and sometimes you find certain diseases (e.g. Diabetes) can cause cataracts. People who are on steroids, long-term steroids, use puffers or oral steroids or topical drops can produce cataracts, but usually it is an age related process. Usually after the 50s, but sometimes it can affect people earlier also. Last week I operated on an 18 year old man who has had congenital cataracts from birth. The patient usually complains of decreased ability to see distances in street signs, traffic lights become blurred, they have to come really close to street signs see them, they may have a lot of glare at night time, particularly in the people who are diabetic. Their cataracts affect their vision in the broad daylight, making it much poorer as compared to night time. When we diagnose, we dilate the pupil and we can see with the microscope that the lenses are cloudy.
There's no particular criteria to say when the cataract surgery should be done. It all depends on how the person's ability to function has been affected. Usually, 20/50 is the normal vision for driving with both eyes open. If they reach below that limit, and when they are approaching that limit, then we will have the cataracts operated, but some young people may complain of a lot of glare, seeing properly and I usually tell my patients that if their lifestyle is being affected and they cannot function properly then it's time to have your cataracts removed.
Cataract surgeries these days take about 15-20 minutes to do. The patient is presented to the cataract suite and the nurses will take a short history and compare that history which has taken in the office. Then the nurses will prepare the person and use the dilating chair to dilate pupil that must be well dilated first to do cataract surgery.
Then patients come to the pre-operation area where the anesthetist goes over their history and checks that everything is appropriate. You have an assistant who also looks over the person and I, as a surgeon, will go talk to the patient again and put in the dilating gel to dilate the pupil. Then we will position the head properly on the operating room table explain what will happen in the surgery to the patient. Then we will wheel them into the operating room. The patients are wide awake because we give them a mild solution to make them calm and comfortable. But usually, the majority of the time it is a painless surgery and I tell the patients to talk to me if there is any problems. If some persons do complain that there is some extra pain then we can give them some more anesthetic to avoid the pain.
The major complications are that, at the time of the surgery, if there is a posterior capsular rupture, the cataract can form back or the lens can form back into the eye. If that happens, that's a major complication and the person has to be referred to a retinal surgeon who would retract the surgery and also take the lens out posteriorly and implant the lens into the eye. That's one of the major complications. The second major complication is infraction and for the infraction, we usually start the patient out on an antibiotic a few days before the surgery. That is the second major complication. But the incidence is very low, whereas the infection rate in my own practice -- my own hands -- is less than 1 in 5,000. The majority of the people are extremely happy.
Within a day or two, their vision should be 20/20. People who have high estivatism in those cases or people who have higher reflective errors might need glasses. Usually we try to make them independent of glasses, but I always tell the patients that for the best vision they need glasses. We try to make them what I call is an operation mark, independent of glasses.
Then they can drive without glasses, to some extent they can read larger print, but anyone needing the best possible vision will have to have glasses. Cataracts only come back in the next life. They don't come back in this life when they have removed it. Yes, sometimes it happens that we leave the posterior caps intact. There are probably some fuzziness on the posterior caps developing in about 5 percent of the patients over a period of time.
If that develops, the person will complain of blurred vision again and then we can use a laser to create a small opening in the posterior capsule and the vision usually recovers. Immediately after the cataract surgery, we usually provide with a plastic sheet to hold it back time for one week. During the daytime they can be any kind of glasses. We usually tell patients not to lift more than 20 lbs of weight for about two weeks and then 50 lbs of weight for another one or two weeks, otherwise they can do practically everything. If there are no complications, as we don't put any stitches, there is no harm in bending forwards -- previously we used to tell them not to bend forwards -- because it would open up. But now we don't restitch those. Yes, we will restrict them from going to the gym or going to the swimming pool because of the risk of infection.
Otherwise, they can start their normal life. The Cataract surgery program at St. Joseph's Hospital I'm very proud of because it's a premier institution. Our cataract suite is very well organized, the patient flow is very good and extremely good care is given to the patients, patients are very happy with the nursing staff and the outcomes of the cataract surgery are extremely good. We have two residents per year in our residence program and residents start working with the cataract suite to learn about the cataract surgery. But then we also have a rat lab in which the residents are trained before they move on to the human eye to do the cataract surgery. Our training program, in my opinion, is one of the best and particularly the surgically training program is the best in the country.
We hear from residents across the country that the surgical program at St. Joseph's Hospital at Ivey Institute is the best.
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