At the surgical center

At the end of the surgical procedure, your doctor may place some antibiotic drops in your eye to prevent infection and administer some anti-inflammatory drops to minimize swelling.

Your doctor may cover your eye with a bandage or shield or simply provide a pair of sunglasses and ask you to rest for a short time. The bandage, if used, may be removed either within a few hours or the next day at the doctor’s office, depending on the type of anesthesia that was used.

You will probably rest in the post-operative room for about an hour.

• You may feel a little groggy from the anesthesia. This is normal and will wear off fairly quickly.
• You may receive prescription medications such as antibiotic or anti-inflammatory eye drops, which you will need to use for the next few weeks.
• You will receive detailed instructions on how to use these medications and care for your eye.
• Your doctor’s staff may ask your caregiver to be present to hear these instructions as well, to help you at home.
• Your follow-up appointment(s) will be scheduled.

Then you will be released. You will need to be driven home and will not be able to drive for 24 hours.

On the way home from presbyopia treatment

Follow your doctor’s instructions about wearing your dark glasses or eye covering. You should avoid touching or rubbing the eye, too.

On the way home, you may still be under the influence of anesthesia or may be extremely excited about your improved vision. Both of these reactions are normal.

Your caregiver should fill your prescriptions on the way home or pick them up and deliver them to you immediately afterward. Use all prescriptions exactly as directed.

At home after presbyopia treatment

Stinging, burning and a slight grittiness in the eye are normal following lens replacement surgery. Do not rub or put pressure on the eye. If you have any discharge, use a warm washcloth to wipe it away gently. Your doctor will tell you what is normal to expect.

It is usually okay to resume light activities like reading, writing, watching TV and walking. You may be tempted to do more but take it easy while your body recovers.

You may take a shower or bath, but keep your eyes closed to protect them.

The bandage is typically removed the day after surgery in the doctor’s office, though some doctors may prefer to remove it sooner.

Don’t judge your success until you have had lens replacement surgery in both eyes and they have had time to heal and your brain has learned to work with both lenses. Some aspects of your vision may improve immediately, like color perception. However, it may take a few weeks and possibly up to six months after the second operation for your brain to finish adjusting to using this new "tool"-the IOL.

The first day after surgery, your eye may be sensitive to the touch and maybe even a little scratchy for a few days. Be sure that you avoid rubbing it.

If your doctor used an injection to numb your eye, you may have some bruising around the eye. This will go away in a few days.

As your body adjusts, you will probably feel like resuming most of your normal activities. Anything that exercises your full range of vision will help your eyes and brain learn how to use your new IOL.

During this first week, you may also see some glare or halos around lights. This is normal and will diminish and then go away.

Do's and don'ts following presbyopia treatment

Although you may be very excited about your new vision, there are a few precautions you need to take. For a week after lens replacement surgery, follow these guidelines.

Do not:

• Rub your eye or get anything in your eye, even water, which can increase the chance of infection. No swimming or hot tubs.
• Drive for 24 hours after surgery.
• Do any strenuous activity, especially bending and lifting anything 15 to 20 pounds or more.
• Wear any eye make-up until your doctor says it is okay.

Do:

• Use your eye drops on the schedule provided by your doctor to avoid post-operative complications. Your caregiver may be able to help with this.
• Resume normal daily activities such as reading, writing, watching TV and walking.
• Keep physical activity light.
• Wear your protective eye covering while you sleep and avoid sleeping on the side that has been operated on.
• Bathe and shower with your eyes closed.

Also:

You may be tempted to use your glasses or reading glasses to help you see clearly, but with your new lenses your old prescription glasses may be out of date. Your doctor will advise you.

Your follow-up exam after presbyopia treatment

You will return to your doctor for a check-up, usually the day after surgery.

Bring all your medications to this appointment and arrange for a caregiver to drive you if it is within 24 hours of surgery. You may want this person to attend the appointment, to help with your full recovery.

A week or two after surgery, your doctor will probably advise you that is okay to resume sexual activity and exercise, even heavy exercise, provided you are in good health. Ask your doctor what level of activity is okay in your case.

After a week of taking it easy, your doctor will probably tell you to do as much as possible to challenge your eyes and brain to work together at all distances with your new lens. You will be adjusting for a while and may feel a little frustrated at times. This is normal.

Two weeks after surgery, if you are like most who have lens replacement surgery, you will be delighted at the great improvement in your vision. However, when any part of the eye undergoes a change, the brain needs to adjust to help us obtain our optimal vision.

After two months, your brain and eyes will have largely learned how to work together, and between two to four months after surgery, your vision should be nearly optimal.

During the first few months, continue to challenge your vision. Check with your doctor if you have any questions about whether what you are experiencing is normal.

If you have another eye condition, such as diabetic retinopathy or glaucoma, you may not fully recover from surgery until a few months have passed. This is to be expected, so continue to see your doctor on your recommended follow-up schedule (for some as often as monthly), to make sure you are healing and adapting optimally.

At follow-up appointments with your doctor, any of the following may occur:

• If you have dry eyes, your physician may provide or prescribe eye drops to ensure you are as comfortable as possible and your vision is as good as possible.
• If your doctor has recommended that you have cataract surgery in the other eye, this is most likely when that surgery will happen.
• You may also be fitted for your new eyeglasses or contact lenses, if you aren’t planning any additional surgeries and if you have chosen monofocal lenses such as standard or toric IOLs.

You may need to practice and strengthen your vision at different distances after your cataract surgery, especially if you have chosen accommodative IOLs or IOL monovision.

For near vision

The following activities are recommended to practice your near vision:

• Reading
• Writing
• Painting, needlework or other close work
• Shaving or putting on make-up
• Dialing the phone or working on a handheld device
• Ordering from a menu
• Eating

For intermediate vision

The following activities are recommended to practice your intermediate vision:

• Looking at the computer monitor
• Watching TV
• Cooking and reading recipes
• Reading tags and labels while shopping
• Gardening
• Sporting activities like focusing on an approaching ball or seeing an object in the road as you approach it on a bicycle

For distance vision

The following activities are recommended to challenge your distance vision:

• Sports, especially golf and tennis or other sports that require the ability to focus on an object in the distance
• Watching a movie in the theater or attending a play

Putting it all together

The following activities are recommended to exercise all ranges of vision at once:

• Playing with pets or children, or any activity that includes people or things approaching and receding from you.
• Sports that use balls require that you train your eye how to see over the entire visual range.
• Walking, especially hiking or any other kind of exploratory activity, in which you look at things near and far.

Possible short-term side effects after lens replacement

This type of presbyopia treatment is based on cataract surgery, the most frequently performed surgery in the world with a 98% overall success rate. However, as with surgery on any part of the body, it is possible to experience the following short-term and treatable side effects as you recover.

Mildly uncomfortable or painful eye

It is not unusual for the eye to feel sensitive to the touch and maybe even a little scratchy for a few days following surgery. This will usually go away and is not a cause for concern.

If you feel deep eye pain, however, it may indicate inflammation or infection, and you should contact your doctor promptly for follow-up treatment.

Inflammation

If you feel deep eye pain or notice a decrease in vision as time goes by, it may be due to inflammation (swelling). Contact your ophthalmologist immediately.

Swelling (unrelated to infection) can occur in the front or back of the eye and typically gets better on its own in time. In some cases, eye drops are needed.

Temporarily increased intraocular pressure

Within 24 hours to one week after surgery, it is rare but possible for your intraocular pressure to rise temporarily. Patients with glaucoma or other pre-existing eye conditions may be more likely to experience this. Drops or pills may be prescribed until your eye pressure returns to its normal range.

Surgeries using the older technique of extracapsular cataract extraction are also more prone to this condition. (While extracapsular extraction is rarely performed, it may be necessitated by certain conditions. Be sure to discuss these issues with your surgeon).

Posterior capsule opacity

Between two and five months after surgery, or up to five years after surgery, some patients may develop posterior capsule opacification, commonly described as a "secondary cataract."

In fact, this condition is not a cataract and is extremely simple to address with a YAG laser treatment, a painless procedure that may be performed in your doctor’s office.

Posterior capsule opacification occurs when cells have grown under the intraocular lens, causing the back of the natural lens capsule-which holds the lens-to become cloudy, blurring your vision.

Complications during or following lens replacement surgery are rare, especially if the patient is in good health and does not have other serious eye conditions. About 98% of patients never experience complications.

As with surgery on any part of the body, however, complications are possible. Procedures are designed to prevent them, yet they may still occur, even in the hands of an experienced surgeon who performs the procedure flawlessly.

Infection

A sterile surgical environment and modern broad-spectrum antibiotics now make infection rare: about 1 of 3,000 cases. However, as with surgery on any part of the body, there is a risk of infection as your eyes heal.

The symptoms of infection are pain, excessive redness of the eye, sensitivity to light and loss of vision. Symptoms usually appear within the first few days after surgery. Patients who have any of these symptoms should call their ophthalmologist immediately.

To help prevent infection, topical antibiotic eye drops are given before, during and after surgery. Most doctors also prescribe daily antibiotic and/or anti-inflammatory eye drops for four to six weeks following surgery.

If necessary, antibiotics may be injected into the eye to control the spread of infection or, in especially rare instances, another procedure may be performed.

Retinal tear or detachment

Following an otherwise uneventful cataract surgery, retinal detachment is rare, occurring in about 0.5% of patients.

The symptoms of retinal detachment are:

• Gradual shading as if a curtain were moving across all or part of your field of vision.
• Flashes of light and dark spots that appear to float in the visual field.

Some of these symptoms may occur during the normal recovery process from cataract surgery. But if you notice flashes, new floaters or loss of part of your visual field, contact your ophthalmologist immediately.

Retinal detachment begins with a tear in the retina. Vitreous fluid from the eye then seeps through the tear and may cause the retina to separate from the back of the eye. If a tear is caught early it can be fixed with a laser. If it becomes a detachment instead, surgery is necessary.

Patients who are extremely nearsighted are more susceptible to retinal detachment following most types of eye surgery, due to the natural shape of their eyes.

Hemorrhage

Hemorrhage-bleeding-inside the eye during cataract surgery is rare, because the incision is placed on the edge of the cornea, which contains no blood vessels. Bleeding on the surface of the eye is rare but can be treated immediately by the surgeon.

On rare occasions, a section at the back of the eye, called the choroid, may bleed-this is called a choroidal hemorrhage. This condition is more likely to occur in elderly patients and those with glaucoma or high blood pressure, but it can occur in others. If the hemorrhage is confined to a small area of the choroid, patients often recover without significant visual loss. In the most severe cases of choroidal hemorrhage, patients may have complete and permanent visual loss. However, the use of smaller incisions in modern cataract surgery has reduced the severity of most choroidal hemorrhages.

Tearing of the posterior capsule

During lens replacement surgery, the natural lens is removed from its natural capsule and replaced with an artificial IOL. The natural capsule, also called the capsular bag, is extremely thin-about the thickness of a single red blood cell. Sometimes the capsule can tear during the procedure.

When this happens, the physician may perform a procedure to remove the vitreous material that has leaked into the capsular bag and seal it off. On rare occasions, fragments of the natural lens may fall into the eye behind the capsule. Your ophthalmologist may perform a procedure to remove the lens material and prevent inflammation. Depending on its size, a tear may prevent the placement of a multifocal or accommodative IOL.

Dislocated or decentered IOL

Rarely, an IOL can become displaced or decentered in the eye. This sometimes happens when the capsule tears or if the fibers that hold the capsule in place, called zonules, become weak or torn. It can also occur after surgery if trauma is sustained to the eye.

Symptoms of a decentered IOL include blurred vision, glare, double vision or fluctuating vision (going between focused and unfocused). If an IOL becomes displaced, your doctor may reposition it, sew it in place or replace it with another.

If you have symptoms of a decentered or dislocated IOL, contact your doctor immediately. Repositioning or replacement is best done within three months of the initial procedure.

Increased night glare or halos

As a temporary side effect of lens replacement surgery, most patients see glare, halos or starbursts around lights at night, especially while driving. These symptoms typically go away within a few weeks or months.

If you choose a multifocal IOL, there is a slightly increased chance you may experience these symptoms for a longer period of time or on an ongoing basis. Typically, the symptoms dissipate within six months or so. A patient may elect to undergo a lens implant exchange for another type of lens if these symptoms interfere significantly with his or her ability to drive at night.

Capsular contraction syndrome

An accommodative IOL is designed to move and flex easily within the capsule that once held the natural lens. If scarring occurs as part of the healing process, however, the accommodative IOL position may change.

This condition is called capsular contraction syndrome and can cause a farsighted or nearsighted shift in vision. It may also rarely cause astigmatism or may limit the ability of the lens to move or flex as designed. It has become rare as the technology for accommodative IOLs has advanced, but the condition may still occur with this or any IOL.

There are steps you can take to protect yourself:

• Choose an experienced, board-certified surgeon.
• Share your full health history with your doctor.
• Follow all instructions before and after surgery.
• Notify your doctor promptly of any problems.

If you have additional eye conditions or poor health, know your personal level of lens replacement risks and make informed decisions with the help of your doctor.

Learn more about how to choose your doctor for optimal results.

No. You will need to make arrangements to have someone drive you home. If this is not possible, ask your doctor to help you make arrangements.

Since clear vision depends on both the eye and the brain working together, the best thing you can do to ensure a speedy recovery is to resume your normal activities as soon as your doctor recommends that you do so. Do the things you do every day-read, watch television, use the computer, and perform a range of activities that require a full range of vision. And be patient-your new IOL is a tool that your body has to learn how to use.

Yes. IOLs are made of plastic, silicone or acrylic-materials that do not contain metal and will not interfere with metal detectors or MRIs.