My presbyopia lens replacement surgery was over before I knew it, just like my doctor said.”
Presbyopia surgery with lens replacement is an "ambulatory" procedure-you walk in and walk out afterwards. The entire experience may take between two and three hours from check-in to check-out, but the procedure itself is usually over in less than an hour.
If you’re feeling nervous about presbyopia surgery, keep in mind-presbyopia lens replacement is based on cataract surgery, which is one of the safest and most effective medical procedures performed today, with an overall success rate of 98% or higher.
It may also make you feel more confident if you know what you can expect every step of the way-from your initial evaluation to the day of the presbyopia surgery. Below are detailed descriptions of the initial examination and surgical procedures your doctor will perform to evaluate and correct your presbyopia.
Preparation for presbyopia surgery [title above expandable sections]
Your ophthalmologist will probably:
Your ophthalmologist will also ask for a full health history, including what medications you are currently taking and what medications you have taken in the past. Certain health conditions, including diabetes, diabetic retinopathy, autoimmune diseases, glaucoma, corneal disease and age-related macular degeneration may need special discussion.
It is especially important that you tell your ophthalmologist if you have ever taken alpha-blockers, including Flomax® or Rapaflo®. Alpha-blockers are muscle-relaxing medications to treat prostate enlargement and other conditions. If you have ever taken these medications, they can cause the iris of the eye to be "floppy" during surgery, increasing the possiblity of a complication, so it is very important to tell your ophthalmologist if you have taken these medications.
Your doctor will also help you weigh your needs to decide which type of intraocular lens is most appropriate for you.
Many patients ask their spouse, friend or caregiver to attend their pre-operative appointment, to serve as an extra set of ears to hear the doctor's recommendations and directions.
Bring all your current medications to this appointment. Your doctor may recommend that you stop taking certain medications at least a few days prior to your procedure, such as aspirin and other blood-thinning drugs (anticoagulants like Coumadin®). But it may be fine to continue other important medications.
In addition, doctors often prescribe eye drops for a few days before surgery, to prevent infection and inflammation.
Don't forget to schedule time off from work. The entire process from check-in to checkout will probably last about two to three hours, but most patients need at least one day to recover before resuming their regular work schedules.
You won’t be able to drive for at least 24 hours after presbyopia surgery, so:
Day of presbyopia surgery
Patients are usually asked not to drink alcoholic beverages for at least 24 hours prior to presbyopia surgery. Some doctors allow their patients to eat a light breakfast on the day of surgery, while others recommend skipping the morning meal.
Make sure you are clear about which medications you must avoid taking on the morning of surgery. Some medications are fine to take, while others are not.
To help maintain a clean surgical environment, you should shower and wash your hair on the day of surgery. Wear clean, comfortable clothes.
Your doctor will be an ophthalmologist trained in eye surgery-and lens replacement surgery in particular. He or she will lead a team that includes a technician and a nurse and possibly other assisting staff.
The operating room will be treated to prevent infection, as it is for any surgery. The team will wear scrubs, gowns, gloves and masks to help preserve this sterile environment.
Advances in surgical techniques make general anesthesia unnecessary except under rare circumstances that may affect your ability to hold still. Your doctor or nurse will instead apply a local anesthetic that will numb and perhaps immobilize your eye.
Thanks to the anesthetic and medications to help you relax, the procedure involves minimal discomfort. You will remain awake and alert but probably will not see any of the surgery.
Your nurse may start intravenous fluids and attach you to a heart rate monitor. A drape will be placed around your face so that only the eye to be operated on is visible.
Most people experience little or no pain or discomfort during lens replacement surgery. If you feel any discomfort, let your doctor know. Most patients are aware of the surgical team and environment but can't make out images.
The doctor will make a very small incision at or near the cornea. In most cases, the incision is so small (an eighth of an inch or less) that few stitches, if any, are required at the end of surgery.
These days, virtually all lens replacement surgeries performed in the United States remove the natural lens using a technique called phacoemulsification. That means your doctor will use a thin probe to break up and remove the lens with ultrasonic energy.
Then, the intraocular lens is rolled up, inserted through the same incision, unrolled and set into its permanent position. Small arms (haptics) extend from the lens to hold it in place. During insertion, the microscope light may seem very bright.
In some cases, your doctor may use a more rigid plastic lens and a slightly longer incision may be necessary. If so, you will likely need a stitch or two.
Learn what to expect after presbyopia lens replacement surgery.
Not sure what a particular term means? Click on words in bold to pull up the glossary tab.
Typically, doctors will perform surgery in the second eye two or three weeks after the first eye. All patients are different, so talk to your doctor about what is right for you.
Age-related macular degeneration (AMD)
Leading cause of vision loss and legal blindness in adults over age 60. Affects the sharp, central vision necessary for reading, driving and other daily activities. Impacts the macula (the centermost part of the retina, responsible for seeing fine detail). Occurs in two forms - dry AMD and wet AMD. Wet AMD is more serious.
Alpha-blockers
Muscle-relaxing medications that treat prostate enlargement and other conditions.
Anesthetic
Medicine that causes a loss of sensation including loss of pain. Local anesthetic causes numbness and pain relief in a localized area, such as the eye, without affecting the senses in the rest of the body.
Autoimmune diseases
Medical conditions characterized by exaggerated immune responses. These exaggerated responses occur against substances and tissues normally present in the body, meaning that the body attacks its own cells. These reactions may be restricted to certain organs or they may involve a particular kind of tissue throughout the body. Examples of autoimmune diseases include multiple sclerosis, Crohn's disease, psoriasis, rheumatoid arthritis, Sjögren's syndrome and others. Treatment typically involves medication to decrease immune response.
Cornea
Clear, curved surface at the front of the eye through which light enters the eye. Along with the sclera (the white part of the eye), provides external protection for the eye. Often called the window of the eye. During many types of vision correction surgery, such as LASIK, the cornea is reshaped to reduce or eliminate the main types of refractive error - nearsightedness, farsightedness and astigmatism.
Diabetes
Disease in which the body does not produce enough, or properly use, the hormone insulin. Most Americans who are diagnosed with diabetes have type 2 diabetes. Can often lead to vision problems such as diabetic retinopathy.
Diabetic retinopathy (DR)
Complication of diabetes that compromises vision and can lead to blindness. Tiny blood vessels in the retina are weakened and leak blood and fluid into the eye, which can progress to new abnormal blood vessel growth on the retinal surface, further affecting vision. Between 40 and 45 percent of American adults with diabetes have some form of diabetic retinopathy.
Dilated
Made wider or larger. In eye health, usually refers to the pupil (the hole in the center of the iris that opens and narrows in response to light levels). During an eye examination and certain types of eye surgery, drops will be used to dilate or open the pupil.
Lens
The transparent disc behind the pupil that brings light into focus on the retina. As the eye ages, the lens often becomes cloudy and is called a cataract.
Glaucoma
Eye disease characterized by too much pressure inside the eye (intraocular pressure). Can cause eye damage and vision loss. Symptoms may include halos around lights, tunnel vision and vision loss. Many patients have no symptoms until severe visual field loss has occurred. Treated with medications or sometimes eye surgery.
Haptics
Specialized arms designed to secure the intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems) after placement within the eye's capsular bag.
Intraocular lens (IOL)
Artificial lens made of plastic, silicone or acrylic. Designed to be implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems, such as cataracts and presbyopia.
Intravenous fluids
Fluids (such as drugs, blood plasma, etc.) introduced directly into a vein by means of a hypodermic needle.
Iris
Colored membrane in front of the eye's lens that manipulates the size of the pupil and thus regulates the amount of light entering the eye.
Laser vision correction
A class of surgeries where a laser is used to reshape the cornea to correct refractive errors. LASIK, PRK, LASEK and Epi-LASIK are all types of laser vision correction.
Ophthalmologist
Doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who is qualified to diagnose, manage and treat all eye and visual system disorders. An ophthalmologist is trained to render total eye care, including vision services, contact lenses, eye examinations, medical eye care and surgical eye care.
Phacoemulsification
Also known as "small incision cataract surgery" or "phaco." Used in the majority of cataract surgeries performed today. Involves making a small incision on the side of the cornea and inserting a tiny probe that emits ultrasound waves to soften and break the lens of the eye into pieces, which are then suctioned out.
Presbyopia
Also called age-related focus dysfunction. Common vision problem that develops naturally over time. Characterized by loss of the eye's ability to focus at close distances or on fine details. Treated with reading glasses, contact lenses, presbyopia laser vision correction (also called LASIK monovision) or presbyopia lens replacement surgery.
Pupil
The black, circular area in the center of the iris (the colored part of the eye) that regulates the amount of light entering the eye by constricting and dilating.
Refractive error
Irregularities in the cornea, lens or shape of the eye that prevent correct focus at any distance.
Ultrasound, ultrasonic energy
High frequency sound waves used during cataract surgery to break up the eye's natural lens so that it can be easily removed and replaced with an intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems).
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The Eye Surgery Education Council provides information and support to help patients and their families make an informed decision about the different types of vision surgery. Developed by members of the American Society of Cataract and Refractive Surgery, the ESEC is backed by the knowledge and expertise of some of the nation’s leading ophthalmologists.
*Copyright © 2010 ASCRS. All Rights Reserved
This site is provided for educational and informational purposes only. Individuals should decide whether to have LASIK, Lens Surgery or Cataract Surgery based on consultations and advice of their eye surgeon and full discussion of the benefits and risk of the procedure. While LASIK, Lens Surgery and Cataract Surgery are generally considered to be safe and effective procedures in correcting vision, individual results may vary.
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