The symptoms

Pterygium is likely to have effects on vision due to the distortion of the cornea, or alternatively, covering of the optical center. Common symptoms include dryness of the eyes, tearing, eye redness, changes in visual acuity, lack of ability to use contact lenses and irritation of the eye characteristic of this phenomenon. Additionally, it is important to note that Pterygium damages the aesthetic appearance of the eye.

Causes of Pterygium

It is known that there is a connection between people who suffer with Pterygium and their exposure to UV radiation from the sun. The general recommendation is to wear sunglasses to prevent the exposure of the eyes to the sun.

An additional factor is a genetically inherited one. Research shows that in a third of cases there is increased frequency of Pterygium in certain families.

Pterygium Surgery

Surgical removal of Pterygium is a relatively simple surgical process which takes 30 to 40 minutes and is performed under local anesthetic. This surgery is performed by an ophthalmic physician who is an expert in corneal diseases. During surgery the Pterygium tissue is excised, and in the area of excision healthy conjunctiva taken from the upper eyelid is implanted. The conjunctiva is adhered with biological adhesive (surgery without sutures) and the area from which conjunctiva was taken more will grow within a few days, so there is no need to worry. At the end of surgery, the treated eye will be dressed, and post-operative treatment is eye drops and antibiotic cream.

Pterygium surgery is not complicated and there are almost no risks involved. The only risk is regrowth of the Pterygium – something which is more common in young people.

Percentage of success of surgery

First, it is important to note that as long as Pterygium is surgically removed in the earlier stages of growth, the percentage of success of the surgery is higher. As a rule, the rate of success for this surgery is between 95% and 98%, figures which denote a high level of success.

Potential complications from surgery to remove Pterygium

As for all surgeries, there is a possibility (while very small) of complications in surgery which could be with respect to regrowth of the Pterygium, which is the most common complication.

An additional complication is a slowed rate of corneal wound healing and the appearance of a chronic ulcer in the place where the head of the Pterygium was removed. This kind of complication is more common in people suffering from dry eye and/or older people. In this case, treatment with lubricant creams and antibiotics is given.

A very rare complication, but one that is important to note, is damage to the muscle which moves the eye inwards and is located under the Pterygium itself. A complication of this kind is likely to limit the movement of the muscle, thereby causing strabismus (crossed eyes). In this case as well, surgery to correct strabismus is possible.

Process of recovery from surgery

The process of recovery from surgery involves certain discomfort with respect to post-surgical pain and a sensation of discomfort. After around two days the pain and feeling of discomfort subside somewhat but will accompany the recovery period until they disappear after a few weeks.

The result, a “white eye”, will be observable around six weeks after surgery.

Side effects post-surgery

After surgery to remove Pterygium, there are likely to be side effects such as redness of the treated eye, bruising, dryness of the eye and a sensation of discomfort.

These symptoms should pass after a few weeks.

Diagnosis

A diagnosis of Keratoconus is made via imaging and topography of the cornea. The imaging device is digital, samples and checks the surface of the cornea and translates the corneal shape into a map of colors. The warm colors – yellow, orange and red – show the curved areas of the cornea, while the cold colors – green and blue – show the flatter parts of the cornea.

Formation of Keratoconus

The cornea is composed of layers, which are linked together in order to preserve its dome-like shape. Weakening of these links causes sliding of the corneal layers one on top of the other, which causes the narrowing of the cornea. The narrower region of the cornea begins to protrude as a result of the positive pressure which exists in eyeball and the protrusion created causes distortion of vision.

The most common cause of the formation of Keratoconus is the rubbing of the eyes.

There is a genetic (heritable) component, so for people who discover that they have Keratoconus, it is recommended that their first-degree relatives (brothers, sisters, children) are brought for examination.

An additional risk factor is that of recurring eye infections (mainly allergic inflammation), which is likely to be due to the irritation caused by the inflammation which encourages the rubbing of the eyes.

For most people, this disease starts in adolescence and develops slowly, until their thirties. It is important to remember that the rate of development of Keratoconus varies from person to person.

Types of treatment for Keratoconus

There are several possible treatments for the disease, but obviously for different stages of the disease, different treatments will be suitable.

The treatment types are divided into those that improve vision and those that stop the progression of the disease.

Treatment with contact lenses

In the early stages of the disease, treatment with spectacles or contact lenses is possible. There are types of contact lenses which are made to suit the patient. An optometrist who is trained in the subject orders them himself. The potential disadvantages of contact lenses are allergies and recurring infections.

 Surgical Treatment – Ring Implantation

Ring implantation is a reversible process. The implanted rings are arch-shaped and placed in the cornea. Their purpose is to decrease the convex curvature of the cornea and straighten the area, something which will enable the use of contact lenses. It is important to state that the process is not always suitable, only in cases where the Keratoconus is with mild to moderate convex curvature. Therefore, they do not cure, rather improve to a certain extent, the convex curvature of the cornea, and thereby improve vision. For this procedure there are also complications such as an inflammatory reaction or an infection around the implanted ring.

Corneal Implantation

Corneal implantation is a surgical procedure. Its success rate stands at around 95% for people suffering from Keratoconus. During surgery, the damaged part of the cornea is removed, and in its place, the cornea of a recently deceased individual is implanted. There are two kinds of implants: a partial corneal implant and a full corneal implant.

The duration of surgery is between an hour and a half to two hours, sometimes performed under local anesthetic and sometimes under general anesthetic.

Complications and risks that may arise from this surgery are an increase in intraocular pressure, rejection of the corneal implant and in rare cases, a recurrence of Keratoconus or a complete loss of vision.

After surgery, wearing spectacles or contact lenses is still required for correction of vision.

Crosslinking Treatment

Collagen Crosslinking is a treatment whose purpose is to stop the progression of Keratoconus. The treatment is performed under a local anesthetic via drops. The objective of this treatment is to harden the cornea and strengthen it by dropping Riboflavin (vitamin B2) onto the surface of the cornea, while simultaneously administering UV-A radiation. The combination of these two actions causes internal crosslinking between collagen molecules in the cornea, thus strengthening the links between the corneal layers.

This treatment has been available in Israel and globally for more than 10 years, and the results of large research studies on the subject show that it can slow or stop the progression of the disease.

The percentage experiencing complications for this procedure is very low, but complications can occur, including corneal infection or inflammation. These symptoms can be treated with antibiotics or anti-inflammatories.

A cataract is the clouding of the lens of the eye, a condition in which the patient undergoes surgery and the eye lens is replaced with an artificial lens. The success rate of cataract surgeries is between 95%-98%.

Following this surgical procedure, it is not possible for the artificial lens to become cloudy again, but secondary cataracts can arise, in which the lens capsule becomes cloudy and the vision in the eye which underwent surgery blurs again. This occurs in about a third of those undergoing cataract surgery.

Secondary cataracts can appear weeks, months or years after cataract surgery, and of course not all patients who have undergone such surgery will experience secondary cataracts.

Symptoms of a secondary cataract

The symptoms of secondary cataracts are similar to those of primary cataracts and include blurred vision, gradual obfuscation of vision, and being blinded by bright light. It should not be concluded that cataract surgery that you have undergone was unsuccessful; this is phenomenon is well-known and treatable.

How secondary cataracts are caused

During cataract surgery, the eye lens which has clouded over is replaced with an artificial lens. This procedure is performed by opening a small opening on the anterior (front) side of the capsule (that the lens is held in), removing the cloudy lens and inserting an artificial lens in place of it. The posterior (back) part of the capsule remains intact. Following cataract surgery, cells belonging to the old lens remain inside the capsule, and in a small percentage of patients, these cells grow and cause white scar tissue. This is what causes the cloudiness and is effectively the secondary cataract.

Treatment of a secondary cataract

Treatment of a secondary cataract is relatively simple and is done via a machine called a Yag Laser which looks like a slit lamp in which a regular eye test is performed. The machine is located at the clinic and there is no need for an operating theatre to conduct the procedure.

First, droplets are placed in order to dilate the pupil of the eye with the secondary cataract, and using the laser machine, a hole is made in the center of the posterior part of the eye capsule which has become clouded over. The hole created helps light to pass through it. This procedure takes a few minutes, is not painful and does not require admission to hospital. A few applications of the laser are required to make the hole in the capsule, with each of its actions being accompanied by a sound. The procedure takes approximately 5 minutes and is not painful.

Most of the patients experience an immediate improvement of vision, with others experiencing improvement within a few days. Following the procedure, treatment with drops is recommended for a few days, and there are no limitations to lifestyle.

You will generally have a follow-up appointment the day after surgery. In the event that the doctor performs the examination a few hours after surgery, you will not be required to return the following morning for the checkup. The examination the morning after surgery is very important. Its purpose is to make sure that no severe inflammation or infection has developed in the eye. Therefore, it is important to come to the follow-up and not try to get out of it with a claim that you are feeling fine (and that applies to the rest of the examinations later). During the checkup, an eye examination will be performed, and you will receive an explanation about the continuation of treatment with eye drops as well as all the post-operative limitations. The limitations include physical exertion such as heavy lifting (bags from the supermarket), bending and getting the eye wet. These limitations continue for a short time after surgery. There is no absolute agreement among ophthalmologists regarding the time you will be limited, but it generally does not exceed a week. For most, after a week you can go back to your routine. A limitation which is in place for longer, around three to four weeks, that of entering the swimming pool or the sea.

It is important to remember that improvement in vision does not occur immediately post-surgery.

Around a week after surgery, there will be a significant improvement in vision, but only after around a month can the final result be determined, and therefore it is recommended that you see an optometrist to be fitted for spectacles only after this period.

It is not always possible to be precise about the final result, with respect to the need for spectacles post-surgery. Occasionally there is a slight shift from the desired result and therefore you need to take into account that you may need spectacles after surgery, regardless of the kind of lens that was implanted. In order to explain the possible imprecision, I will compare the difference between surgery, where a lens was implanted according to the results of a lens-measuring device that was done prior to surgery, with the examination by the optometrist. While during surgery the doctor fixes a particular lens in place, the optometrist can change lenses throughout the examination until reaching the optimal and desired state. This substitution process is not possible during surgery.

Sensations such as burning, itching, tearing and “sand in the eyes” are completely natural following surgery. These phenomena are caused by increased dryness in the eye and pass after a period of time which varies from one person to another. The time ranges from between a few weeks to a few months.

There are a number of chronic eye conditions known before surgery that “worsen” afterwards. This is “seeing black spots”, which for most existed before surgery as well. These are changes of the vitreous fluid (the gel filling the eye) and are connected to age. The reason they are viewed more clearly post-surgery is that removal of the cataract “screen” allows more light to enter the eye and makes vision clearer, not only of objects around us but also those that disturb that exist inside the eye.

Additional and frequent complaints post-surgery are redness of the eyelids, itching, white discharge, burning and tearing. Here too for an existing chronic condition, following the anti-inflammatory treatment given after surgery, it appears to a different extent. This is Blepharitis – inflammation of the edge of the eyelid which causes dryness of the eyes. The anti-inflammatories suppress it, and it recurs after treatment is stopped. It is not a new inflammation, that appears post-surgery, rather an existing condition which became unbalanced due to surgery. The treatment for these conditions is quite simple: clean the border of the eye and the eyelashes using special wipes that can be purchased from any pharmacy without a doctor’s prescription, no-tears shampoo, and treatment with tear substitutes which can also be purchased without a prescription. There are a large number of tear substitutes, and each one has advantages and disadvantages. There isn’t one that is better than another, and therefore it is a good idea to try and see what suits you in terms of providing relief. My only recommendation is that it is preferable to use tear substitutes without preservatives. Treatment with them is as needed, in accordance with the extent and frequency of the complaints.

Seeing halos, blindness due to glare, and seeing colors more strongly are normal phenomena after surgery and are common in certain types of lenses, but for the most part these symptoms disappear after a time. That is also so as regards seeing a black arch on the external side of the field of vision of the eye that was operated on. If the symptoms do not go away over time (it could take a few months), it is recommended that you come for an eye examination and consultation with a doctor. There are different treatments available to improve the condition.

Symptoms which should worry you post-surgery are the following: severe pain in the eye that underwent surgery which are occasionally accompanied by headaches and vomiting – this is a sign of high intraocular pressure; pain accompanied by swelling and redness of the eyelids, purulent discharge and a decrease in vision – these signs raise the suspicion of an infection inside the eye. These conditions warrant you to see an ophthalmologist urgently.

Normal monitoring by an ophthalmologist post-surgery involves three examinations: the day after surgery, a week after surgery and again after a month. It is a regular examination similar to the examination before surgery. The medicinal treatment post-surgery usually finishes after a month. This is also the time to see an optometrist and be fitted for spectacles if necessary.

The lens implanted during surgery will accompany you throughout your life. The eye does not identify that there is an artificial lens inside it, and you will not feel it either. Vision is usually stable in the event that additional diseases of the eye do not develop.  Sometimes the capsule the artificial lens sits in can become scarred and cloud over, and then vision is weakened. This phenomenon is known as a “Secondary Cataract” and can occur at different times post-surgery. Laser treatment which lasts around five minutes at an eye clinic returns vision to its former state. It is a safe procedure, does not hurt, and is low risk.

I will stop here and say that I am full of hope that this article has contributed to your understanding of what goes on “behind the scenes” of cataract surgery and that I has reduced your feeling of stress and anxiety. Remember that in the vast majority of cases the process is very successful.

Be calm and trust your doctor.

Wishing you the best of luck.

Most cataract surgery is performed under local anesthetic (anesthetic drops are administered), and therefore there is no need for fasting. You can eat a light meal a few hours prior to surgery, and of course take your regular medicines (including blood thinners, unless your doctor has advised you otherwise).

It is important to remember to bring with you:

• Drops that you bought in advance for after surgery (according to the doctor’s instructions)
• Documents: ID card and payment commitment if necessary.
• A chaperone – It is advisable not to come to surgery alone.

Coming with a chaperone is requested for surgery of this kind even though it is quite a simple procedure performed under local anesthetic, because it is for vision (our primary sense) and there are cases where you are not able to see from the eye that is not operated on. Vision does not come back immediately post-surgery, and therefore it is advisable that someone accompanies you and makes sure that you get home okay. Aside from that, in my opinion, the feeling that someone is with you and cares about you, is far nicer. There is no need to arrive two hours before your appointment in the hope that maybe you will be seen earlier. All you will get from early arrival is a longer wait. The appointments at government-run and private hospitals take into account that it takes time to prepare before surgery and therefore, the time on your letter of appointment is not the time for surgery but the time of arrival. Upon arrival, you must go to the reception desk, identify yourself and provide the secretaries with the required documentation.

You will then be asked to go to the surgical preparation room. You will be received by a nurse, who will ask you some questions such as whether you are sensitive to any medication, which eye is to be operated on (right or left) and what surgery you are due to undergo. Be patient and answer the question.

The nurse will measure your vital signs: pulse, temperature and blood pressure. You will receive a cloak, hat and overshoes, and be asked to change your clothes. It is with these clothes that you will enter the operating room. Their purpose is to maintain sterility and prevent infections. After changing clothes, you will be asked to wait in the waiting room before entering surgery.

An additional part of preparation before surgery is receiving a tablet sedative (to relax you) and drops to dilate the pupils. The process of administering the drops is very similar to what you experienced at the examination before surgery. The difference is that it is a larger quantity of drops and of different kinds which you will receive in several rounds. This time too you need to look up during administration of the drops and not rub your eyes afterwards. The burning sensation passes within a few seconds.

This preparation and organization take time, so you need to take into account that fort minutes to two hours will pass from the time of arrival at the secretaries until the start of the surgery itself.

It is recommended that you arrive without jewelry on the day, as before surgery you need to remove it. Additionally, it is recommended that you do not apply makeup on the day, as before entering surgery you must remove it. The face must be without makeup or any kind of cream.

Hearing aids – If it is on the side of the eye due to be operated on, you will need to remove it. In this case, ask the doctor before you remove the hearing aid about the surgical process and check that the doctor remembers that you have removed your hearing aid.

Sometimes the wait can be longer due to the arrival of emergency cases for surgery. Remember that these are people, and it is not always possible to stick to the precise schedule. I warmly recommend that you are well prepared in advance that it is possible for the waiting time to be longer than you expected, and thereby try to reduce the level of stress. Further, stressful conditions and increased irritability can reduce the success of the operation. The surgical team and nurse do all they can to look after you.

You are asked to enter the operating room. Make sure you use the bathroom beforehand, and if you have forgotten or did not have time, ask to do so before entering surgery (for your own comfort). There will be another questionnaire in the operating room regarding the side of the eye is to be operated on, and it will be marked with a marker pen above the eyebrow, your ID number, sensitivities to medicines. All this is done to prevent, Heaven forbid, a mistake.

Upon entering the operating room, you will be asked to open the cloak from behind so that it will not put pressure on the neck while lying on your back, and you will be given a warming and pleasant covering as it is cold in the operating room. If you are uncomfortable lying on your back due to back problems or breathing issues, now is the time to say so, and they will take care to place you in a comfortable position. It is not possible to conduct the surgery while seated. If there are problems which do not permit for lying on your back, surgery will be conducted under general anesthetic and therefore you need to state that during the pre-surgical examination.

After lying on your back, you will be hooked up to monitoring devices which check blood pressure and ECG. These devices do not hurt or irritate, the only thing you will feel is the pressure on your arm when blood pressure is measured (something that you are familiar with already).

You will be tied to the bed. It sounds terrible, but it is done so that you do not fall off the narrow bed that you are lying on during surgery. It is done routinely in all kinds of surgeries. A strap is passed from one side of the bed to the other, at chest level. Tying is not strong or pressurizing, so there is nothing to worry about. Attachment to Oxygen is performed (to the nose or the chin area) so that you can breathe normally throughout surgery as even the face is covered.

From this moment you need to listen and carefully follow the doctor’s instructions and remember that surgery is of short duration and will be over before you know it.

A few more drops will be administered (and maybe gel as well, as the doctor sees fit). This time the drops are for sterilization and anesthesia. Again, a burning sensation is possible, perhaps a little more than on the previous occasions, but it will pass within a few seconds. After that, the doctor sterilizes the skin with Polydine solution, used for wound sterilization. Sensitivity to iodine injection, the contrasting matter in CT scans does not prevent external sterilization with iodine. During sterilization with Polydine, you will be asked to close your eyes (not tightly, rather, as if you are sleeping). In the next stage you will be covered with a sterile sheet. In the eye area, the sheet has a transparent and sticky window that will adhere to the skin around the eye to prevent bacteria from contaminating the surgical area. You will be asked to look up or down, according to the type of sheet. During this stage as well, and until the end of surgery, you must keep the muscles of the body and especially the eyelids in a relaxed state and try not to close your eyes. I have seen cases here the patients felt like they were suffocating when the sheet was placed. This phenomenon is completely psychological. It is not without cause that I chose to write this article, it is very important for me to reduce the worry and symptoms of anxiety experienced by the public who are undergoing surgery.  Do not forget that you are attached to Oxygen and can breathe freely. It is possible to share your feelings with the doctor and sometimes he can slightly lift the lower part of the covering (like a tent) so that you will not feel it so close to your mouth, something that can relieve the sensation.

After completion of covering, the device which separates the eyelids will be placed. During the first moments, you will feel mild pressure on the eyelids. It is important not to resist or try to close the eyes so that you do not cause yourself unnecessary pain. Think about relaxing the body all the time and remember that there is nothing that is supposed to hurt during the surgical procedure and as long as you are relaxed and calm, surgery will be completed faster and more successfully. The doctor will be assisted by a microscope which he will place opposite the eye. You will be asked to look at the light from the device without moving until the end of surgery (approximately 15 minutes). If you feel that the light is very blinding to you, tell the doctor. It is possible to reduce the intensity of the light or alternatively to look downwards slightly and not directly at it (around 1-2 mm under the light). You need to keep both eyes open, even though the eye not being operated on is covered.

Up till now, these are the things you will be asked to do. From this moment, surgery begins. Focus on a certain point and be relaxed. Usually, the doctor will talk to and calm you for the duration of surgery. During surgery, water will be dripped onto the eye, and therefore you will feel it on the skin around the eyes. It is possible you will see lights and shadows. All these things do not hurt and are not scary. There are rare cases where pressure in the eye is felt at certain stages of the surgical procedure.

Occasionally there is a need to either cough or sneeze. It is important to inform the doctor of this so that he can stop surgery until the attack passes. Do not wait until the last moment where you cannot hold it. Know that it is possible to stop surgery at almost every stage. It is possible to speak for the entire duration of surgery and so you must not worry about informing the doctor about pain which would require a top-up of anesthetic, or about the need to cough etc. It is important to speak without moving (do not lift your hand or move your head).

Surgery is completed. The doctor informs the patient of this, removes the eyelid separator (there is still a need to keep the eye open) and removes the covering from you. The stage where the covering that is stuck to the skin around the eye is the stage that is the least pleasant. During this stage, you must keep the eye open. Thereafter, a few more drops will be administered (Again, a burning sensation is possible.) and the monitoring devices will be disconnected. You will receive assistance in being brought from a lying down position to a seated one and then to standing. It is a good idea to sit for a few seconds before you get up, and in the event that there is dizziness upon getting up, it is recommended that you look upwards and breathe deeply.

You walk out of the operating room to the recovery room (with help, obviously), where the person who accompanied you on arrival is waiting. The doctor informs that the surgery was successful (as this happens in the vast majority of cases) and either he or a nurse then explains the recovery process and treatment post-surgery. For the majority, the eye will not be covered with a dressing. Remember that it will take time for vision to improve.

After you have recovered, you can get dressed and go home.

The surgical process and all its stages are part of the routine work of physicians and therefore in their explanation to patients, they focus on the medical essence of the surgery and far less on the other details which accompany it. In a series of three articles, I will try to describe the stages of the process in detail, from the moment a cataract is discovered until the end of recovery from surgery. Those details, in my experience as a cataract surgeon, is what worry the patient.

I hope to make cataract surgery more familiar and reduce the level of stress and anxiety connected with the lack of knowledge about what is about to happen.

Sight is the most significant of the five senses in humans. From this, it is possible to understand the level of anxiety that exists when there is damage to vision. A cataract is the process of clouding over of the lens of the eye. How can you tell if there is a cataract? What are the signs due to which we go to see a doctor? Is it a dangerous process? Does it hurt? Will we recover from it? There are many questions like these that flood our thoughts and accompany you when you detect a change in your vision. The main sign of a cataract is the gradual deterioration in vision. This process is likely to continue for months and even years. Generally, the process does not occur simultaneously in both eyes nor to the same extent, and this is probably the reason that the deterioration of vision is not really felt. When the vision in one eye is normal relative to the other eye, we can continue to function routinely without sensing that the vision in one eye has deteriorated. These changes are discovered during at a routine examination at the ophthalmologist, so regular eye tests are important. An additional manner of discovering a cataract is when the eye which is less damaged, where the cataract is less advanced, is damaged due to inflammation, a foreign object entering etc. In this case, the patient is present to discover that the vision in the other eye is not normal. Aside from the decrease in vision, there are additional signs which could indicate the existence of a cataract such as: being blinded by glare (mainly while driving at night), or the need to replace spectacles frequently (every few months).

Disturbance of vision that is caused by the development of a cataract in the majority of cases is completely reversible by surgery. It is important to remember that in very advanced cases, the cataract causes additional problems in the eye, such as an increase in intraocular pressure or inflammation, which can cause irreversible damage.

In summary, I say that there is no need to rush into surgery. That said, neglecting the cataract to the extent that vision is almost completely damages is likely to cause irreversible damage or more complex and extensive surgery.

Ophthalmologist’s Examination

The doctor’s examination does not hurt at all.

First, the doctor will conduct a conversation with the patient in order to understand why he has come to see him. He asks a series of questions related to the status of vision, such as: when did the deterioration of vision begin? Were there problems with the eyes in the past? How does the decrease in vision present? etc.

It is very important to share all relevant medical information with the doctor and note if there is a lazy eye, history of eye problems during childhood, previous eye surgeries or trauma to the eye, medications that are taken regularly and the reasons for taking them. It is a good idea to bring your spectacles (if you wear them) to the examination as well as eye drops, if you use them. You should get a summary from your general practitioner (family doctor) which includes background illnesses, medical history and the list of medications that are taken regularly. There are many diseases that have an effect on the eyes and can influence the surgical procedure and its results. Despite the effort that the healthcare system in our country makes, the detailed information in the hands of the general practitioner is not necessarily available to a doctor outside the HMO, at the hospital or at private clinics. Due to this, it is recommended that the patient arrives at the examination with all the relevant information stated above.

The clearer and more complete a picture the doctor has regarding his patient, the better he will be able to give a diagnosis, explanations and more precise treatment.

The moment of the examination has arrived, and I am full of hope that I can take away the feeling of pressure accompanying you as you arrive for it.

The entire visit lasts for about an hour. The eye examination takes approximately 10-20 minutes with a pause in the middle of about 20-30 minutes which is the waiting time for the pupil-dilating drops to take effect.

First, the doctor will want to check the status of vision in each eye separately – here I remind you again to bring your spectacles for distance and reading, those which are best suited to you. Many times, patients claim to have forgotten their glasses at home or did not bring them because “they don’t help with reading anyway”. The glasses that you have with you assist the doctor in understanding the problem and in giving you information about the status of your vision.

At the end of the vision examination, the eye examination will be performed. The examination is performed using a device which looks like a microscope, with light. This device allows the eye to be viewed from the outside and inside and to understand the level of cataract and what additional problems may interfere with vision or the surgical procedure. The examination does not involve pain or discomfort, apart from blinding from the glare. You can be comfortable and relaxed, and the more relaxed you are, it will be easier to conduct the examination more precisely. The chin is rested on the device itself; the forehead is brought towards the upper part of the device and the head is fully supported with no need to hold it in the air. The doctor moves parts of the device so that they are suited to each person according to his dimensions. The height of the chair can also be adapted so that it is comfortable for the duration of the examination. Sitting comfortably is important for the patient as well as the doctor. After being placed in the correct and comfortable position, the doctor brings the device close to the eye. The sensation you will experience is that it touches your eyes, but not so much (except in the case if checking pressure in the eye. All you must do is follow the instructions about which direction to look, and despite the glare from the light coming out of the device, to keep the eyes open and relax the muscles. You are not required to see anything, the attempt to see and pick out details causes the eyelids to close together slightly. The instinct is often to close the eye, and then the doctor assists the patient in opening it by lifting the upper eyelid. The more you cooperate, the faster and more efficient the examination will be. The key word is “relax”. Another detail which is important is to have both eyes open for the duration of the examination. Closing one eye causes the other to roll upwards, making the examination more difficult.

Twice or three times during the examination, drops will be put into the eyes. You will be asked to look upwards so that the doctor can place the drop onto the lower part of the eye. If you have followed the doctor’s instructions, you will not see the bottle or the drop coming towards you, and you will not feel the need to close your eyes. Trust him and help him to do is work properly. The drops burn a bit for a few seconds after being placed, and this varies from patient to patient. It is not a good idea to rub the eyes or put pressure on them, as this could increase the burning sensation. It is advisable to blink a few times and wipe the closed eye with cotton wool (that you receive or can ask the doctor for).

The pupil-dilating drops are administered to allow the doctor to check the eye in depth. After administering the drops, you must wait for 20-30 minutes. These drops are temporarily blinding from glare and cause blurred vision, but there is no need to worry as these symptoms pass after 3-4 hours. It is a good idea to come equipped with sunglasses and accompanied by somebody.

It is important for me to state that after the examination driving is forbidden.

For the examination of intraocular (inside the eye) pressure, there is slight contact of the device with the eye. Before the examination, anesthetic drops are administered so that you will not feel anything in the eye. The eyelids are not numbed and if you try to close the eye there will be an unpleasant sensation. Therefore, you really should listen to the instructions. You will be asked to look forward with the other eye, or in the direction of the doctor. Look with the eye that is not blinded by the glare and continue to keep your eyes open. Do not move your head, and the examination will be over within a few seconds.

At the end of the examination, the doctor will be able to determine the level of cataract and the need for surgery as well as if there are any additional problems in the eye which are likely to influence or interfere with the surgical procedure. The examination will also assist the doctor in determining the kind of lens that will be implanted in the eye. If the deterioration in vision is caused only by the cataract, the surgery will fully correct it. If there are other illnesses causing disturbance to vision such as problems with the optic nerve, the brain or retinal diseases, the surgery to remove the cataract will only partially improve vision.

The biometric test, or as the doctors call it “lens measurement”, is an integral part of the examination that is conducted prior to surgery. It can be performed together with the eye test or at a later date. During the test, a number of measurements of the eye are taken, thereby allowing the lens number to be implanted to be determined. The duration of the test is around 5 minutes, during which you will be asked to rest your head on the device (as you did for the eye test), and look at a particular target in the device, usually a red dot. You must have both eyes open for the duration of the test.

Sometimes you will be asked to complete other tests which also require pupil dilation. These tests may cause the date of surgery to be postponed. There is no need to feel under pressure, as in most cases surgery is not urgent.

Summary conversation with the doctor

At the summary conversation the findings will be presented in clear and understandable terms. You will receive an explanation about the different types of lens implant which exist – single or multifocal, and whether there is a need to correct cylinder as well (if necessary), and of course the type of anesthetic – local or general – according to the case. This is the stage where you can ask all the questions, share whether you have concerns and glean information about the process. You do not have to decide anything at that moment. You can always say that you want to think about it and then give a response.