Surgery

Answering cataract surgery questions

These responses to many common patient queries will help set proper expectations.

BY APRYL MCELHENY, RN, BSN, CASC

As an ophthalmic professional, it is critical to competently answer a patient’s questions regarding cataract surgery. This includes what to anticipate when reporting for the following:

• Initial cataract consultation

• The surgical encounter

• Post-operative care.

By accurately responding to a patient’s question, you establish trust and build the foundation for a sound practice reputation. I have identified some common patient questions along with appropriate responses and a quick discussion of each topic.

Q: What is a cataract, and why did it develop?

A: A cataract is clouding of the lens located within your eye. The lens allows light to travel through your eye and focus onto the back of the eye (the retina). As we age, the lens becomes less clear, and light cannot pass through the lens as well. Besides age, many factors cause cataracts, including diabetes, medications, and sun exposure.

This question is common because patients may blame themselves for their condition. It may be reassuring for a patient to find many common causes of a cataract are beyond their control.

Q: Do I have to undergo surgery right now?

A: No, cataract surgery is an elective procedure, meaning your surgery will be scheduled in advance and isn’t considered an emergency. You can take your time in making the decision to have surgery. If you are still unsure, request to speak with our surgeon or staff again. The only treatment for cataracts is surgery. If you chose to not have surgery now, your vision may be temporarily improved with a change in your glasses, bifocals or better lighting.

A patient may feel pressured to have surgery once the condition is diagnosed. It is vital patients understand there is no emergency and cataracts will not cause harm to their eye or general health.

Q: What happens during surgery?

A: Cataract surgery is performed in an outpatient setting, meaning no overnight hospital stay. Your eye will be numbed and dilated with drops and then cleaned to prevent infection. The surgeon will perform your surgery in an operating room with sterile instruments. A small incision will be made, and an instrument will be inserted into the eye to break up the cataract using ultrasound.

The cataract is then suctioned from the eye, and an artificial lens, called an “intraocular lens” or “IOL,” will be inserted into the capsular bag. You will be given medication to ensure your comfort, and the procedure is considered painless. You will then be taken to a recovery room where you will be allowed to eat, drink and, reunite with your family.

Surgery evokes anxiety for many patients. Fear of the unknown can be decreased with verbal explanation, followed up by written information, such as a patient handbook.

Q: What are the potential risks or complications?

A: Cataract surgery is common and safe, with rare complications. If you do encounter a complication, the surgeon may perform additional measures during surgery to correct the issue. You may need to return to the OR on a separate day to treat a surgical complication, but again, this is rare. You will have post-operative appointments to monitor potential complications, such as swelling or infection.

This is a crucial part of the informed consent process that occurs between the patient and surgeon, but patients may ask you to repeat the risks/complications. Patients need to understand that, although cataract surgery is very common and safe, it is not without risk.

Q: How does the surgeon know what lens to implant?

A: The surgeon will order testing to determine specific measurements of your eye. We select lenses based upon the results of those tests, your goals, and your preference regarding reading glasses.

A wide variety of lenses are available. Monofocal lenses, the most commonly implanted, have one focus and correct either distance or near vision. A multifocal lens has multiple focusing points and helps correct distance and near vision. Toric lenses are specially designed for patients with astigmatism. Monovision, using one eye for near and one eye for distance vision, is also achievable through monofocal lens selection. Not everyone is a candidate for all lens options, and some lenses include an additional expense.

This is often a complex process for the patient to understand, requiring extra time and effort on education. Discussions regarding lens selection should include the patient’s preference in wearing glasses and firmly established realistic expectations.

Q: Will my cataract come back?

A: No, once a cataract is removed, it cannot come back. In the months and years following cataract surgery, you may develop a posterior capsular opacity (PCO). This means the capsule, the membrane behind the implant, becomes hazy. We can perform a safe, quick and painless laser procedure, called a laser capsulotomy, to clear up your vision.

A frequent misconception for patients is that their cataract can return or that PCO is a cataract. PCO is common, and patients should be made aware of the potential need for a laser capsulotomy.

Q: What will recovery be like?

A: Your vision will be impaired following surgery and you may feel tired from the sedatives. We will prescribe drops for you to use after surgery to prevent infection and swelling and to help your eye heal. You may have the sensation of something being in your eye, like an eyelash or speck of dirt. This will subside with healing. Also, your eye may burn or look red. It is important to remember that, until the swelling in your eye decreases and your incision heals, your vision will be impacted. Outcomes from cataract surgery are typically very successful, but your eye will need time to heal. The doctor will closely follow your recovery and your vision.

Along with what is to be expected following surgery, the patient should be given a list of symptoms to report that may indicate a complication. Our practice has found the discharge instructions to be an appropriate place to discuss this with the patient and family.

Conclusion

It is important to assess and consider the patient’s ability and readiness to learn when providing education about cataract surgery.

Even more importantly, listen closely to the patients’ visual goals and what is required to achieve personal satisfaction with their individual outcome. Each patient presents with different educational needs, and you are responsible for adapting to those unique requirements.

Finally, consider the patient’s rationale for asking the question(s). The patient may be expressing a specific expectation or concern in the form of a question. Considering these theories and implementing measures to capture this information will facilitate the continued success of your practice. OP

Apryl McElheny, RN, BSN, CASC, is the clinical director of the Laurel Laser & Surgery Center in Duncansville, PA (Altoona) and the clinical manager at the Laurel Eye Clinic, Eastern Region. Email her at amcelheny@laureleye.com.