No Gap Cataract Surgery

Cataract surgery is an operation to remove your eye’s lens when it is cloudy and interfering with the quality of your vision. Cataract surgery is the most common eye operation performed in Australia and it is one of the most effective and safe procedures in modern medicine. During cataract surgery, your cloudy natural lens is removed and replaced with a clear artificial lens, called an intraocular lens (IOL) implant. Modern cataract surgery uses technology such as phacoemulsification (using ultrasonic energy) and/or laser (femtosecond laser-assisted cataract surgery or FLACS).

Before the operation, your ophthalmologist will measure your eye in the clinic using specialized equipment (ocular biometry) to see what type and strength (focusing power) of IOL you need. The IOL chosen to be implanted in your eye during surgery is customized to the shape and size of your eye, with the aim of providing you with improved eyesight and without the need for glasses for some or most situations. The accuracy of ocular biometry measurements and tailored discussion with the patient about suitable IOL options is very important, and our cataract surgeons take meticulous care with respect to this.

Some patients with both cataract and glaucoma may benefit from cataract surgery combined with a glaucoma stent implant (such as microtrabecular bypass stent) that helps to lower the eye pressure for better glaucoma control. This is a relatively new surgical technique that has been proven to be both safe and effective, and Dr John Chang offers this to suitable patients.

Cataract surgery is performed as a day surgery procedure, so you will only be admitted to the hospital for several hours and be discharged back home on the same day (ie. you do not need to stay overnight in hospital).

• The operation is done under local anaesthetic, meaning that your eye will be numbed with eye drops and an injection around the eye. You will also be given a medicine to help you relax.
• You will be awake during the surgery. You will be aware of some sound, light and movement during the procedure, but you will not see what the doctor is doing to your eye and the procedure will be pleasant and there will be no discomfort at all. You will be lying flat on your back, and some drape will be placed over your face and to keep the operation site clean.
• The eye operation itself will take about 30 minutes. Your surgeon will enter into the eye through tiny incisions (cuts only few millimetres in length, created by laser or a blade) near the edge of your cornea (the clear window covering the front of your eye). The surgeon uses these incisions to reach the lens in your eye. Using very small instruments, he will break up the lens with the cataract and remove it. Then your new lens is inserted into place.
• Cataract surgery is “sutureless”, meaning that there is usually no need to stitch the incisions closed. These “self sealing” micro-incisions eventually heal by themselves over time. A plastic shield will be place over your eye t protect it while you heal from the surgery over the first one week.
• The recovery from cataract surgery is rapid and there is minimal down-time. Often the eye sight will be bright and clear from the very first day after surgery, but there is usually continuing improvement in the eye sight over the first 1-2 weeks after the operation. The eye can feel a bit gritty and water for the first couple of days, but usually there is no discomfort and patients are often driving and working within a few days of the surgery.
• You will have to use post-operative eye drops after surgery. They are usually instilled 4 times a day initially and are required for a total of 4 weeks. Be sure to follow your doctor’s directions for using these drops.
• Avoid heavy lifting, bending over, or strenuous exercise for the first week after surgery. Do not rub or press on your eye. You will need to wear a protective eye shield when you sleep for the first week.
• You will be given a schedule of post-operative clinic visits so that your progress and recovery after the surgery can be carefully monitored and supervised. Any concerns or unforeseen problems that may arise will be address promptly. Our eye surgeons also gives their own personal phone number to their surgery patients, so that they can be reached for advice at any time, including after hour or over the weekend.

An intraocular lens (IOL) is a tiny, artificial plastic lens for the eye. It replaces the eye’s natural lens that is removed during cataract surgery. IOLs come in different focusing powers, just like prescription eye glasses or contact lenses.

There are various types of IOLs that are available for implantation during cataract surgery. All IOLs have their pros and cons, and currently there is no “perfect” IOL for everyone. The choice of the type of IOL depends on the individual person’s visual needs and wants, and how it fits into their lifestyle. This must be discussed with your eye surgeon before the operation itself.

Types of IOL or focusing (refractive) outcome goals include:

• Monofocal IOL: This has one focusing distance. It may be set to focus for distance vision or up close for reading. Most people have them set for clear distance vision so that they do not need glasses for driving or watching the TV. They then wear reading glasses for close work.
• Monovision outcome: Here, one eye (the dominant eye) is set to focus for distance vision with a monofocal IOL, whilst the other eye (the non-dominant eye) is set to focus for near vision. This allows suitable patients to enjoy both distance and near vision without the need for glasses. Some patients have already had “monovision” in their contact lenses prescription, and such persons are ideal candidates for this when they have their cataract surgery.
• Toric IOL: This lens corrects for astigmatism, which is a refractive error caused by an uneven curve in your cornea.
• Multifocal IOL: These lenses have different focusing powers within the same lens. It splits the light coming into the eye to provide both distance and near focus at the same time. These IOLs may be suitable for patients who are highly motivated to have reduced dependence on glasses. However, there are downsides to this type of IOL including haloes, glare, and reduced contrast sensitivity. For example, they are generally a bad choice for someone who does driving at night time.
• Extended depth of focus (EDOF) IOL: These are newer IOL technology that aims to provide a more extended range of sharp vision and a low incidence of halo and glare. These IOLs differ from multifocal IOLs as they create a more continuous range of near vision instead of multiple points of focus.

Although cataract surgery is very safe, like any surgery, it does carry potential risks of problems or complications. Some of these include eye infection (around 1 in 1,000 chance), bleeding in the eye, pain, vision loss, retinal problems such as swelling or retinal detachment, or a need for a second operation. These are uncommon to rare problems, and even if they do occur, they are often treatable. There is no substitute for a detailed and tailored discussion with your eye surgeon about all the potential risks that may apply to most people and also if there are specific issues pertinent to your eye. For example, patients with other co-existing eye conditions such as diabetic retinopathy, glaucoma, uveitis or prior retinal detachment, have other additional issues that need to be addressed.

Our eye surgeons are highly experienced and skilled cataract surgeons who have each performed thousands of operations over the years.

They regularly audit their surgical results and outcomes, comparing against the highest of national and international benchmarks. Our cataract and retinal surgeons deal with some of the most difficult and complex eye surgeries includingcataract surgery in more complex situations such as patients with diabetic retinopathy, glaucoma, ocular trauma, retinal detachment and uveitis.

Our doctors pay meticulous attention to their patient’s eyes from even before the surgery as well as of course during the operation itself and during the post-operative aftercare. Our proven track record of surgical outcome of the highest standard and the word-of-mouth referrals from happy patients to their family and friends is the ultimate testament to the quality of care that our eye surgeons provide.

Some patients with both cataract and glaucoma may benefit from cataract surgery combined with a glaucoma stent implant (such as microtrabecular bypass stent) that helps to lower the eye pressure for better glaucoma control. This is a relatively new surgical technique that has been proven to be both safe and effective, and Dr Chang offers this to suitable patients.

The cost of cataract surgery in the private hospital is determined by various factors and should be discussed with the eye surgeon and his clinic staff. As a general guide, the fees associated with surgery can be divided into the surgeon’s fee, anaesthetist’s fee and the private hospital’s facility fee (which includes the use of their specialised equipment to perform the surgery as well as the intraocular lens implant, and the expertise of the theatre nurses). These fees can vary depending on numerous factors, including which doctors (each surgeon and anaesthetist set their own fees) as well as which hospital and the amount of rebate paid by Medicare and private health insurers.

It is important to have a thorough discussion of the fees and estimates of any out of pocket expenses before the surgery is booked. This is called informed financial consent, and patients should ensure that they fully understand this and are comfortable with the explanation provided.

Dr John Chang is pleased to provide “No Gap” cataract surgery for his insured pensioner patients and "Known Gap" eye surgery for other patients with private health (hospital cover) insurance policy. This means that his patients will incur either zero or only a small, fixed (known) out of pocket cost for their cataract surgery.