Cataracts: It's an elective surgery so it's important to know the risks and the rewards

Dr. James Wentzien, an eye surgeon for Kaiser Per-manente, says that making the decision to have cataracts removed is unique to each individual.

Can’t see things clearly anymore? Need a magnifying glass to read? Does the glare from oncoming headlights inhibit your night driving?

When vision dims and night glare heightens, cataracts may be the cause.

“If your vision is not adequate for your daily needs with your best glasses or contact lenses, and your eye doctor determines it is due to cataracts, then surgery can be considered,” says Dr. James Went-zien, an eye surgeon with Kaiser Permanente, who operates one day a week at the Skyline Ambulatory Surgery Center in Salem.

He says a common misconception is that cataracts must be “ripe” in order to be removed.

“Cataracts come in various types and stages, and the decision to operate is based mainly on how the cataract affects vision and activities in daily life,” he says. “This is a unique determination for each person and is based on mutual decision making between patient and doctor. No ‘cookbook’ approach.”

Once you decide to have surgery, Wentzien says it’s important to converse with your doctor about your visual needs, expectations, and specific activities and lifestyle.

“The doctor should clearly explain the risks of surgery and the expected visual outcome, especially if other eye problems exist like macular degeneration or glaucoma, that might affect the final outcome or increase the risks,” Wentzien says. “Have a good idea of what types of lifestyle activities you would like to do better, and ask if the surgery would be expected to improve those abilities.”

About this time, people may get jittery about a trip to the “eye ward,” but most health professionals assure that the surgery is one of the easiest to experience.

“Any surgery is scary, but for some reason eye surgery is very scary,” says Corinne McCloud, who has been with Kaiser Permanente since 1998, becoming a registered nurse in 2009. “Here at Skyline, the nurses are here for you, the patient. We do our best to make you feel comfortable and try to ease the anxiety that goes with this procedure.”

Also on the Skyline KP team, registered nurse Kathy Rathbaurn calls cataract surgery “a modern medical miracle.”

“It’s the only surgery I know of that is truly painless,” she says. “It takes only about 10 minutes and gives nearly instant results. I often hear the hardest part of the entire process is waiting two weeks for the second cataract to be removed.”

An operating room RN for 23 years, Heather Anderson finds it rewarding for cataract patients to be able to see more clearly immediately after having their new lens implanted.

“The patients leave the room with a smile on their face and amazed at how quickly the operation is completed,” she says.

Tonya Wells, RN, loves being a member of the KP Skyline ASC eye team.

“Many return in two weeks for their other eye surgery,” she says of her patients. “It’s nice to be reunited with patients we’ve already built a rapport with from their previous visit. Patients often report seeing better before leaving the facility.”

To prepare for surgery, Wentzien emphasizes the importance of reading and understanding all of the materials provided regarding arrival times, eating restrictions, and anticipated activity restrictions.

“Ask questions if you don’t understand any instructions,” he says. “It is important to be able to comply with postoperative activity restrictions and the use of eye drops or other medications that might be prescribed. If you need help at home, have that arranged in advance.”

Steps to prepare for surgery usually entail use of eye drops, eating and drinking prior to surgery, medications prior to surgery, what to bring and what to wear.

The procedure is simple: Drops numb the eye. The surgeon places a sterile cover over your face and tells you to stare at the lights — three dots surrounded by black, which is all the patient sees during the entire surgery. A tool is inserted to hold the eye open. Traditionally, a small incision in the periphery of the cornea is made by the surgeon, who then removes the cataract, leaving the capsule intact to receive the new lens which is then slid into place. For a more detailed explanation of the procedure, ask your surgeon.

According to Kaiser, patients have a 95 percent chance of improved vision after having a cataract removed. As in any surgery, some risks are involved, including infection and corneal swelling. Most patients don’t need anesthesia during the procedure. Stitches are also not needed.

“When somebody gets their eyesight back, it’s one of the greatest wonders,” McCloud says. “One patient told me when she came back for her second eye to be done that she was so excited. After having the first surgery, she realized for years she thought her living room walls were cream-colored. She realized her walls were white, and now that she could see the color, she wanted to paint her walls at home.”

Comments such as “colors are so bright,” “no glasses anymore” and “should have done this sooner” are common among those who undergo cataract surgery.

“Of all the surgeries we do here, I think cataracts have the greatest impact on life,” says Sherri Boesen, RN, on the KP team. “It’s fun to see patients come back excited after seeing new spring flowers or Christmas lights.”

Wentzien says his patients frequently tell him that retaining good vision is one of the most important health concerns for them.

“I take this very seriously,” Wentzien says. “Realize that you, the patient, are ideally in control of your health care decisions, especially when it comes to elective surgery, like cataract surgery. Your doctors are your partners and should be helping you improve and retain your best functioning, tailored to your specific lifestyle needs, by providing information, advice and options.”

Wentzien finds being an eye surgeon “extremely rewarding,” and enjoys “having a positive impact on so many lives.”

McCloud agrees, “It’s so very fulfilling to be part of a team that helps with a procedure that can so dramatically improve someone’s life.” n

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