PORT ELIZABETH OPHTHALMOLOGIST’S

You have been advised to undergo cataract surgery in one or both eyes. Information regarding the risks, benefits and alternatives to this procedure is available from the practice and should be well studied before consent is given.

As part of cataract surgery, an Intra-ocular lens (IOL) is implanted in your eye after the cataract has been removed. This lens is typically made from acrylic or silicone material, and is placed in your eye for the rest of your life time.

There are numerous strategies and choices for IOL placement. This leaflet will provide information about the different choices. Please discuss this with your surgeon and ask questions before choosing any specific lenses.

Monofocal IOL

This is the standard choice as a lens type. These lenses have a single power, meaning you will havevision “tuned” to be better for either near or far, but will require spectacles or contact lenses for “fine-tuning”. Additionally, this lens does not allow you to vary your vision between near and far. Theadvantages of this lens is the good quality of vision and perceived lack of glare and diminished night vision. The cost of these lenses are also covered by most medical aids.

Multifocal IOL:

These intra-ocular lenses are also known as premium IOL’s. They are modern IOL’s with differentregions of power, meaning they provide the ability for you as patient to be able to see near and far after the surgery. The lenses are well known to cause glare (5%), haloes around lights (5%) and diminished contrast / night vision (5%) and are expensive. Medical aids do not cover the cost of these lenses, and if you choose to implant these lenses, out of pocket expenses will be incurred.

These lenses are not advisable to patients known with severe dry eye, glaucoma, macular degeneration, astigmatism or other corneal irregularities. If you are highly expectant of perfect quality of vision, or prone to fault finding with small details, then you should best avoid these lenses.

The benefits of these lenses (greater range of vision and more spectacle freedom) should be weighed up against the slightly decreased quality of vision you might perceive.

If you choose to implant the lens, and become unhappy with the quality of vision, the lens can be removed and replaced by a different lens. From research, it appears that about 1% of patients choose to have the lenses removed and replaced with a different lens. Re-operation could potentially also lead to further expenses which the medical aids may or may not cover.

Toric IOL:

If you suffer from more than 1D of astigmatism, special intra-ocular lenses called toric lenses can be implanted at the time of cataract surgery to reduce the amount of astigmatism. These lenses are now covered by some medical aids, although a co-payment might be required depending on the specific plan you are on. An alternative to the toric lens is making small corneal relaxing cuts at the time of cataract surgery so as to relieve some of the astigmatism.

Mini mono-vision

This lens placement strategy uses monofocal IOLs (see above) of different strengths placed in both eyes. This is well tolerated by patients and represent the most cost-effective means to attempt greater spectacle independence after cataract surgery. One eye (the dominant eye) corrects for distance vision and the other eye receives a stronger monofocal IOL so as to correct for near vision. As a combination then, the two eyes together will allow the patient to have good vision for near and distance, allowing them greater spectacle independence. Mono-vision strategies require some getting used to, so it is often useful to do a contact lens trial for a week or two before implementation.

All of the above-mentioned choices are available to you. The choices will be discussed with you, and depending on individual risk factors, preferences and medical aid cover, a choice of lens implant can be made.

INFORMATION ON CATARACT OPERATION AND IMPLANTATION OF AN INTRAOCULAR LENS

This information is given to you so that you can make an informed decision about having cataract surgery. Take as much time as you wish to make your decision about signing an informed consent. We encourage you to ask any and all questions you may have about the procedure before agreeing to have it done.

Except for unusual situations, a cataract operation is indicated only when you cannot function satisfactorily due to poor sight produced by the cataract. Remember that the natural lens within your own eye, even with a slight cataract, has some distinct advantages over any man-made lens. After your doctor has told you that you have a cataract, you and your doctor are the only ones who can determine if or when you should have a cataract operation based on your own visual needs and medical considerations. You may decide not to have a cataract operation at this time. If you decide to have an operation, the surgeon will replace your natural lens with an artificial intraocular lens in order to restore your vision. This is a small synthetic lens, usually made of plastic, silicone, or acrylic material, surgically and permanently placed inside the eye. Conventional eyeglasses will be required in addition to an intraocular lens for best vision.

In giving my permission for a cataract extraction and/or for the possible implantation of an intraocular lens in my eye, I understand the following:

  1. Cataract surgery, by itself, means the removal of the natural lens of the eye by a surgical technique. Implantation of an intraocular lens at the time of cataract surgery is nearly always the best way to restore visual function when a cataract is removed.
  2. Complications of surgery to remove the cataract and insert the intraocular lens: Although very unlikely, it is possible that my vision could be made worse as a result of the surgery or (if used) local anesthesia injections around the eye. In some cases, complications may occur weeks, months or even years later. These and other complications may result in poor vision, total loss of vision, or extremely unlikely, loss of the eye.

a) Complications of removing the cataract may include hemorrhage (bleeding), perforation of the eye, loss of corneal clarity, retained pieces of cataract in the eye, infection, detachment of the retina, uncomfortable or painful eye, droopy eyelid, glaucoma and/or double vision. These and other complications may occur whether or not a lens is implanted and may result in poor vision, total loss of vision, or even loss of the eye in rare situations.

b) Complications associated with the intraocular lens may include increased night glare and/or halo, double or ghost images, and dislocation of the lens. In some instances, corrective spectacle lenses, surgical replacement of the intraocular lens, or laser refractive surgery may be necessary for adequate visual function following cataract surgery.

c) Very rare complications of Anesthesia may include risk of a severe allergic reaction, stroke, loss of vision, paralysis or even death.

  1. If an intraocular lens is implanted, it is done by surgical method. It is intended that the small plastic, silicone, or acrylic lens will be left in my eye permanently.
  2. Unexpected conditions may arise during surgery that causes the surgery plan to be changed to include additional procedures and I consent to having my doctor make such changes according to his best judgment. At the time of surgery, my doctor may decide not to implant an intraocular lens in my eye even though I may have given him permission to do so.
  3. The results of surgery cannot be guaranteed. Additional treatment and/or surgery may be necessary. I may later need laser surgery to correct clouding of vision. At some future time, the lens implanted in my eye may have to be repositioned, removed surgically, supplemented with a second intraocular lens, or exchanged for another lens implant. Refractive laser surgery may be necessary to adjust the optical power or the eye in some cases. Typical recovery times and symptoms have been explained, and I realize recovery sometimes takes longer than expected.
  4. I understand that cataract surgery and the calculations for intraocular implants are not “an exact science.” My options for near and far vision have been explained, as well as various intraocular lens implant options for vision correction. I accept that I am likely to need to wear glasses or contact lenses subsequent to surgery at least some of the time to obtain my best vision.
  5. Photographs and or videotaping may be done during my surgery in such a fashion that I will not be identifiable. These images would be intended for educational or scientific purposes rather than as part of the permanent medical record.