Your cataract surgery consultation is the appointment where your surgeon assesses whether surgery is appropriate, measures your eye for a lens implant, and discusses your lens options with you. It is also the opportunity to ask questions and understand what the procedure involves. Most consultations take 60 to 90 minutes because of the measurements required.
What happens at a cataract assessment?
A full cataract consultation includes several components. Your visual acuity is measured with and without your current glasses. Your ophthalmologist examines the front and back of your eye under a slit lamp, assessing the type and density of your cataract, the health of your macula, and the condition of your optic nerve.
Biometry is performed, which is a precise measurement of the length of your eye and the curvature of your cornea, used to calculate the power of the intraocular lens implant. In most cases, two separate biometry devices are used to cross-check the measurements and improve accuracy.
If you have had previous laser refractive surgery such as LASIK or PRK, additional calculations are required to account for the change in your corneal shape. This is one area where fellowship training in both cornea and cataract is particularly relevant. The two most widely used formulae for post-refractive IOL calculation were developed and validated at the Wilmer Eye Institute, where I completed my fellowship.
What should I bring to my consultation?
Bring your current glasses, including reading glasses if you use them. Bring a list of your current eye drops and systemic medications, particularly blood thinners and alpha-blockers such as tamsulosin, which can affect the surgical plan. If you have previous eye records or a recent optometry report, bring these as well.
Your pupils will be dilated during the examination, which temporarily blurs near vision and increases light sensitivity. Arrange for someone to drive you home, or plan not to drive for several hours afterward.
How is the lens implant power calculated?
The power of the intraocular lens is calculated from your biometry measurements using a mathematical formula. Modern formulas take into account the length of your eye, corneal curvature, anterior chamber depth, and lens thickness. For most eyes, this calculation is highly accurate.
Eyes that have had previous corneal surgery, eyes with very long or short axial length, or eyes with corneal irregularity require more complex calculation methods. I use a combination of the Barrett Universal II, Hill-RBF, and Haigis-L formulae depending on the individual eye, and cross-reference against multiple targets before finalising the lens power.
What lens options will I be offered?
At your consultation, your surgeon will discuss which lens types are appropriate for your eye and your visual goals. The main categories are monofocal lenses which correct one focal distance, extended depth of focus lenses which provide a range of functional vision, and trifocal lenses which target distance, intermediate, and near vision simultaneously.
Not every lens is appropriate for every eye. Corneal irregularity, pre-existing astigmatism, macular disease, and pupil size all influence which options are suitable. Your surgeon will give you a specific recommendation rather than a generic menu of options. For a full overview of lens types, see the intraocular lens options guide at corneaeyedoctor.com.
What questions should I ask at my cataract consultation?
The questions that give you the most useful information are: How many cataract surgeries has my surgeon performed? What is their experience with cases like mine specifically? Which lens are they recommending for my eye and why? What are the risks relevant to my individual eye, not just the general risks of cataract surgery? And what happens if I am not happy with my vision after surgery?
A surgeon who has performed over 7,000 cataract surgeries, including complex cases at a tertiary referral centre, will give different answers to these questions than a surgeon earlier in their career. Volume matters because cataract surgery has a well-established volume-outcome relationship. See the high-volume cataract surgeon Melbourne post for more on the evidence behind this.
What is discussed at the end of the consultation?
At the end of your consultation, your surgeon will summarise their findings, confirm whether surgery is recommended, explain the planned procedure, and give you a quote for your out-of-pocket costs. You will have time to ask further questions before deciding to proceed.
There is no obligation to book surgery at the consultation. Most patients take a few days to consider their options, discuss with family, and confirm their dates.
How do I book a cataract consultation with Dr MacIntyre?
Dr MacIntyre consults at Northern Eye Consultants in Bundoora and at Bass Coast Eye Centre in Wonthaggi. A referral from your GP or optometrist is required. Contact Northern Eye Consultants on (03) 9466 8822 or via HealthLink EDI nthneyec to arrange an appointment. For information on what to expect after surgery, see the cataract surgery recovery guide at corneaeyedoctor.com.