Cataract surgery is not one operation for everyone. This page explains how I plan it around you: what I ask, which tests I do, which medicines matter, and how I manage other eye conditions at the same time.
What do I ask about your daily life?
Before recommending a lens, I ask how you live. I ask about your work, hobbies and driving, particularly how much you drive at night, and how much you want to be free of glasses. I also talk about your personality and how comfortable you are with imperfection, because these shape what will satisfy you.
These answers matter because no lens suits everyone. Some lens designs are more likely to cause glare or haloes around lights at night, so night driving can change which lens I recommend. The aim is to match the lens to your priorities and be honest about the trade-offs. For more detail, see the guide to choosing a lens for your lifestyle and my article on toric lenses for astigmatism.
Which tests do I do before surgery?
Before cataract surgery I measure the eye with biometry to calculate lens power, and scan the macula and the retinal nerve fibre layer with OCT. I also map the front of the eye with corneal tomography and assess you for dry eye. Together these show whether anything besides the cataract needs attention.
- Biometry: measures the eye to calculate lens power.
- Macular OCT: checks the macula for conditions such as macular degeneration or diabetic changes.
- Nerve fibre layer OCT: looks at the optic nerve fibres, which helps in assessing glaucoma.
- Corneal tomography (Pentacam): maps the shape of the cornea and astigmatism, and I review corneal thickness on the scan.
- Dry eye assessment: an unhealthy tear surface can affect the accuracy of measurements and your comfort after surgery.
For more on these measurements, see the guides to lens power calculation and treating dry eye before cataract surgery, and my article on cataract surgery after laser eye surgery.
Which medicines and health conditions change my plan?
I ask for your complete medication list. Blood thinners and prostate medications are especially important, because they can affect surgical planning. Please do not stop any medicine unless I or the doctor who prescribed it advises you to. I also take your general health into account.
For routine cataract surgery, I do not usually ask patients to stop blood thinners. If your pupil dilates poorly and I need to use a device such as a Malyugin ring to enlarge it, the risk of bleeding is higher, and in that situation I would recommend stopping them. I decide this with you and the doctor who prescribes them.
Some prostate medications, such as tamsulosin, can change how the iris behaves during surgery (intraoperative floppy iris syndrome), and this can still apply if you have stopped taking them. Please tell us about any current or past use so I can plan ahead.
For more detail, see the guides to cataract surgery anaesthesia, pupil size and lens selection and cataract surgery with diabetes, and my article on complex cataract surgery.
What if you have other eye conditions?
Many patients have another eye condition alongside their cataract. I assess and manage these at the same time as your cataract assessment, including diabetic retinopathy, macular degeneration, glaucoma, and corneal or front-of-eye conditions such as pterygium. This means your care is planned together.
For more detail, see the guides to cataract surgery with glaucoma and cataract surgery with macular degeneration, my article on combined cataract and corneal transplant surgery, and the referral information on coexisting eye disease.
How do we decide on the plan together?
After the tests, we go through the results together and I explain your options, including what each lens can and cannot do. I recommend a plan based on your eyes, your health and your priorities. The decision is yours, and you can ask questions or take time before booking surgery.
Please bring a referral from your GP or optometrist to either location. For Bundoora, appointments are arranged through Northern Eye Consultants on (03) 9466 8822 or through its contact page. For Wonthaggi, phone Bass Coast Eye Centre on (03) 5672 4300 and ask your referrer to address the letter to Dr Ross MacIntyre. For more on the two locations, see Eye Care in Bundoora and Wonthaggi: How It Works.
GPs and optometrists can find referral information for all services.
References
- Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005;31(4):664-673. doi:10.1016/j.jcrs.2005.02.027