Indications for Surgery
The most common indication for cataract surgery is the patient’s
desire for improved visual function. The decision is not
based on a specific level of visual acuity. Rather the patient
and physician determine whether reduced visual function
interferes substantially with desired activities. A detailed
history is all that is necessary to document the subjective
issues the patient faces. The process to proceed is therefore
individualized according to the patients visual needs and
potential and the same indications govern the decision to
operate on the second eye. There are a number of situations
in which the surgeon will encourage surgery out of necessity.
For instance, if a patient would not pass a Drivers test,
prudence would indicate a more aggressive approach by the
surgeon. Another common situation occurs when the surgeon
is attempting to evaluate and or treat ocular disease further
back inside the eye, such as glaucoma, macular degeneration,
or diabetic retinopathy and cataractous degeneration precludes
an adequate view for the surgeon. Again, in these circumstances
the surgeon will be more aggressive in encouraging a surgical
solution!
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Surgery
Cataract surgery, as performed by Dr. Ruff occurs at Lake
Forest hospital. Over the past 16 years Dr. Ruff has performed
more cataract surgeries, at Lake Forest hospital, than any
other procedure performed by any other individual surgeon.
He currently performs 10-15 cataract surgeries per week,
on Wednesdays and Thursdays, and is always scheduled a number
of weeks in advance.
Cataract surgery is performed as outpatient. Patients are
at the hospital approximately 3-4 hours. One eye is performed
at a time and the second eye, if necessary is usually completed
2-4 weeks later. Patients are in the operating room approximately
23-25 minutes. They are positioned on a special eye operating
table and lightly sedated with iv (intra-venous) medication.
As soon as the patient Drifts off to sleep, the eye lids
are numbed so that the patient cannot see or feel anything
during the procedure. This medication last for up to 24
hours, so that the overwhelming majority of patients never
feel anything throughout the entire experience.
In the hands of Dr. Ruff, the surgical procedure last only
12-14 minutes. Cataract surgery is performed by entering
the eye, making a circular opening in the anterior cellophane
covering of the lens. Dr. Ruff, then uses an ultrasonic
probe to remove the cataractous tissue, leaving behind a
cellophane shell. Into the shell, Dr. Ruff places a new
lens called an implant. The entrance site Dr. Ruff has created
may or may not be sutured depending upon whether he is also
trying to correct pre-operative astigmatism. In addition
he may perform what are called limbal relaxing incisions
or LRI. These are cuts at the periphery of the cornea once
again to reduce or eliminate the degree of pre-operative
astigmatism so that the patient can be as free as possible
of post-operative glasses.
When completed, the patient is fully awake with a bandage
over the operated eye. The patient then goes to a recovery
area where they get Dressed, have something to eat, and
then have someone take them home. The rest of the day is
spent on the couch, in bed but not necessarily i.e. Just
a quiet day at home. The patient are essentially able to
care for themselves, coming to the table for meals and sleeping
the way they want.
The next day, they are Driven to the Lake Forest office,
home care instructions are given and then normal activities
resume including Driving, work, social activities, many
types of exercise etc.. The second eye comes 2-4 weeks later.
In many cases the patient no longer needs distance glasses
for Dr.iving or normal activities. Readers are frequently
required however. Regardless, new glasses are generally
prescribed 3-4 weeks after the second eye.
Happily, post-surgical patients will discover a new visual
existence. Incredible clarity in the distance for Driving,
sports (golf), improved reading and other near vision activities,
night vision improvement and a new appreciation of colors,
are exciting discoveries after the effort made by the patient
and Dr. Ruff to achieve a surgical improvement.
Indications for Surgery
