Cataract Surgery: Patient Information
How do the Eyes Work?
As light enters the eye, it first passes through the cornea—the clear “window” of the eye. Because thecornea is curved, the light rays bend (refract). The light then passes through the pupil to the lens. Theiris—the colored portion of the eye—regulates the amount of light that enters the eye. This is achievedby the action of the muscles that cause the pupil to contract if there is too much light or to dilate if there istoo little light. When the light hits the curved surface of the lens, it is refracted or bent even more so that it
focuses properly on the retina. The retina then converts the light into electrical energy that passes
through the optic nerve to the brain. This sequence may be summarized as follows.
Cornea is the clear surface of the eye. Light rays refract as they
pass through to the pupil.

Iris is the colored portion of the eye. It regulates the amount oflight that passes through the pupil.

Pupil is the opening at the center of the iris. Light passes
through the pupil to the lens.

Lens refracts light in order to focus it properly on the retina.

Retina converts light rays into electrical energy, which is passed
to the optic nerve.

Optic nerve serves as a pathway to the brain stem, which
forwards the electrical energy to the occipital lobe.

Presbyopia
People with good vision and people who rely on the aid of glasses or contact lenses for distancevision adjust focus for close objects by altering the thickness of the crystalline l ens, which functions
as an intraocular lens. Age-related loss of elasticity to the crystalline lens and weakening of themuscle that adjusts the crystalline lens thickness, lead to a declined ability to adjust focus and makes
it more difficult to see close objects. This condition is called presbyopia. Around the age of 45, mostpeople begin having trouble reading newspapers or the display on cell phone screens and realize
they have presbyopia as such inconveniences in daily routines increase in frequency.
Initial stage

Cataract
In addition to presbyopia, age-related changes to the lens include a white
opaque condition called cataract. In the initial stage, this lens opacity createsthe scattered reflection of light, leading to glare even in patients who otherwise
have good visual acuity. Some patients who think their vision is affected bypresbyopia may also have cataracts. As the opacity increases, more light andimages are blocked from reaching the retina, resulting in failing vision. Thisaffects daily life and requires the surgical removal of the cataract.
－1－Progress stage

SurgeryIn cataract surgeries, the surgeon removes the opaque lens and implants a transparent artificial IOL.
After receiving cataract surgery to one eye, the patient is observed for about one week before
undergoing surgery to the other eye.

The opaque lens is removed.

The IOL is inserted into the lens
capsule.

The surgery is finished.

Kinds of IOLs
There are two types of IOLs: monofocal IOLs and multifocal IOLs.

Intraocular lenses

Monofocal IOLs: They offer no focal adjustment function and have
only a single focus point. Patients implanted with monofocal IOLs
have the same presbyopic condition as before the surgery. If theimplanted lens is set for better distant vision, then near vision suffers.
Conversely, if the lens’ focus point is set for near distances to allow

Monofocal lensreading books or computer screens, a patient will have trouble
watching TV or recognizing acquaintances when passing them on
the street. Therefore, eyeglasses will be required after surgery.
Multifocal IOLs: They are designed based on a cutting-edge optical

Multifocal lenstheory for distributing light in such a manner that provides multiple
points of focus, thereby eliminating the dependence on eyeglasses indaily life. However, for very far away landscapes or fine print,
eyeglasses may still be needed.
Monofocal IOLs
 Setting the focus for far distances
achieves clear far vision.

Advantages
Disadvantages

 Eyeglasses will be needed
because setting the focus for far
distances results in poor near orintermediate distance vision.
 Astigmatism will persist.

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Multifocal IOLs
In daily life, after undergoing surgery
patients will be able to see both far andnear to some extent.
Multifocal IOLs also offer the potential forcorrecting astigmatism.
It may result in poor Intermediate distancevision.
Better vision may be achieved with theaddition of eyeglasses where needed.
Night may feel darker and patients may
experience light blurring such as halos andglare.

Indication: Am I a Candidate?
IOLs are suitable for cataracts.
IOLs are not suitable for the following conditions.
 Repeated endophthalmitis
 Intraoperative complication such as continuous bleeding, vitreous prolapse and posterior
capsule rupture Uncontrolled glaucoma
 Proliferative diabetic retinopathy Pregnant or nursing
Multifocal IOLs are suitable for pupils that are larger than 2.5mm in size in bright conditions in addition to theabove.

Procedure From Examination To Surgery
1. First examination: During this examination, the doctor will determine whether you are a suitable
candidate for IOL surgery.

2. Final examination: To order the appropriate IOLs, repeat axial length measurements are conducted.
During this visit, we will take a sample of your blood, and this sample will be subjected to laboratory
examination for infectious diseases.

3. Surgery: If you wear contact lenses, you can use them the day before the surgery. You should notwear them on the day of the surgery. After administering local anesthesia, the surgeon makes anincision at the limbus of the cornea, from which surgical instruments are inserted to remove theopaque lens. Subsequently, the surgeon inserts an IOL to conclude the surgical procedure.

4. Post-surgery: Postoperative exams are scheduled periodically at one day, one week, two weeks,
one month, two months, three months, six months, one year, two years, three years, five years andevery year.

Potential Complications
Similar to other surgical procedures, there are risks associated with this surgery. The possible
complications are as follows: Pain, foreign body sensation or sting: Most patients experience slight pain or discomfort,
particularly during the first few days after the surgery. Please use pain reducing medications
according to the instructions provided.

 Subconjunctival bleeding: Subconjunctival bleeding (bleeding of the white of the eye) may occur.
This may lead to reddening of the eyes and will take approximately two weeks for the blood to beabsorbed.

 Infection: Infection is a potential complication that follows all surgical procedures. You should nottouch your eyes or eyelids on the day of the surgery. In order to minimize the risk of postoperativeinfection, it is critical to precisely follow the prescribed postoperative medication regimen.

 Elevated eye pressure: The postoperative transient inflammation may lead to elevated pressure
inside the eyes. In order to minimize the risk of postoperative elevation in eye pressure, it is critical toprecisely follow the prescribed postoperative medication regimen.
－3－ Undercorrection or overcorrection: IOL surgery is not a 100% accurate procedure. It is notpossible to accurately predict how your eyes will respond to the treatment. If undercorrection orovercorrection is significant, you may need to wear glasses or contact lenses. Eventually, additional
refractive surgery may be necessary to achieve your best vision after more than three months.

 Inadequate position of the lens: The lens may be dislocated from the center of the pupil. Usually,
this does not affect vision. However, in case of major dislocation, retreatment may be required.

 Cloudiness of posterior capsule: The posterior side of the capsule may become cloudy. Thecloudiness may progress enough to significantly decrease your vision. In a few cases, the removal of
the cloudiness of posterior capsule with laser may be required.

 Rupture of lens capsule: In rare cases, the lens capsule may be ruptured during the surgery. So
the surgery may be prolonged or the IOL may not be inserted.

 Other complications: These include the loss of endothelial cells, uveitis (inflammation of the middle
layer of the eye), endophthalmitis (swelling of the intraocular cavity), macular degeneration (loss oftissue in the center of the retina), expulsive hemorrhage, distortion of the IOL and others.
In addition, the possible complications of multifocal IOLs are as follows: Night vision problems such as halos, glare, starbursts, and light sensitivity: Vision may besomewhat blurred and there could be mild glare and/or halos at night.

 Insufficient accommodation: Insufficient distant and near vision may occur. In a few cases,
glasses may be necessary for good distant or near vision. LASIK refractive surgery is also possible
after three months.

Precautions
Instruction for Patients Wearing Contact Lenses
Contact lenses alter the shape of the cornea. Therefore, people who wear contact lenses will need tostop wearing them for a period of time before the final examination, depending on the type of contactlenses used. Following the below instructions will ensure the proper measurement of the refractive error
in patients.
Hard or gas permeable lenses (HCL) should not beused for 4 weeks prior to the final examination.

Soft contact lenses (SCL) should not be used for 3
days prior to the final examination.

Any kind of contact lenses can be used the day beforethe surgery. Please do not use them on the day of thesurgery.

Precautions Before the Surgery
From 3 days before the surgery: Please use eyedrops according to the instructions provided.

－4－On the day of the surgery: Please do not put on any makeup (except skin toner/emulsion).
 Please do not wear any sweater or garment made from mohair or a similar yarn.
 Please avoid any outfit that exposes your shoulders or bring a jacket with you (the operating room
is chilly).

 Please do not operate a vehicle.
 Please do not drink alcohol.
 Please do not put on any perfume, hair dressing, or strongly scented cream when you come to theclinic for the surgery.

 Please remove earrings before the surgery.
 If you have long hair, please tie it to the side before the surgery.
 Please bring the informed consent document with your signature.
 Please inform the doctor regarding any drug allergies that you have experienced.
Precautions After the Surgery
Please follow the instructions mentioned below in order to prevent postoperative infection.
For the day of the surgery: Please do not touch your eyes or eyelids.
 Please do not take a bath, shampoo your hair, or wash your face. Instead, please wipe your facegently with a wet towel. You may take a shower, but please avoid wetting your face. After
examination by the physician on the day subsequent to that of the surgery, in case there are nocomplications, you may take a bath, shampoo your hair, or wash your face.

 Please be sure to come to the clinic on the day following the surgery.
 Please use eyedrops according to the instructions provided.
During the first week after the surgery: Please use protective sunglasses outdoors.
 Please do not wear eye makeup.
During the first month after the surgery: Please use protective eye patches while sleeping.
 Please do not participate in sports.
 Please prevent water or sweat from entering your eyes and avoid vigorous rubbing of your eyes.

Remaining Myopia, Hyperopia, and Astigmatism After Cataract Surgery
If you have astigmatism before the surgery, you may not have good vision due to it. Furthermore, there may
be slight myopia, hyperopia, and astigmatism after the surgery. If you need better vision, you can have LASIK
surgery to reduce the remaining refractive errors after three months. LASIK is a common refractive surgery inorder to produce clearer vision and it is used to correct myopia, hyperopia, and astigmatism. The cost ofLASIK on one eye is 130,000 JPY including consumption tax.

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