Cataract Surgery, South Canterbury Eye Clinic & Timaru Hospital

During 2016, Leah's eyes were painful, so she visited her Fairlie GP who said she had cataracts & needed to see an ophthalmologist. There was a long waiting list for ophthalmologist appointments at Timaru.

Breadwinner teacher Leah needed good eyes at Lake Tekapo School, St Joseph's School, Fairlie, working with private students at Fairlie & lecturing Specific Learning Difficulties topics at Seabrook Mackenzie Centre, Christchurch.

Leah's 3 year teaching contract ended at Lake Tekapo School, so at year's end we moved to Pleasant Point, after Leah got a Resource Teacher Literacy post at Timaru. Leah would need good eyes to commute daily by car from Pleasant Point to Timaru. Her new job also needed good driving eyes to South Cantebury schools from Timaru to Waimati southwards, Peel Forest northwards & Twizel westwards, requiring her regularly visiting & advising 40+ South Canterbury schools.

Wed 15.02.17. South Canterbury Eye Clinic appointment: Over 2 hours, Leah was seen & tested by 2 ophthalmologist nurses & an ophthalmologist to assess her for placement on the 4 month waiting list for cataract surgery at Timaru Hospital. Leah was told NZ state would pay $3000 for cataract surgery in one eye.

If Leah wanted cataract surgery in the other eye she would have to go through the whole bureaucratic nonsense again, seeing staff at South Canterbury Eye Clinic again to get on another waiting list for cataract surgery in her other eye. Or if we had the money, opt for cataract surgery by a private surgeon & pay his private fee. Meanwhile without cataract surgery on both eyes simultaneously, Leah's sight would be marginal & glasses defunct, while waiting for surgeries in separate eyes several months apart.

South Canterbury Eye Clinic gave Leah a handout - CATARACT SURGERY INFORMATION - PUBLIC which read:

Cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and helping to produce clear, sharp images. The lens is contained in a capsule within the eye. Over time the lens changes, making images blurred or fuzzy.

For most people, cataracts are a natural result of aging but can also be caused by certain medications or injury to the eye.

In cataract surgery, the clouded natural lens is removed and, in most cases, a permanent intraocular lens (IOL) implant replaces the natural lens.

Eye tests at the Eye Clinic

The nurse puts drops into your eyes to make the pupils bigger [Leah's pupils became as wide as blackberries] so that the Ophthalmologist can examine the eye. He can advise you of possible risks and outcome you can expect from the surgery. He will get you to sign a consent form for surgery.

The nurse checks both your distance and reading vision and questions you to determine how your reduced vision is impacting on your life. Your eyes are measured on two different machines to obtain the exact lens strength required. You may also have had the operation explained to you and have been given written information. The nurse will also ask you questions about any other health issues, medicines you may be using, medication allergies and whether you have been in hospital before.

The office staff will get you to sign a form to give your permission to put your name on the waiting list. The office staff will get contact details for you and your next of kin for the Hospital.

You will be given a prescription for the post-operative eye drops, Please get this filled when you get your surgery date. Inform staff if help is required for the post-operative drops.

You have been placed on the list for cataract surgery. The Hospital Booking Office staff will notify you of the date when your surgery is scheduled. You will be sent admission information. Read the hospital information and the fact sheet and keep them.

If you take Warfarin you will be asked to have a Blood Test prior to surgery. Cataract surgery is usually done as a day case meaning you will be discharged from the hospital on the same day as your surgery.

Smoking

You are advised to stop smoking at least six weeks before your operation as smoking causes anaesthetic complications, can damage the eye's blood supply and impairs the body's healing ability. Eye Clinic or Hospital staff can refer you onto quit line. Please contact them prior to admission if you wish to take advantage o this service.

Discharge planning

Arrange for someone to take you to and from the hospital and to the post-operative appointment. You won't be able to drive yourself. You should either arrange to stay with someone, or have someone stay with you on the first night in case of unanticipated problems. [Like what?]

Food

* You will be advised by the Hospital or Ophthalmologist, but normally if your surgery is under local anaesthetic you will eat a light meal prior to admission.
* If you are having a General Anaesthetic or sedation you will receive fasting instructions from the Hospital. / Anaesthetist.
* Take your normal prescribed medication as usual unless told otherwise. Diuretics (water pills, e.g. Furosemide) may be omitted. You will be advised if there is any alteration for diabetic medication. Remember to take all your medications with you. The hospital will advise you about Warfarin according to INR results.

Do not wear any make-up (other than moisturiser) or nail polish.

On the day of your surgery

Go to the Day Patients on Level 4 of the Hospital. You will be seen by the Ophthalmologist performing your operation; you will sign the Consent Form, if it has not been signed, for the operation and a mark is placed over the operative eye.

You will also be assessed by the anaesthetist; and asked to sign Consent for the Anaesthetic. The Anaesthetist decides the type pf anaesthetic most appropriate for you - local anaesthetic - numbing of the eye before you have your operation, you may require light sedation or a general anaesthetic.

About one hour before your operation, drops will be placed in your eye to dilate the pupil. [Blackberry wide again]. Once you are taken to the operating theatre, other drops will be placed in your eye to numb the surface, and any other Local Anaesthetic will be given before the operation. If you are having a general anaesthetic you may not require these numbing drops. You will be asked your details and the operation you are having several times during your hospital stay - this is called 'Safe site surgery' and is recommended by the WHO (World Health Organisation).

During the operation

[Two pics of a plastic lens being folded into place with a surgical instrument behind the iris. Caption: Inserting the new lens].

The theatre nurses will make you comfortable on the theatre table.

You will be given a constant supply of oxygen during surgery and the clear, light, plastic, sterile drape will be lifted off your mouth and nose.

The procedure will be explained to you and you will be asked to warn them if you need to move or speak. It is important that you don't move any part of your body or talk. The ophthalmologist has instruments inside your eye and any unexpected movement you make could therefore result in damage to your eye. [Why not use a head brace?] He can usually stop and remove his instruments from your eye, or let you know when it is safe for you to move or cough.

The actual operation usually takes about 10-20 minutes per eye. so that is the only time you will need to be still for.

The time from when you arrive at hospital to the end of your surgery, will be subject to differing circumstances which cannot be controlled. [Like what?]

After the operation

You will return to the day ward with a cover over the eye which stays in place until the next day. After a light snack you will be free to leave.

The nurse will give you:

* an instruction sheet with contact phone numbers (in case of problems). [Like what?]
* eye drops should be collected prior to returning home, so the eye drop regime can be commenced when the cover is removed the next day - these drops will help settle inflammation.
* if the eye is uncomfortable, take Panadol (not Asprin or Disprin) [Why?] to relieve the discomfort.

Don't be alarmed if clear vision does not return immediately following your cataract surgery. In some cases this can take several days. [Why?]

If you have glaucoma: you may be given Diamox tablets to take morning and evening for 3 days. Restart glaucoma drops the day after surgery unless instructed by the ophthalmologist. You will be given an appointment for 1 week after surgery to ensure the eye pressure is normal.

After the surgery

You will be phoned by the Eye Clinic nurse the morning after your surgery.

Tinted glasses will be more comfortable outside as the eye will be light sensitive. Either sun glasses, or prescription tinted glasses will be suitable.

It is quite normal to feel a slight sensation of something in the eye for a while after the operation. This is part of the healing process.

Wear your own glasses if they help, they may not. The Eye Clinic in Timaru will see you again for the follow-up after the operation and will advise you whether to change your glasses at that stage.

You do need to be aware that normally the artificial lens placed in your eye during the operation is for distance vision, so you will require glasses for reading. [Misinformation. See later information].

Contact the Eye Clinic on ... if you experience any of the following problems:

* Pain
* Worsening of vision after initial improvement
* Discharge / Infection

Do's

* Use your common sense. If it hurts don't do it.

* Follow the instructions of your eye drop regime.

* Carry on with normal activities as you feel comfortable.

* Avoid dusty or dirty environments.

* If working, expect to be off work for up to 2 weeks.

* Driving will depend on the vision of the other eye, how quickly the operated eye recovers, whether you need glasses and your own self confidence.

Don'ts

* Don't rub the eye.

* Don't use your handkerchief to wipe the eye. Remember the wound is not yet healed and could provide an easy entry for infection. [Blame the patient for crap surgery].

* Don't get water in your eyes for three days after the surgery, refrain from washing your hair yourself for 3 days, as again the wound is not healed and could become infected [What about wet tears, blepharitis, etc?]

USE of EYE DROPS

It is very important to always wash your hands first, as infection in the eye may be disastrous

PUTTING DROPS IN YOURSELF

Method: [11 bulleted steps, how to put drops in your eyes].

IF SOMEBODY IS PUTTING YOUR EYE DROPS IN FOR YOU

Method: [7 bulleted steps for somebody].

FREQUENTLY ASKED QUESTIONS

 If you have any questions that are not covered here, please call the clinic.

WHEN CAN I DRIVE?

This depends on the individual. After your post op assessment, we will tell you for sure. We take into account, e.g. the vision of your other eye, whether you need glasses adjusted. [Costly].

CAN I READ OR WATCH TV?

You should avoid reading for the first few days. TV is fine.

CAN I WEAR MY GLASSES?

You can wear your old glasses in most cases until your follow-up.

WHEN CAN I HAVE NEW GLASSES MADE UP?

After your eye drops are completed. If it is on your licence to wear glasses to drive, you must ensure you get your licence changed if you no longer need them.

CAN I WASH MY HAIR?

Yes after a few days, but please don't get dirty water in your eye.

I FEEL LIKE THERE IS SOMETHING IN MY EYE

Some mild discomfort is common in the first few days, but may continue for some time. Please contact us if concerned.

WHEN CAN I FLY AFTER SURGERY?

Please avoid flying for at least two weeks. If you must fly, ask us for advice first.

POST CATARACT EYE DROP REGIME

[A 4 week table with daily tick boxes, to be ticked 4x/day when using Prednisoline eye drops].

POST CATARACT DROPS

DO NOT TOUCH YOUR EYE ON THE DAY OF THE OPERATION

Prednisoline 4 times/day for 4 weeks commencing the morning after surgery

IF THERE ARE ANY SUBSEQUENT (GLAUCOMA) DROPS WAIT FIVE MINUTES BETWEEN DROPS.


Mon 22.05.11 Leah went for a pre op appointment at Timaru Hospital. She waited most of 3 hours in a waiting room to intermittently see a cataract op nurse, doctor & anaesthetist. They were apologetic about her long wait. Leah reported there was adequate parking at Timaru Hospital, unlike poor parking at Christchurch Hospital.

Leah was given a South Canterbury District Health Board, Patient Information Booklet, Cataract Surgery which read:

Please understand that your surgery may be cancelled at short notice due to unforeseen circumstances or emergencies.

NOTES...

Please report to Day Patient Services Level 4

Timaru Hospital Admission

for...

Please confirm you can attend surgery by phoning the Booking Office on the highlighted number on the next page and leaving a message as soon as possible.

BOOKING OFFICE CONTACT NUMBERS...

INSTRUCTIONS TO PATIENTS NEEDING ANAESTHESIA

NB: LOLLIES AND CHEWING GUM ARE NOT TO BE CHEWED OR SUCKED

FASTING INSTRUCTIONS

a) If your operation is in the morning, do not eat anything after midnight. You may drink WATER ONLY up until 6am.

b) If your operation is in the afternoon, you may have a light breakfast (toast or cereal, NOT a cooked breakfast) before 7.30am. You may drink WATER ONLY up until 11am.

PREPARING FOR YOUR SURGERY

This checklist is to assist you and the team caring for you before, during and after your stay in hospital.

NB: Methicillan Resistant Staphylococcus Aureus (MRSA)
- have we asked you if you have been in hospital the last 6 months? If you have let us know as soon as possible.

If you have a cold, or any other infection near the day of surgery, please inform the Booking Office without delay as it may be necessary to postpone your admission until you have recovered.

OWN MEDICATIONS:
Take your usual medications on the morning of surgery, using a sip of water to swallow pills except - do not take pills for diabetes. Ignore instructions on your medications to take with food, take with water only.

You may also be given special instructions regarding:

* Insulin
* Anticoagulants (e.g. Wafarin, Pradaxa, Clopidogrel)
* Anti-Inflammatories (e.g. Aspirin, Voltaren)
* Diuretics (Water tablets)

Please bring all your medications with you to hospital.

SMOKING:
Smokers develop more complications than non smokers. It is in your interest to stop smoking 6 weeks before your operation, but if your operation is arranged at short notice, you should not smoke for at least 48 hours before operation.

PRIOR TO YOUR ADMISSION

* Remove all makeup, especially lipstick and nail polish before arrival st Day Patient Services.

* Please arrange to have a capable person stay with you for 1-2 days after discharge if possible. [Me].

* It is a good idea to have some quick meals prepared and household chores up to date so you can spend 1-2 days resting and recuperating in your home after your visit to hospital.

* Please have a bath or shower on the morning of your operation.

WHAT DO YOU BRING TO HOSPITAL WITH YOU?

* Your current medications
* Glasses or lenses
* Hearing Aids and Case (if required)
* Walking Stick (if required)
* Dentures

You will require a brimmed hat and sunglasses to wear when you go home and please wear comfortable clothes on the day of your operation.

As a precaution against loss, we suggest that you have clothing clearly marked and DO NOT bring valuables or large sums of money with you.

WHO SHOULD ACCOMPANY YOU ON THE DAY OF SURGERY?

* You should be accompanied by a capable person who will be responsible for your transport home. [Me].

* Due to lack of suitable space for waiting, we ask that the person leaves their contact details with staff so that they can be notified when you are ready to be discharged. [Poor planning & inadequate facilities for the patients' family / post op carers].

ON ADMISSION

* Please report to Day Patient Services, Level 4 at your reporting time.

* A gown will be provided for wearing during your operation. [A gown for an eye operation?]

* A Nurse will outline your procedure to you.

* If you haven't attended a Pre-Admission Clinic you may be seen by the Anaesthetist or House Surgeon.

REMEMBER
You are responsible for your own belongings while in Day Patient Services. They will be locked away while you are having your surgery.

WHAT HAPPENS AFTER YOUR OPERATION?

* After your operation you will be returned to Day Patient Services.

* You will be given something to eat and drink.

* When the Nurse decides it is appropriate you can get dressed. [A humiliating gown's essential for an eye operation huh?]

WHAT HAPPENS ON DISCHARGE?

* When you are ready to be discharged your nominated person will be contacted.

* In consultation with you and your family any services required by you after discharge will be arranged. If you or your family have any concerns please tell the staff as soon as possible.

* You will be given a written discharge summary.

* Commence your eye drops as instructed.

* You will be given a follow up appointment if necessary.

COMPLAINTS

Should you or your family wish to make a complaint, you can do so by using one of the following ways:

* Talk to the Staff concerned

* Contact the General Manager Clinical Governance...

* Contact the Patient Advocacy Service...


FACTSHEET                                                         South Canterbury District Health Board

INSTRUCTIONS TO PATIENTS FOLLOWING GENERAL ANAESTHESIA OR SEDATION

1. DO NOT drive any vehicle or operate any machinery, for at least twenty four (24) hours after general anaesthesia or sedation.

2. You should arrange for someone to take you home from hospital.

3. You need to have a person to stay with you overnight.

4. DO NOT drink any alcohol for at least twenty four hours afterwards. It would be advisable to avoid any social engagements for this period.

5. AVOID any activity which requires the use of skill or judgement - e.g. delicate work, cooking or similar activity for twelve (12) hours afterwards.

6. DO NOT make any important decisions or sign any important papers for at least twelve (12) hours afterwards.

Thurs 25.05.17. Leah had the cataract op on her right eye. Day 1 after the op, Timaru Hospital phoned Leah at home. Leah told the nurse her eye was red. The nurse said that was normal post op.

Days later while recovering at home, Leah found the local anaesthetic took a while to flush from her body. The post op, anti inflammatory, eye ointment ("eye drops" below) left her eye teary & gritty & her body whoozy, with flu like symptoms & nose bleed. Leah soon stopped using the hospital ointment in favour of self medicated, homeopathic tablets, thuja & ferrum phos. She trusted her homeopath more than hospital iatrogenic quackery. There were plastic bottles of hand antiseptic for public use all over the hospital! Leah was allergic to antibiotics, so her post op reactions to conventional medicines were expected.

Leah said the op soon improved her colour vision, things looked brighter, but it took several days for her visual discrimination & focussing to improve. She would need a cataract op on her left eye before she could get prescription glasses, which was inconvenient for Leah a teacher.

Cataract surgeons only did one eye at a time due to possible complications.

Facebook chatter with friends: One said his dad had cataract ops, both eyes at different times, no problems. Another had a cataract op on her eye, which years later needed correctional laser surgery, before another cataract op on her other eye.

Post op info from Timaru Hospital:

Post Cataract Surgery Eye Drop - [Prednisolone AFT Ey 1% (Pre)]
Day of Surgery

Commence eye drops as instructed on your discharge summary.
Commence eye drops the next morning and remove your eye shield as well at this time.

Information Sheet

Points to report immediately any of the following symptoms:

* Redness
* Pain
* Headaches
* Sudden deterioration of your vision on operated eye

Please instil one drop as per instruction sheet to your operated eye only. For one month. (The regime is on the backside of this sheet).

[Wow! Regime: One squeeze of Prednisolone AFT Ey 1% (Pre) ointment 4 x per day = 112 doses in one eye per month. Leah disregarded the one month "eye drops" regime after 2 days, due to the whoozy / exhausted body reaction the "eye drops" created. She was convinced the corticosteroid anti inflammatory was poisoning her. The one month corticosteroid regime was a "better safe than sorry" medication from Timaru Hospital, which didn't take Leah's aversion to toxic drugs into consideration, despite Leah telling hospital staff at the pre op appointment, about her allergic reaction to drugs, like penicillin.

Five days post op Leah phoned Timaru Eye Clinic & told the nurse she had stopped using the anti inflammatory ointment due to side effects. The nurse replied OK, but would check with the surgeon if Leah's non compliance was OK. Hours later the nurse phoned & told Leah the surgeon said it was OK to stop the drops. One of the side affects was that the ointment could actually cause sub capsular cataracts!].

Wear dark glasses after your operation and a wide brim hat when outside.

You can wash your hair 3-4 days post operation.

Notes for patients with glaucoma:

* If you are prescribed drops for your glaucoma use them from the morning after your surgery unless the surgeon tells you differently.

If you need advice please contact Timaru Eye Clinic - 68 High Street, Timaru, Phone...

Copyright Mark JS Esslemont.

See South Canterbury Eye Clinic

See Timaru Hospital

See Prednisolone AFT Ey 1% (Pre) sterile eye drops suspension