Cataract Surgery & Anesthesia

I am not seeking advice. Rather, I have a question answered on the use of anesthesia. My Dad had cataract surgery, and the anesthesia had adverse effects on his Parkinson’s. He is going to have the other eye done soon, and I fear it will leave him virtually paralyzed.

My question is this: I thought the anesthesia is local, and I thought the procedure was performed with a laser. Are there other procedures that require general anesthesia? Do some procedures not use a laser, but a conventional scalpel? Just trying to understand. Maybe there are some options???

AFAIR from my cataract surgery, it is not done with a laser. In fact, it can’t be - they have to make a cut, destroy your eye’s natural lens, suck the pieces out, and insert the new lens instead.

There is local anesthesia, but you’re also sedated, otherwise you’d be very uncomfortable and you’d be moving around too much. I remember being kinda dreamy, I knew they were doing something and could in fact answer questions etc. but was “out of it”.

For my cataract surgery last year it was all local anesthesia. Supposedly they gave me a drug to relax me, but it pretty much did nothing for me at all.

Same here.

There are newer procedures that use a laser. It is more expensive, but gives excellent results, at least according to the claims made by the manufacturers of the equipment.

Are you sure you are not thinking of something else here, such as laser treatment of the cornea to improve focus (nothing to do with cataracts) or the non-surgical laser treatment sometimes used subsequent to cataract surgery to burn off the film that sometimes forms on the new artificial lens?

I suppose you could do the cut in cataract surgery with a laser instead of a scalpel, but I am not sure what the point of that would be. You will still have to physically remove the old lens and insert a new artificial one. There is bound to be touching involved.

I have had it done on both eyes, and my experience was as described by Terr. I was conscious throughout, but sedated.

With my cataract operations I had only local anesthetic. They put a tube in the back of one hand “just in case”, but it was never hooked up to anything. And I certainly took nothing oral either. My head was pretty much clamped in place and I could twitch if I wanted to. I was instructed to raise an arm if I felt a sneeze coming.

Laser cataract surgery is most definitely a real thing. It’s still very expensive, so not as widely used as conventional phacoemulsification cataract surgery, but it offers several benefits, including “increased precision, improved effective lens positioning, and less damage to surrounding tissue,” so we should probably expect that as the price comes down, it will become more popular.

This is definitely a question for the ophthalmologist or surgeon who did the procedure. While a general anesthetic isn’t routinely used, it wouldn’t shock me if due to his Parkinson’s tremors, it was needed in this case. But you can certainly talk to them and discuss other options for the other eye.

IANAOphtho guy but, droperidol is frequently used as part of the anesthestic regimen for eye surgery (or at least used to be).

Given that droperidol is an antidopaminergic drug (i.e. it opposes dopamine), it would be expected to exacerbate the symptoms of Parkinson’s Disease, i.e. since PD is characterized by dopamine deficiency.

I urge you to discuss this with the anaesthetist well in advance of your Dad’s next surgery. There are alternative agents.

I just had my left eye done a few days ago. Local anesthetic only. First there are multiple drops to numb the area, then the anesthetist makes an injection to numb the eye and pretty much half of your face completely. They offered an optional oral relaxant for those who feel nervous about the procedure, but it’s a pretty mild drug from what I saw. I turned it down, was fully conscious and aware throughout the procedure. They cut the eye like a pie in four pieces, fold back the flaps, slip in a tiny vacuum from one side and use what can best be described as a tiny hoe or rake to pull all of the old lens to the suction point for removal. Once it’s all removed, the artificial lense is slipped in and unfolded. During all this, your BP and heart are monitored, and your eye is continually flooded with saline. Total elapsed time under the knife was about ten minutes. Oh, and no laser.

On the other hand (from your link):

The article does not make it very clear what the laser is doing, but it looks to me as though, as I suggested before, it is just an alternative cutting tool instead of a scalpel (although possibly the laser also contributes to the destruction of the old, defective lens in some way). Either way, it appears that you still have to have the new lens inserted “by hand” as it were, and probably have the old lens, or its remains, removed “by hand” too.

Frankly, even if a laser provides a neater or more accurate cut, I would question whether it is really an improvement to have turned one 5-10 minute procedure into two procedures that have to be carried out in different rooms, and in which most of the tricky aspects of the old procedure are still there in the second part of the new one.

Thanks for that excellent, concise description of the procedure.

The laser is used to make a precise circular incision and to make a series of cuts in the lens to facilitate chopping it into pieces. They also use optical coherence tomography to measure the eye during the procedure. I’ve seen films and the comparison is remarkable. It makes the old approach look barbaric, though I am not aware that there is a dramatic difference in the outcomes.

When I had my second eye cataract done I just had a local and everything was not painful. My first one was done with anesthesia and I had a lot of trouble My eye swelled up and I had to have a couple of laser surgeries to fix the problem.

Things can, and do, go wrong with cataract surgery, as with any surgery. If you read the form they give you to sign, there’s a long list of possible negative outcomes. I, unfortunately, did have one of them. I’ve detailed the whole story elsewhere. Short form: I developed map-dot-fingerprint syndrome on my cornea. It took forever to heal. After paying two grand for the extra-special multi-focal lens, astigmatism developed. The final result is that I still need expensive glasses, and the vision in the eye that was operated on is WORSE than it was before.

Now, this is an extremely rare thing, but sh!t happens. I will not have the other eye operated on unless it becomes practically useless.

And this was with a highly regarded ophthalmologist, at the premier eye surgery center in the area. No malpractice, just bad luck.

Spam two posts prior reported.

Sorry you had a problem; that really sucks.

I thought it was amusing that they showed me a video that explained many of the things that could go wrong. At the end of the video the woman announces, with a cheesy grin, that “the list of things that could go wrong is much too long to enumerate here.” The video ended and a nurse came in with a pressure cuff. I said “NOW you’re going to check my blood pressure?” :smiley:

I had bilateral cataract surgery a couple of years ago. Medical paid for it except for &500 each eye due to the need to use an orange light, which was necessary because of bilateral RK sx in 1991. Does anyone know what the orange light accomplished? I could see the light and had to keep staring at it.