Frequently Asked Questions

We are all born with a clear lens in the front part of our eye.  With age, this lens becomes cloudy for a variety of reasons.  When the lens becomes very cloudy the quality of vision drops significantly.  Tasks like driving at night, reading menus in a dark restaurant and seeing in the distance become more difficult.

If you are told you have a cataract but are seeing quite well, you probably don’t need cataract surgery.  However, even if you think you are seeing well you may need cataract surgery if:

• your vision, even with glasses, is not good enough to drive according to your province’s rules
• your cataract is getting so firm that it would be dangerous to let it go unoperated
• your eye has certain conditions that make earlier cataract surgery a good idea.  Your eye care clinician will alert you if this is the case

Your eye will be measured to determine the power of the lens implant. You will start using drops 1-2 days before the surgery. Make sure to arrange for a ride home after the surgery. Avoid wearing make-up or jewelry.

Before the surgery the patient’s eye is prepared by the nurses who put in several sets of drops.  The patient is then asked to lie down on a special operating room bed.  Their body is covered with a paper drape leaving the eye to be operated uncovered.  A small wire device is used to keep the eye open so it won’t close during surgery (even if you blink).  Then a gel is placed on the eye to “freeze” it so no pain will be felt during the surgery.  The eye is opened by a blade (2-3mm wide) and the cloudy cataract is removed.  The only part of it that is left is the remaining clear part (the posterior capsule).  Then a lens implant is put into the remaining “capsule” and the eye is “closed”.  Before the operation is over, the surgeon checks to make sure that the eye is “watertight”.  The operation takes approximately 8-15 minutes.

Most surgeons do not use needles to “freeze” the eye for cataract surgery.

It is extremely rare for a patient to be given general anaesthesia (“be put to sleep”) for routine cataract surgery.  If you are anxious please let your eye surgeon know about it.  They will prepare the nursing staff to provide some sedation (by your vein) to calm you down during the surgery.

The cataract, or lens, that is removed during surgery has a certain focusing power.  This must be replaced in order for the eye to see afterwards.  The focusing power is replaced in the form of an implant (intra-ocular lens implant) which is put in the same place as the cataract used to be.  Before cataract surgery the power of the implant is a subject that will be discussed between you and your eye surgeon.  The two of you will decide which power of lens to use depending on if you want to see without glasses for far or near after surgery.

The lens implant power is calculated in precise measurements (called biometry) of the eye. There are some lenses that correct for astigmatism (toric lenses) and even some lens implants that allow you to see far and near without glasses (multifocal).  The subject of lens implants will be discussed in great detail by your eye surgeon during your pre-operative (before surgery) visit.

After successful, uncomplicated cataract surgery there are few restrictions.  You can bend down, lift light to moderate weights, go to the gym for a moderate work out, wash your face and take a shower but must ensure not to splash or spray water directly into your operating eye. You cannot go swimming for a period of time which will be decided by your surgeon.

You can usually drive one day after surgery as long as your vision meets the rules of your province. Your depth perception may be temporarily affected, so you will have to take precautions when beginning to drive after surgery.

LASIK surgery is an operation that has become very routine; so routine that some people don’t consider it “real” surgery.  Although it is a quick and safe procedure, each patient’s eyes must be properly analyzed to make sure that they can safely have LASIK.  Although most people can have LASIK, some people cannot because their cornea (the front of the eye that is operated on) may be too thin or “warped” to have LASIK.  This must be detected before LASIK is performed in order to avoid any “surprises” after the operation.  Only a qualified eye surgeon can decide if a patient is able to have LASIK or not.

Glaucoma takes a few forms…open angle (the most common), normal tension glaucoma (a little less common) and closed angle (the least common).

Open angle glaucoma is a silent painless disease that will lead to loss of your side (peripheral) vision over years if it is not treated.  You can have this disease and not even know it.  That is why it is important to have your eyes examined even if they “feel” comfortable and you “feel” that your vision is fine.

Normal tension glaucoma is the same as open angle glaucoma but patients usually have a normal eye pressure.  Because of the normal pressure,  this problem may go unrecognized unless they are examined by someone who is familiar with normal tension glaucoma.

Closed angle glaucoma is a disease in which the drainage part of the eye is very narrow.   If the angle closes acutely (suddenly), the pressure in the eye becomes very high very quickly and causes a very painful attack of angle closure glaucoma. All patients who are seen in our clinic have their angle graded.  If a narrow angle is seen, patients will either be followed to see if the angle gets any narrower or will be scheduled for glaucoma laser surgery by our clinicians if the angle is too narrow to leave alone.

If you are diagnosed with eyes that are suspicious for glaucoma you will be followed by your eye care specialist with specific types of exams and tests.  As long as you are stable and do not show that you have lost any side (peripheral) vision you will be followed as a “glaucoma suspect” and will not be treated.

If during your exam it is clear that you have glaucoma, you will be treated with drops or laser to bring your pressure down.  You will be followed with exams and tests to make sure that your glaucoma does not progress.

Patients are usually given the option of treating their glaucoma with drops or a laser (selective laser trabeculoplasty).  The various options of drops and their side effects will be discussed in detail before beginning any treatment.  Some patients do not want or cannot put in eye drops.  These patients can be given the option of treating their glaucoma with a laser.  This procedure is performed by our ophthalmologists in a hospital setting

Patients who have their glaucoma diagnosed early enough, are properly treated and are followed closely, rarely lose significant vision.  In the event that your eye care clinician notices that despite adequate treatment you are losing your vision you will be directed towards more aggressive treatment methods.

The retina is the film at the back of the eye that receives the images as they come through the front of the eye.  The center of the retina is the macula, which allows us to see fine detail in the center of our vision (print, traffic signs, etc.).

Unfortunately, for various reasons, the macula can waste away (“atrophy”) – this is called “dry “macular degeneration.  Another way the macula is damaged is it may suddenly get lifted by bleeding or new blood vessels – this is called “wet” macular degeneration.   Once the macula is damaged by either of these two processes patients generally cannot read, drive or see things in the center of their vision.

If the macula “wastes away” (atrophies) or is disturbed by drusen (yellow spots in the macula), the degeneration is called “dry” macular degeneration.  A large study in the United States (AREDS) has guided us to prescribe certain vitamins to patients with dry macular degeneration to slow it down.

If the macula is lifted from its flat position to a dome like shape by bleeding or new blood vessels the process is called “wet” macular degeneration.  This may begin slowly or quickly.  Patients may notice distortion of their vision (straight lines appear crooked) or may suddenly lose the center of their vision.

If this occurs patients must be diagnosed quickly and directed to a retinal specialist who is familiar with treating “wet” macular degeneration.  This includes certain tests followed by injections with a treatment that is supposed to “dry up” the bleeding and new blood vessels.

Dry macular degeneration cannot be treated, but according to a larger American study called AREDS, we know that it can be slowed down by certain vitamin supplements.  These supplements will be prescribed by our clinicians if you are diagnosed with dry macular degeneration.

Wet macular degeneration can be treated in most cases by “anti-VEGF” eye injections by a qualified retina specialist.

In order to read, a number of things occur in your eye…basically your reading muscle (the ciliary body) contracts and this makes your lens change shape in order to focus on your task.  As you get older, your reading muscle and your lens get “stiffer” and less able to focus on small print. This natural age related process is called presbyopia.  Although it happens to everyone it happens at a different age and is more pronounced in different circumstances for each patient.

People that are born with “long” eyes have distant objects focused somewhere in the middle of their eye and the image appears blurry.  This is called myopia and usually stops getting worse sometime in the early 20’s.  However, as myopic people bring objects closer they are able to bring them into clear focus right onto the back of the eye – this is how the term “near-sighted” came into being.  In order to focus distant objects clearly patients with “long” eyes must wear glasses with a “myopic” prescription.  These patients can also wear contact lenses or have a laser procedure called LASIK to avoid wearing glasses.

People who are born with “short” eyes have distant objects focused somewhere behind their eye.  In order to see clearly the eye’s focusing muscle (the ciliary body) contracts and focuses a clear image onto the back of the eye. This is called hyperopia and usually allows people to see clearly for near and far until sometime in their late 30’s to early 40’s.  Then “suddenly” these patients with “great vision” can’t see at far or near because their focusing muscle (the ciliary body) isn’t able to work as well as when they were younger.  This can be corrected with glasses, contact lenses or in some cases with laser surgery (LASIK).  In addition, if someone with hyperopia has a cataract, a lens implant can be chosen to help the patient see well at distance without glasses after surgery.

Astigmatism is not a disease but is something you are born with.  It means that your eye is not shaped like a round golf ball but more like a football i.e. one part is round and one part is oval.  When you are looking at an object a blurry image is focused onto the back of the eye (“the retina”).  To avoid having a blurry image you can wear glasses or contact lenses or can have a laser procedure (LASIK).  If you are scheduled for cataract surgery there are astigmatism lenses that can be implanted to help you “get rid” of your glasses after surgery.

Some patients have inflammation of their eyelids and this results in the production of a thick secretion during sleep.  These patients wake up with eyelids that are crusty and “glued” shut.  The diagnosis causing this problem may be “blepharitis”.  Depending on the type of blepharitis, our eye care clinician will prescribe the correct treatment to prevent any permanent damage to your eyelids and cornea (the front of your eye).

If you work with a grinder or do anything that you suspect may have caused you to have a foreign body in your eye, you must seek the attention of an eye care specialist urgently.

If this is not the case and you feel the sensation of a foreign body in your eye then it is likely that you have dry eyes.  There are several causes and treatments for the sensation and diagnoses of dry eyes.  Our eye care clinicians will analyze your eyelids, tears and cornea (the front of your eye that gives the feeling of dry eyes) and prescribe the treatment that will be most effective for you.

Corneas (the front of your eye) are supposed to be almost perfectly round so that any light or image that enters the eye is clearly focused.  Some patients can only see clearly if they wear special contact lenses or have a corneal transplant.  Recently, a treatment called corneal cross-linking has been shown to slow down this process.  Dr. Cheema, a cornea specialist, can analyze the corneas of patients to see if they are able to have this treatment.

Seeing new floaters in your vision is quite common and may happen after trauma or by chance.  Because it may be a symptom that the retina has torn or is detached, it requires relatively quick analysis.  This is performed by dilating a patient’s pupils with drops and looking in all areas of the retina.

We are all born with a large “balloon” of firm, clear gel that fills our eye.  With age this gel becomes more liquid and suddenly collapses.  When this happens “floaters” or a single floater (some people say it looks like a fly) are seen. Sometimes the floaters are accompanied by “flashes” of light with eye movement.  This process is called a posterior vitreous detachment.  Although it is usually benign, sometimes it is linked to a tear or detachment of the retina.  This must be diagnosed by a dilated retina exam and treated quite quickly.