It's completely understandable to be terrified before cataract surgery. That’s a very normal reaction. Anything unfamiliar to us can give us stress and anxiety. Add to that that the unfamiliar thing is an operation on the eyes!
One of the biggest ways cataract surgery can be scary is not knowing what to expect. What you will see, what you will experience, even what meds you will get to reduce your stress and anxiety. So what is a good way to reduce your anxiety and stress before cataract surgery? Knowledge. Understanding what it’s like to go through the procedure.
Knowing exactly what to expect ahead of time can help keep you calmer.
Awaiting The Procedure
Cataract surgery is frequently performed in a surgery center. It is a quick procedure with a quick recovery and so afterwards you'll go home to rest.
So when you show up at the surgery center, the goals are primarily to 1. prepare the eye for surgery and 2. make you feel more comfortable.
To remove the cataract, the eye must be dilated. So, before cataract surgery begins, eye drops are added to the eye. These eye drops aren't all too different from the eye drops you’ve already gotten in the clinic at a previous date. Because some eye drops can burn when placed in the eye, a numbing eye drop is typically added to make the eye drops more comfortable (but this numbing eye drop will burn first before numbing the eye).
Keeping calm
As you wait there waiting for the eye to dilate and for the surgeon to be ready for you, your stress will more than likely increase.
To help keep relaxed:
- Take deep breaths or meditate
- Keep your eyes closed (as an extra benefit, this helps keep the eyes from drying out before the procedure)
- If you are cold, ask for some additional blankets
- Wear loose comfortable clothing for the day
- Ask if you can listen to music ahead of time
- Take a relaxing sedative medication
Of course, an easy way to relax immediately before cataract surgery is to take a medication such as Valium that relaxes you. In fact, your surgeon may have already have this medication ordered for you. But if not, ask your surgeon ahead of time about taking this medication while awaiting surgery.
Valium (generic name diazepam) falls into a class of sedative medications called benzodiazepines and is a common pill used before cataract surgery. In fact, just taking a Valium can be all the sedative needed or desired for cataract surgery.
As with most pills, Valium can take some time for it to take full effect and thus is best used at least 30 minutes before the procedure. In some cases, the pill can be a little more challenging to get the perfect dose. Some may require a higher dose than others to get a full effect (especially if you regularly take a benzodiazepine such as Xanax to help treat anxiety). Let your surgeon know if you think you may need a higher dose.
Just Before The Start
After the eye is dilated, it will be your time to have the cataracts removed. Usually, you won't need to get up and move, the same bed that you are lying in will be wheeled to the operating room.
There are a few things that happen first before the procedure starts:
- You will laid down completely flat. In addition, it is also common that your chin will need to be elevated higher, tilting your head back. This is all with the goal to align the eye as flat and level as possible. But it can be a slightly awkward position.
- The operating room nurse will clean the skin and eyelids around the eye.
- The operating room scrub technician will then place a drape over the face and eyelids to create a sterile clean area and to keep the eyelashes out of the way. Having a covering over your face can be stressful, especially if you have claustrophobia. To help, the anesthesiologist frequently gives you extra oxygen through your nose to help with your breathing.
- Finally, an eyelid holder is placed underneath the eyelids. This eyelid holder expands to keep the eyelids out of the way during the procedure. Thus, you don't need to worry about blinking during cataract surgery. But if you have tight eyelids, you WILL have some stretching discomfort from this eyelid holder. And if you squeeze back, you will have a lot more discomfort. So at this point, its important to keep your eyes open, blink naturally and act like nothing is underneath the eyelids.
IV Sedative Meds
When you become situated in the operating room, it is very common with cataract surgery to receive IV meds to make you more relaxed and calm. And just like with the pills that can be taken before cataract surgery, another benzodiazepine is very commonly used. This one is called Versed (generic name midazolam).
Versed works much quicker than Valium (as does most IV medications). It will only take a few minutes for it to take effect. In addition to reducing anxiety, Versed may often cause you to forget parts if not all of the procedure.
Sometimes another medication, Fentanyl, is given in combination with the Valium to help reduce pain. But isn't absolutely necessary as we'll see coming up.
But despite the sedative medication, whether you received the pills, through IV or both, its important to note that you will still be awake during cataract surgery - just more sedated. This means that you will see and experience some weird things.
During Cataract Surgery
You are awake during cataract surgery. This allows you to follow the surgeon's commands, this also allows you to focus on keeping your eyes still looking at the lights above you.
Being awake wouldn't be possible if cataract surgery was painful. But thankfully, it's not. And in fact, control of pain comes from something as simple as those numbing eye drops.
What you feel
Most of the pain receptors we have on the eye are on the cornea itself. Numbing anesthetic eye drops are very effective at blocking those pain receptors.
Inside the eye, there aren't as many pain receptors. But commonly, surgeons will also add more lidocaine anesthetic inside the eye to block those pain receptors as well.
Thus, between the eye drops and additional lidocaine in the eye, pain is controlled very well during cataract surgery.
But this does not mean that ALL sensation is gone. There are other things the eye can feel.
During cataract surgery, the pressure of the eye is controlled. However, this pressure can fluctuate at different points during the procedure. This change in pressure can be uncomfortable to some (especially those that are highly nearsighted).
Another thing that can be felt is changes in temperature. This often comes from cool water used to wash the cornea and keep it from drying out during cataract surgery.
It's just important to going into cataract surgery expecting to feel some strange things.
What you see
But in addition to feeling some weird things, you of course will be seeing some weird things. These visual sensations are one of the larger causes of anxiety before cataract surgery and understanding what you'll see helps reduce this stress.
The first thing you will see are the bright lights on the microscope. The brightness of these lights can at first seem uncomfortable. Gradually, as the procedure continues, the eyes adjust more to these lights. These lights will become more blurry and are commonly described as marshmallows in the sky.
Looking up at the microscope lights during cataract surgery
You won't be able to really see clearly exactly what is happening. Instead, what you make out are blurry shapes and objects that approach the eye. The eye just can't focus on things that are so close to it. In addition, as the pressure inside the changes, this can cause your vision to fade in and out as well.
But the real craziness happens when that cataract is removed. Before the cataract was a cataract, it was the natural lens inside the eye focusing light on the retina. It's when this lens gets cloudy, that it becomes a cataract.
But when removing the cataract, this lens still acts like a lens. But instead of focusing light on the retina, when it is being removed, it focuses light everywhere. In addition, it can work like a prism scattering light into different colors. As a result, when the cataract is removed, you see a kaleidoscope of lights and colors. It ends up being a bizarre light show.
Also check out Exactly What Do You See During Cataract Surgery for a full description
What you do
During this whole experience, your main goal during cataract surgery is to continue looking up towards the microscope. This ensures that the cataract surgery goes as quickly and as smoothly as possible.
Not to worry, however, the whole success of the procedure doesn't completely depend on your ability to look straight ahead, the surgeon also will have some control of the movement of the eye during cataract surgery.
But the main goals are to avoid sudden movement:
- Moving your body, head, even feet or legs can cause large movements in the position of the eyes. It's important to get in a comfortable position at the beginning to make sure you won't squirm to get comfortable during the procedure.
- Staying awake is preferred during cataract surgery. Falling asleep and waking up suddenly can cause sudden movements.
- If you feel a cough or sneeze coming on, be sure to let your surgeon know so that they can pause until the cough or sneeze passes. (It is generally ok to talk during cataract surgery since that can be done with minimal movement of the head and eyes).
So the best thing is to just lie back and enjoy the whole show.
Additional Note About The Second Eye Surgery
After you've gotten through one cataract surgery and realize that it isn't so difficult, it is common to go into the second eye surgery a little more relaxed.
Paradoxically, however, it can make the second eye surgery seem more stressful or painful.
Being stressed going into the first surgery is normal. And while you see and experience weird things, it doesn't match up to the expectation built up in the mind. (and forgetting things from the Versed also helps you recall it being very easy to go through).
So going into the second eye, you expect things to be easy. But you start noticing things more and experiencing things you don't remember from the first surgery. And even though it could be the same or even easier than the first eye, it isn't what you “expect" and can make you more stressed during the second eye surgery.
Knowing this ahead of time helps to mentally prepare you for this unusual phenomenon.
Summary
Cataract surgery is stressful for everyone, and it isn't unusual to be terrified of getting it done. But what can help is learning ahead of time what you will experience and see during it all. Preparing for it ahead of time can allow you to be more calm and relaxed during the procedure (and of course, the sedative medications will help as well).
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