"No Needle, No Stitch, No Patch" Cataract Surgery

Cataracts are not a disease, but rather are a part of the normal aging process.  In fact, everyone has a cataract in both eyes by age 60.  A cataract means that the natural lens located inside the middle of the eye has become cloudy as compared to the crystal clear state in which it had been up to that point.  At about age 50-60 the lens begins to take on a yellowish discoloration, and this gradually progresses over the years to an orange color and then a darker amber color.  Sometimes, cataracts have a white color.

A cataract is not a growth; it is simply the natural lens that has become cloudy, thereby making it more difficult for the light rays to pass through the lens onto the retinal nerves in the back of the eye.  Early on cataracts do not effect the vision at all, but eventually a decrease in vision is noted either as a general blur or as problems with glare from lights noticed especially while driving at night.  When the cataract has advanced enough that the vision is significantly effected then it is time for it to be surgically removed.

Cataract surgery today has become amazingly safe and convenient for the patient.  Dr. Lipstock is one of the only surgeons in Central Virginia who routinely performs the most advanced form of cataract surgery known as “No-Needle, No-Stitch, No-patch" cataract surgery.

Almost every patient in Richmond undergoing cataract surgery today by a surgeon other than Dr. Lipstock is first put to sleep with intravenous medication for a few minutes in order to receive a painful shot with a needle injection of numbing medication.  It is injected into the socket behind the eye.  This way the entire ocular area including the eyelids is anesthetized.  After the surgery the eye droops open, thus it is closed and patched shut the first day.

With the “No-Needle, No-Stitch, No-Patch" technique only numbing drops are used to anesthetize the eye.  You are not put to sleep, no painful needle is administered around the eye, and at the end of the case you can sit up alert, not having been sedated heavily.  You will begin to see things right away out of the operated eye!!

The “No-Needle, No-Stitch, No-Patch" technique has certain distinct advantages.  Numbing drops are used instead of a needle.  A needle injection can be painful (the patient is heavily sedated for this injection so the pain is not felt), and can cause potential medical complications and possible damage to the eye.  Some of these complications, although rare, can be life threatening.  Such damage can include unsightly bruising, double vision, droopy eyelids, and even puncture of the eye itself with the needle that can cause severe loss of vision.  There can also be difficulty breathing and possible aspiration pneumonia.  It is because of these reasons that Dr. Lipstock has been performing the “No-Needle, No-Stitch, No-Patch” technique since 1995.

The Day of Surgery

On the day of surgery you will go to Stony Point Surgery Center.  You will receive dilating drops and numbing drops on the eye that will be having cataract surgery.  You will receive an I.V. line in your arm, and if the need arises we will administer a mild sedative through the I.V. line.  You will enter the operating room where you will see Dr. Lipstock and several nurses.  You will lie down on your back on a bed.  Dr. Lipstock will be seated at the head of the bed.  During surgery he will be seated looking at your eye through an operating microscope similar to the microscope with which your eyes have been examined in the exam room in our office.  In the office you rest your chin in the chin rest of the microscope and Dr. Lipstock looks across your eye; in the operating room Dr. Lipstock looks down at your eye as you lie under the microscope which is situated 6 inches above your eye.

First a sterile plastic drape will be placed over your face to keep the area sterile.  Then an opening in the plastic will be cut with scissors.  Next an eyelid opener will be placed between your eyelids so you won`t have to worry about blinking.  You won`t feel the need to blink since your eyes will be numb from the drops.  The eyelid holder looks like a paper clip with a little spring mechanism that gently keeps your eyelids open.

As you lie under the microscope, Dr. Lipstock, who will be explaining each step of the procedure, will tell you to look at the light of the microscope.  This will be easy to see, and it gives you something to look at during the surgery so your eye won`t be wandering around.  This is called microsurgery.  In other words, everything being done by the surgeon is viewed through the microscope.  The first thing Dr. Lipstock does is create a microscopic opening in the eye through which he places numbing medicine into the middle of the eye.  Now your eye is numbed both on the outside and the inside.  Then a microscopic probe is placed into the middle of the eye where the cloudy lens is located.  This is an ultrasonic probe; it creates sound waves that dissolve the lens away.  Next a tiny plastic lens called an “intraocular lens” or an “implant” is used.  This implant is made out of a soft plastic that is folded into a microscopic cartridge.  The folded implant is placed through the tiny opening in the eye. When it reaches the middle of the eye where it is supposed to go it unfolds, and in this way the opening of the eye remains microscopic.  The procedure at this point is finished.  It only takes about 10 to 15 minutes.

After surgery you will sit up and go down the hall into another room where you will be given post-operative instructions, which consist mostly of how to use the eye drops that the nurses at Stony Point Surgery Center will be giving you.  After surgery there are few restrictions, but it is important not to rub your eye or get germs in your eye.  It is normal to have a mild foreign body sensation the first 24 hours after surgery.  It is also normal for your vision to be somewhat blurry the first few days but that will get better and better over the first week.

Risks & Complications

Fortunately cataract surgery today is not only convenient, but it is also very safe.  Nevertheless it is not 100% safe.  It is however 97% successful.  Those are great odds.  From the negative standpoint that means that about 3 out of 100 patients can have some sort of problem.  Fortunately many of those problems can be treated and fixed either with eye drops or repeat surgery.  A complication that can`t be improved with treatment occurs less than 1% of the time.  But you already have a problem; your visual quality is decreased  from a cataract and it is going to continue getting worse as the cataract inevitably progresses.  It would be unrealistic to harp on the rare but possible complications when the vast majority of people do beautifully; and you should do beautifully as well.