Pre-Operative Appointments:

1.  Pre-operative eye exam with surgeon

2.  Intraocular lens measurement and power calculation

Soft contact lenses must be removed one week prior to appointment. Hard contact lenses must be removed two weeks prior to appointment. Contact lens wear may change the results of the implant power measurement.

3.  Physical exam, lab work & EKG with your Primary Care doctor

Schedule this appointment with your primary physician. Your physical exam and lab work needs to be completed within thirty days of surgery.

Transportation Arrangements

Arrange transportation to and from the surgery clinic for the day of surgery and the day after surgery. Please be flexible, it may be necessary to adjust your arrival times.

 Leading up to Surgery Appointment:

two weeks before surgery

DISCONTINUE: certain Glaucoma Drops: (FOR THOSE WITH GLAUCOMA) Pilocarpine, Isoptocarpine, Pilogel or Carbachol in the SURGERY eye only.

Male patients taking FLOMAX® (tamsulosin) for urinary frequency MAY BE ASKED TO STOP PRE-OPERATIVELY. You MUST report using FLOMAX® to your surgeon. Special measures will be necessary to compensate for ocular effects of Flomax® If your surgeon asks you to stop 2 weeks pre-operatively, that may be helpful. If you can’t reasonably do without it, inform your surgeon and special measures will be taken to compensate. Surprisingly, this usually causes little distress from urinary symptoms. Patients taking Flomax® generally do quite well with surgery as long as the doctor is aware of it beforehand.

Click here for MORE INFORMATION on Flomax. If stopping causes intolerable side effects, please call to notify us and resume the medication.

Continue: all other glaucoma drops should be continued.

COUMADIN is usually continued, unless your INR test result is more than 3.0.

    The INR should be checked before surgery. Consult your primary care physician.

Three Days Before Surgery

Begin using your pre-op eye drops four times a day in your operative eye, at mealtimes and at bedtime.

Zymar (antibiotic) use just one drop in your operative eye four times a day.

Acular (anti-inflammatory) use just one drop in your operative eye four times a day.

Remember: You only need one eye drop from each bottle (more is not harmful at a single time), in any order that you like. It doesn’t matter which bottle of eye drops you use first. It is important that you wait five minutes between each eye drop, so that the medicine has a chance to be absorbed before the next drop comes along.

EVERYONE:

Wash your hair before surgery for hygiene. It won’t need washing, then, in the first day or two postoperatively.

The Day of Surgery

DIABETICS:

If you are INSULIN-DEPENDENT your surgery will be scheduled early. DO NOT TAKE YOUR MORNING INSULIN; instead, bring your insulin to surgery for administration after surgery.

EVERYONE:

No solid food for 6 hours prior to your surgery.

No thick liquids after midnight (Milk, cream, orange juice, prune juice.)

Up to 2 hours before surgery, we encourage you to drink clear liquids (coffee, tea, apple juice, water, soft drinks or meat broth.) Sugar in your coffee and tea is okay, but no milk products.

You Must Take usual morning medications, except for Insulin and other diabetic medication, prior to arrival at the surgery center. (Heart, High Blood Pressure, Chronic Pain, Seizure, or Tremors) Take with a sip of water only.

Put your pre-op eye drops your surgery eye.

Completely and thoroughly remove all face makeup. (This includes all types of oils, lotions, sunscreen, facial moisturizer, liquid foundation, powder, eyeliner, mascara, eyebrow pencil, and eye shadow. Lipstick is okay!)

Please remove all of your jewelry and leave it at home. (Wedding bands and small earrings are okay.)

Wear comfortable clothing. Please wear shirts or blouses that button or zip up the front. Long sleeves are okay as long as the fabric is lightweight.

Checklist for the DAY OF SURGERY

        I installed my surgery eye drops (Zymar and Acular) in surgery eye.

I took usual morning blood pressure, heart, seizure, chronic pain or tremor medications with a sip of water. (If you are treated for these conditions)

I have no cream, lotion or makeup on my face. (Lipstick is okay)

 I removed my jewelry and left it home.

 I have not eaten any food since midnight.

 I did not drink any clear liquids for four hours before my surgery.

 I am wearing a lightweight blouse or shirt with a zipper or buttons down the front.

 I have arranged transportation to and from surgery today, and also tomorrow for my post-op appointment.

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Surgery day at Marin Ophthalmic Surgery Center

Our Surgery Center is located across the hall from our clinic in room 260. Please ring the doorbell at room 260 when you arrive.

The nurse will provide you with a cap to wear over your hair and a gown to be worn over your clothing.

You will be assisted to a comfortable reclining chair where you will rest. An anesthetic eye drop will be administered followed by dilating gel.

Your general health is monitored, and an anesthesiologist will start your IV and administer appropriate sedation.

Sedation and topical or local anesthesia will be given to ensure your comfort before, during and after surgery.

After your surgery you will be offered something to eat and drink. Your IV will be discontinued and the nurse will review your post-op instructions with you. This is a good opportunity to get any questions answered that you might have.

You will need someone to drive you home after surgery. Plan on spending approximately two hours at the Surgery Center.

After Surgery:

Take it easy.

Watch TV, if you like. You may read if it doesn’t cause any discomfort.

Resume your normal diet.

Do not strain to lift, don't rub your eye.

Take 1-2 Tylenol tablets every 4-6 hours if needed for mild discomfort. Call if that is insufficient.

Blurry vision, tearing and a sandy feeling are common the first day after surgery. Close your eyes to rest them if this occurs.

For serious discomfort

Call (415) 454-5565 at any time.

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Permitted Activity Week by Week

The day after surgery

 1.  Please have someone drive you, to your appointment.

 2. Please bring your eye drops with you to your appointment.

 3. Instructions will be given to you regarding your medications.

One-day Postoperative visit

All patients must be seen the day after surgery by your surgeon or  one of his associates. This must be incorporated into your schedule and transportation plans. Someone else should drive. The eye will be examined and instructions reviewed.

Bring all medications, instruction sheets and supplies to every post-operative visit.

During the first week

Avoid getting soap in your eye.

Avoid creams lotions and make-up around the operated eye.

Wear eye glass protection, especially outdoors.

Use moderation in your activities:

Walking, running and golf are OK.

Wash your hands carefully and avoid touching or rubbing your ere.

Do not swim, lift weights or engage in contact sports, including tennis and racquetball.

 During the second week

Don’t engage in activities risking direct impact to your eye. Still no weight lifting, aerobics are OK. Wash your hands carefully and avoid touching or rubbing your ere.

Wearing eye make-up is okay.

There may be some redness, itching, mild discomfort or bruising around the eye. These  sensations will decrease and your vision will improve progressively.

2-Week Postoperative visit

We plan to give you a new prescription for glasses. You may wish to fill this prescription at our Optical Gallery.                         

Ask your physician whether there are any continuing activity limitations.

6 Week Postoperative Visit

Our Optometrist will recheck your vision and if there are any problems refer you to your surgeon.

At Any Time: Call the office IMMEDIATELY, (415) 454-5565, if you have:

Pain unrelieved by Tylenol.

Persistent irritation.

Increased redness or discharge.

Worsening vision.

Spots or flashes in your vision.

Any sensations or worries that concern you.

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COMMON QUESTIONS (with answers!)

Questions for before surgery

Medication Questions

HOW DO I TAKE MY PRE-OP EYE MEDICATIONS?

Antibiotic (Zymar) and anti-inflammation (Acular) drops are used by most patients beginning three days prior to surgery. Drops are taken four times each day. Wait 5 minutes between drops.

CAN I WEAR EYE MAKEUP BEFORE SURGERY

Eye make-up can contain particles and bacteria (particularly eyeliner and mascara) so we stop them three days prior to surgery and  week after.

IF I AM USING EYE MEDICATIONS IN MY EYE TO BE OPERATED ON, DO I STOP TAKING THEM?

Continue all eye medications through the day before your surgery. Do not use eye medications in the eye to be operated on the day of surgery. Eye drops for the fellow eye should be continued as usual.

CAN TAKE ASPIRIN (or Plavix) BEFORE AND AFTER MY SURGERY?

Modern cataract surgery rarely causes any bleeding. Topical anesthesia removes the risk of bleeding behind the eye from local anesthetic injections. So, continue your aspirin unless you are specifically instructed to stop.

(Patients who will be having glaucoma surgery please do stop aspirin 10 days ahead of time. Glaucoma surgery is often better performed under local anesthetic, and the nature of the incision does result in some bleeding during surgery. Inform your primary care doctor if you do this. Also, if you are on coumadin you will be asked to stop 3-7 days ahead, and this you must discuss with your primary care physician.) Ask your surgeon when you can restart.

DO I NEED TO STOP COUMADIN (WARFARIN) BEFORE MY SURGERY?

Coumadin does not generally need to be stopped prior to cataract surgery. Patients ALSO having glaucoma surgery may need to stop several days ahead, please ask your surgeon and inform your primary care doctor.

NOTE: PATIENTS SCHEDULED FOR CATARACT SURGERY combined with GLAUCOMA SURGERY

Patients who will be having glaucoma surgery please stop aspirin 10 days ahead of time. Glaucoma surgery is often better performed under local anesthetic, and the nature of the incision does result in some bleeding during surgery. Inform your primary care doctor if you do this. Also, if you are on coumadin you will be asked to stop 3-7 days ahead, and this you must discuss with your primary care physician. Ask your surgeon when you can restart.

IF I AM TAKING ORAL MEDICATIONS FOR ANYTHING OTHER THAN MY EYES, DO I NEED TO STOP THEM PRIOR TO SURGERY?

Use of most medications can be continued preoperatively. Ask our staff or your doctor.

An exception is male patients taking FLOMAX® (tamsulosin) for urinary frequency. You MUST report using this to your surgeon. Special measures will be necessary to compensate for ocular effects of Flomax® If your surgeon asks you to stop 2 weeks pre-operatively, that may be helpful. If you can’t reasonably do without it, inform your surgeon and special measures will be taken to compensate. Surprisingly, this usually causes little distress from urinary symptoms. The complications that FLOMAX can cause with cataract surgery were discovered at Marin Ophthalmic Surgery Center by Dr. John Campbell and staff.

DO I TAKE MY PILLS ON THE MORNING OF SURGERY? HOW?

Yes. Take all your usual medications the morning of surgery with a sip of water.

Can I eat or drink before surgery?

We encourage you to take clear liquids, NO MILK up until 2 hours before surgery. We want you to be well hydrated when you arrive for your surgery.

YOU CAN EAT AND TAKE MILK up until 6 hours before surgery. NO FOOD OR MILK AFTER THAT!

DO I TAKE MY INSULIN?

Your medical doctor should direct insulin dosage. We’ll try to schedule you early so you can take your insulin with a snack right after surgery.

CAN I WEAR MY CONTACT LENSES RIGHT UP TO SURGERY DAY?

Depending on what kind of contacts you wear, you will need to go without them prior to the Intraocular Lens power measurements. Contact lenses distort the cornea, and might cause a "surprise" result from our IOL power calculations. You will receive specific instructions on this.

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Questions About Day of Surgery

HOW LONG WILL I BE AT THE SURGERY CENTER THE DAY OF MY SURGERY?

Even though your operation itself usually takes less than 20 minutes, you should plan to spend 2 hours at the Surgery Center. Preparation and post-operative observation and instruction take time. We are committed to providing the finest surgical care.

WHAT CAN I DO WHEN I GO HOME AFTERWARD?

Take it easy, rest and don’t plan on doing any important paperwork or making any decisions. You’ll probably feel like taking a nap at some point.

ON THE DAY OF SURGERY, WHAT SHOULD I WEAR?

Wear a loose shirt or a shirt that buttons in front. Do not wear jewelry.

WILL SURGERY HURT?

That would be unusual. Most patients are surprised when we tell them “Your surgery is over!” You are typically very relaxed from the sedation we use and may even doze during the operation.

WILL I BE AWAKE DURING SURGERY?

You may doze off, but many of our patients are awake and very relaxed for the surgery.  Most times, patients recall very little from the actual surgery itself.  The effects from the anesthesia are the reason why you must have somebody to drive you home from the surgery.

HOW DO I KEEP FROM BLINKING DURING THE SURGERY?

We will gently prop your eyelids open for surgery.  If you are awake, your only task is to relax. That will be easy, we'll be giving you a very pleasant relaxing medication just before surgery.

DO I SEE MY SURGERY?

No, all you will see (if you happen to be awake at any point) is a beautiful, random swirl of colors.

WILL IT HURT AFTERWARD?

While there is sometimes minor pain after surgery, plain Tylenol nearly always relieves it. If this is ineffective, call our office. It is very common to have some "sandy" or "scratchy" feelings mostly the first day and decreasing thereafter.

WILL I GET STITCHES?

Usually no. The vast majority of cataract surgery at MarinEyes is accomplished with such a small incision that stitches are unnecessary. Just the same, your surgeon will use stitches if he believes it is indicated.

IS IT LASER SURGERY?

No. Lasers have not gained widespread acceptance for this use. Cataract surgery uses ultrasound (sound waves) – the current standard in cataract surgical technology - to soften the cataract so it can be vacuumed out through a very small incision. The use of sound waves to soften and remove a cataract is called phacoemulsification.

A laser may be used months or years after cataract surgery for a different purpose. In about 5-15% of patients who have had cataract surgery, a thin film of cloudy tissue develops behind the lens implant. The vision clouds and progressively blurs, causing symptoms very like those of the cataract! Because the symptoms are like the cataract symptoms you had before surgery, this is called "Secondary Cataract." This blurring can be corrected with a simple and painless laser procedure called YAG laser Capsulotomy.

WHO ADMINISTERS ANESTHESIA?

For most "Routine" cataract surgeries, board-certified anesthesiologists supervise your anesthesia. For some surgeries, your surgeon and his nurse administer "Conscious Sedation," along with topical or local anesthetics. It would be unusual for the surgery to hurt. Most patients are surprised when we tell them “Your surgery is over!” You are typically very relaxed from the sedation we use and may even doze during the operation.

WHAT IF I COUGH?

If you have chronic respiratory problems, bring your usual medications and inhalers. We can give cough suppressants if we need to. If you have a "cold," and are coughing, call and let us reschedule your surgery!

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Post-operative care Questions

HOW DO I TAKE MY POST-OP EYE MEDICATIONS?

You will receive specific written instructions on the day of surgery, as well as samples, medication prescriptions and a post-op kit.

SHOULD THE DROPS STING?

Ideally, no, but they often do! Acular is the most common cause of irritation.  We currently prescribe the “less stinging” form of Acular, called "Acular LS." The initial discomfort will diminish rapidly after the first day.  The drops will sting momentarily after you have put them in the eye. After the first day, if it gets wors again please call and we will evaluate the situation.

IS IT NORMAL FOR MY EYES TO FEELS SCRATCHY AFTER SURGERY?

Expect this the first day, diminishing thereafter. Artificial tears can be soothing. Use them as often as you like.

WILL I BE WEARING A PATCH AFTER SURGERY?

Generally, no. Most patients do not require an eye patch after surgery.

WHY DO I SEE HALOES THE FIRST FEW DAYS AFTER SURGERY?

The best lens implants today have special edge treatments to reduce the chance of "Secondary Cataract" formation. This edge often produces a halo effect or arc of light in the peripheral vision for a few days after surgery. For some patients the symptom takes longer (weeks) to resolve, but rarely is a permanent serious problem. Occasionally, under particular lighting conditions, glare may be noticeable permanently but this is rarely bothersome to the patient. Proper corrective glasses with anti-reflective coating are helpful.

HOW SOON WILL I SEE AFTER SURGERY?

Vision on the day of surgery is quite variable from one eye to the next, even for the same patient. It is usually blurry in all patients on and off during the first day. You usually experience your best vision after cataract surgery 3-4 weeks post-operatively. Glaucoma surgery patients need longer healing time before returning to maximum vision.

WILL I NEED GLASSES AFTER SURGERY?

Many of our patients see very well and function well without glasses. However, all patients must be prepared to wear glasses for optimal vision. Visual needs vary greatly among patients. As a result, our surgeons personalize your surgery and strive for the best surgical result to meet your needs and requirements. More detailed information is available. If there is a large difference between the glasses required before surgery and the desired goal of your surgery, you may be inconvenienced for the two weeks between the first and second eye surgery because it is hard to please both eyes with very different eyeglass prescriptions. The problem will be resolved when the second eye is done.

WHEN CAN I RETURN TO WORK?

This varies among patients. Many patients return to work the following day, although we often recommend the patient take a day off.  Please ask your surgeon or his associate on the day following your surgery for recommendations.

WHAT TYPE OF PHYSICAL ACTIVITY AM I ALLOWED TO DO FOLLOWING MY SURGERY?

WHEN CAN I RESUME MY NORMAL ACTIVITIES?

WHEN CAN I DRIVE AFTER MY SURGERY?

Be prepared to have someone else drive if your vision is not sufficiently clear to drive safely and confidently! If your vision is good the morning after surgery, you may drive that day. Use good judgment, and if you have any question don't drive!

HOW SOON CAN I GO TO THE MOUNTAINS OR RIDE IN AN AIRPLANE?

High altitude and air travel pose no problems after cataract or glaucoma surgery.

IF I STOPPED COUMADIN, WHEN DO I RESUME IT AFTER SURGERY?

If coumadin is stopped preoperatively, ask your surgeon when to restart.

IF I STOPPED ASPIRIN OR PLAVIX, WHEN DO I RESUME IT AFTER SURGERY?

Ask your surgeon when to restart.

HOW SOON CAN I WEAR MAKEUP?

For the first week, keep makeup away from the eyelid margin. Lipstick, eyebrow pencil, etc are OK. Powders and foundations often make their way into the eye, as does eyeliner and mascara and should not be used until the second week. After that makeup is OK.

For any problems

Call (415) 454-5565 at any time.

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