Does cataract surgery need a referral for blue cross and blue shield patients?

What tools are used to take out a cataract?

First, an incision is made in the eye. These incisions used to be quite large (at least by today's standards). You may even know people who had surgery over thirty years ago who had to stay in bed for weeks with sandbags on their eyes in order to keep these large incisions closed. Today, however, the incision is often less than three millimeters wide. That's about twice the thickness of a standard door key. The incision is so small that a suture might not even be necessary for the eye to heal. Once an incision is made in the eye, a clear gel (called a viscoelastic or viscosurgical device) is injected into the eye. This gel protects the cornea from the ultrasound energy and keeps the eye pressurized during surgery. For many surgeons, the most challenging part of cataract surgery comes next: creating a small round opening in the membrane that holds the cataract in place. This membrane is called the capsular bag. As membranes go, this one is pretty thin: somewhere between five and fifteen millionths of a meter thick (that's about 0.0004 inches thick). Hard to imagine? Well, it's hard to see. Not only is it at the limits of what the human eye can discern, it's also transparent! Other things that are about this size include individual particles of fog, a large spec of household dust, or a small spec of pollen. Amazingly, most experienced cataract surgeons are able to successfully create a round continuous opening in this delicate, transparent membrane. Occasionally, the capsule does tear. If this happens, your surgery may take longer to complete but most people still do very well. Once the opening in the capsule has been created, the cataract (or natural lens of the eye) is removed using an ultrasound probe. Essentially, the cataract is broken into small pieces (emulsified) and then removed (aspirated) from the eye. Once the natural lens is removed, the capsular bag is polished and some additional protective viscoelastic gel is placed in the eye. Now that the cataract is gone, the eye is ready for placement of the intraocular lens (IOL). The IOL is most often folded, placed through the incision, and unfolded in the capsular bag - just where your old lens (the cataract) used to be. Occasionally the IOL will have to be placed in front of the capsular bag or iris. Sometimes it is even necessary to sew it in. After the IOL is placed in the eye, the protective gel is removed, If necessary, a suture is placed at this point to seal the incision. "Sutureless," or "No Stitch" surgery has been a big selling point in the advertisements and marketing materials of many cataract surgeons. The obvious implication is that having a suture is somehow inferior to surgery without a suture. Although the majority of my cataract surgeries are done without the use of a suture, it is important to note that sometimes a suture is a good idea. Don't be drawn in by glitzy advertisements. What is important is that you get the best possible surgery for your eye. Not everyone is a good candidate for sutureless cataract surgery. Once surgery is complete, the eye may be covered with a protective shield to be worn overnight. The entire process (from the time you enter the operating room until a shield is placed over the eye) is often less than an hour. Sincerely, David Richardson, M.D. Medical Director San Gabriel Valley Eye Associates, Inc. Website: http://www.sgveye.com/ Blog: http://www.about-eyes.com/ Cataract Audio CD: http://www.cdbaby.com/cd/DavidDRichardsonMD San Gabriel Office: 207 S. Santa Anita St., Suite P-25 San Gabriel, CA 91776 (626) 289-7856 Pasadena Office: 800 E. Colorado Blvd. Suite 450 Pasadena, CA 91101 (626) 289-2223