Cataract and Glaucoma Surgery: What to Expect

An Interview with Dr. Smits
Dr. Smits, who specializes in glaucoma and cataract diagnosis, treatment and surgery at Cheyenne Eye Clinic & Surgery Center, was drawn to ophthalmology in medical school after sitting in on cataract surgery and witnessing how quickly an ophthalmologist can improve someone’s vision – and their life!

What’s the difference between treating cataracts and treating glaucoma? Are you a good candidate for surgical treatment? Here’s how Dr. Smits explains it.

When would a patient come to see you at the Clinic?
Most referrals to me are cataract, glaucoma or medical retina. Dr. Miller and I both do cataract and glaucoma surgery.

 How do you determine whether a patient is a good candidate for cataract or glaucoma surgery at the Cheyenne Eye Clinic?
Cataracts and glaucoma are very different. Cataract surgery is really a fixing of vision loss and it’s an elective procedure 99% of the time, so I treat cataracts when they’re affecting someone’s day-to-day life and activities. They’re having trouble doing something that they like to do, whether it be to drive, or read, or crochet or whatever they do. If they have trouble doing that on a day-to-day basis and I think it’s due to a cataract, those are the people that may benefit from cataract surgery.

Glaucoma’s a little different. It’s a chronic disease and often that chronic disease needs treatment to help slow down or halt progression. It’s not typically to improve vision, but rather to prevent vision loss.

If a patient is going to have cataract surgery, what can they expect the surgery to be like, and the recovery to be like?
The surgery is quick – it’s an outpatient surgery. The patient comes into the Surgery Center the day of, they don’t go under general anesthesia so they’re awake, but we give them numbing medicine around the eye so they’re comfortable. The surgery itself is quick, anywhere from 10-30 minutes depending on how difficult the cataract is, and they’ll go home the same day and put a patch on the eye.

Generally, the recovery period is pretty quick, usually about a week to be nearly fully healed, but people can pretty much get back to their daily life over the first week, other than not doing any heavy lifting or rubbing of the eye. Certainly seeing the TV or reading or using their eyes they can do the first day. Usually there’s a little inflammation, but it’s a quick recovery; usually over the first week patients report things are pretty much fully recovered.

Is glaucoma surgery about the same, or is it different?
The range of surgeries with glaucoma can go from very mild, just doing a laser procedure in the eye and you have no restrictions, to combining a small procedure with cataract surgery where there are the same restrictions as cataract surgery, to larger procedures for very advanced glaucoma that have quite a bit of follow up and  more recovery time. So it’s a very wide spectrum.

You also specialize in and perform minimally invasive glaucoma surgery. Who might be eligible for the minimally invasive glaucoma surgery?
People with mild to moderate glaucoma are good candidates for minimally invasive surgery, especially if they plan to have cataract surgery in the near future. If you have glaucoma and you have a cataract, it’s a scenario of killing two birds with one stone. You get two times the benefit because while we’re taking the cataract out, we can better treat glaucoma at the same time by doing procedures that have minimal additional risk.

What led you to specialize in cataracts and glaucoma?
Cataract surgery is such an elegant procedure, the most elegant procedure in probably all of medicine. It’s very quick, it’s very effective, with overall very good outcomes. Cataract surgery is why I went into ophthalmology.

I specialized in glaucoma partly because it’s a field that is quickly expanding and it’s a chronic disease, so you get to know your patients. We have better treatments for glaucoma today, but it hasn’t been completely figured out yet. There are a lot of things coming in the future that I think are going to be interesting.

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