I performed my first cataract surgery in 1973, while a resident in training at the Medical College of Virginia.  The patient was admitted to the hospital on the evening prior to the day of surgery.  The surgery took about an hour and the patient was returned to the hospital bed.  On the patient’s second hospital day, she inhaled an orange peel and had a respiratory arrest which resulted in  brain damage.  It was my belief that had she been at home in familiar surroundings that this never would have occurred. 

As chief resident in Virginia, I began a crusade to shorten the length of hospital stay for cataract surgery.  The best that I could do was to reduce it to two days.  From Virginia, I moved on to Bascom Palmer Eye Institute.  In the mid-seventies the same policy was adhered to; in-patient hospitalization for cataract surgery.  I was able to get folks home on the day following surgery but still not good enough.  Ultimately, I went into private practice at the old Victoria Hospital.  This was the infancy of the HMO movement in Miami.  One of my early patients was in AvMed HMO and on the first day following cataract surgery I got a phone call from the president of the HMO advising me that it would be a good idea to discharge the patient that day.  That was the incentive that I needed and I sent the patient home on day one much to the chagrin of my colleagues.

Fast forward to this week.  I operated ten cataract patients at Miami Eye Center which does not even have a postoperative bed in which to put patients; there are lounge chairs.  The surgery takes ten minutes, there are no preoperative shots, no stitches, no patches and the patient is on his/her way home after a fifteen minute recovery.  How is all this possible?  In 1973, I was operating with magnifying glasses to see the surgery.  The wound was 3cm and it was closed with silk suture.  The entire cataract was frozen (intracapsular cataract surgery) and removed in a large piece through this large wound.  Occasionally the sutures broke and the wound opened leading to serious complications.  In general, the trauma to the eye left it quite inflamed.  Today the surgery is performed with the aid of an operating microscope which allows for microscopic management of the details of the surgery.  The wound is 2.6mm long and no stitches are necessary.  The cataract is removed via this tiny bloodless incision by breaking the lens into a soupy material and aspirating from the eye (phacoemulsification).  The wound is secure so folks can become quite active on the next day.  Very sophisticated antibiotics and anti-inflammatory drugs reduce inflammation to the point that patients rarely feel any discomfort.  And most importantly, patients have the opportunity to come away from the surgery with little or no need for eyeglasses.

If you are in need of cataract surgery, step up to the twenty-first century advances.  The experience will amaze you.