Cataract Evaluation & Treatment - 05/07/21

Cataract Evaluation & Treatment

Table of Contents What is a Cataract?............................................................................................................. 4 Top 3 Cataract Myths........................................................................................................ 5 Who is at Risk for Cataracts?....................................................................................... 6 Cataract Surgery................................................................................................................... 7 Traditional Vs. Laser-Assisted Cataract Surgery.........................................10 Patient Testimonials......................................................................................................... 14 Types of Intraocular Lenses.......................................................................................16 Cataract Surgery Options........................................................................................... 20 What if I Delay My Cataract Surgery?.................................................................22 Can Cataracts Come Back?.......................................................................................23 What Happens at a Cataract Consultation?..................................................25 Preparing for Cataract Surgery............................................................................... 26 Where to Go on the Day of Your Surgery?......................................................27 Map of Campus.................................................................................................................. 28 Cataract Consultation Checklist............................................................................ 30 How Billing Works............................................................................................................. 31 Financing Options.............................................................................................................32 What to Expect After Surgery..................................................................................34 Patient Forms....................................................................................................................... 36 Glossary of Terms..............................................................................................................47 Our Locations........................................................................................................................ 51

Contact Us MEC Surgery Scheduling Phone: (678) 784-0235 Email: cataractquestions@mariettaeye.com Copyright 2021

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Hello! Thank you for trusting the Marietta Eye Clinic with your vision. Restoring eyesight with this amazing procedure is a primary focus of our practice. We have performed over 100,000 cataract surgeries and counting.

Our History The Marietta Eye Clinic was founded over 50 years ago in 1967.

Over the years, multiple branch offices were added to our original clinic near Kennestone hospital in Marietta. Throughout our history, you and your vision have been our focus. We are dedicated to providing the highest quality and most technologically advanced solutions for your eyes. We now have 10 office locations across metro Atlanta in Marietta, East Cobb, West Cobb, Acworth, Woodstock, Hiram, Douglasville, Canton, Roswell and on Windy Hill Road – and we’re still growing!

How to Use This Booklet Choosing to have cataract surgery is a big decision. This once-in-a-lifetime opportunity will determine how you see the world every day for the rest of your life. There are many things to consider. We created this guide to help you through the process of planning your cataract surgery.

We’ve included information that addresses common questions regarding cataract surgery. If you have additional questions, please don’t hesitate to reach out to us via email or phone at (678) 784-0235.

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What is a Cataract?

Your eye has a natural lens that bends, or refracts, light rays as they enter your eye. This refraction allows you to see clearly. When you’re young, your lens is clear. As you age, the lens becomes yellow, cloudy, and dense. This is a cataract.

With a cataract, your vision will become increasingly blurry, hazy, or less colorful. You may feel as if you’re looking through a dusty windshield. However, you may not notice much at all.

Many patients report after having cataract surgery that they simply forgot how clear and colorful the world truly is.

Symptoms of Cataracts • Cloudy or • Seeing halos blurry vision around lights • Seeing double • Seeing bright • Sensitivity to light colors as faded • Trouble seeing or yellow-tinted at night • Needing more • Difficulty reading light to read in dim lighting

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• Less enjoyment with recreational activities like golf • Difficulty driving • Difficulty with street signs • Glare

Top 3 Cataract Myths There are many common misconceptions about cataracts, but these are the ones we hear most often.

1



Myth: Cataracts can be treated with medication.



Fact: The only proven treatment option for cataracts is cataract surgery. Surgery is done one eye at a time.

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

Myth: Cataract surgery hurts—or is scary.



Fact: During surgery, your eye will be numb from the drops and you will be given sedation to ensure you are comfortable, relaxed, and without pain.



3 Myth: Cataract surgery has a long recovery period.

Most patients can see pretty well immediately after  Fact: cataract surgery, and you should be able to return to your daily routine within a day or two.

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Who is at Risk for Cataracts?

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As you age, you’ll experience changes on the inside just as you see them on the outside. Unfortunately, cataracts are simply unavoidable. Eyes become noticeably affected by the aging process around age 40. Once over age 55, most people will notice a change in the quality of their vision due to cataracts. Cataracts and their symptoms will worsen over time.

Rarely, patients may Risk Factors experience cataracts • Increasing age that are not age• Family history of early onset related. Cataracts can cataracts be brought on earlier • Certain chronic diseases in life due to genetics, • Eye injury certain chronic • UV damage diseases, eye injury, • Certain medications UV damage, or certain medications.

Cataract Surgery Cataracts are progressive and initially changing your glasses prescription might keep your vision clear for a period of time. However, cataracts will progress and at some point will start to negatively affect your daily life. Your quality of vision will decrease and activities such as driving will become limited or restricted by the vision loss caused by cataracts. This is when you need to consider cataract surgery.

Cataract surgery is the only way to treat cataracts and stop the progressive loss of vision.

Your ophthalmologist will recommend removing a cataract when it keeps you from doing things you want or need to do. Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. That lens is called an intraocular lens (IOL).

Your ophthalmologist will talk with you about IOLs and how

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they work at your cataract evaluation. Cataract surgery is performed on an outpatient basis, which means you don’t have to stay in the hospital after the surgery.

When considering cataract surgery, keep these questions in mind: • Can you see to safely do your job and to drive?

• Do you have problems reading or watching television?

• Is it difficult to cook, shop, do yardwork, climb stairs or take medications?

• Do vision problems affect your level of independence?

• Do bright lights make it more difficult to see?

• Do you have trouble seeing while playing sports such as seeing your golf ball?

Modern technology has made cataract surgery the most common surgery performed. Each year, about three million people in the United States have cataract surgery. In years past, cataract surgery required several days in the hospital and a long recovery period. Today, it is performed under local anesthesia on an outpatient basis and people are back to their normal lives within days. The success rate is high and the rate of vision-threatening complications is relatively low.

When to have surgery, which type of surgery to undergo (traditional vs. laser-assisted), and what type of lens to choose are key decisions you will make with your surgeon’s guidance. We discuss types of surgery and lens options next.

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Watch This Video for an Overview of Cataract Surgery

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Traditional Vs. Laser-Assisted Cataract Surgery Vision loss due to cataracts is reversible. In the early stages of cataracts, your ophthalmologist will monitor the progression, updating your prescription for glasses or contacts along the way. When your lenses become so clouded that updates to your prescription no longer help, surgery is the only treatment option. During cataract surgery, the cloudy lens is removed and an artificial lens, called an intraocular lens (IOL), is implanted. There are two methods of doing this. You can opt for traditional cataract surgery or laser-assisted cataract surgery.

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Traditional Cataract Surgery Traditional cataract surgery is performed manually with a surgical blade. An ophthalmologist makes two small incisions in your cornea. The eye is filled with a viscous material that helps to maintain the natural volume of the eye. The capsule, the bag that contains your cataract, is opened. An ultrasound handpiece is used to break up the cataract. The handpiece has a vacuum that aspirates the pieces of your cataract. An intraocular lens is inserted in the same capsule that contained your cataract.

Traditional cataract surgery is one of the most commonly performed surgical procedures in the world. It is universally recognized as being both safe and effective.

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Laser-Assisted Cataract Surgery In laser-assisted cataract surgery, the laser is used to adjust corneal astigmatism, create the circular opening in the capsule, and soften the cataract. The laser can also create the corneal cataract incisions. Removal of the cataract is still done by the ophthalmologist.

What are the Differences?

Laser-assisted surgery is more precise. This allows eye surgeons to treat your corneal astigmatism, which allows for more spectacle independence. Because a laser can be used to soften the cataract, less ultrasound energy is needed to break it up, which decreases the risk of swelling of the cornea. Laser-assisted surgery also provides for a safer surgery in patients who have weak zonules, which are the support structures for the cataract.

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Watch This Video to Learn About the CATALYS Precision Laser System

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Patient Testimonials If you’re nervous about cataract surgery, here’s what some of our former cataract patients have had to say about their experience.

“ “ “ “

My experience at Marietta Eye was great.

Efficient, no-wait service. The staff was professional and courteous, and overall, it was a great experience.”

Great place! Doctors and staff are very professional and knowledgeable. ... Explained thoroughly the plan and what I could expect from the surgery.”

I’ve had surgery here 3 times now and had wonderful care every time!”

Thanks to the entire team at Marietta Eye Surgery. They made me feel comfortable from the moment I walked in. Each step was explained, and questions were answered. ... It was painless! I was in and out in 2 hours.

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Watch This Video to Hear From a Marietta Eye Cataract Patient

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Types of Intraocular Lenses When the cataract is removed during surgery, it is replaced with an intraocular lens (IOL) that focuses the light into your eye. There are several types of IOL implants: A Monofocal Lens is the basic type of lens implant. It only provides a single focus point in each eye: distance, mid-range or near focus. People who have a monofocal lens will need to wear glasses for at least one point of focus (distance, midrange or near).

Watch This Video for An Overview of IOLs

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Treating Astigmatism & Presbyopia During Cataract Surgery A Toric Lens is a type of lens implant that is used for those who have astigmatism. Astigmatism is a condition that causes blurred vision if not treated. Like a monofocal lens, you will need to wear glasses after surgery for at least one point of focus (distance, mid-range or near).

A Multifocal Lens is a type of lens implant that corrects vision at multiple points of focus: distance, mid-range, and near. The multifocal lens also comes with astigmatism correction as a Multifocal Toric Lens. These types of lens implants are designed to reduce one’s dependence on glasses or contacts after surgery. Many patients who choose this option are free of glasses after surgery.

Since there are several IOL options with cataract surgery, your surgeon will help you select the best lens for you.

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Learn About the PanOptix Trifocal IOL

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Learn About the Vivity Extended Vision IOL

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Cataract Surgery Options The costs of traditional cataract surgery and monofocal intraocular lenses (Standard package) may be covered by Medicare and private insurance. Laser-assisted cataract surgery, toric, or multifocal intraocular lenses are not covered by Medicare or private insurance.

Standard Traditional cataract surgery (non laser) Monofocal lens Please note: Your surgeon will recommend options based on your eyes and lifestyle preferences. Outof-pocket costs are determined by your deductibles, copays, and coinsurance.

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Precision

Premium

Cataract surgery with CATALYS® Precision Laser System

Cataract surgery with CATALYS® Precision Laser System

Astigmatism management

Astigmatism management

Monofocal lens

Toric or multifocal lens

This package will incur an upgrade fee.

This package will incur an upgrade fee.

Your Questions About Surgery Options The type of surgery you have and the intraocular lenses you choose are big decisions. We recommend that you write down questions you may have as you think of them. Please bring this booklet to your cataract consultation to remind you of any questions you may have for your doctor.

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What if I Delay My Cataract Surgery?

A lot of patients who are nervous about having eye surgery, or who want to wait until they have saved up more money, wonder what will happen if they delay their cataract surgery.

Fortunately, cataract surgery is generally not an urgent procedure. You can schedule it whenever it is best for you.

Keep in mind, your cataracts will progress. In most cases, postponing your cataract surgery by a few months or even up to a year won’t make much difference. However, cataracts that are not removed for several years will continue to become cloudier and more dense.

When your cataracts become very dense, the surgical risks increase. Untreated cataracts will eventually lead to blindness, and you may reach a point where surgery is no longer a feasible option.

If you’re concerned about when to have cataract surgery, discuss your timeline with your surgeon.

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Can Cataracts Come Back?

We’ve discussed that, during cataract surgery, a clouded lens (cataract) is replaced with a clear artificial lens. Your eye’s natural lens and the replacement lens are held in place in a bag called a lens capsule. In some cases, scar tissue may form behind your lens implant, causing the capsule to become cloudy or wrinkled over time.

This can result in blurry vision. It is referred to by medical professionals as posterior capsule opacification, but you may also hear it called PCO or “secondary cataract.”

If this occurs, it is not because anything went wrong with your cataract surgery. It is very common for this to occur some time after having cataract surgery.

Posterior capsule opacification is treated with a procedure called a posterior capsulotomy. This is a procedure that is performed with a YAG laser. You may also hear the procedure referred to as a YAG capsulotomy. It is a low risk, painless, and quick outpatient procedure that requires no sedation or fasting.

If you begin to experience cloudy vision after cataract surgery, don’t panic! Reach out to us, and we’ll get back to the business of keeping your eyes healthy and your vision clear.

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Can Cataracts Come Back?

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What Happens at a Cataract Consultation Your upcoming appointment is what we call a cataract consultation. This appointment will last about three hours.

You will have pre-operative testing, a full eye exam, and thorough discussion with your surgeon and surgical vision coordinator. While most patients who present for cataract consultations receive recommendations to have cataract surgery, your vision changes may be due to other underlying causes. The goal of a cataract consultation is to determine if cataracts are the cause for your vision changes.

Your cataract consultation will occur in three steps:

1.1. An ophthalmic technician will gather your medical history and take measurements of your eyes. You will then have your eyes dilated. This information will help your surgeon decide what types of lenses to recommend.

2.

2. Your surgeon will discuss your symptoms with you and perform an examination of your eyes. Then, he or she will discuss your options and let you know if cataract surgery is recommended.

3.

3. If your surgeon recommends cataract surgery, you will meet with a surgery coordinator to schedule your surgery dates, review your payment options, and coordinate any pre-operative clearances if they are necessary.

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Preparing for Cataract Surgery What to Do Leading Up to Your Surgery • Start by taking your eye drops one day before surgery.

• Do not eat or drink anything after midnight the night before your surgery unless you have been otherwise instructed by your pre-admission nurse.

• Bathe or shower that morning of your surgery to minimize risk of infection. Please do not wear makeup, lotions, fragrance, or jewelry. Underarm deodorant/anti-perspirant is OK. Wear loose-fitting clothing.

• Do not take oral diabetic medications on the day of surgery.

You’llreceive receivea aphone phone call from your pre-admission You’ll call from your pre-admission nursenurse in the in theleading days leading upsurgery. to yourYour surgery.

Your pre-admission days up to your pre-admission nurse will tell nurse willtime tell to you what to arrive at the surgery center. you what arrive at time the surgery center.

Please arrange to Please arrangeover to bring someone over of 18during who can bring someone the age of 18 who canthe waitage outside your wait during drive you afterward, and stay surgery, driveyour you surgery, home afterward, andhome stay with you at home at with you at home atyour least four hours after your surgery. least four hours after surgery.

Bring These with You on the Day of Your Surgery Your insurance card, a photo ID, your post-operative prescriptions (e.g., your eye drops).

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Where to Go on the Where to Go on the Where to Go on the Day of Your Surgery Day of Your Surgery Day of Your Surgery

Although Althoughyour yourcataract cataractconsultation consultationand andpost-operative post-operative Although your cataract consultation and post-operative around aroundmetro metroAtlanta, Atlanta,all allcataract cataractsurgeries surgeriesare areperformed performedatatour our around metro Atlanta, all cataract surgeries are at our surgery center ininMarietta, located next-door totoperformed our surgery center Marietta, located next-door ourKennestone Kennestone surgery center in Marietta, located next-door to our Kennestone Here is a photo of the front entrance for checking in:

895 895Canton CantonRoad RoadNE, NE,Building Building200 200 895 Canton RoadGA NE, Building 200 Marietta, Marietta, GA30060 30060 Marietta, GA 30060

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Map of Campus Campus Map

MARIETTA EYE CLINIC

MAI N LAS CAMP US IK

SURGERY DISCHARGE

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SUR CHE GERY CK IN

RETINA OCU L OP LAS T IC S

MEC/MES Campus map form #784 – Updated 1/22/20 AD

Where to Pick Up Patients Here is a photo of the back exit where to pick up patients after the surgery is complete:

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Watch This Video to Learn About Our Eye Surgery Center

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Cataract Consultation Checklist These are a few things we recommend you do to prepare for your cataract consultation.

Please stop wearing your soft contact lenses 7 days prior to your scheduled cataract evaluation (unless you do not have glasses).

Discuss surgery options with your family.

Explore finance options.

Prepare any questions you may have for your doctor or surgery scheduler.

Complete the forms on the following pages. Submit them electronically through the portal link or bring printed or written forms to your consultation.

Bring the following to your consultation: • Your glasses or contact lenses (if you wear them) • Your insurance card(s) • A photo ID • This booklet and completed forms Plan to be in the office for three hours.

Arrange for transportation if needed. Your eyes will be dilated during your consultation.

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How Billing Works Be aware that after your surgery, you will be billed for your out-of-pocket cost in three separate bills:

1.1. A bill from your surgeon 2.2. A bill from the surgery center 3.3. A bill from the anesthesiologist

While your surgeon is affiliated with Marietta Eye Clinic, your anesthesiologist is not. The bill from your surgeon and the surgery center are determined by the type of surgery and the type of lenses you choose. The bill you receive from your anesthesiologist will be determined by your insurance provider and your insurance plan.

Marietta Eye Clinic utilizes anesthesia services from MAK Anesthesia. For billing questions regarding anesthesia, contact MAK Anesthesia at:

Phone: (770) 702-1806, ext. 209 Email: billing@makanesthesia.com

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Financing Options CareCredit Because we want to make laser-assisted surgery and premium lens options available to as many patients as possible, Marietta Eye Clinic partners with CareCredit. CareCredit is a healthcare credit plan that offers a variety of interest-free payment options for up to 24 months after your procedure. Plans may also be extended by up to five years with interest.

When paying with CareCredit, you will not owe anything to Marietta Eye Clinic at the time of your surgery. You will make payments to CareCredit after your surgery.

FSA and HSA If you have a flexible spending account or a health savings account, you can pay for your cataract surgery using pre-tax income.

Tips for Paying with an HSA or FSA • • •

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Make sure you understand the rules of your plan.

Set aside enough money to cover your care.

Use all of the money you set aside before the time limit associated with the account.

Your Questions About Costs and Payment You’ll have an opportunity to discuss co-pays and out-ofpocket costs associated with different surgery options at your cataract consultation. Please bring this booklet to your cataract consultation to remind you of any questions you may have for your surgical coordinator.

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What to Expect After Surgery Blurriness and seeing halos around lights are common up to 2-3 days after surgery due to the pupil being dilated. You may also notice a flickering light or shadows in the corner of the eye up to several weeks after surgery.

For any decrease in vision, severe redness, or severe pain, call us immediately at (770) 427-8111. Let them know you just had surgery and ask for the Clinical Supervisor.

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DO • Use your drops as prescribed.

• Use lubricating drops (Blink, Systane or Refresh) 4 times an hour for a dry, scratchy, or gritty feeling.

• Wear glasses, if comfortable. Older glasses may not work well after surgery. Your doctor will help with a new prescription if needed. Wear Sunglasses as needed for light sensitivity.

• Wear your eye shield for the first 5 days when asleep (napping or bedtime). Secure with tape provided.

• Take showers and wash your face. Wash around your eye gently with a clean warm washcloth twice a day.

• Resume normal medications, including glaucoma drops.

Resume normal activities (eating, drinking, walking, bending, reading, television, cooking,etc.)

• Take Tylenol or Advil (Ibuprofen) if your eye aches; call us for severe pain.

• Bring your blue post-op bag, surgery drops, glasses, and a driver with you to your post-op visit the day after surgery.

DO NOT • DO NOT RUB THE EYE AT ANY TIME!!

• DO NOT let soap or water in the eye.

• DO NOT let any dirty water in your eye. No swimming pools, saunas or hot tubs for 5 days.

• DO NOT drive yourself to your post-op appointment unless otherwise approved by your doctor.

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Patient Forms In order for your surgery to run smoothly and efficiently, please ensure that all forms are filled out prior to your arrival.

These forms include: • Patient Medical Information (3 pages) • Patient Questionnaire (1 page) • Vision Preferences Checklist (1 page) Easy ways to complete the forms: 1. Complete forms by hand in paper booklet or 2. Pick up printed forms at Marietta Eye Clinic Office or 3. Print forms from digital booklet and complete by hand or 4. Fill out the form by clicking on it in the booklet and typing your responses. Then print the form. Please note your information will not be saved. You must print the form when you have completed entering the information or 5. This is the preferred method. Access the patient portal to complete the forms electronically. Once in the portal, click > My Health and then > My Forms to find the forms.

This option will send your completed forms directly to your surgeon! Simply click on the link below or type this URL into your browser. Patient Portal: http://bit.ly/3hlV5XA

Questions?

Email: cataractquestions@mariettaeye.com Direct Phone Number: (678) 784-0235

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PATIENT MEDICAL INFORMATION The Following information is needed by your Physician to provide the best type of care for you.

Patient Name

Cell Phone Number (

Email Address

Birth Date

-

)

Home Number (

)

-

Age

Emergency Contact Person with different phone number Name

Phone (

)

-

Name

Phone (

)

-

Primary Physician Name

Phone (

)

-

Cardiologist Name

Phone (

)

-

Pulmonologist Name

Phone (

)

-

Neurologist Name

Phone (

)

-

Pharmacy Name

Phone (

)

-

Does the Patient live in a Nursing Facility? If so, which Facility?

Last Seen

Last Seen

Last Seen Last Seen

Address

Patient Height

Allergies / Sensitivities

Weight

Reactions

Any body piercings? (Location)

Latex Allergy? Yes Reaction

No

Ocular History: Have you ever been treated for the following:

Y

N

Retinal Tear or Detachment

Y

Y

N

Eye Trauma or Injury

Y

N N

Cataract

Glaucoma

Any other eye surgeries?

Y

Y

N

N

Cornea Problem

Diabetic Eye Disease

Y

N

Eye Muscle Problems

Current Medications including vitamins, herbal supplements, over-the-counter medications, etc.

Please add dosage and frequency.

MEC SX Forms 612 PMI Patient Medical Information | 05/06/2021

Page 1 of 3

PATIENT MEDICAL INFORMATION Patient Name

SOCIAL HISTORY

DOB

Are you taking any diet/appetite suppressants medications? Yes Smoke? Yes No packs per day for years Drink? Yes No How much?

Illegal or Prescription Drug Abuse? Yes No Which drug?

No

Last date taken I quit years ago

MEDICAL HISTORY Do you have or have you had: (If you mark “yes,” please explain) PATIENT YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

CARDIAC DISEASE

Implantable cardioverter-defibrillator (AICD)?

STENTS? DATE: “Yes” to following require cardiology notes: A-FIB/PALPITATIONS? Pacemaker? Date: Cardiac Bypass? (CABG) Date: Chest pains/angina/congestive heart failure/swelling to lower extremities?

(Circle all that apply) Can you walk up 2 flights of steps without feeling short of breath?

Can you lie down flat for 30 minutes without feeling short of breath?

High blood pressure?

Are you taking aspirin or blood thinners? *Be advised if you Do you have diabetes? have an uncontrolled Do you require insulin? high blood pressure What was your last A1C level? the day of surgery, the PULMONARY DISEASE anesthesiologist may HOME OXYGEN? cancel your surgery.

COPD?

YES

Asthma/Wheezing? (Circle all that appl Date of last attack: NO Chronic Cough?

NO Sleep Apnea?

YES NO Do you use CPAP?

YES

NO

YES

NEUROLOGICAL

YES

STROKE? - Date: NO TIA?- Date: NO Seizures/eplipesy? (Circle all that apply) Date of last seizure: NO Tremors/Parkinson’s Disease? (Circle all that apply)

YES

NO

YES

NO

YES

NO

YES YES

YES YES YES

**Be advised if your blood sugar is above 275 the day of surgery, your surgery will be cancelled.

KIDNEY DISEASE Dialysis? What day?

Kidney Disease?

LIVER DISEASE

Liver Disease/Cirrhosis? (Circle all that apply) NO Anemia/Blood Transfusion? (Circle all that apply) When?

NO Sickle Cell Disease or Trait?

NO Do you have a history of blood clots or a bleeding disorder?

MEC SX Forms 612 PMI Patient Medical Information | 05/06/2021

Page 2 of 3

PATIENT MEDICAL INFORMATION Patient Name

DOB

MEDICAL HISTORY Do you have or have you had: (If you mark “yes,” please explain) cont.

PATIENT YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

ANESTHESIA

Problems with anesthesia?

TMJ? Difficult IV start?

Slow to wake up from anesthesia?

Ulcer/Hiatal Hernia/Reflux or Heartburn? (Circle all that apply) Any broken facial bones (nose or jaw)?

Dentures/bridges/loose teeth caps/crowns? (Circle all that apply) Thyroid Disease?

Could you be pregnant?

List previous surgeries:

INFECTIOUS DISEASE

YES

Ever been diagnosed with HIV, AIDS, HEPATITIS, TB, C-DIFF/MRSA? (active MRSA not ASC candidate) NO Have you completed your COVID vaccination(s)? Date of last injection

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

OTHER

Do you have any surgical implants or prosthesis?

Arthritis? Chronic back pain?

Do you have other health concerns?

Sick or hospitalized in the last 30 days? (need hospital notes) Do you feel unsteady when standing or walking?

Do you use assistive devices to walk?

Are you able to transfer from wheelchair to stretcher with minimal assistance?

Signature of Patient: X

Date:

PATIENTS: DO NOT FILL OUT INFORMATION BELOW. THIS IS FOR PHYSICIANS USE ONLY Other Findings: Date updated with patient Date updated with patient Date updated with patient HISTORY REVIEW Reviewed By: Reviewed By: Reviewed By: Reviewed By:

Tech/Nurse sig Tech/Nurse sig Tech/Nurse sig ,RN/LPN , MD - Surgeon/Anesthesiologist ,RN/LPN , MD - Surgeon/Anesthesiologist

MEC SX Forms 612 PMI Patient Medical Information | 05/06/2021

Date Date Date Date

Time: Time: Time: Time:

am/pm am/pm am/pm am/pm Page 3 of 3

VISION PREFERENCES CHECKLIST (PLEASE BRING WITH YOU TO CONSULTATION) Cataract surgery is a once-in-a-lifetime procedure with an opportunity to permanently change how you see the world. With advances in today’s lens technology, combined with precision laser surgery enhancements, vision after cataract surgery can be improved like never before! Your Marietta Eye Clinic team will help educate you about the variety of choices available. This questionnaire can provide insight on how you expect to see after your procedure. It is important to understand that most patients will need glasses for some activities after cataract surgery.

Have you worn contact lenses?

Yes

Monovision contact lenses?

No

Are you interested in seeing well in the distance without glasses?

Yes

Yes

No

No

Are you interested in seeing well near (within arms-length) without glasses?

Yes

No

Which near vision, hand/eye activities do you enjoy or perform often? (check all that apply) Carpentry Piano/Reading Music Gardening Reading Print Painting Puzzles/Crosswords Reading Mobile Phone/Tablet Cooking Cards Needlework Which activities do you enjoy / perform most often? (check all that apply) Biking Shopping Swimming Writing Hunting Driving Tennis Time with kids Traveling Watching TV Golfing Fishing Computer (# of hours daily) Others How enjoyable would it be for you to be free of glasses for all of your daily activities?

Awesome Very Nice OK Not a Big Deal Do you do a lot of night driving?

Yes

No

Somewhat

How would you describe your personality? (Place an “X” on the following scale) EASY GOING Patient Name:

Vision Preferences Checklist Rev. 2/22/2017

PERFECTIONIST DOB:

Date:

Page 1 of 1

PATIENT QUESTIONNAIRE Please complete this form and sign after printing.

Patient Name Please Check Eye(s) with Symptoms:

Date of Birth

Left

Right

VISUAL FUNCTIONING

Do you have difficulty, even with glasses, with the following activities: YES NO

Reading small print, such as labels on medicine bottles, food labels, or text on a smartphone?

Reading a newspaper, book, or tablet?

Reading a large-print book, large-print newspaper, or large numbers on a telephone?

Recognizing people when they are close to you?

Seeing steps, stairs, or curbs?

Reading traffic signs, street signs, or store signs?

Doing fine handwork like sewing, knitting, crocheting, or carpentry?

Writing checks or filling out forms?

Playing games such as bingo, dominos, or card games?

Taking part in sports like bowling, handball, tennis, or golf?

Cooking?

Watching television or looking at a computer/laptop screen?

SYMPTOMS

Have you been bothered by: YES NO

Poor night vision?

Seeing rings or halos around lights?

Glare caused by headlights or bright sunlight?

Hazy and/or blurry vision?

Night Driving?

Day Driving?

Seeing well in poor or dim light?

Poor color vision?

Patient Signature Date

Double Vision?

Patient Questionnaire Rev.12/20/2016

Page 1 of 1

Glossary Unfortunately, ophthalmology sometimes involves a lot of big words, and you may hear a term you don’t know now and then— or you may hear multiple terms used to describe the same thing.

Hopefully, this short glossary will help clear up any confusion.

These are some of the most common buzzwords you’ll hear when talking about cataract surgery.

Acuity: How sharp your vision is.

Astigmatism: A condition in which the front of your eye (the cornea) is not perfectly round. The shape of your cornea can affect the way light focuses in the back of your eye. People with astigmatism may report seeing double vision.

CATALYS Precision Laser System: The brand of laser we use to perform laser-assisted cataract surgery. It’s a type of femtosecond laser. You might also hear “femtosecond” shortened to “femto.”

Cataract: A natural lens that has become yellowed, clouded, and hardened due to age. The goal of cataract surgery is to replace the cataract with a clear and flexible artificial lens.

Cornea: The clear, dome-shaped window of the front of your eye.

It focuses light into your eye.

Extended depth of focus intraocular lens: A type of multifocal lens. Your surgeon will discuss multifocal lens options at your cataract consultation.

Femtosecond laser: The laser we use to perform laser-assisted cataract surgery. It’s called a femtosecond laser because of the length of time the laser pulses for (a femtosecond). The type of femtosecond laser we use is called the CATALYS Precision Laser System. You might also hear “femtosecond” shortened to “femto.”

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Floaters: A normal sign of aging in the retina. They occur when tiny specks of vitreous break loose and float around inside the eye.

Hyperopia: Vision that is blurry up close but clear at a distance. It is sometimes referred to as farsightedness.

Intraocular lens (IOL): The artificial lens that is implanted during cataract surgery. The intraocular lens will function like a young, healthy natural lens.

Intraocular pressure: Eye pressure—also called IOP—is a measurement of the pressure inside the eye. Measuring it is like measuring blood pressure Iris: The colored part of your eye. It controls the size of your pupil to let light into your eye.

Macula: The macula is a small but important area in the center of the retina. You need the macula to clearly see details of objects in front of you, like faces and written text.

Multifocal intraocular lens: A type of lens that will allow you to see clearly near, at medium range, and far without depending on glasses or contact lenses.

Myopia: A condition in which vision is clear up close but blurry at a distance. It if often referred to as nearsightedness.

Natural lens: The part of your eye behind the iris of your eye. Just like the lens of a camera, light comes in through the lens of your eye and is focused in the back of your eye. If you have cataracts, your natural lens has become clouded, yellowed, and dense, which affects your ability to see clearly.

Ophthalmic: Anything that is related to eyes or eye disease.

Ophthalmologist: A medical doctor and surgeon who specializes in diagnosing and treating eye disorders. Your surgeon is an ophthalmologist.

Optic nerve: A nerve at the back of your eye that connects to

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your brain. The optic nerve sends light signals to your brain so you can see.

Phacoemulsification: Using ultrasound during cataract surgery to break up the cataract.

Postop global period: A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure.

Presbyopia: A condition in which your eye loses its ability to focus on objects that are near. Everyone will experience presbyopia. It usually becomes noticeable in your 40s.

Pupil: The opening at the center of the iris that allows light to enter the eye.

Retina: The back of the eye, where images are focused. Your lens sends images to your retina.

Toric intraocular lens: A type of lens that corrects an astigmatism.

Vitreous: A clear, gel-like substance that fills the inside of your eye.

YAG: A laser used to make an opening in the cloudy capsule holding your artificial lens and restores clear vision. Also called a posterior capsulotomy.

Zonule: The structural supports in the eye that hold the lens in place. Some people have weak or loose zonules, which may affect how cataract surgery is performed.

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Thank You Thank you for taking the time to read this booklet. When it comes to your health, knowledge is power. We hope this guide has helped clear up some of your questions about cataracts and the available treatment options.

Remember that this is a once-in-a-lifetime opportunity to achieve customized vision that suits your lifestyle. Consider what you would use your vision for if it was clear and vibrant. Soon, it will be. We want to make sure you end up with the options that are right for you—your hobbies, your lifestyle, your budget.

We’ll be ready to answer all of your questions at your consultation. We look forward to seeing you!

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Marietta Eye Clinic — Kennestone 895 Canton Road NE Marietta, GA 30060 (770) 427-8111

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