Clinical Information for Cataract Surgery Co-Management

Thank you for co-managing your patients with Southeast Connecticut Eye Care, LLC. We'd like to coordinate our care with you to ensure your patient has a pleasant, safe, and seamless surgical experience. Below please find some information that will describe our standard clinical pathway and give you some helpful information about caring for cataract surgery patients with us.

Some patients' care may deviate from this pathway. Always use your clinical judgement in deciding on the care of a particular patient. Please call the surgeon at any time if you have questions. Our telephone number is 860-373-4148.

Candidates for cataract surgery:

Good candidates for cataract surgery include patients with cataract who:

Note that the standards for Medicare coverage of cataract surgery have changed. There is no longer a requirement that the patient be 20/50 or worse for Medicare to cover surgery. The Medicare Local Coverage Determination (LCD) for cataract surgery now allows us to perform surgery when it is medically necessary and does not specify an arbitrary visual acuity standard for surgery.

Indications for comanagment:

We strongly believe in the potential benefits of co-management for your patients. Co-management is usually more convenient for the patient and minimizes travel time. It allows their primary eye doctor to be more involved in their care and promotes a team approach in the perioperative period.

Whether to co-manage is always the patient's choice. Most of our patients do choose to have their care co-managed, and we will notify you when the patient elects this option.

Referring a patient to us:

The best (and fastest) way to refer a patient to us is to use the online referral form. Your front desk staff can enter basic information in the form and we will call the patient. It is HIPAA compliant and secure. If you give us the patient's cell phone number, they will automatically receive a text with our information. We will call the patient, and track the referral to make sure we see them and that you receive a letter.

Of course, you can always call our office (860-373-4148) to refer a patient if you prefer.

Clinical pathway:

This is the usual schedule of visits for a patient having cataract surgery.

Visit Timing Physician Description
initial consultation within 4 months of surgery surgeon At the initial consultation the surgeon takes a history to determine indications for surgery. He examines the patient for the presence of cataract and findings that may affect the surgery. He will discuss with your patient the risks, potential benefits, and alternatives of cataract surgery. Together, the patient and the surgeon will decide whether to schedule the procedure or not. If they schedule surgery, the patient will receive a date for a preoperative appointment. (S)he will also receive a handout on cataract surgery, directions to viewing educational material on our website, a booklet on the surgical center, and forms needed for scheduling the procedure.
preop within 30 days of surgery surgeon The patient will have immersion A-scan ultrasonography at their preoperative appointment. The surgeon will then go over options for lenses. Together, the surgeon and patient will agree on a lens to be implanted. The patient receives prescriptions for perioperative medications to use, with written instructions on their use. We complete all paperwork and make postoperative appointments at this visit.
surgery usually a Monday surgeon The surgery center staff will call the patient with a time for surgery. The patient will arrive at the Constitution Surgery Center East in Waterford. The entire process normally takes two hours. The actual procedure usually takes fifteen minutes, more if the surgery is complex. The patient will receive postoperative instructions prior to leaving the surgery center.
postop 1 day of surgery, or day after surgeon or optometrist This initial check is the most important one. At this visit, the physician asks how the patient feels, checks visual acuity and pressure, verifies good lens position, ensures no wound leak, and reviews the drop instructions with the patient. Because the patient is usually already dilated, this is a good time to perform a dilated examination. The patient's vision may be excellent, somewhat blurry, or poor at this visit. The physician reviews activity restrictions with the patient and answers any patient questions.
postop 2 1-2 weeks after surgery surgeon or optometrist At this check the physician asks the patient about their vision and comfort, checks visual acuity, IOP, and performs an anterior segment examination. Unless there is concurrent pathology that restricts vision (eg ARMD), the patient's best-corrected vision should be reasonably good at this visit. If the patient is still phakic in one eye, it is important to review with the patient at this visit whether the patient still needs surgery in the other eye. Surgery may be cancelled if the patient is happy with their vision, and if there is no other indication for surgery.
second surgery? If surgery is indicated in the other eye, the patient undergoes surgery, with two postop visits as above. The optometrist may perform one or both postops according to the patient's wishes.
postop 3 3-4 weeks after surgery surgeon or optometrist This is normally the final visit in the process. At this visit, the physician assesses the patient's satisfaction with their vision, checks visual acuity and IOP, examines their eyes for residual inflammation, and performs refraction. If needed, the physician gives the patient a prescription for spectacles. The physician makes appropriate followup appointments.

Post-operative checks:

Some things to check after surgery include:

Drops:

Below is a list of the usual drops our patients use for surgery. Sometimes their drops may differ from these, if the patient is allergic, or for financial or insurance reasons.

The patient receives a written schedule for their drops at their preoperative appointment. If they need a new one, you can print it from our website.

Time Medications
Starting 3 days before surgery Gatifloxacin: 1 drop in the surgical eye 4x/day
Prolensa: 1 drop in the surgical eye 1x/day
Starting after surgery Gatifloxacin: 1 drop in the surgical eye 4x/day
Prolensa: 1 drop in the surgical eye 1x/day
Prednisolone: 1 drop in the surgical eye 4x/day
Starting five days after surgery Prolensa: 1 drop in the surgical eye 1x/day
Prednisolone: 1 drop in the surgical eye 2x/day
30 days after surgery Stop all drops

This course of medications may be adjusted based on the clinical situation, of course.

Elevated IOP is common in the immediate postop period. Some ocular anti-hypertensives that are useful after surgery are:

Prostaglandin analogs (eg latanoprost) should be avoided if possible, as there is at least a theoretically increased risk of cystoid macular edema when using these medications around the time of cataract surgery. Avoid use of carbonic anhydrase inhibitors in patients who are sulfa allergic, and be careful about using beta-blockers in patients with breathing problems (asthma, COPD and others), cardiac issues (bradycardia or others), or diabetes.

Complications:

Please call the surgeon immediately for serious complications or for any questions regarding the post-operative care of the patient. Serious complications that you should call the surgeon for include:

If you are uncertain about how to best manage a complication, please call the surgeon.