wHAT IS cataract surgery?
Cataract surgery involves removing your cloudy lens and replacing it with an artificial lens. We make small incisions (cuts) in the side of the eye and use ultrasound probes in a technique called ‘phacoemulsification’ (not lasers, as is commonly believed) to remove your cataract, and then replace it with the artificial lens. This is made of plastic and stays in your eye forever, only rarely needing replacement. The operation usually takes under half an hour.
why should i have cataract surgery?
Cataract surgery aims to improve your vision. Once the cataract is removed you should be able to see more clearly. Your colour perception may also improve. A cataract is rarely ever urgent. It should be performed only if you are having trouble with your vision. Your doctor will advise you if there are any urgent conditions that may require you to have cataract surgery.
The staff caring for you will need to ask your permission to perform a particular treatment or investigation. You will be asked to sign a consent form that says you have agreed to the treatment and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or if you need more time to think about it, please tell the staff caring for you.
Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind. Your wishes will be respected at all times.
Figure 1. Simulation of blurred vision as a result of cataract.
(Image courtesy of NIH National Eye Institute)
HOW IS cataract surgery performed?
Cataract surgery involves removing your cloudy lens and replacing it with an artificial lens. It is usually performed as day surgery under local anaesthetic, so you are awake but your eye will not feel any pain. You will not be able to see properly during the operation as your eye will be draped with a sterile sheet and your other eye will be covered by this. You may however notice bright lights or colours while we're doing the surgery. You will need to lie relatively still during the operation; if you need to cough or adjust your position, please warn your surgeon.
We make small incisions (cuts) in the side of the eye and use ultrasound probes in a technique called ‘phacoemulsification’ to remove your cataract, and then replace it with the artificial lens. This is made of plastic and stays in your eye forever, only rarely ever needing replacement.
WHAT are the risks?
Cataract surgery is usually very successful, with over 95 out of 100 of people noticing an improvement in their vision after surgery if there are no other pre-existing eye conditions. However, it is important to realise that there is always a risk of complications associated with any operation.
Some of the complications that may occur during the operation include:
damage to other structures of the eye, including the capsule surrounding the lens
incomplete removal of the cataract
part of the cataract falling into the back of the eye.
Some of these complications can be dealt with at the time of the surgery or just after surgery.
Potential complications occurring after the operation include:
fluid accumulating in the retina (the light-sensitive layer at the back of the eye)
detachment of the retina
incorrect strength of lens inserted
clouding of the membrane behind the lens
These complications can sometimes occur even if the operation itself is carried out perfectly. Many of these complications are manageable, although it may mean that other treatments may be required and that the recovery period may be longer than usual. This includes the need for additional surgery in approximately one in 100 cases. The most serious consequence of all the complications is the risk of loss of vision, which may be temporary or permanent. The chance of severe or complete permanent loss of vision in the operated eye is less than 1 in 1,000.
what to prepare for surgery?
At the time of your booking for surgery, measurements of your eye will be taken to help us decide which lens strength is right for you. Usually, we aim to make you glasses-free for distance, so that you only need glasses for reading. However, there is a chance you will need glasses for both distance vision and reading after surgery, particularly if you have a history of astigmatism or an irregularly shaped eye. If this is the case you may like to have a special 'toric lens' implanted which can also correct for high astigmatism. If you feel you would rather be glasses-free for both distance and reading, you may opt for a 'multifocal lens' implantation. Both the Toric & Multifocal lenses will need to be custom-ordered for your eye so please inform your doctor at the time of booking so arrangements can be made. Please bear in mind however that not everybody is suitable for Multifocal IOLs so please discuss this with your eye doctor.
On the day of surgery, do ensure you give yourself ample time to get into hospital. You do not want to be rushing or getting stressed prior to surgery as this can raise your blood pressure. Please do not bring any valuable items to the hospital and ensure you have made arrangements to be escorted home after surgery.
We cannot tell you in advance exactly what time your operation will be, as this depends on numerous factors on the day. Please allow a half day attendance in our unit if your operation is under a local anaesthetic, and a full day if your operation is under a general anaesthetic.
If you are having your operation under local anaesthetic, you will need to be able to lie flat for approximately 30 minutes. You will also need to be able to keep your head still during the surgery. If you are unable to do this, please discuss this with your doctor.
Eating, drinking and medications
If your operation is under a local anaesthetic, you can eat and drink as normal before and after the operation. You should take your regular medicines as you would normally. To reduce anxiety, some people may be offered may be offered a sedative drug to help them relax during the procedure. If you think you may need sedation, please talk to your doctor.
If you are having a general anaesthetic, you will need to fast before your operation. Fasting means that you cannot eat or drink anything for 6 to 8 hours before surgery. We will give you clear instructions about whether you need to fast and when to start fasting. It is important to follow the instructions. If there is food or liquid in your stomach during the anaesthetic it could come up to the back of your throat and damage your lungs. You should take your essential regular medications with a small sip of water only.
If you are diabetic, you will be given instructions by our pre-assessment nurses about your diabetic medication. If you take blood thinners (like warfarin), we will have asked you to have your INR blood test checked a few days before surgery. If it is high, it may need to be repeated on the day of surgery. Depending on the result, we may need to reschedule your operation. If you take a diuretic (water tablet) in the morning, it may be better to take the tablet after surgery instead of beforehand. Always keep a list of your medications with you. (TIP: Save this to your phone and include a list of your ALLERGIES as well)
what do i need to do after i go home?
After your operation, you will have an eye pad and/or shield over your eye (Figure 2), depending on your surgeon. Once you have recovered from the anaesthetic, you will receive your eye drops, instructions about caring for your eye, and details of your next appointment. You will then be discharged and can go home. You should not drive on the day of surgery so do ensure someone escorts you home. Please clarify when you can resume driving with your doctor when you attend your follow-up appointment. The amount of time that you will need to take off work depends on the nature of your job. Please discuss this with your doctor.
Here are some DOs after surgery:
DO put your drops in as instructed
DO wear sunglasses when you go outside
DO clean your eye daily as instructed
You CAN continue reading / watching TV as usual
There are NO dietary restrictions after surgery.
Here are some DON'Ts after surgery:
DO NOT allow any water into your eye for 2 weeks (ie. when showering etc.)
DO NOT rub your eye - if you really need to wipe it, gently dab the skin around your eye with a clean tissue.
DO NOT strain or carry anything heavy after surgery
DO NOT perform any 'major' cooking - you do not want anything splashing into your eye
DO NOT play any sports for a few weeks after surgery
DO NOT do any gardening for 6 weeks after surgery
DO NOT sleep on your eye - if you have a tendency to do this, then wear a plastic eyeshield when you sleep at night.
Figure 2. Eye Patch applied after surgery
(Image courtesy of NIH National Eye Institute)
will i feel any pain after surgery?
During the night after your operation, you may experience some mild discomfort. Please take simple pain-killers as required. The drops you have been given should also help to relieve the irritation and are usually required for up to four weeks after your operation. Before you leave the hospital, we will give you specific instructions on how often to use your eye drops and when you should stop using them. Your vision may take up to a few weeks to improve. It is normal to experience some redness, watering, or grittiness of the eye, but you should never have severe pain.
In general, symptoms should gradually improve as time passes. If any symptoms get worse, especially pain & redness with rapidly worsening vision, please contact your eye department urgently or attend your nearest A&E department.
do i have to wear glasses after surgery?
In most cases we aim for you to see as well as possible without glasses for distance. However, you will need new reading glasses after the operation. It is recommended that you wait six weeks after surgery before visiting your local optician. Patients who need cataract surgery in the other eye sometimes prefer to wait until they have had the operation before getting new glasses. Rarely, you may end up being more long sighted or short sighted than we had anticipated. If this occurs, you may need a stronger glasses prescription or a further procedure.
what should i do if i have a problem?
Please contact your doctor if you have any problems or concerns. It is important to do so URGENTLY if you have any of the following:
Severe pain after surgery
Increasing redness, pain and blurring of the vision in the days or weeks after surgery
Worsening vision – especially if you find that your vision initially improves after surgery, but then starts to decline.