Cataract surgery

I am an experienced cataract surgeon, having performed over 2500 cataract operations to date. I regularly audit my outcomes and they are consistently above the national average. If you’d like to arrange a cataract assessment with the practice, please contact my secretary.

What is a cataract?

A cataract is a clouding of the lens within your eye. The lens is the part of your eye that focuses light on the retina, much like the lens in a camera. As you get older, the lens within your eye changes; the lens proteins ‘denature’ and degrade, and this affects the clarity of the lens. As a result, your vision starts to become blurred. Alongside this degradation, the lens slowly increases in size and this can change the refractive effect of the lens. This can explain why your glasses prescription may change as a cataract develops, often making you more short-sighted.

What causes a cataract?

Ageing is the most common cause of cataracts, but they may also occur due to trauma or radiation exposure. They can be present from birth, and can sometimes occur following eye surgery. Risk factors for developing a cataract include diabetes, smoking tobacco, prolonged exposure to sunlight, and alcohol.

What effect does a cataract have on my vision?

In the early stages of a cataract, there may not be any noticeable changes to your vision. The visual impact often happens very slowly, and indeed sometimes people adjust to the changes. In some situations, the changes can be more sudden. Cataracts often affect both eyes, but not always at the same time or at the same rate. Common visual symptoms that can occur with cataracts include:

  • blurry vision
  • faded colours
  • glare or halos around light, especially when driving at night
  • trouble with bright lights
  • trouble seeing at night

How are cataracts treated?

If you’re concerned that you might have a cataract, a detailed examination will confirm if that is the cause of your symptoms. We can then discuss the best way to manage the cataract. This will depend on how much the symptoms are bothering you, what your visual requirements are (do you drive a car etc) and many other factors. Making a decision about the best treatment is a very individual choice and will vary from person to person. I will be able to explain all the options to you and come up with a plan that fits your needs. In the early stages of a cataract, and if the symptoms are not too severe, a change in glasses can make a big difference. If the symptoms are causing a problem, cataract surgery is likely to be the best option. (Please note that you’ll need to arrange for someone to collect you after your consultation: see Driving to and from appointments, below.)

What are the risks of cataract surgery?

Cataract surgery is usually performed as a day case procedure under local anaesthetic. The operation is very successful in improving the vision. However, as with any surgical procedure, there are risks, and sometimes complications can occur which may result in a reduction of vision. Fortunately, in most situations the risk of complications is very low. Most complications can be treated with medicines or further surgery.

I have listed the most common complications below. They can be divided into operative and postoperative complications.

Operative complications

  • posterior capsular tear: this may require additional surgical procedures either at the time of surgery or later

Postoperative complications

 

  • infection: the risk of a severe infection after cataract surgery is very low – about 0.03%. This is usually managed with further procedures and medicines. Unfortunately, half of the patients with a severe infection do not recover sight despite treatment
  • inflammation: this often settles with additional eye drops
  • corneal oedema (swelling of the clear window of the eye): this will often settle with time; if it doesn’t settle and remains a problem, we can offer further surgery
  • cystoid macular oedema (swelling of the central part of the nerves at the back of the eye): this usually requires further courses of eye drops, and then settles. If the oedema is persistent, we could consider additional procedures
  • posterior capsular opacification (thickening and scarring of the thin membrane that the new lens sits on): this can affect the vision months to years after the surgery and can be managed with a very successful laser procedure.

All the above complications can cause reduced vision postoperatively, but most only reduce the vision temporarily – it’s very rare for the vision to remain reduced in the long term. At the same time, it’s important to remember that if a cataract is symptomatic and not operated on, it will cause a loss of vision over time; this risk needs to be balanced against the risk of surgery.

What happens during surgery?

In cataract surgery, the patient usually lies in a relatively flat position on a specially-designed surgical bed. We carefully clean the eye and the area around it, then place a drape over the eye that is about to have surgery. This drape also covers the other eye. An opening is made in the drape so that the eye with a cataract is visible. A special prop is placed between the eyelids to keep the eye open. The surgery is performed using a surgical microscope, which shines a bright light down onto your eye. As a result, you are not able to see any of the surgery in detail. You’re only likely to be aware of the light and the changes that occur to it during the surgery. Patients often describe it as being like a ‘kaleidoscope light show’ and even find it to be quite pleasant. Your eye will be numb, and surgery will not be painful. You may feel some pressure, and the wet feeling of fluid on the surface of the eye, but nothing more than that.

What happens after surgery?

After the operation, you’ll be given eye drops to use for the next four weeks. You will also be given a plastic shield to place over the eye to protect it. This will need to be worn at night for the first two weeks. You should avoid any heavy lifting or straining in the first week. You should wait one to two weeks before resuming your normal daily activities. You should avoid swimming for four weeks. You must not drive until you reach the minimum legal standard of vision, and even then you should be cautious as your eye may not react to certain light and situations in a way that you’re expecting. It is much better to be patient and to wait until your eye feels completely back to normal.

If you have any of these symptoms in the postoperative period, you must contact me or my team immediately:

  • Severe pain
  • An eye that steadily becomes more, rather than less, painful with each day
  • Loss of vision
  • Increasing redness of the eye
  • Discharge from the eye

When should I see my optician after surgery?

This will depend on whether you are having one or both cataracts removed. If it’s just one, I would recommend you see the optician after you have completed your course of eye drops, which is usually about four weeks after the operation. If both eyes are having surgery (each one is often done at least two weeks apart) then I recommend waiting until four weeks after the operation on your second eye.

Will I need glasses after my surgery?

After the cataract is removed, a new lens is placed into the eye. This lens focuses light to the retina. Prior to the surgery, I will take detailed measurements of your eye: these allow me to choose the correct power of the new lens. We will have already discussed the refractive options for you at your initial assessment – this will allow me to choose the right lens. In most cases I would use a lens with a single point of focus. Most patients prefer these for distance vision. This means that, after surgery, they will then need a pair of glasses for reading, with relatively good, unaided distance vision. It’s important to be aware that even the most accurate formulae and measurements can have a margin of error, and this margin of error can be much larger if your eye has previously had any refractive laser treatments. I therefore always explain that there may still be a chance that you will need a weak prescription for distance vision tasks such as driving, as well as a pair of glasses for reading, but that your unaided distance vision will be much clearer.

Multifocal and toric lenses are available. Toric lenses are lenses that help to focus the eye in the presence of astigmatism. Astigmatism is when the cornea (the front surface of the eye) is not a regular shape; it is usually corrected with glasses or contact lenses, but in the setting of cataract surgery, a toric lens can be used to increase the chances of obtaining good, unaided distance vision post-operatively. If you wish to consider either of these options, I will be happy to discuss them at your appointment.

Driving to and from appointments

Please note that any examination for cataracts, or to investigate visual disturbance, will require me to put drops in your eyes to dilate your pupils. When this happens, your vision will remain a little blurred until the drops wear off (usually after a few hours). During this time you should not drive. We therefore advise that you arrange for someone to drive you to and from your initial appointment.

I also advise that if you’re attending for surgery of any kind – including a biopsy, minor operation or cyst removal – that you arrange for someone to drive you to and from the appointment. After surgery, I may choose to place an eye patch / pad over the eye, and you should not drive if one has been applied. The pad is usually removed the next day (please see the section on postoperative advice for more details). Please note that even if a procedure is performed under local anaesthetic, you may feel a little unsteady afterwards – so it’s always sensible to have someone to collect you and take you home safely.

For additional information please see the Royal College of Ophthalmologist cataract patient information page.

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