Cataract Surgery

A cataract is a clouding of the lens inside the eye. Cataracts cause visual loss and other visual symptoms such as glare. The lens is normally transparent and is located behind the iris, the coloured part of the eye and the pupil. The lens is responsible for focussing light on to the retina which is equivalent to the film in a camera. A cloudy lens or cataract will prevent a clear picture from being formed on the retina and will cause reduced vision.

Cataract surgery is one of the most common eye operations performed today. It can restore vision in the large majority of patients. The procedure has been refined over the years and is now a minimally invasive procedure. It is undertaken as a day case usually requiring only eye drops for anaesthesia.

The operation is called phacoemulsification. Through a small incision of under 2.5mm, your cloudy lens is removed using ultrasound and replaced with an implant made of a clear plastic material. The implant can be tailored to your requirements. Astigmatism may be corrected and you may wish to consider a multifocal implant which can give both good reading vision and also distance vision. Eyedrops are given to numb the eye. There is no need for an injection (which can be painful) or a general anaesthetic but either can be given in exceptional circumstances. The operation nowadays is very well tolerated and, in the overwhelming majority of cases, restores vision without side effects.

If you are due to have cataract surgery, your requirements and details of the operation will be discussed with you at your clinic visit.

FAQ on cataract surgery

What causes cataracts?

Cataracts most commonly form as part of the ageing process, although they may occur at all ages. In younger people, they may result from injuries, taking certain medications, inflammations or from diseases such as diabetes.

What are the symptoms?

Some cataracts may not cause too many visual symptoms, but as they progress people usually complain of the gradual onset of various symptoms:

Blurred vision and reading difficulties
Glare and sensitivity to bright light
Increased short sightedness
Other visual disturbances such as double vision when looking out of the affected eye

Cataracts do not cause eye pain.

How and when should a cataract be treated?

Surgery is the only treatment for cataracts. Cataract surgery should be considered if the cataract is causing you symptoms that you would like to be improved. Your eye doctor will tell you if your symptoms are caused by the cataract. Nowadays we do not wait for cataracts to ripen, but operate as soon as they cause troublesome symptoms for the patient.

Will I need spectacles after the operation?

Most patients need reading glasses after cataract surgery. The aim for most patients is to make the distance vision as good as possible and for the patient to use reading glasses. This is the most common target. Occasionally, short-sighted patients wish to remain short sighted to allow them to read without glasses but to use distance spectacles. These options are available for patients having a single focus (monofocal) intraocular lens inserted at the time of surgery. You should wait until you have had a post-operative check before visiting the optician.

Am I able to read after surgery ? You may use your eyes as much as you like after surgery. If the aim is to make you good for distance without glasses, you can use ‘off the peg readers’ in the time before visiting the optician. A pair of ready readers with a + 2.00 to +2.50 power should suffice. These are available from some opticians, pharmacies, supermarkets and on the internet.

What if I do not want to use spectacles after the surgery?

There are two options:

Firstly, monovision may be a possibility for you. The dominant eye is made good for distance and the non-dominant eye good for near. This situation can be tolerated very well by some patients and is an option for patients who have been used to monovision before they developed a cataract.

Secondly, a multifocal lens implant may be used. These are a good option for the patient who wishes to use spectacles as little as possible after cataract surgery. The surgical procedure is identical to other cataract procedures, the only difference being the the type of implant used.The lenses are not free from side effects but are almost always very well accepted by patients. There are two main side effects of multifocal implants. The first is the possibility of seeing haloes around lights following surgery. This is usually an observation rather than a complaint and tends not to cause long term issues. The second is that reading spectacles are sometimes still needed, particularly in dim light.

What is a toric lens?

A toric lens implant is simply a lens that corrects astigmatism. Astigmatism causes an irregular focus and is usually caused by an irregular curvature of the cornea. If this is significant and it is not corrected with a toric lens, the chance of needing glasses after cataract surgery is much higher. Both single focus and multifocal implants can have a toric addition, and this will be discussed at the preoperative visit.

The day of surgery

The nurses will have given you information about do's and dont's on the day of surgery. You can expect to be at the hospital for about three to four hours, dependent on where you are on the operating list.

Your pupils will be dilated with a small pellet placed inside your eyelid that slowly releases a dilating substance in the hour before surgery.
You can expect to be at the hospital for two to three hours depending on where you are on the operating list.
You will be asked to sign the consent form by Mr Sandy and asked if you have any questions.
You will be taken to the operating room by one of the nurses.

How is the surgery done?

The operation is done under local anaesthetic to numb the eye.local anaesthetic drops. You will not feel any pain.

Your eye and face will be cleaned using iodine solution

A plastic drape will be placed over your eye to make a sort of tent which you will lie under. Some fresh air will be blown under the drape to prevent things becoming too stuffy.

The operation is then started under an operating microscope.

Some very small incisions are made in the eye using a special ultrasound instrument the size of a pen. The contents of the lens are dissolved and sucked from the eye.

This is called phacoemulsification.

The machine makes a variety of hissing and beeping noises.

You may be aware of water running down the side of your face.

You may see a variety of interesting visual symptoms such as various colours, patterns and shadows during the surgery.

The majority of the outer coating of the lens, the lens capsule, is left within the eye. This will support the artificial lens implant that will replace the natural lens.

At the end of the operation, a pad and a shield will be placed on the eye to protect it.

After the operation

When you return to the ward you will be offered a drink and something to eat.

A nurse will explain to you how to use the eye drops and will give you some post operative advice and instructions . An appointment will have been made for you for follow-up. We recommend that a friend or relative takes you home from hospital but it is not necessary for them to stay with you overnight.

The day after surgery, you will be telephoned by one of the nurses who will ask you a series of questions to make sure that all is well. Your follow-up appointment should be two to three weeks after surgery.

Do's and dont's after surgery

Do use your eye drops as instructed
Do continue normal daily activities and moderate exercise such as walking
Do bend down to pick things up if you wish
Do wear your old glasses if you find them helpful, especially for reading
Do wear ready reading glasses if needed before seeing the optician after a few weeks
Do take gentle exercise or play a gentle round of golf after a few days
Do Shower but take care not to get anything into the eye during the first week
Don’t rub or press the eye
Don’t carry out strenuous activities or heavy lifting in the first week.
Don’t get anything in the eye over the first week
Don’t wear eye makeup for the first week
Don’t swim for two weeks

Driving after cataract surgery

Don't drive until you are able to read a number plate at 21.5 metres and feel comfortable to do so. Some patients may drive very soon after surgery. Others may wish to wait, especially if distance spectacles need updating, or if there is a temporary imbalance between the eyes.

You will be advised about returning to work by your doctor. When you return to work largely depends on the type of work you do. Office workers may return to work within a week but manual workers may need to take two weeks off work.

You will need to contact the eye department without delay if you notice any of the following symptoms:

Increasing pain
Rapid loss of vision
Increased redness or a discharge from the eye
Flashing lights, floaters or a curtain across your vision

What are the risks of cataract surgery?

All eye operations involve some element of risk to your vision. However, over 98% of patients who have cataract surgery have a successful outcome. The important risks are listed below.

Tears to the posterior lens capsule

This may occur in about 2% of patients' eyes. It is not usually associated with a poor visual result and an intraocular lens implant can usually be inserted into the eye. Occasionally, a small piece of lens fragment may fall back into the main cavity of the eye. If this happens another operation may be needed to remove it.

Endophthalmitis (infection within the eye)

This is a rare but serious complication which can result in visual loss. It occurs in about 1 in 3000 cataract operations. The first symptoms are increasing blurred vision and redness and pain in the eye. If you experience these symptoms you should contact the eye department without delay.

Haemorrhage

Bleeding within the eye during surgery is very rare and unpredictable. If the bleeding is localised, the eye may recover but in some cases, severe visual loss may occur. The risk is approximately 1 in 5000 cases.

Retinal detachment

A retinal detachment occurs when the fluid from the cavity of the eye passes through a tear in the retina and separates the retina from the wall of the eye. Cataract surgery increases the risk of retinal detachment especially in shortsighted eyes. If you notice new symptoms of flashing lights, seeing floaters or a curtain over your vision, contact us immediately.

Macular oedema

The most sensitive part of the retina is called the macula. It allows us to see fine detail. After cataract surgery fluid may collect at the retina for no apparent reason or as a result of inflammation. It usually resolves spontaneously but may cause a prolonged visual disturbance. It occurs in up to 1% of cases.

Posterior capsular opacification

Thickening of the posterior lens capsule may occur in 50% of patients up to five years after cataract surgery. Instead of being like transparent polythene, this membrane becomes cloudy, reducing the amount of light getting to the retina. The vision may become blurred again rather like having the original cataract. Visual loss months or even years after cataract surgery is most commonly caused by this. It is easily treated with a small laser procedure in the outpatient department which restores the vision.

When should I go to the optician?

Do not go to the optician until you have been seen in the clinic after the operation. Your eye doctor will tell you when to go to the optician but it is usually about five or six weeks after surgery. Before this you may use any glasses that you feel are helpful. If you are particularly keen to read as soon as possible, you may use some 'temporary' off the peg reading glasses that you may buy from chemists and department stores. Using the 'wrong' glasses will not do the eye any harm.

Laser treatment after cataract surgery (YAG laser)

Laser treatment may be needed in up to 25% of patients in the first five years after cataract surgery.

The lens capsule which contained your own lens is left in the eye at the time of cataract surgery in order to support the plastic lens that is inserted in its place. The capsule is usually completely clear like polythene but months and even years after cataract surgery, it can become cloudy and can impair the vision. The treatment of choice for this problem is a laser capsulotomy. A laser is directed at the capsule and a small cut is made with the laser to open it and allow clear passage of light to the back of the eye. This usually improves the cloudiness and improves the vision.

What can I expect at the time of laser treatment?

The laser treatment is performed in the outpatient department and takes a few minutes. Your doctor will insert some anaesthetic drops into the eye. These may sting for a few seconds. A contact lens is then placed on the eye and this allows the doctor to focus the laser beam on the capsule. You will then hear some clicks and beeps of the machine when the laser fires but you will not feel any pain. Usually about 20 or 30 shots are needed to open the capsule. From your point of view it is important to try to keep still during the procedure.

After the procedure, the doctor may put some drops into the eye and you are then free to go home. It is important not to drive to and from the hospital for this appointment because your vision may be affected by the drops and, for a short time, by the treatment. Your eye may feel numb for about 15 minutes but you may also feel as though the contact lens is still in place. Your doctor will have removed the contact lens and your eye will feel comfortable after an hour or so.What are the side effects?

Side effects are rare. A transient rise in pressure within the eye may occur but you may have been given drops to counteract this. Very occasionally the eye becomes inflamed after the procedure requiring treatment with eyedrops. If the eye becomes red and painful after this laser treatment you should contact the eye department without delay. It is possible that the vision becomes worse after the procedure. Rarely the retina can become waterlogged after laser capsulotomy. This may occur for no apparent reason but there are some patients who are at greater risk of this complication. If you are one of these patients, your doctor will discuss the risks of treatment beforehand. Retinal detachment is a potential complication but is very rare.

If you have any questions regarding this information, please ask your eye doctor.

Cataract treatment summary

Cataract surgery has improved greatly over the years due to advancing technology. It is not a painful procedure to have done and it is associated with a high level of patient acceptability. Success rates are high and complication rates are low. The visual results are excellent if the patient has no other eye conditions.

Download Cataract Information Sheet

Cataract Surgery

FAQ on cataract surgery

What causes cataracts?

What causes cataracts?

What are the symptoms?

What are the symptoms?

How and when should a cataract be treated?

How and when should a cataract be treated?

Will I need spectacles after the operation?

Will I need spectacles after the operation?

What if I do not want to use spectacles after the surgery?

What if I do not want to use spectacles after the surgery?

What is a toric lens?

What is a toric lens?

The day of surgery

How is the surgery done?

After the operation

Do's and dont's after surgery

Driving after cataract surgery

What are the risks of cataract surgery?

Tears to the posterior lens capsule

Endophthalmitis (infection within the eye)

Haemorrhage

Retinal detachment

Macular oedema

Posterior capsular opacification

When should I go to the optician?

Laser treatment after cataract surgery (YAG laser)

What can I expect at the time of laser treatment?

Cataract treatment summary

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