Cataract Surgery
What is a cataract?
A cataract is a condition of the eye that makes it very difficult to see as you normally would. The lens (the part of the eye that we use to focus) becomes clouded. The eye is like a camera with a lens system at the front and a photosensitive area at the back. The normal function of the lens is to focus light, allowing you to see sharp clear images. If the lens of the eye becomes cloudy, this then restricts the amount of light that's able to enter the eye, therefore reducing the eyesight.
A cataract usually develops gradually, eventually making it difficult to carry out your daily activities. If the cataract is not removed, your vision usually becomes worse over time. One or both eyes can be affected, but a cataract cannot spread from one eye to the other.
Symptoms
Treatment
The only effective treatment for a cataract is to have them surgically removed. Cataract surgery should be considered when you are having difficulty seeing well enough to carry out normal daily activities, such as watching TV, driving or reading. Cataract surgery is usually performed as a day case procedure under local anaesthetic, during the operation, the cloudy lens (cataract) is replaced with an artificial lens (implant) inside your eye.
What to expect
Typically our cataract surgery treatment involves:
Your pre-operative assessment
At this appointment, our clinical team will examine your eyes and take measurements to ensure that cataract surgery is appropriate for you. We will arrange dates for surgery and your follow-up visits. The measurement of your eye (known as biometry) allows the strength of your new implanted lens to be calculated. Drops to dilate the pupils will be put in both eyes before the doctor's examination. These drops will blur your vision for up to four hours, and sometimes longer. You will have the opportunity to raise any queries or concerns with members of the SpaMedica team. It is important to bring the following with you:
Important points
Our eye drops usually cause blurred vision for about four hours. Therefore, you'll need someone to drive you home after each appointment. You may take a holiday inbetween appointments, but not for at least one week after the operation. Although complications of cataract surgery are rare, they could cause cancellation of your holiday. It is advisable to go to areas where high quality medical services are available and to notify your travel insurance company about your forthcoming surgery.
Contact lenses
Please remove soft contact lenses (both eyes) 48 hours before your pre-assessment appointment. If you wear permeable of hard contact lenses these should be removed 7 days prior to your appointment. You can wear them again two hours after the appointment is finished but your vision may still be blurred for a number of hours. Remove your lenses 24 hours before your cataract surgery.
Changes to your eyesight
The cataract operation involves placing a new lens in your eye (lens implant). We have about 60 different strengths of lens implants and we match one to your eye to optimise your visual outcome. We use the latest technology to measure the length and shape of your eye to enable us to determine the ideal power of lens for your specific needs. It is routine to plan the power of your eye to leave you with minimal requirement for glasses to see clearly in the distance. On rare occasion we may discuss leaving you short-sighted or long-sighted if we feel this may be of benefit to you. The following are possible refractive (power) outcomes following your surgery that you may wish to discuss:
Myopia (short-sighted)
You will be able to read close up but will require glasses or contact lenses to sharpen your distance vision
Emmetropia (normal sighted)
You will be able to see at a distance but will need glasses for near vision
Hypermetropia (medical decision only):
Glasses will be required for distance and near vision
Astigmatism
In any of the above, if there is significant astigmatism, glasses will be needed at all distances to see clearly. Toric lenses (implants), capable of correcting astigmatism, are also available but unfortunately cannot be offered via the NHS. Please contact SpaMedica for more information. If you have private health insurance and wish to discuss this option please contact SpaMedica.
Monovision
One eye is focused for near, the other for distance. If your optician has created this with the use of glasses or contact lenses, we can mimic the effects with cataract surgery.
Bifocal and accommodative lenses:
These lenses (implants) allow you to see clearly in the distance and for near without the need for glasses. Unfortunately these are not available via the NHS. Please contact SpaMedica for more information or visit our website for details. If you have private health insurance and wish to discuss this option please contact spaMedica.
The cataract operation
The eye surgeon will remove your cataract by making a very small incision in your eye. The incision is usually self-healing but may sometimes require stitches, which are easily removed in the outpatient unit. Inside your eye, your natural lens (cataract) is inside a capsule, rather like the skin of a grape containing the fruit. The lens is softened with ultrasonic waves before it is removed through a hollow probe. The surgeon removes the lens and leaves the capsule intact. A new artificial lens is implanted in the lens capsule which 'shrink wraps' it to hold it in place.
On the day of the operation
At Reception
The receptionist will confirm your details and direct you towards the ward.
In the ward
Most patients do not require sedation for their surgery. However if the doctor has identified this as a requirement at the time of the pre-assessment clinic then the appropriate sedative tablet will be offered to you. Please tell the nurse if anything has changed since your pre-operative assessment, for example, new medication, illness or eyesight change. Your Consultant Ophthalmologist will visit you in the ward area or in the anaesthetic room.
Ambulatory Reception
You will be escorted to the ambulatory reception, close to theatre, where anaesthetic and antiseptic drops will be placed in to your eye. In some cases, the whole eye needs to be anaesthetised in order to prevent it moving. The Consultant Ophthalmologists may then use an injection close to your eye.
In theatre
You will be wheeled into the operating theatre. The area around the eye will be cleaned with a surgical skin cleaner containing iodine, and your face, head and chest will be covered to create a sterile barrier. This sterile sheet is adhesive and sticks to the skin around the eye. Removing it at the end of the procedure is like having a sticking plaster removed - if you have particularly delicate skin please let us know. Water is used to irrigate the eye during the procedure. This sometimes gets behind the surgical sheet and can run down into your ear or neck. We therefore remove hearing aids on the side of the surgery just before the operation. The water is coloured with iodine and may be difficult to wash out from white clothing. The surgeon uses a high powered microscope to perform the surgery and the light is very bright. You will be asked to look straight into the light so the operation can take place. You need to keep as still as possible during the procedure. Even slight movements, like talking or nodding, are amplified under the microscope and make the surgery more difficult. You will be shown how to indicate to the surgeon if you need to cough or sneeze.
What does the surgery feel like?
After the operation - in the ward
You will be accompanied back to the ward by one of our staff. Your eye will be covered with an eye shield. Eye drops will be given to you to prevent infection and reduce any post-operative swelling. Written post-operative care instructions and instructions on how and when to use the drops will be provided to you. The staff will give you a booklet explaining your drops. It also has a chart that can be used to record when you need to instill your drops and for you to complete when you have instilled them. Many patients find this very useful. It is very important to remember to put your eye drops in your eye as directed, in order to prevent infection or inflammation. Infection in the eye can lead to permanent loss of vision.
After the operation - at home
If you suffer from glaucoma, it is very important that you continue with your regular eye drops as usual. Your eye might be sensitive to the light for a few days after the procedure, and the eye may have a mild watery discharge. It is quite normal to feel mild discomfort after the operation. This may include itchy and/or sticky eyelids. One to two days after the operation this mild discomfort will start to subside. If you have discomfort, we suggest that you take Paracetamol or your regular choice of painkiller every four to six hours, in accordance with correct dosage. (Avoid Aspirin unless it has been prescribed). Vision in the healing eye may be blurred when reading or watching TV as the eye heals and the new lens stabilises. Call us immediately if you experience:
Important post-operative information
Driving
Flying
There are no restrictions to flying except under very rare circumstances (less than one in 10,000), which your surgeon will tell you about.
Working
You can aim to return to work on the seventh day after surgery, unless you work in a dusty or dirty environment, in which case it should be 14 days.
Opticians
Please visit your own optician between 1-7 days prior to your four week follow-up appointment. Ask your optician to test your eyes and complete the form given to you after your surgery. This will inform us of the power of your eye and your level of vision.
Four week follow-up
At your follow-up visit four weeks after surgery, you should be close to finishing or have just finished your eye drops. Please do not drive to this appointment as eye drops will be used to dilate the pupil, which may blur your vision. The doctor will examine your eye after the pupil has been dilated. He or she will then do one of the following:
