Cataract Surgery

A cataract forms when the lens of your eye, a small transparent disc, develops cloudiness. This lens sits just behind your iris (the coloured part of your eye). Normally your lens is clear and helps focus the light entering your eye. Cataracts most commonly affect adults as you age and causes your sight to become cloudy, misty, and sometimes blurry.

They normally develop very slowly with little impact initially (a change of glasses may help) but as they worsen, you may experience symptoms such as:

• Feeling your glasses are dirty and need cleaning, even when they’re clean.
• Your sight becoming misty and cloudy.
• Becoming more sensitive to light (bright sunlight or car headlamps may dazzle you more).
• Everything looks more washed out and less colourful.

Although cataracts do not damage the eyeball, they generally get worse over time and surgery to replace the cloudy lens is the only way to improve your eyesight. There are no proven medicines or eye drops able to improve cataracts or stop them getting worse.

It is up to you to decide whether to have surgery or not. You may choose to put off having surgery for a while and have regular check-ups to monitor the situation. Your decision should also not be based solely on eye test results (visual acuity) as cataracts may change aspects of your vision other than sharpness.

Surgery is usually offered on the NHS if your cataracts are affecting your eyesight and quality of life such as daily activities, hobbies and interests.

Cataract surgery replaces the clouded lens with an artificial one and afterwards you should be able to:

• See things in better focus, though glasses may still be needed.
• Look towards bright lights without being dazzled as much.
• Tell the difference between colours more easily.

If you have another condition affecting your eyes such as diabetes or glaucoma, you may still have limited vision, even after successful cataract surgery.

The risk of serious complications developing because of cataract surgery is estimated at around 1 in 50 cases.

These can include:

• Blurred vision.
• Some loss of vision.
• Detached retina, where the thin light sensitive layer at the back of your eye (retina) becomes loose.

Most of these serious complications can be treated with medicines or further surgery.

There is a very small 1 in 1,000 risk of permanent sight loss in the treated eye as a direct result of the operation.

Before surgery, you will be referred to an ophthalmologist (specialist eye doctor) for an assessment when they will take different measurements of your eyes and eyesight.

Please ensure you have somebody to drive you to and from this appointment as the ophthalmologist cannot properly examine your eyes without dilating your pupils with eyedrops.

Please bring to this appointment:

• Your current distance glasses and prescription if possible.
• A list of all your medications or repeat prescription from your GP.

If you wear contact lenses, leading up to your clinic appointment please do not wear:

• soft lenses for one week.
• hard lenses for two weeks.

The assessment is an opportunity to discuss anything to do with your operation, including:

• Your lens preference, such as for near sight or long sight.
• The risks and benefits of surgery.
• How much you will still need glasses after surgery and for what activities.
• How long you will take to fully recover.

If you are used to using monovision (one eye for distance and the other for reading), you can ask to stay that way. This usually means you will get a near-sighted lens fitted in one eye and a long-sighted lens fitted in the other eye.

The entire cataract process from admission to discharge usually takes 1-1.5 hours. The actual surgery is a straightforward procedure that usually takes 10 to 12 minutes, sometimes a bit longer. It is carried out as day surgery under topical anaesthetic using eyedrops (an injection not being necessary for most people) and you will be able to go home the same day.

• Please arrive promptly on the day of surgery.
• Please ensure you have somebody to bring you into hospital and take you home again, and make sure you have the contact details for the person collecting you.
• You can eat and drink as normal before you come in.
• Take all your medication as usual unless specifically advised not to.
• Please do not wear ANY make-up or face creams whatsoever. This includes all types of facial make-up from mascara to foundation and even lipstick. The face should be completely bare in the operating theatre.
• Do not bring valuables to the appointment.
• Please ensure you bring hearing aids to the appointment as you must be able to listen to instructions.

On the day of surgery and before your operation, the surgeon will see you to answer any questions you may have and to confirm and sign the consent form that gives us your permission to proceed with the operation.

During the operation, the surgeon will make a tiny cut in your anaesthetised eye to remove the cloudy lens and replace it with a clear plastic one, which is of very high quality and permanent.

With the NHS, you will be offered monofocal lenses, which have a single point of focus. This means the lens will be fixed for either near or distance vision, but not both. It may not correct astigmatism.

If you choose to have the procedure done privately you will be able to choose either a multifocal or an extended range of focus lens, which can allow the eye to focus on both near and distant objects. You may also be offered a toric lens, which can reduce the effects of astigmatism.

Most people will still need to wear glasses occasionally for at least some tasks such as reading, regardless of the type of lens they have fitted.

If you have cataracts in both eyes, it may be recommended that both eyes are treated on the same day, but as separate procedures. This procedure is known as immediate sequential bilateral cataract surgery (ISBCS). ISBCS is usually only recommended for people thought to have a low risk of complications. The surgeon will discuss this with you if this is an option. If it is not, the surgeries will be done six to twelve weeks apart to allow the recovery one eye at a time.

You will be able to go home within two hours after your appointment.

You may have a plastic shield over your treated eye when you leave hospital, which can usually be removed the day after surgery. These shields are not essential.

Feeling should start to return to your eye within a few hours of surgery, but it may take a few days for your vision to fully return.

It’s perfectly normal to have:

• Blurred vision.
• A red or bloodshot eye.

These side effects usually improve within a few days, but it can take four to six weeks to recover fully.

If you need new glasses, you should not order them until your eye has completely healed (usually six weeks) or after you have had both cataracts removed. We recommend buying a pair of cheap reading glasses from a local chemist or optician to use until you have been discharged.

Contact your eye surgery department as soon as possible if you experience:

• Increased pain and/or redness or weeping.
• Sudden loss of vision or decreased vision.
• Flashes of light, many black spots or a curtain effect across your vision (please bear in mind slight peripheral flickering is not uncommon).

Do:

 Take painkillers if you need to.

• Use your eye drops as instructed for a month.
• Take it easy for the first two to three days.
• Use your eye shield at night for three days.
• Avoid dusty environments, dusting and gardening for a week.
• Shower yourself, from the neck downwards for first week, or have a bath.
• Wash your hair leaning backwards over the sink for seven days to prevent the soap from getting in your eye. You may need help with this.
• Read, watch TV and use a computer if you would like to.
• Avoid swimming for at least two weeks.
• Use sunglasses if you would like to, as everything will appear bright initially.
• Do be careful about doing any strenuous exercise or housework. The most important thing is to avoid contamination to the recovering eye.

Do not:

• Try not to rub your eyes.
• Try not to allow soap or shampoo to get into your eye.
• It is recommended not to drive for the first week. Remember, the DVLA states you must be able to read a car number plate at 20m with at least one eye for private vehicles.
• Do not wear eye make-up for at least two weeks.
• Do not fly without seeking advice from your doctor

You could arrange for someone to help take care of you until your vision returns, particularly if the vision in your other eye is poor.

If you work, how soon you can return will largely depend on the type of job you do and if you need new glasses. Most people do not need any more than one week off work and do not need a certificate from us as employers must allow you to self-certify.

Before you leave hospital, you will be given some eye drops to help your eye heal and to prevent infection. It is important to use your eye drops as instructed by your doctor as they contain antibiotic and steroid anti-inflammatory.

You will be given full instructions on the day of surgery and unless told otherwise, you should:

• Start your drops the morning after the operation.
• Only use them on the operated eye.
• Wash your hands before and after using your drops.
• Do not stop your eye drops without advice from your doctor.
• Do not let anyone else use your eye drops.

You will have a follow up appointment four to six weeks postoperatively either at Tetbury Hospital Trust or with your optician.

1. Wash your hands.
2. Tilt your head back.
3. Look up at the ceiling.
4. Gently pull down the lower eyelid.
5. Invert and tap the bottom of the bottle until a drop goes into your eye.
6. Close your eye and wipe away any excess with a clean tissue.
7. Try not to let the bottle touch the eye.
8. Safely dispose of the drops once you have finished your course of treatment.

• Boil some water and allow it to cool.
• Wash your hands.
• Dip cotton wool or clean gauze in the cool boiled water.
• Gently wipe eyelashes from the nose to the outside corner of your eye, then throw away.
• Try not to wipe inside your eyelid.
• Do not wash your eye out with water.
• Try not to press on your eye.

During the first two weeks, you need to clean your eye because the drops and the healing process can cause slight stickiness.