Cataract Surgery
Cataract surgery is generally considered safe and has a high success rate, with most patients experiencing significant vision improvement following the procedure
What is a Cataract?
We all have a lens in our eye, which is positioned just behind the coloured part of the eye (the iris). Like a lens in a camera, this helps the focussing of light onto the retina and is essential for vision.
Cataract is the term used to describe clouding of the lens, which can then sometimes impair vision.
What are the Symptoms of Cataract?
There are many possible symptoms from developing a cataract but commonly these include:
• Blurring of vision, which usually develops over a long period of time (typically years), although blurring can occasionally develop rapidly.
• Glare - sometimes whilst driving for example, you may notice that lights take on a star burst type appearance and can be distracting.
• Short sightedness - due to the increasing density of the cataract, you may notice that you are gradually becoming more short sighted.
This can sometimes be corrected with an ever increasing distance prescription on the glasses.
What are my options?
In many circumstances it may be entirely reasonable to live with a degree of cataract if it is not impairing the vision. The vision may be improved by simply strengthening the glasses prescription that you wear.
For many people, especially those with blurred vision, who are struggling to go about daily activities, they may choose to go ahead with cataract surgery.
This will be discussed with you in more detail in your consultation, where your eyes will be assessed and you will have the opportunity to ask questions.
What does surgery involve?
The operation is generally done under local anaesthetic as a day case procedure. Occasionally, it is performed under general anaesthetic or sedation. Local anaesthetic eye drops are used to numb the eye itself.
Occasionally an injection around the eye is required to help freeze the whole eye for comfort. A sterile drape will cover the face for a short while, although there will be oxygen felt underneath, so as not to get claustrophobic.
Several small incisions are made to allow access to the cataract itself, which is then broken up with ultrasonic power. A new foldable lens will then be inserted into the eye, which will unravel and sit where your old lens used to. Only very rarely is a stitch required to secure the eye afterwards.
Cataract assessment
Once you have decided you would like to have cataract surgery, you will have several tests done including a basic check of your vision, a dilated examination of the eye, and measurements taken to determine which lens will be appropriate.
Further tests may be necessary if any issues are shown at this stage. In contacts lens wearers we ask that soft lenses are left out for 2 weeks and hard lenses for a month, prior to having measurements taken (as this can affect the shape of the cornea).
We will discuss the choice of lens with you at your clinic appointment. Some individuals may wish to seek vision for distance and near, and in which this will be discussed at your consultation.
Where there is pre-existing astigmatism, you may benefit from a toric lens, which can help improve this.
We will also discuss the type of anaesthetic. Most people are perfectly happy having cataract surgery under local anaesthetic (awake, usually with drops). Other people may feel more comfortable being asleep (general anaesthetic).
What are the risks of cataract surgery?
Cataract surgery is one of the safest surgeries carried out in the NHS and private sector. Almost half a million are performed in the UK every year. It is, however, an operation within the eye, and therefore carries a degree of unavoidable risk.
• There is approximately a 1/100 chance of the lens not being stable during cataract surgery, specifically due to posterior capsule rupture. If this happens, it may not be possible to implant a lens, or an altered position of the lens may be required.
• There is an approximately 1/200 chance of needing a second operation. This could be due to, for example, retained lens fragments, or rarely the need to remove and replace an intraocular lens.
• Very rarely, a sight threatening complication may occur during or after cataract surgery, such as the development of an infection inside the eye (endophthalmitis) or a bleed within the eye (suprachoroidal haemorrhage). The risk of such a complication is very low, probably around 1/1000 to 1/2000.
• Refractive surprise. Whilst we aim for perfection in every patient, occasionally the desired prescription (i.e. distance or near) may not be achieved. This may sometimes be corrected with glasses/contact lenses, or rarely there may be a need for lens exchange or refractive laser surgery.
• A small number of patients may notice that they have a slightly droopy eyelid after surgery (ptosis). In most cases this will not interfere with eyesight and will not need any intervention.
• Less severe complications such as mild oedema (swelling) within the retina may occur, usually in around 1/100 patients, or there may be persistent inflammation within the eye, both of which would usually need a longer course of post operative drops.
• Retinal tears and detachment are rarely encountered post operatively, although are more likely in those who are short sighted.
• Dry eyes/sensitive eyes may be encountered after surgery, but thankfully this is typically short-lived and is helped by lubricating drops.
• Up to 1/3rd (possibly up to 50%) of patients will develop some clouding of the capsule that surrounds the back of the eye (posterior capsule opacification). This is easily treated with laser which is a painless, quick, out patient procedure.
What happens after surgery?
After surgery is complete you will usually have a shield on the eye to protect it. I advise that you wear the shield for the first evening after cataract surgery, and then at night for a week following to protect the eye whilst you sleep.
There will be drops to put in the eye, usually on a tapering course, starting at 4 x per day for the first week and reducing down over 4 weeks.
It is sensible to avoid swimming/getting anything into the eye for one week following surgery, and to avoid contact sport or strenuous exercise for a month.
You will be followed up by telephone the day after surgery, and then 2-3 weeks following the operation in clinic.
It is sensible to get a new prescription about 6 weeks after surgery, although if you are having the second eye operated on it is best to have both done before getting new glasses.
Book A Consultation
Email:
nicky@huwoliphant.com
Phone:
07307184540
Location:
Polegate Consulting Rooms (Eastbourne)
Nuffield Health (Brighton)
The Doctor Clinic (Lewes)