Cataract Surgery - What To Expect
Mr Moriarty operating.
You and I must first agree that surgery is necessary to remove the cataract.
The operation itself can be performed as a day case or as an in-patient.
A. Pre-operative assessment
Sometime before surgery is scheduled, you will attend for an assessment. This consists of measuring the length and curvature of your eye to be operated on. A quick and painless process, these measurements are essential for successful surgery to take place and enables me to assess the correct power of intraocular lens to replace the patient's own lens.
B. Eating and drinking
You can have a light meal up to four hours prior to surgery if under local or six hours if general anaesthesia. Drinks are permissible prior to surgery under local but none closer than four hours before surgery under general. No alcohol on the day of surgery.
C. Tablets and medications
These are taken as normal. However, patients on warfarin and diabetics should discuss medication with me specifically.
D. What happens during the operation?
You will usually be admitted to the hospital several hours before surgery. You will need to sign a consent form before the operation can be done.
Removing the cloudy lens.
Just before the operation you will be given eye drops to dilate the pupil. Local anaesthesia applied to the eye means that you must remain awake and lie relatively still during the operation. A general anaesthetic, which puts patients to sleep during the operation, is offered to those who have difficulty remaining still or are anxious about local anaesthesia. The local anaesthetic numbs the eye so that you will not feel any pain whilst I am operating on you and you will be wide awake. You will need to lie still during the operation which lasts 20 minutes but often less. During the operation your face will be covered by a light cloth but a nurse will hold your hand and make sure that you are all right.
An implant lens used in cataract surgery.
If your operation is under local anaesthetic you may hear some strange noises from machines and voices but do not be alarmed. I will talk to you during surgery to keep you reassured.
The operation is performed with the help of a microscope. A small incision is made in the top of the eye through which the cloudy lens is removed using a probe (a process known as phacoemulsification) and a lens implant is inserted. The incision in the eye is usually so small that stitches may not be required at the end of the procedure. A pad is then put over the eye for protection against rubbing and bumps after the operation.
Please be reassured that the eye is NOT removed from its socket at any point.
What is a lens implant?
After the cloudy lens has been surgically removed it is usually replaced by a synthetic lens implant, so that the eye can focus properly.
Rarely I may decide that someone's eye is not suitable for a lens implant. In these cases contact lenses or special glasses will be provided instead.
Phacoemulsification microincision cataract surgery
Using a very small ultrasonic probe the cataract is removed by ultrasound waves inside the eye and dissolved and sucked out of the eye. (THIS IS NOT A LASER, though once safe and reliable lasers are available for cataract surgery, I will be adopting this technique).
The incision remains small, thus only a very small incision is made and this is preserved by folding an implant lens of the correct power to sit in the old bag in which the cataract was contained. By using a lens of the correct power, short or long sightedness can be treated at the same time.
This means return to activities - reading, driving, work etc. is accelerated compared with more conventional surgery with larger incisions.
E. After the operation
You will usually be allowed to go home soon after the operation is complete. On the following day, I will probably want to see you for a quick check-up, just to look at the eye.
Your sight will usually improve after a few days, although complete healing can often take several weeks. You will be given eye drops to use.
Using your eye drops
When you are given the eye drops, you will be instructed on how to use them. There will also be a leaflet with each type of eye drop. Follow these instructions carefully each time you use the eye drops. Remember to only use the drops in the eye that has been operated on and only ever use the eye drops prescribed to you. Here are some simple points to remember:-
- Wash your hands.
- Tilt your head back.
- Pull the lower eyelid down with one hand.
- Using the other hand, put one drop (or the amount you have been instructed) into the eye without letting the dropper touch your eye.
- Close your eye gently.
- Mop up any fluid around your eye with a clean tissue.
- Put the cap back on the dropper.
Take it easy!
It can often be frustrating for an otherwise active person to be restricted from doing the full range of activities they normally perform and enjoy. I appreciate this, but you must accept the fact that your eye needs time to heal properly without any complications. To minimise the risk of any such problems, please adhere to the following for two weeks following the operation :-
- Avoid rubbing your eye; wear an eyeshield if you are a restless sleeper.
- Don't do any heavy lifting.
- Avoid strenuous exercise and swimming.
- Avoid strenuous housework.
- Cover the eye when going outdoors in windy conditions, in case anything blows in your eye.
- You can bathe or shower as normal, but avoid splashing water on your face.
- Wash your hair leaning backwards rather than forwards.
- Avoid using eye make-up for four weeks.
- Resumption of your sex life can take place two weeks after surgery.
- Avoid driving until I recommend you can do so.
- Time off work depends on your job.
Will the operation ever need to be redone?
YAG laser.
Once the cataract is removed it will NEVER recur. Occasionally however, a part of the eye called the lens membrane (posterior capsule) may become cloudy after cataract surgery. This can be corrected immediately and successfully using a special type of laser treatment, called a YAG laser (shown on right). It clears the vision which may become cloudy after months or years. The treatment takes a few seconds and is painless.
What next?
You will be required to attend follow-up clinics as per appointment. It is important that you attend these appointments, in order to check that the eye is healing well, and also to assess the state of your vision. An eye test, probably 2–4 weeks after the operation, will allow glasses to be prescribed.
If, at any point dirt gets into the eye or it becomes sticky, gently clean the eye using a cotton bud soaked in sterile saline or cooled boiled water. If the vision in your eye suddenly worsens or it becomes red and/or painful, or if you notice a yellowish/green discharge, contact the hospital or myself immediately via Highfield House or the hospital.
Finally, it is important that you use your eye drops and any other medicines given to you by the doctor as instructed. Remember that it may take some time for the vision in your eye to improve fully.
Hopefully this guide has answered any queries you have had, and reassured you that cataract surgery is something which should not be feared. If you have any questions unanswered by this guide then do not hesitate to ask me. Remember, we are here to help you and to make the whole process as comfortable for you as possible.
Are there ever any complications?
As with all surgery there is always a chance of complications occurring. However, these are rare, and if they do occur, can usually be dealt with. The greatest risk with any type of eye surgery is post-operative infection of the eye. If this occurs the vision in the affected eye can actually become worse permanently. Therefore you should be aware of this. By and large however, cataract surgery is safe with very effective outcomes.
The other main complications are haemorrhage into the eye or damage to the capsule supporting the implant lens. Rarely, swelling of the centre of the retina (macula) or a detached retina may occur. Very rarely, the cataract may dislocate into the back of the eye, requiring re-operation and, rarely, it is felt advisable not to implant a lens at the original time of surgery. These are rare and, fortunately, when recognised can be managed correctly.