Cataract Surgery

What happens during the operation?

A cataract operation usually lasts about 10 minutes to 20 minutes. You will be able to go home the same day. Most people have a local anaesthetic before the operation. This means you'll be awake during your operation, but you won't feel any pain. If you are very anxious, you may be given a drug (sedative) to help you relax. Very occasionally, people have a general anaesthetic to make them sleep.

Before your operation, a nurse will put drops into the eye you're having the surgery on. This makes your pupil (the black hole in the middle of the coloured iris) bigger so it's easier for your surgeon to reach the lens inside the eye.

You won't usually need to change out of your normal clothes, and you'll probably walk to the operating theatre. Once you're there, you will be asked to lie down on a trolley or bed that has a special pillow to hold your head still. Your face will be covered with special sheets (drapes) to keep germs out of your eye but a space will be left for you to breathe through.
No pain....No needle....No stitch....No pad

A doctor or nurse will numb your eye with anaesthetic eye drops. This may sting a little. The area around your eye and your eyelashes will be cleaned with an antiseptic. This keeps germs from getting inside your eye.

You'll have to lie still and not speak. A nurse will hold your hand and talk to you. He or she will explain how to signal if you feel uncomfortable. During the operation, you'll probably see the light of the microscope your surgeon uses. You may also see flashes of light and changes in colour or brightness. In a study of 102 people, no one found these things unpleasant, although two people said the light from the microscope was uncomfortably bright.

Your surgeon will look into your eye with the light of a microscope and make a tiny incision in the thin window (cornea) that covers the surface of the eye. The surgeon then removes the cloudy lens through the cut. The natural lens sits inside a case of thin tissue called a capsule. The capsule stays in place to support the artificial lens.

The most common way of doing the operation is called phacoemulsification (or 'phaco' for short). The operation can also be assisted by a femtosecond laser.

Your surgeon gently makes a cut in the clear, thin window  (called the cornea) that covers your eye. The cut is just over 2 millimetres long. It isn't painful and heals very quickly without the need for a stitch.

The surgeon then puts a probe with a very fine tip through the cut to reach the lens inside your eye.

The probe gives off high-energy ultrasound waves. These sound waves break down the lens into small soft pieces which are then sucked out through the centre of the instrument tip.

Your surgeon will then put a lens made of a flexible plastic into your eye using a special injector in which the lens is tightly folded. This lens unfolds once it's inside the eye. The small cut on your eye shouldn't need stitches.The artificial lenses can come in different focusing strengths, rather like the lenses in glasses. Your eye specialists will have measured your eye before the day of your operation to choose a lens that matches your eye. The artificial lens an intraocular lens (IOL). It will become part of your eye, and apart from being clear it won't feel any different from your natural lens.

How can this operation help me?

After your operation, if you don't have other eye diseases, you should be able to:

  • See things in focus
  • Look into bright light without as much glare as before
  • Colours become more vivid and you will be able to tell the difference between them easily
  • Get back to your usual activities such as reading, working, watching television, sport and driving

One big study collected information on the results of 18,000 cataract operations that took place in 100 eye units across the country. It found that most people who have the operation can see much better afterwards, no matter how poor their eyesight was before.

People who have cataracts along with another eye problem, such as macular degeneration( an age related condition affecting the central vision), diabetic retinopathy (when blood vessels leak blood and fluid into the eye) or glaucoma (pressure builds up in the eye damadging the optic nerve so you can't see well), probably won't see as well after their operation as people who have just cataracts. But about 7 to 8 out of 10 people with other eye problems can still see well enough to drive after a cataract operation.

Enjoying life more

Researchers have also looked at how cataract surgery affects people's enjoyment of life. One way of doing this is to ask about how a person's eyesight affects their ability to do things like reading the paper, reading labels on bottles, seeing shop signs, cooking, taking part in sport, sewing, filling out forms, playing card games or watching the television.

A set of questions can be asked before and after the operation and the results compared. One study that did this with about 300 people found that most of them had much less difficulty performing everyday tasks four months and 12 months after their operation.

But having your cataract removed may not give you perfect eyesight without glasses. Problems such as astigmatism (when the eye is shaped like a rugby ball rather than a sphere) may mean that you still have to wear glasses for perfect vision, although there are some intracoular lenses called toric lenses which can also correct astigmatism at the same time as cataract surgery. The eye will not normally be able to change its focus to let you see things in the distance and read things close up without using different glasses. This means that you will have to wear reading glasses unless a mutifocal lens implant has been fitted. Ask about this at your consultation.

What will happen if I choose not to have an operation?

If you choose not to have an operation, your cataract won't get better and your sight will gradually get worse. Your cataract will keep growing until the whole lens is white and you can no longer see.

Cataracts may cause problems that can severely damage your sight. And leaving them to grow can make surgery more difficult, which increases the chance that something will go wrong during the operation.

But cataracts usually develop slowly over the years, and many people with cataracts manage well with glasses and contact lenses. If your cataract isn't interfering with your daily life, you may choose not to have your operation straight away. Unfortunately, your doctor won't be able to tell you exactly how fast your cataract will grow. There hasn't been any good research on this.

Older people sometimes put off having an operation and may avoid it altogether.

What can I expect after the operation?

After having a rest, you will be able go home. You won't be able to drive, and if you've had a sedative you'll need someone to stay with you for 24 hours. The operation doesn't usually hurt, but your eye may feel a bit uncomfortable and itchy for a couple of days. Your eye may also be sensitive when you look at bright light or when you touch it.

You'll need to put eye drops in the treated eye every day usually for 4 weeks. These make it less likely that you'll get an eye infection and will reduce any swelling.

You may need to go back to the hospital a few days after your operation. This is so that checks can be made to ensure there are no problems with your eye.

You'll be able to do most things when you get home, but take care not to knock your eye. You should be able to read or watch TV almost straight away. But your vision may be blurry as your healing eye gets used to the new lens.

It's best not to swim until a few weeks after the operation and you should avoid sports like tennis, where there's a risk you will get knocked in the eye.

You may notice that colours are much brighter than before. This is because your new lens is clear and natural lenses become yellowy-brown as you get older. If you wore glasses or contact lenses before your operation, you may need new ones afterwards because your sight has improved. After a few days, you'll probably be able to see things in the distance well enough without your glasses, but you may find it hard to see things close up until you have new glasses. You'll probably not notice the full benefit of your cataract operation until you get new glasses.

There are laws about how well you need to see before you can drive. The nurse can give you advice at the follow-up appointment about when it's safe to drive.

What other treatments are there?

Having an operation is the only way to remove your cataract and improve your sight. Eye drops and other treatments are available to treat cataracts, but there's no evidence that they work.

New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses might help with the first signs of a cataract (slight cloudiness at the edges of an image), but these won't stop the cataract growing and blurring your sight.

What are the risks?

All operations have risks, although serious problems with cataract operations are rare. Around 1 in 100 people have complications during surgery to remove their cloudy lens. There's a risk that you won't be able to see as well as you did before. But serious problems that can make your sight worse happen in only 1 in 1,000 operations.

Problems during the operation

  • Bleeding: Bleeding inside the eye (haemorrhage) happens to less than 1 in 1,000 people. But it is serious and can damage your sight.
  • Damaged capsule: The capsule that supports the lens can tear or break. This happens to about 1 in 100 people. If it happens, your sight may be worse than normally expected but usually the visual outcome is still excellent.
  • Piece of lens left behind: A bit of the lens with the cataract can break off and become lost in the eye. This happens to less than 1 in 100 people. You may need another operation to remove the lost piece of lens usually without any adverse effect on your visual outcome.

Problems after the operation

  • About 1 in 4 people have a problem within a couple of days of their operation. Most of these are mild and clear up without treatment or are easily treated.
  • Swelling of the cornea: The cornea is the clear, dome-shaped layer on the front of the eye. It can sometimes swell up and become water logged. The cornea may turn cloudy. Usually, the swelling is temporary and will go away by itself. But you might need another operation to transplant a cornea so you can see better again. This happens very rarely.
  • Increased pressure in the eye: This is uncomfortable and happens to about 8 in 100 people. Your doctor may give you eye drops to make your eye feel better.
  • Inflammation of the front part of the eye: This is called uveitis. It happens to about 6 in 100 people.
  • An infection inside the eye: This is called endophthalmitis. It's extremely serious and you can lose your sight in the infected eye. However, due to recent improvements in surgical technique and antibiotic delivery, endophthalmitis is fortunately even more rare than a few years ago. The infection should be treated with antibiotics straight away. Under 1 in 1,000 people will get an infection after surgery.
  • Bruising: It's possible that your eye or eyelid may be bruised.
  • Swelling of the retina: Fluid may build up in the retina between two weeks and 12 weeks after the operation. It usually happens after more complicated surgery and if the lens capsule has torn. If this happens, you'll notice that your sight becomes cloudy a couple of weeks after your operation. Doctors call this cystoid macular oedema. It usually goes down by itself but sometimes requires some treatment to help resolution.
  • Injury to the iris: Less than 1 in 100 people have an injury to their iris (the coloured part of the eye) if they have their cataracts removed by phaco. This risk is increased if the patient is taking alpha-blocker drugs (such as Tamsulosin or Doxazosin)

Problems that may happen later

Some problems can happen months or even years after your operation.

  • Cloudy lens capsule: This is called posterior capsular opacification, or PCO. Around 1 in 5 people get this problem, although it may be less common than this with newer lenses. It happens when the thin capsule that is left in place to support the artificial lens becomes cloudy. As light from the lens has to pass through the capsule, it needs to be clear for you to see sharply. It can be treated with a minor outpatient procedure using a laser beam. This is called a yag laser capsulotomy.
  • Detached retina: This is where the light-sensitive area at the back of your eye (known as the retina) comes away from the back of your eyeball or is torn. It happens to around 7 in 1,000 people on average after a cataract operation. It can be serious and could make you blind in that eye. You'll need another operation straight away to put the retina back in place. The risk of retinal detachment after lens surgery is increased in people that are very short sighted or having lens surgery at a young age.

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