Cataract Surgery (Lens Replacement Surgery) Guide

What is a cataract?

A cataract is the medical term for cloudiness that develops within the natural lens within your eye. Your natural lens is usually clear when you are young but can become cloudy when you get older. The majority of people over the age of 65 have some degree of cataract.,. This cloudiness can lead to blurred vision halos around light and problems with seeing colours.

Other causes of cataracts include:

• Congenital - born with them due to your genes
• Trauma or damage to the eye
• Exposure to radiation
• Prior eye surgery
• Diabetes
• Smoking
• Extreme sun exposure
• Long term use of steroid medication

Here is an illustration that shows a cataract forming within your eye:

What can cataract surgery achieve?

Sometimes when people have early cataracts, their vision is not affected. In these cases, many people are able to manage with new glasses and optimise reading with a good light source. However, cataracts will continue to develop once they have appeared, so this is not a permanent solution. This is important to remember, especially if you drive, as you may not be able to continue safely without receiving treatment. The only proven way of restoring your vision is to undergo surgery to remove cataracts.

To find more information on Cataracts and the potential management options, you can visit our affiliated surgeon’s website. It would also be important to speak to your ophthalmologist directly as they will be the best person to give you advice.

Who are the ideal candidates for cataract surgery?

Cataract surgery is a quick and commonly performed operation that can substantially improve your life and restore your vision. Worsening vision may affect your day to day life, your work and your ability to drive. Occasionally, people develop cataracts in both eyes or to different degrees in either eye. If this happens, your doctor can treat each eye separately in two operations that are a few weeks apart or treat both eyes on the same day if you are a suitable candidate. You may be a suitable cataract surgery candidate if you:

• Have a cataract in one or both eyes
• Suffer from worsening vision or changes that affect your daily life
• Want to drive again in the future but struggle with night vision driving and feel less confident
• Have work or hobbies that require good eyesight such as sewing, laying tennis or golf or watching subtitles on your television
• Care for a loved one and feel less confident because of your failing eyesight

Vision

It's common for patients to know their vision in 2 numbers, e.g. 20/20. Having 20/20 (6/6) vision means that you can see at 20 feet (or 6 meters) what a person with normal vision can see at the same distance. This is often considered "normal" vision or sometimes "perfect" vision. People with 20/20 (6/6) vision, can see things clearly and sharply from a distance of 20 feet (6 meters) the same as someone with normal vision can see from that same distance.

Measuring a patient's vision this way is a useful factor for assessing eye conditions and how severe the condition is. In cataracts for example, patients typically need vision to be under 20/40 (6/12), seeing at 20 feet (6 meters) what a "normal" person can see at 40 feet (12 meters) in order to qualify to have surgery.

Referral letter

It's important that patients also have a referral letter from their optometrist or GP before having a consultation. It is highly recommended patient's see their optometrist carry out tests prior to seeing the ophthalmologist for their cataract consultation.

Cataract surgery is a safe and fast procedure and can improve your vision significantly, quickly and safely. The only proven treatment is surgery. Drops and tablets have been tried to treat cataracts in the past but unfortunately do not work. If you leave your cataracts, you may well be able to cope for a while but they will inevitably worsen with age. If you have symptoms, your ophthalmologist will generally recommend surgery sooner rather than later. Cataract surgery can be more difficult if you have dense cataracts that have been left a long time.

How is cataract-removal surgery performed?

Cataract surgery is quick and only takes between 15 to 45 minutes to perform using high-frequency ultrasound t called phacoemulsification. Surgery is usually carried out under local anaesthetic but there are options for mild sedation or even a light general anaesthetic if you are particularly nervous. Cataract surgery is a day case procedure so you will not have to stay in hospital overnight.

The process for your cataract surgery procedure will usually go as follows:

1. Consent

You will meet your ophthalmologist to sign your consent form before the procedure takes place. This may happen at your pre-operative consultation or on the day of your surgery. Although you may be aware of the risks and complications, it is important that you read the consent form fully before signing your consent. Your surgeon will happily answer any queries or concerns you have.

2. Anaesthesia

Your doctor will give you an anaesthetic before having your procedure so you will not feel any discomfort during your procedure. In most cases, this will be a local anaesthetic and you will remain awake for the 15 minutes it takes for your operation. If you feel anxious before surgery, then your surgeon may offer you some light sedation where you will remain awake during your procedure but more relaxed. If you are very nervous then your surgeon may offer you a very light general anaesthetic where you are asleep for 15 minutes during the procedure. All forms of anaesthetic are safe.

1. Incisions and removal

Your doctor will make small openings into the sides of your eye. This is so they can place a small ultrasound probe in the eye. This tiny probe vibrates very quickly, which allows your surgeon to break up the cloudy lens into small pieces They then remove these pieces from the eye using suction with the same probe. . We encourage you to stay still whilst the doctor operates, so please let them know if you need to move for any reason. Your surgeon can make any necessary allowances for a sudden cough or sneeze as long as you inform them beforehand. A little clip opening the eyelids prevents you from blinking during your cataract operation.

4. Replacing the lens

Once the old, cloudy lens has been removed, your surgeon carefully replaces it as seen in the diagram below.

This artificial lens is an artificial material made of silicone polymer There are several options for the type of intraocular lens listed below.

• Monofocal
• Multifocal

A mono-focal lens focuses on a single point, whilst a multifocal lens focuses on multiple distances to include distance ( eg TV or driving), intermediate ( computer screens) and near ( reading a newspaper or your mobile phone). Your surgeon will discuss which lens type they plan to use with you during your consultation to suit your requirements. Not everyone is suitable for a multifocal intraocular lens

4. Closing of incisions

The large majority of patients do not require any form of stitches to close the eye after surgery. The openings to the eye are self-sealing. Your eye will be covered with a protective pad after surgery which you can expect to wear for the first day after the surgery. It is important to only take this pad off when your doctor instructs you to do so.

5. Return to the ward

Finally, once your surgery is over, the medical staff will take you back to the ward. It takes a few hours for you to get feeling back in and around your eye, and it can take a few days for your vision to improve. You will usually be able to return home after a few hours on the same day of your surgery.

What should I expect from my cataract surgery consultation?

You will meet your ophthalmologist for an assessment before having your cataracts removed. During this assessment, they will look at your eyes and ask some questions about your vision and any symptoms you may be having. Your cataract surgery consultation will usually last between 15 minutes to 1 hour. It will be an opportunity for your doctor to discuss the procedure with you and find out more about you. To do this, they will ask you about:

• Your current general health
• Any medical conditions you have
• Your past medical history
• Any operations you have had
• Any medications that you are currently taking ( including prescription, over-the-counter and herbal medications)
• Your alcohol consumption and smoking history if relevant,
• Any allergies you may have

What questions should I ask during my cataract surgery consultation?

Whilst your consultation is a good chance for your ophthalmologist to ask you questions, it is also a good time to ask any questions you may have. We, therefore, recommend that you spend some time thinking of some questions you would like to ask. Try to write these down and take them with you to the consultation. This will make you feel more prepared, and you are less likely to forget to ask the things that are important to you!

Below is a list of questions you may like to ask:

• Is cataract-removal surgery suitable for me?
• Will I be in pain afterwards?
• How good will my vision be after surgery?
• Is the surgery always a success?
• How long will it take me to recover?
• Will cataracts come back?
• Do you think my expectations are realistic?

What are the main cataract surgery risks and complications?

Many of the cataract surgery risks and complications are rare. Therefore, you might think that it is not necessary to know about them. However, it is sensible that you fully prepare yourself and are fully informed. No surgery is 100% effective unfortunately but thankfully the likelihood of you being worse off after cataract surgery is very rare. Before you consent to have your cataracts removed, you should take time to consider them all.

The cataract surgery risks and complications include:

Failed surgery

Cataract surgery is thought to work in over 98% of cases. However, very rarely, the surgery does not lead to an improvement in vision, often due to one of the complications listed below. Each complication has its own distinct treatment, which can often include eye drops, medication or further eye surgery.

Infection

Any surgery is invasive and introduces the risk of infection to your body. If you develop an infection due to your surgery, you will notice that things are not settling down as you would expect.

Key signs of infection to look out for are:

• Your vision getting worse rather than better in the first 3 to 4 days
• Worsening redness of the eye
• Worsening sensitivity to light
• An increase in pain that your pain medication does not help.

Mild infections usually go away with antibiotics. There is a small chance that an infection may affect the final results of your operation. If this were the case, you might require further surgery to remove the source of the problem. It is very important that you seek help if you have any sign of an eye infection so your doctor can treat it as soon as possible.

Posterior capsule opacity

- Around 10 to 15% of patients will develop this mild change which is nothing to be concerned about. Posterior capsule opacity (PCO) refers to when the area behind the new lens becomes cloudy. This happens because some cells from the lens start to grow on the back of the eye, making it cloudy. Posterior capsule opacity can affect your vision the same way cataracts do but can be treated effectively and safely with laser therapy which can be done in the eye clinic and takes one treatment and about 10 minutes to complete by your surgeon.

Damage to the eye

Any surgery has the potential to damage the area surrounding the target of the operation. It is rare, but possible, for other parts of the eye to come to harm by accident whilst the surgeon operates. This can rarely cause bleeding at the back of the eye and loss of vision This very rare complication can occur in 1 in 10000 patients.

Retinal detachment

Having cataract surgery slightly increases your risk of retinal detachment. It is an emergency that requires immediate medical treatment. If left untreated, it could cause you to lose vision in that eye. Therefore, you must tell your doctor to seek urgent medical help if you notice –

• Curtain-like darkness has appeared over part of your eye
• New floating spots in your vision
• Seeing flashes of light.

Vision loss

This is the most serious risk of cataract surgery and can be either short-term or permanent. The chance of severe or complete lifelong loss of vision after cataract surgery is very low. Even so, it is crucial that you are aware that this complication exists.

How can I prepare for cataract surgery?

After your surgery, you will want to relax as much as possible during your recovery. Getting things prepared before your surgery can help you do this. We have put together a list of cataract surgery preparation tips that we hope you will find useful!

Household work

We appreciate that getting on top of household chores can sometimes be difficult, even on a normal day! Therefore, we recommend that you try to get some of the big jobs out of the way before your surgery. For example, you may like to do the laundry and take the bins out the day before your procedure. This way, you will hopefully not have to stress or worry about doing chores in the first few days of your recovery.

Shopping

You will likely not feel up to going to the supermarket in the first few days after your cataract surgery. Therefore, we advise that you do a big food shop and stock up a day or so before you come to the hospital for your surgery. You may even like to make some meals and freeze them. This means that you won’t need to worry about cooking whilst you settle back at home after surgery.

Children and pets

To minimize your stress levels during your recovery, you may ask that some family or friends help you look after your young children and pets.

Driving

You will be unable to drive yourself home after your surgery. You may like to ask a family member or friend if they will be able to collect you from the hospital. You need to follow your doctor’s strict advice on when it is safe for you to drive again.

Diet

Your surgeon might recommend that you eat healthy low-sodium foods, including fresh fruits and vegetables, after surgery. You should try to stay hydrated with water and caffeine-free beverages. Try also to avoid consuming high amounts of salt and sugar during your recovery time.

You must follow your doctor’s strict instructions regarding smoking, alcohol and drug use both before and after your surgery.

Sleeping

Your doctor may recommend that you avoid sleeping on the side of the affected eye for the first few days. This may help to avoid contact with the treatment area and may also help to reduce any inflammation.

Your ophthalmologist will give you specific advice on your cataract surgery preparation. Following their advice will help to achieve the best possible results and the smoothest recovery.

What can I expect after cataract surgery?

Your doctor will give you specific instructions regarding your cataract surgery aftercare. You must follow their instructions to ensure you reduce the risk of complications as much as possible.

They will give you specific time frames for when you can begin to start activities like driving, exercising and when you can go back to work.

We like to stress the importance of following the advice of your surgeons. Of course, it can be hard to slow down the pace of your life and refrain from certain activities. Despite this, you must remember that your surgeon’s advice is in your best interests for a smooth recovery. Your surgeon will also explain any medications you may have to take after the procedure.

Below are some general cataract surgery aftercare tips:

Directly after the surgery

In most cases, the surgeon uses a local anaesthetic. You may experience altered sensations on and around your eye, but this will wear off over a few hours. If you also had sedation, you might feel a bit groggy or disorientated, but this will also wear off. You may not be able to see clearly immediately after the surgery. This is normal and not something to worry about.

Returning home

You will usually be able to return home on the same day. You will be unable to drive so you should arrange for someone to collect you from the hospital.

Before you leave the hospital, your surgeon or optometrist will arrange for you to return within 1 to 2 weeks for a follow-up appointment. They will examine your eyes, check your vision and get you new glasses if necessary. They will also advise you on the next steps of your care, such as when you can have the other eye treated if you have cataracts in both eyes.

Pain management

You should expect to experience a little pain and swelling around your eyes after your cataract surgery but most patients feel a mild gritty sensation. This can take up to a month to settle down but often settles down in a few days with the drops prescribed to you by your surgeon. In the meantime, you can manage it by using over-the-counter pain relief. You should also avoid sleeping on the side of the eye that was operated on. This will help to reduce swelling and, in turn, pain.

Returning to work

After your procedure, your doctor may recommend that you take around 3 to 5 days off before you return to work. In addition, you must avoid driving until your doctor says it is ok to do so and once you fully adapt to your new lens inside the eye. Your brain will require a little time to adjust to the new focusing ability.

Returning to exercise

Your doctor may recommend that you avoid strenuous activity, heavy lifting and contact sports for at least 4 to 6 weeks. Swimming must be avoided for at least 4 weeks after cataract surgery.

Eyecare

You must use the eye drops that your doctor gives when you leave the hospital; this help prevents any infections and allows your eye to heal. Your doctor may also advise that you avoid rubbing your eye, wearing eye makeup and getting the eye wet, such as in the shower or bath.

You may have to use the protective eye shield at night and when washing for at least the first week. Your doctor will go through all of this advice in detail so that you have all the information that you need in advance.

Finally, be aware that you should not bend forwards for the first week after the surgery. This is because of the increase in pressure inside the eye, which could cause the openings to become weak.

Final Results

You may initially feel that your vision is worse after the surgery. This is quite normal and not a cause for alarm! You should normally see improvements after the first few days, and the eye should heal fully within 4 to 6 weeks.

If you have any questions about your cataract surgery aftercare, you should speak to your doctor directly.

Well done - you are now fully prepared for your cataract operation - as ever if you have any questions we can happily answer any of your queries.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/cataracts/ NHS
• www.guysandstthomas.nhs.uk NHS
• Uptodate.com Up to Date
• https://www.rcophth.ac.uk/ The Royal College of Ophthalmologists

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.