Cataract Eye Surgery

cataractsThe very thought of needing cataract eye surgery can be disconcerting. Fortunately, cataract surgery is one of the safest and most rewarding operations available to restore your sight and ensure you enjoy the life you deserve.

What is a cataract?

The eye works just like a camera. It has within it a lens that is normally crystal clear. The function of the lens is to focus light onto the retina, and this is necessary for a clear, sharp image. The lens becomes increasingly cloudy and yellow with senescence. This reduces the clarity and quality of the picture landing on the retinal surface. As the lens becomes increasingly yellow, it also reduces the amount of blue light entering the eye. Colours look increasingly faded and you may notice increasing difficulty in the dark.

What are the symptoms of cataracts?

Imagine looking through a frosted, yellow window versus a clear window. There are many different ways a cataract can affect your vision. The most common symptoms are:

  • Blurred vision
  • Things looking hazy
  • Glare in bright lights or when driving at night
  • Difficulty seeing in the dark
  • Star bursts around lights
  • Frequent changes of your spectacle prescription
  • Colours looking faded and more yellow in colour
  • Rarely, double vision in one eye

What causes cataracts?

Essentially, it is time. However sometimes there are types of cataracts that are present from birth and these may worsen earlier in a person’s life. Some diseases such as diabetes are associated with the early development of cataracts as are certain medicines such as the use of steroids. Cataracts can also develop after an injury to the eye. It is important to let your ophthalmic surgeon know about any injuries as this can impact the nature of the operation and the outcomes.

Does a cataract have to be ‘ripe’ before it is removed?

No. Cataract surgery is safe operation and can be performed whenever you become aware of poor vision that reduces the quality of your life. For example, you may have given up driving or lose confidence getting about by your self.

There is a very low risk of visual loss with any intraocular procedure (1:1000). It is therefore important to justify this low risk with the need for an operation. If a someone develops cataracts, but is not aware of any visual symptoms, there is no need for cataract surgery.

How is a cataract removed?

Very small cuts (micro incisions) are made on the surface of the eye. The cataract is then broken down into very small pieces using a special machine and an artificial lens is inserted into the eye. This process is called phacoemulsification. The artificial lens (intraocular lens) can remain there indefinitely. The surgery does not routinely require any stitches to close the incisions on the eye surface. Under certain circumstances, this may become necessary and the stitches are removed after a few weeks or may dissolve away spontaneously.

What can I do after a cataract eye surgery?

Most normal daily activities can continue after surgery. It is a good idea to take it easy for the first few weeks. The myth about not bending after cataract surgery can be ignored. However, your judgement of distances will change after having cataract surgery, especially if your other eye still has a cataract. Although the brain quickly adjusts to this new vision, it is important to make sure you are not near any objects (such as table edges) when bending, as you could misjudge the distance from this and accidentally injure your eye.

It is important to avoid contaminating the eye with any dirt so we advise our patients to avoid gardening and swimming in the first 2-3 weeks. It is advisable to wash your hair so that water runs backwards, away from your face, for the first week after eye surgery.

What should I expect after cataract surgery?

You will be given eye drops to use by your surgeon and these will be required for the first month.

The vision is likely to be blurred for the first few days and will gradually improve over the first 1-2 weeks. The most common lens used is a monofocal lens (one that is set to focus for a particular distance). Most people choose to be able to see in the distance without the need for glasses, though glasses may still be needed for the best vision. Your current glasses will need to be changed about 4 weeks after surgery. Most people will need glasses for reading. There are specialised multifocal lenses that can help you achieve near and distance vision without depending on glasses. These may not be suitable for everyone and your surgeon will help you make the best choice of intraocular lens to suit your needs.

If you have other problems with the eye such as macular degeneration or diabetic eye disease, your final level of vision may not be as good as one would hope. However, even in the presence of retinal disease, most patients will notice an improvement in the quality of their vision (things looking brighter and sharper) after surgery.

I have a problem with my retina. Does this prevent me from having cataract surgery?

No. Cataract surgery is safe in the presence of diseases such as age-related macular degeneration, diabetic eye disease, vein occlusions and uveitis. It is important to ensure that there is no macular oedema prior to eye surgery and that there is no active uveitis. Patients with retinal disorders are at higher risk of developing post-operative problems such as macular oedema.

Having your surgery with a retina specialist, such as Miss Sivagnanavel, will ensure that any such problems are rapidly identified and treated to ensure the best visual outcome. Sometimes, your surgeon may choose to give extra injections of a drug during your cataract operation or at a later date to protect your retina.

What are the risks of cataract surgery?

Cataract surgery is very safe and the risk of serious problems after surgery is small. However, there are some problems that can occur and these problems can usually be rectified to give a very good visual outcome.

Common problems
Posterior capsular opacification is the most common problem after cataract surgery. It can develop in up to 10-20% of patients undergoing surgery. This occurs when the capsule of the lens becomes cloudy after surgery and it is a bit like getting a second cataract. This is harmless and can be easily and safely treated with a laser as an outpatient procedure.

Rare problems from cataract eye surgery (1% or less).
These problems can usually be treated with medication or extra surgery and do not have a long-term impact on your vision.

Macular oedema (swelling of the retina). This occurs in 1% of those undergoing surgery and is more common in patients who have diabetes. It can usually be treated by anti-inflammatory eye drops. Sometimes, injections will need to be given into the eye. This requires careful management by a retina specialist.

Posterior capsular rupture. This happens when the capsule that holds the artificial lens is torn. If this occurs, your surgeon will perform an anterior vitrectomy and insert the lens into the sulcus, which is a safe alternative place for the lens to rest. This lens implantation may occur on a separate day.

All or part of the cataract dropping into the vitreous space. This is a very rare complication but can be corrected with further surgery at a later date.

Refractive surprise. Prior to your cataract operation, you will have measurements taken of the eye to determine the power of the lens to be inserted. These are usually very accurate. However, a small proportion of patients may need to use glasses for distance in order to get the best visual outcome, as a result of unexpected variations in the measurements obtained.

Very rare complications (less than 1: 1000)
Whilst it is uncomfortable to read about the worst case scenario, it is important to consider that a very small proportion may be left with a permanent reduction in vision, including a less than 1:1000 risk of blindness.

Intraocular bleeding. Some bleeding under the skin of the eye is normal after cataract surgery. This does not result in any harm. Very rarely, a severe bleed may occur below the retina. This is known as a suprachoroidal haemorrhage and may result in permanent loss of vision.

Infection. If the eye becomes progressively painful, red or if the vision starts to deteriorate soon after cataract surgery, you must contact your surgeon immediately. Infections inside the eye can be treated if identified early. If they are not treated early, it can result in permanent loss of sight. The highest risk for an infection is in the first 5-7 days.

All patients operated on by Miss Sivagnanavel will be given a contact number on which she can be reached directly in the event of a problem. This includes emergency contact during the evenings and weekends.

Although it is frightening to read about the potential problems, it is important to remember that cataract surgery remains one of the safest operations and is the means to significantly better vision after surgery, so that you can enjoy life at its best.