Summary
The eye's lens helps to focus an image on the back of the eye (retina). When we are young, our lens is clear. As we age, the lens proteins begin to age, causing the lens to get cloudy and we call this a cataract.
This can then lead to symptoms of glare and reduced vision. Most people develop cataracts with increasing age. Very occasionally, you can be born with cataracts.
Studies have shown that people get an improvement in their vision, contrast sensitivity, depth perception, activity, anxiety, depression, visual disability, confidence, handicap and quality of life and reduce falls after cataract surgery. (1-3)
The Surgery
Cataract surgery is one of the most frequently performed operations in the country. Approximately 330,000 cataract operations are performed each year in England alone.
Most people undergo cataract surgery under local anaesthetic. Local anaesthetic can be administered as drops on the eye or as a small injection around the eye.
In a small number of cases where patients are highly anxious or unable to keep their eyes still, they can be given sedation or general anaesthetic.
The surgical time can vary from 10 minutes to an hour depending on the type of cataract and complexity of your case.
When Dr Rupal Morjaria sees your case, she will discuss your case in detail with you before surgery.’ is repeated.
What happens before the operation?
When you come for your operation, the nurse will check your details and start putting drops in your eye. Dr Morjaria will come and speak to you and mark the eye that is being done with a mark on your head.
When it is time for your operation, you will have drops put in the anaesthetic room and the anaesthetic that has been decided by you.
What happens during the operation?
You will be brought into the operating room, where the nurses and Dr Morjaria will check your name and information again. Your eye will then be cleaned. Dr Morjaria will place a thin clean gown over your eyes and face. You will feel some oxygen near your face.
It is very important that once surgery starts you do not make sudden movements. If you need to move or cough, please raise your hand so that the surgeon can stop the operation safely. During the operation you may hear the doctor and nurses talk. This is normal as they are passing the instruments. You may feel Dr Morjaria’s hands rest on your forehead. Occasionally water can drip down your face that will be cleaned at the end of surgery. A small cut less than 2.5 mm is made and two smaller ones through which your natural lens is broken down in small pieces and then cleared away. A new clear lens is then injected carefully in the previous space to help you focus clearly. If a stitch is needed during the surgery, this is normally removed after 6 weeks.
The surgical time can vary from 10 minutes to an hour depending on the type of cataract and complexity of your case. When you are seen by Dr Morjaria, she will discuss your case in detail with you prior to surgery.
Will I need glasses after surgery?
Measurements of your eye are taken before surgery so Dr Rupal Morjaria can discuss options with you.
Most people choose to see clearly for distance without the need for glasses but will need reading glasses after surgery.
Special lenses can be put in your eye that helps you with your distance and near vision, such as multifocal lenses and extended depth of focus lenses.
These lenses, however, are often unsuitable for people with any conditions affecting the retina at the back of their eye.
Post-operative management
In most cases your vision should settle down within 24-48 hours. If you have other ocular pathology your eyes can take 2-3 weeks to recover. Most people need to take drops for 3 weeks four times a day. Occasionally, more drops are needed.
Immediately after the operation it is important to keep the eye clean and avoid dusty environments. You should wash your hands before putting in your eye drops. If you take eye drops for other conditions such as glaucoma or dry eyes, please use a new bottle of drops in the eye that has had the operation. Dr Morjaria recommends you avoid heavy lifting, intense gardening or splashing your eyes with water for at least 10 days after the surgery.
References
- Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; (9): CD007146.
[PMC free article] [PubMed] - Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005; 89: 53–59.
[PMC free article] [PubMed] [Google Scholar] - Hodge W, Horsley T, Albiani D, Baryla J, Belliveau M, Buhrmann R et al. The consequences of waiting for cataract surgery: a systematic review. CMAJ 2007; 176: 1285–1290.
[PMC free article] [PubMed] [Google Scholar] - Day AC, Donachie PHJ, Sparrow JM, Johnston RL. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye (Lond) 2015; 29: 552–560.
Risks of Cataract Surgery
On the whole, cataract surgery is incredibly safe and more than 95% of patients will experience a significant improvement in vision.
Like all surgery however, cataract surgery does carry small risks.
Serious or sight threatening complications are rare and occur in less than 1:1000 cases and can occur as a result of bleeding in the eye during the operation or infection after the operation. (4)
Approximately 1/100 may need an additional operation as a result of complications in the first surgery although the outcome still remains good in the majority of cases.
What happens if I do not have the surgery?
Cataracts progress the longer they are left. This can cause more difficulty in reading, driving and worsening glare. If cataracts are left too long the surgery can become a higher risk surgery. Having thicker cataracts can also make it more difficult for your Optometrist and Ophthalmologist to examine the health of the back of your eyes.
Most cataracts need surgery at some stage as very mature cataracts can cause secondary problems with the pressure in the eye going up. This can be from a lack of space for fluid drainage (phacomorphic glaucoma), or inflammation as the lens proteins begin to break down (phacolytic glaucoma).
