Cataract surgery: your questions answered

Cataracts are the leading cause of loss of sight in adults over 55 years of age. However, cataracts are easily treatable with good sight usually being restored. A cataract operation for some patients is a life changing experience and it is an absolute privilege and source of immense satisfaction for an eye surgeon to restore a patient’s sight. In this article on cataract surgery, Mr Ghazi-Nouri addresses the questions most often asked by patients considering cataract eye surgery.

What is a cataract?

A cataract occurs when the natural lens in the eye clouds over and surgery is required if the loss of vision interferes with daily living. Cataract surgery is the commonest elective surgical procedure performed in the UK.

How do you confirm that the surgery is required?

If your doctor thinks you have a cataract, you will be referred to an eye surgeon who will decide if an operation is needed. The examination involves assessment and discussion about the patient’s visual requirements. Tests and measurements are carried out to establish the power of the lens implant needed during the surgery.

What happens on the day of the surgery?

On the day of surgery, the patient will be administered eye drops by the nursing staff to dilate the pupil. The patient remains lying down and is then taken to the operating theatre. The surgeon will put in local anaesthetic eye drops and clean the eye and the area around the eye with antiseptics. The face is covered with a sterile drape, which is held up like a little tent with adequate supply of fresh air and oxygen underneath. This provides a sterile surgical field to eliminate the risk of infection. The eyelids will be kept open using a clip. This may cause a gentle stretching feel.

Are eye drops the only anaesthetic required for it?

The choice of local anaesthetics depends on the patient and surgeon’s preference. Some patients do not like the idea of injection near their eyes and tolerate the local anaesthetic eye drops very well. Other patients require additional anaesthetics, which can be given around the eye without any sharp needles. Occasionally, patients who are anxious require sedation or general anaesthetics.

Is an overnight stay required?

Surgery is done as a day case if it is completed under local anaesthetic. This means that the patient will be awake. The actual operation usually takes about 15-20 minutes in routine cases, but this may vary from case to case. Almost all cases of cataract surgery are performed as a day case, and there is no need to stay in hospital following the procedure.

What treatment is required following the surgery?

Patients are given eye drops to use typically four times daily, gradually tailing off over a four weeks period. A follow-up appointment is usually arranged four to six weeks after surgery, unless there is a need for an earlier review.

How does the surgeon perform the cataract operation?

Modern cataract surgery is performed by making small incisions in the periphery of the cornea, the clear window on the front of the eye. The typical incision is just over two mm wide and does not require suturing as it will seal and heal on its own. The fine layer on the surface of the lens is called the capsule. A circular opening is made in the capsule and the content of the capsule (the cataract) is removed using a fine vibrating needle powered by ultrasound. An artificial lens is then placed within the empty capsule also called a bag. At the completion of surgery, an antibiotic injection is given inside or on the surface of the eye to further reduce the risk of infection.

What happens immediately after the surgery?

An eye pad or shield is then placed over the eye and the patient is accompanied back to their ward or room. About an hour after surgery, the patient will be checked by a trained nurse before being discharged home.

Will new prescription glasses be required?

Prescription glasses usually change after surgery and a visit to the optician is necessary after the course of prescribed eye drops has been completed.

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