What is it?
You are finding it difficult to see because you have a cataract. A
cataract simply means a cloudy lens in your eye. The lens is the clear
part in the front of the eye that helps to focus light or an image on
the retina (the lining at the back of the eye) which is sensitive to
light. There the light or image is converted into nerve waves or signals
and these "travel" through the nerves o a certain area of the brain
that finally helps you to see the light and image. In an early cataract,
the lens may become yellow, or turn brown. This would make things look
yellow or brown through that eye. Some cataracts turn white. In the old
days, people thought it really looked like a waterfall, or a cataract.
Cataracts usually form in both eyes. They steadily get worse. One eye
will probably be more trouble than the other. Cataracts are most common
in later years, but children and young people also get them. Sometimes,
they happen with other diseases, such as diabetes. Some drugs such as
steroid tablets can cause them. Smoking, alcohol and excessive exposure
to sunlight are three other risk factors for developing a cataract. Some
cataracts run in families. Finally, a cataract can develop years after a
trauma in the eye or after exposure to radiation. If you have other
things wrong with your eye as well as a cataract, you may not be able to
see perfectly after the operation.
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The operation
The surgeon will usually operate on one eye at a time. This means two
operations with a wait of a few months in between. Most patients have
the eye numbed with a local anaesthetic. Very rarely, a patient might
need to be put to sleep with a general anaesthetic to allow him or her
to have this operation comfortably, If you have a local anaesthetic, you
will be awake during the operation, but will feel no pain and will not
see anything, because the injection stops the eye working. A small cut
will be made in the wall of the eye where the coloured part (the iris)
joins the white part. Most of the lens iwill be taken out. A special
plastic lens, or implant, will be placed where the old lens was. The
lens will last for your whole life. It does not wear out or go cloudy.
It does not need to be renewed. The cut in your eye may be closed with
tiny stitches. Sometimes, a slanted cut in the wall of the eye is made,
which does not need stitches. The operation takes about 60 minutes.
Any alternatives
If you leave things as they are, your cataracts will not get better.
You may find that you can see well enough for your needs. You can make
close-up jobs like reading easier, by using a good light, big print, and
a magnifying glass. If you are not living life to the full, you should
be thinking about treatment. If you are being clumsy and you have
accidents, you have left things long enough. If your optician has
checked your glasses in the last three to six months, changing your
glasses will not help you see through cataracts. There are no medicines
or other ways to make your lens clear again.
Before the operation
Stop smoking and get your weight down if you are overweight (See
Healthy Living). If you know that you have problems with your blood
pressure, your heart, or your lungs, ask your family doctor to check
that these are under control. Check the hospital's advice about taking
the Pill or hormone replacement therapy (HRT). Bring all your tablets
and medicines with you to the hospital. On the ward, you may be checked
for past illnesses and may have special tests to make sure that you are
well prepared and that you can have the operation as safely as possible.
Many hospitals now run special preadmission clinics, where you visit
for an hour or two, a few weeks or so before the operation for these
checks.
After - in hospital
Most patients have little pain after a cataract operation. You may be
given tablets or an injection to control any pain or discomfort. You
can wash, bathe, or shower normally after the operation, but you must
not get water in your eye for a month. If you have your hair washed,
have it done with your head leaning backwards. Do not use makeup on your
eyelids for one month. You will normally be able to go home on the day
of your operation. You will be given a supply of eye drops, and shown
how to put them in your eye. You will be given an appointment for the
outpatient department for a check-up one to two weeks after you leave
hospital. The nurses will advise about sick notes, certificates etc.
After - at home
Your eye will be covered by a pad and a protective plastic shield.
This is to stop you touching your eye, especially when you are half
asleep. Many patients find they can see dramatically better as soon as
the pad is taken off. Sometimes it takes a few days for a patient to see
better, as the eye settles down after the operation. You MUST wear the
eye shield to protect the operated eye at night, or if you sleep during
the day. You will be told in the out patient clinic when you can stop
using the shield (normally about one month). During the day you can try
wearing your old glasses, but they may no longer suit you. Sun glasses
are a good idea to protect your eyes from the glare. If you have
stitches in your eye, they usually stay in for ever and do not cause
problems. Sometimes they are uncomfortable after six to eight weeks, and
can be taken out if they are troublesome. A hard knock in the eye in
the first month can break the stitches and be very serious. If you wear
contact lenses, do not put one in the operated side for eight weeks.
Plan to go back to light work in one to two weeks, and a heavy manual
job in three months.
Possible complications
In the rare case that you have this operation under general
anaesthetic, there is a very small risk for complications related to
your heart and lungs. The tests that you will have before the operation
will make sure that you can have the operation in the safest possible
way and will bring the risk for such complications very close to zero.
Infection can be very serious, but is very rare. A serious
infection can result in loss of your sight on the operated eye. The
eyedrops that you will be given also contain antibiotics, so it is
important you use them as directed. A tiny amount of blood in the eye
may stop you seeing clearly. The blood usually goes in a few days, and
you will see better. Very seldom, there is severe bleeding in the back
of your eye. This can even lead to damage to the retina and require a
second operation to correct the problem.
The day after surgery, the pressure may go up in your eye. This
causes pain and blurred vision. It normally settles down with tablets
and eyedrops. If you have severe pain on the night of the operation,
please tell the nurses. Sometimes the eyelids swell up, and the upper
lid may droop. These usually settle down without any treatment. Some
patients get swelling at the back of the eye, leading to blurry vision.
In most cases this settles down by itself.
Very rarely, the operation on your lens can cause detachment of
the retina from the back of the eye. If you suddenly see dots, flashing
lights, or something like a curtain in the eye, come straight away to
the Accident and Emergency department. You will most probably need an
operation to fix the retina back in place. The detachment of the retina
is an emergency situation that needs to be treated urgently. The longer
the delay, the greater the chance of significant or complete loss of
your vision in the affected eye. Even when the detachment of the retina
is treated promptly it can result in some loss of your vision.
Sometimes, the new lens implant has to be put in front of the
iris (the coloured part of the eye) instead of behind it. Rarely, for
technical reasons, a new lens cannot be put in at all. You may then need
thick glasses or a contact lens.
Sometimes, the eye tissues behind the new lens can become cloudy
and affect your vision. This happens months or years after the
operation and it is called an after-cataract. Approximately 25% of
patients that have cataract surgery experience an after-cataract. The
condition is successfully treated with a minor operation: the surgeon
uses a laser to open a small hole in the cloudy tissues behind the lens
to allow the light to go through.
About 90% of patients who have the operation of replacing a lens
affected by cataract with a new lens have better vision compared to
before the operation. However, if you have more wrong with your eye than
just a cataract, then you may not be able to see as well as you had
hoped after the operation.
You must be very careful with driving in the early stages,
because you may not be used to seeing well. Also your sight may not be
as good as you think it is. Ask whether your sight is good enough. If in
doubt, don't drive.
General advice
These notes should help you through your operation. They are a
general guide. They do not cover everything. Also, all hospitals and
surgeons vary a little. If you have any queries or problems, please ask
the doctors or nurses.
