Cataract surgery

About a cataract

A cataract is a clouding of the normally clear lens in your eye.

Cataracts typically cause blurred or misty vision and sensitivity to light. They occur at different rates and can affect one eye or both eyes at the same time.

As they develop, vision becomes worse and everyday activities become more difficult.

Causes

This clouding is normally due to the ageing process. It can also be related to eye injuries, genetics (family history), diabetes, and some medications (such as steroids).

Treatment

We can treat your cataract safely and effectively in an operating theatre, using a micro-surgical technique. This is a procedure which removes the cloudy lens and replaces it with an artificial lens implant.

We make small incisions (cuts) at the junction between the white and coloured part of your eye. We use an ultrasonic probe to break the cloudy lens into small pieces. Then we  gently vacuum the pieces out of your eye.

We then implant an artificial lens into your eye to replace the cataract.

Surgery is the only available treatment for cataract.

When to choose surgery

Your optician may have seen a cataract in one eye or both of your eyes. Unless you are troubled with symptoms from the cataract(s), there is no rush for you to have the operation. These symptoms may include:

• blurred or cloudy vision
• difficulty driving at night due to glare.

We can perform surgery at any stage once the cataract is affecting your daily life. There is no need to wait for the cataract to be ‘ready’.

For routine cataracts (to improve vision), there is no immediate urgency for you to have the operation.

However, there may be other reasons for you to have the surgery. For example to help lower the pressure in your eye.

For every person with a cataract, the decision to undertake surgery is a balance of risks and benefits.

Benefits of surgery

The main benefits of surgery are clearer vision and improved colour vision. Once removed, cataracts cannot return and the artificial lens that we insert is designed to last for life.

The artificial lens implant we choose for you will also help make up for existing focusing problems, such as being short-sighted. Most people find that their vision improves considerably after surgery.

Some patients will still need glasses and may need to update their glasses prescription after surgery. For more detail, see 'Changes in your vision after surgery' below.

If you have another eye condition such as diabetes, glaucoma, or age-related macular degeneration (AMD), your vision may still be limited, even if your cataract operation is successful.

Changes in your vision after surgery

The lens we implant during cataract surgery is usually designed to give you clear distance vision without needing glasses.

Sometimes the surgery does not achieve this, and you may still need distance glasses for fine-tuning.

Since the lens implant does not result in close vision, most people still need reading glasses afterwards. Your reading prescription is likely to be slightly different after surgery.

Most patients prefer to have independent distance vision, and put on their reading glasses for close work.

Some patients prefer to keep their distance glasses, and have their vision corrected for reading. (This is often the case for patients who are short-sighted and have worn distance glasses for years).

Risks

Cataract surgery is a safe operation, but there are some risks.

• About 1 in 20 patients have a minor problem following surgery which either corrects itself or needs further treatment. For example superficial eye infection, soreness or swelling.
• For about 1 in 100 patients, their sight does not improve after surgery.  They may need a longer recovery period, further treatment or additional surgery.
• About 1 in 1,000 patients develop serious complications, leading to permanent severe or complete loss of vision. This is rare.

Types of artificial lens 

We will discuss with you the most suitable lens for your needs during your cataract assessment appointment. Let us know if you have specific vision needs (for work or hobbies).

We offer the following types of artificial lens.

What to expect before surgery

You can expect the following before you have surgery.

• We will examine your eyes and perform special tests (biometry) to measure and determine the correct strength of the lens implant which we will insert in your eye.
• We usually carry out these tests at your clinic visit or during your pre-assessment appointment in the cataract clinic.
• We will also discuss with you how cataracts affect your daily life. We will explain the benefits and risks of surgery, and discuss the most suitable lens to implant for your needs.

Let us know if you have had any previous eye surgery, including laser vision correction.

Preparing for surgery

Follow this guidance to prepare for your surgery.

• If you wear contact lenses, stop wearing them 24 hours before your surgery.
• If you start taking antibiotics for an infection during the week before your surgery, let us know immediately.  Telephone us on 020 8934 6404 or email us on: krft.reuhelpdesk1@nhs.net

If you do not let us know about your antibiotics before you arrive, we may have to cancel your surgery.

On the day 

• Bring this leaflet with you on the day of your surgery.
• Before you leave home, remove all make-up, nail polish and jewellery (you can keep your wedding ring on).
• Wear comfortable clothes because you will keep them on during surgery.
• Take your usual prescribed medications unless we told you not to at your assessment appointment.
• Bring with you a list of your usual medications.

When to arrive

When you arrive, a nurse will admit you and give you some eye drops to make your pupil bigger in preparation for your operation.

The surgeon will come to see you.

During the procedure

• An eye surgeon will carry out your operation and/or directly supervise a doctor who is still in training. In routine cases, surgery takes 30 to 40 minutes.
• If you wear a hearing aid on the side of the eye to be operated on, we will ask you to remove this just before your operation.
• We will place a light sterile sheet over your eye, partly covering your face. You will still be able to breath comfortably.
• We will numb your eye so you feel no pain. We usually use local anaesthetic eye drops for this. Sometimes we need to inject anaesthetic into the space around the eye.
• You will feel no pain. You may be able to hear the medical team speaking and feel the surgeon’s hands on your cheek or forehead. 
• We will place a small clip (speculum) in your eye to keep the eyelids from closing during the operation. This means you do not need to worry about blinking.
• We use a large amount of water during the operation, and you will feel this continuously around your eye. We will tape a cotton pad above your ear to catch any water drips.
• Once we have removed the cataract, we will use the clear bag (capsule) that held the natural lens in your eye as the holding place for your new lens. We leave this capsule in place. During the years after surgery, it can develop cloudiness and mimic the symptoms of a cataract. We offer a quick and safe laser treatment (called YAG capsulotomy) to correct this.
• We will make small surgical incisions (cuts) during the operation, and most patients do not require stitches. Sometimes we use fine stitches to safely close the incision and stop it from leaking. We will let you know if we use stitches. It is quick and painless to remove the stitches and we will schedule an appointment so we can do this in clinic.

After surgery

Immediately afterwards

• Immediately after surgery, your vision will be blurred and may appear worse than it was before surgery. Most patients notice their vision gradually improving during the days after surgery.
• It will be safe for you to go home on the same day.
• A nurse will give you some eye drops to take home after the surgery, and explain when and how long you need to use them.

When you get home

We advise you to rest when you get home.  You can eat and drink as normal.

You can expect some/all of the following symptoms when you get home. They are all normal, and for most patients they resolve over a few days.

• Some discomfort or a gritty feeling or dull ache.
• Red, bruised, or bloodshot eye.
• Watery eye.
• Some stickiness of your eyelashes when you wake.
• Hazy or blurry vision and sensitivity to lights. 

Pain

As the anaesthetic wears off you may feel some pain. This varies with each individual, but the pain will resolve. If necessary, take a mild painkiller such as paracetamol.

Try to relax as much as possible.

Within a few days most patients feel much better and their vision gradually improves.

Looking after your eye at home

Follow this guidance when you get home.

Eye patch or shield

Remove this 4 hours after you get home. Start using the eye drops we have given you.

Wear the plastic shield at night only for the night after surgery (unless we tell you otherwise).

Eye drops

Continue with any medications you use for eye or other health problems (such as glaucoma) unless we tell you otherwise.

Wash your hands before using your drops.

Do not let anyone else use your eye drops.

Start using the eye drops we give you, as instructed. They will help your eye heal and prevent infection.

Evenly space out the times you add drops during the day. A useful way is to remember to use them at mealtimes. 

Cleaning your eye

Gently wipe your eyelids and eyelashes from the inside (near your nose) to the outside corner of your eye.  Do this using either of the following:

• tissue or cotton pads moistened with cooled boiled tap water
• Lid-Care sterile wipes which you can buy from most pharmacies.

Do not wipe inside your eye.

Do not rub your eye for the first week after surgery.

Wearing glasses

Your current glasses may not be the correct strength after surgery.

It will not harm your operated eye if you continue to wear your old glasses to see better with the unoperated eye.

We will let you know when you can change your glasses when you come for your follow-up appointment.

If you have trouble reading, you can buy 'over-the-counter' reading glasses at most supermarkets or opticians. You can use these until you have a new glasses prescription.

Everyday activities after surgery

After surgery it is important to reduce the risk of infection.

We advise you to take it easy for at least a week after your surgery.

You must avoid environments or activities that might increase this risk, such as working in the garden, cleaning a dusty attic or swimming.

Do not carry out any activities which can press or squeeze the eye so that the incisions in your eye can heal properly. To help them to heal, avoid lifting heavy weights or bending excessively. 

Emergency help

Get in touch with your nearest eye emergency service immediately if you experience any of the following:

• worsening eye pain
• worsening vision
• worsening eye redness
• nausea (feeling sick).

Opening hours and contact numbers

Kingston Hospital Eye Casualty

Galsworthy Road, KT2 7QB

8.30am to 4.30pm (last appointment at 4pm).
Closed on weekends and bank holidays.

No referral needed. Call the telephone triage system on 020 8934 6799.

St George's Hospital

Blackshaw Road, London SW17 0QT

8.30am to 6pm on weekdays.
24 hours on weekends and bank holidays.

Call the telephone triage system on 020 7702 5542 (option 6)