Cataract Surgery FAQs

When do I have my cataract treated?

In many cases, cataract is harmless and may be left in your eye. It is usually safe not to have surgery if you feel that you do not have a problem with your vision or do not wish to have an operation. When the cataract progresses to the point that it is interfering with daily activities or lifestyle, even when using up-to-date glasses, then cataract surgery may be the next step. An important indication for cataract surgery is to meet the DVLA driving standard. Your optician or eye doctor can advise about whether your vision meets this standard and if cataract surgery would be of benefit.

Can anything be done to stop my cataract worsening?

There is no known method of preventing cataract.

I have cataract developing in both eyes – are both operated at the same time?

It is common for cataracts to develop more quickly in one eye than in the other. The timing and sequence of surgery is decided after discussion between you and your cataract surgeon.

Usually, your more seriously affected eye is operated on first. If the second eye is affected, ideally the second cataract operation is scheduled so there is not a long delay between the two as both need to be done before new glasses can be prescribed.

If the second eye does not have a cataract, it may still need to undergo lens replacement surgery to balance the fist eye if the eyes are long-sighted (hypermetropic) or short- sighted (myopic) to start with. This is in order to balance the two eyes after cataract surgery.

Cataract surgery can be performed in both eyes at the same time and this is mostly done for convenience rather than for a medical reason.

The benefit of performing cataract surgery in the two eyes separately is safety and increased precision. If the cataracts are performed separately, the refraction is measured after the first case and that gives us information to improve the precision of lens selection for the second eye.

There is a risk of infection after any operation and if cataract surgery is performed simultaneously, the concern is that an infection may arise in both together. The risk of infection and loss of vision in any single eye cataract operation is usually quoted as being around 1 in 1000 according to one of the largest studies. With careful additional precautions, it is closer to 1 in 6000. The risk of infection and loss of vision in both eyes after bilateral surgery is quoted as being around 1 in 500,000.

Are cataracts removed by laser?

New technology is available using a specially designed ‘femtosecond’ laser for part of the procedure. However, the surgeon still needs to operate to complete the surgery as it is currently not possible to remove cataract by laser alone. Additionally, recent studies have not shown any benefit of having laser assisted cataract surgery over traditional cataract surgery. Please ask your surgeon if you have any further questions about laser cataract surgery.

What is it like during the operation?

The operation is performed while you are lying down on your back. Your face is partially covered by a sterile sheet. If you have difficulty lying flat or are claustrophobic, we will do our best to make sure that you are comfortable before the operation starts, but please tell the nurses during your pre-operative assessment.

During the operation, the surgeon uses a microscope. The bright light from the microscope and the covering sheet mean that you do not see the operation or the detail of the instruments but you may see moving shapes.

Usually you will be awake during the operation and will be aware of a bright light, and often pretty coloured lights and shadows. You may feel the surgeon’s hands resting gently on your cheek or forehead.

A lot of fluid is used during the operation. Sometimes, excess fluid may escape under the sheet and run down the side of your face, into your ear or on your neck, which can be uncomfortable.

You might hear conversations during the operation. These could be about the operation or for teaching or about other subjects. Please do not join in as it is important that you remain still during the procedure.

What kind of anaesthetic is necessary?

Most operations for cataract are performed under local anaesthetic, in which you are awake but your eye is numb. This is usually given by eye drops or as an injection around your eye. A small number of patients require sedation or even a general anaesthetic. This is usually for anxiety or an inability to remain still such as Parkinson’s disease. Here, you are asleep for the duration of surgery and wake up with an eye shield over the eye..

Will I have to stay in hospital?

Cataract surgery is performed on a day- care basis. This means you are admitted to hospital, have your operation and are discharged home all in the same day. You could spend several hours in hospital from arrival to discharge. This is usually the case even for a general anaesthetic.

How accurate are the results of cataract surgery?

The pre-operative measurements usually allow your surgeon to choose a lens implant which gives the desired near or distance vision, but individual patient outcomes vary and it is not possible to guarantee an exact refractive outcome.

Follow up is arranged after cataract surgery to discuss the outcome and if the operated eye is more long or short sighted than expected then your surgeon will discuss further treatments if required.

Colour vision

Cataract in your eye scatters and absorbs blue light selectively. After surgery, your lens implant is very clear so a change in colour vision is common. This can be dramatic, especially in the early period after surgery, and can make colours look brighter or bluer than usual.

Most lens implants have ultra violet (UV) blocking built in, but you can use sunglasses when outdoors in bright sunlight to block excess UV light reaching the retina. If you have an occupation where colour vision is critical, you should seek specific advice.

Do cataract operations have any complications?

Yes. Serious complications are uncommon but, if they occur, they can permanently damage your eye and your vision:

• 1 in 1,000 risk of severe and permanent visual loss
• About 1 in 100 risk of requiring additional surgery to rectify a problem
• 1 in 20 operations have less serious complications, which may require further treatment at the time of surgery or following the operation
• 1 in 10 patients need laser treatment at some time in the future for opacity of the capsule behind the implant.
• The upper eyelid can droop after cataract surgery
• A very small risk of vision loss to the fellow eye.

What to look out for after surgery

Increasing redness, pain, blurring of vision or yellow/green discharge

This can indicate a serious infection or inflammation.

Blurring of the central vision

This may indicate macular oedema (water logging of the central part of the retina).

Red sore eye after stopping drops

This can be due to a recurrence of post- operative inflammation inside the eye.

Distorted vision

The implanted lens can move from its original position, causing distorted vision, though this is unusual. If this happens, you might need further surgery to reposition the displaced lens.

A shadow, lights or floaters in your field of vision

The most common cause of a shadow or lights in the peripheral vision is due to the different way that the light is focused on the retina through the new lens implant. Following the operation, you may become aware of a shadow or bright light to the side of your vision, often described as a ‘half-moon’ or ‘crescent’. The effect is usually temporary as your eye rapidly adapts to the new lens. Shadows can also be caused by the retina becoming separated from the inner wall of the eye. This is known as a retinal detachment. If you notice an enlarging shadow in your field of vision, especially with increasing floaters or flashing lights, please contact the hospital as soon as possible.

If you experience any of the above, or you are worried about your eye, you must contact/attend the hospital where you had your surgery or contact Mr Modi’s directly or via secretary as soon as possible. Alternatively, attend your local A+E if either of these are impossible.