Learn everything about your treatment
Learn everything about your treatment
Cataract surgery overview
What is a cataract?
This cataract surgery overview page aims to explain what cataracts are and how your doctor will treat them.
A cataract is the medical term for a cloudy white spot which forms on the lens of your eye. As the lens is usually clear, when cataracts form it can affect your vision. This can cause blurriness, haloes of light and problems with seeing colours. Cataracts are most commonly linked to growing older and so most often affect adults. However, it is possible for babies to be born with them as a part of some rare conditions. Other causes of cataracts include:
- Trauma or damage to the eye
- Exposure to radiation
- Prior eye surgery
- Extreme sun exposure
- Long term use of steroids
If left without treatment, the cataract will continue to form and your vision will worsen. Ultimately, this can lead to blindness. Therefore, it is important to speak to your doctor about your options.
What can cataract surgery achieve?
Of course, it is for you to decide whether cataract surgery is the right option for you. Sometimes when people have early cataracts, their vision is not affected. In these cases, they may be able to manage with new glasses and ensuring that they read with a good light source. However, cataracts will continue to develop once they have appeared and so this is not a permanent solution. This is important to remember, especially if you drive, as you may not be able to continue without receiving treatment. The only proven way of restoring your vision is to undergo surgery to remove the cataracts.
To find more information on Cataracts and the potential management options, you can visit the NHS website. It would also important to speak to your ophthalmologist directly as they will be the best person to give you advice.
Cataract surgery candidates
Who are the ideal candidates for cataract surgery?
Cataract surgery is a quick and commonly performed operation which can substantially improve lives by restoring vision. Often, cataract surgery candidates choose to have this surgery because of their declining eyesight.
Worsening vision may affect your day to day life, your work and your ability to drive. Sometimes, people develop cataracts in both eyes. If this happens, your doctor will treat each eye separately in two operations that are a few weeks apart. You may be a suitable cataract surgery candidate if you:
- Have a cataract in one or both eyes
- Suffer from worsening vision or changes that affect your daily life
- Want to drive again in the future
- Have work or hobbies that require reasonable eyesight
- Are relatively fit and well
- Have sensible goals for your surgery
- Feel mentally and emotionally ready for the procedure.
Why have cataract surgery?
As mentioned above, there are a few different reasons why you may wish to have your cataracts removed. In addition, as there are no other treatments available at the moment, surgery is the only way of undoing the effects that the cataract has.
Cataract surgery is a safe and fast procedure and can help:
- Improve your vision
- Make colours appear brighter
- Remove any haloes or lights in your vision
- Allow you to better enjoy daily life and hobbies
- Allow you to drive more safely.
Because of this, cataract surgery can alter your whole life and offer great relief from your visual problems. As cataracts can take years to become troublesome, you should take time after your consultation to make sure you are certain that you want to go ahead with the surgery at this stage. Furthermore, you should think about a few other factors before you make a decision. This includes:
- How quickly your vision has worsened
- How much of a problem this is for you
- The length of time you have had cataracts.
Although the final decision is, of course yours, it is important that you speak to your ophthalmologist if you have any more questions about whether this is the right treatment for you.
Cataract surgery procedure
How is cataract removal surgery performed?
The cataract surgery procedure is quick and only takes between 15 to 45 minutes to perform. In the UK, the most common technique is called phacoemulsification. Almost always, it is carried out under local anaesthetic. After the procedure is complete, you should be able to go home on the same day.
The process for your cataract surgery procedure will usually go as follows:
You will meet your ophthalmologist to sign your consent form before the procedure takes place. This may happen at your pre-operative consultation or on the day of your surgery. Although you may be aware of the risks and complications, it is important that you read the consent form fully before signing your consent.
Your doctor will give you an anaesthetic before having your procedure. In most cases, this will be a local anaesthetic. After surgery, the anaesthetic may make your eye and face feel strange but this should wear off within a few hours.
3. Incisions and removal
Your doctor will make small incisions into the sides of your eye. This lets them remove the area in front of the lens so they can place a small ultrasound probe in the eye. This tiny probe vibrates very quickly which allows your doctor to break up the cloudy lens into small pieces. Then, the doctor removes these pieces from the eye using a small suction tool. It is vital that you stay still whilst the doctor operates, so please let them know if you need to move for any reason.
4. Replacing the lens
Once the old, cloudy lens has been removed, your doctor will need to replace it. This artificial lens is plastic and is either:
A monofocal lens focuses on a single point, whilst both multifocal and accommodating lenses let the eye focus on objects that are close and far away. Your surgeon will discuss which lens type they plan to use with you during your consultation.
4. Closing of incisions
Next, your doctor will use tiny sutures to close the incisions and secure the new lens in place. They may also cover the eye with a protective pad which you can expect to wear for the first day after the surgery. It is important to only take this pad off when your doctor instructs you to do so.
5. Return to the ward
Finally, once your surgery is over, the medical staff will take you back to the ward. It takes a few hours for you to get feeling back in and around your eye, and it can take a few days for your vision to improve. You will be able to return home after a few hours, depending on how well your recovery is going.
Cataract surgery consultation
What should I expect from my cataract surgery consultation?
You will meet your ophthalmologist for an assessment before having your cataracts removed. During this assessment, they will look at your eyes and ask some questions about your vision and any symptoms you may be having. Your cataract surgery consultation will usually last between 15 minutes to 1 hour. It will be an opportunity for your doctor to discuss the procedure with you and to find out more about you. To do this, they will ask you about:
- Your current general health
- Any medical conditions you have
- Your past medical history
- Any operations you have had
- Any medications that you are currently taking ( including prescription, over-the-counter and herbal medications)
- Your alcohol consumption, smoking, and recreational drug use
- Any allergies you may have.
We strongly advise that you are as honest with your doctor as possible at this consultation so they can collect accurate information about you. Being open and honest allows your doctor to formulate a clear picture of your health and in turn, allows them to make decisions that are appropriate for you. If the information you provide is not accurate, you may hinder their ability to make good decisions about your care. This way, they can decide whether or not you are a good candidate for cataract surgery and advise you accordingly.
What questions should I ask during my cataract surgery consultation?
Whilst your consultation is a good chance for your ophthalmologist to ask you questions, it is also the time when you get to ask any questions you may have. We therefore recommend that you spend some time thinking of some questions you would like to ask. Try to write these down and take them with you to the consultation. This will make you feel more prepared and you are less likely to forget to ask the things that are important to you!
Below is a list of questions you may like to ask:
- Is cataract removal surgery suitable for me?
- Will I be in pain afterwards?
- How good will my vision be after surgery?
- Is the surgery always a success?
- How long will it take me to recover?
- Will the cataracts come back?
- Do you think my expectations are realistic?
Cataract surgery risks and complications
What are the main cataract surgery risks and complications?
Many of the cataract surgery risks and complications are rare. Therefore, you might think that it is not necessary to know about them. However, this is not the case and it is vital that you fully prepare yourself. Before you consent to have your cataracts removed, you should take time to consider them all.
The cataract surgery risks and complications include:
Cataract surgery is thought to work in over 98% of cases. However, very rarely the surgery does not lead to an improvement in vision, often due to one of the complications listed below. Each complication has its own distinct treatment which can often include eye drops, medication or further eye surgery.
Any surgery is invasive and introduces the risk of infection to your body. If you develop an infection due to your surgery, you will notice that things are not settling down as you would expect.
Key signs of infection to look out for are:
- A fever or temperature of 38° C or more
- Redness of the eye
- New visual problems
- An increase in pain that your pain medication does not help.
Mild infections usually go away with antibiotics. There is a small chance that an infection may affect the final results of your operation. If this were the case, you may require further surgery to remove the source of the problem. It is very important that you seek help if you have any sign of an eye infection so your doctor can treat it as soon as possible.
Posterior capsule opacity
Thought to be the most common complication of cataract surgery, posterior capsule opacity (PCO) refers to when the area behind the new lens becomes cloudy. This happens because some cells from the lens start to grow on the back of the eye, making it cloudy. Posterior capsule opacity can affect your vision in the same way cataracts do, but can be treated with laser therapy.
Damage to the eye
Any sort of surgery has the potential to damage the area surrounding the target of the operation. It is rare, but possible, for other parts of the eye to come to harm by accident whilst the doctor operates. This can cause inflammation and loss of vision.
Having cataract surgery slightly increases your risk of retinal detachment. It is an emergency that requires immediate medical treatment. If left untreated, it could cause you to lose vision in that eye. Therefore, you must tell your doctor seek urgent medical help if you notice –
- A curtain-like darkness has appeared over part of your eye
- New floating spots in your vision
- Seeing flashes of light.
This is the most serious risk of cataract surgery and can be either short-term or permanent. The chance of severe or complete lifelong loss of vision after cataract surgery is very low. Even so, it is crucial that you are aware that this complication exists.
Cataract surgery preparation
How can I prepare for cataract surgery?
After your surgery, you will want to relax as much as possible during your recovery. Getting things prepared before your surgery can help you do this. We have put together a list of cataract surgery preparation tips that we hope you will find useful!
We appreciate that getting on top of household chores can sometimes be difficult even on a normal day! Therefore, we recommend that you try to get some of the big jobs out of the way before your surgery. For example, you may like to do the laundry and take the bins out the day before your procedure. This way, you will hopefully not have to stress or worry about doing chores in the first few days of your recovery.
It is likely that you will not feel up to going to the supermarket in the first few days after your cataract surgery. Therefore, we advise that you do a big food shop and stock up a day or so before you come to hospital for your surgery. You may even like to make some meals and freeze them. This means that you won’t need to worry about cooking whilst you settle back at home after surgery.
Children and pets
To minimize your stress levels during your recovery, you may like to ask that some family or friends help you to look after your young children and pets.
You will be unable to drive yourself home after your surgery. You may like to ask a family member or friend if they will be able to collect you from the hospital. It is very important for you to follow your doctor’s strict advice on when it is safe for you to drive again.
Your surgeon might recommend that you eat healthy low-sodium foods, including fresh fruits and vegetables after surgery. You should try to stay hydrated with water and caffeine-free beverages. Try to also avoid consuming high amounts of salt and sugar during your recovery time.
It is vital that you follow your doctor’s strict instructions regarding smoking, alcohol and drug use both before and after your surgery.
Your doctor may recommend that you avoid sleeping on the side of the affected eye for the first few days. This may help to avoid contact with the treatment area and may also help to reduce any inflammation.
Your ophthalmologist will give you specific advice on your cataract surgery preparation. Following their advice will help to achieve the best possible results and the smoothest recovery.
Cataract surgery aftercare
What can I expect after cataract surgery?
Your doctor will give you specific instructions regarding your cataract surgery aftercare. It is vital that you follow their instructions to ensure you reduce the risk of complications as much as possible.
They will give you specific time frames for when you can begin to start activities like driving, exercising and when you can go back to work.
We like to stress the importance of following the advice of your surgeons. Of course, it can be hard to slow down the pace of your life and refrain from certain activities. Despite this, you must remember that your surgeon’s advice is in the your best interests for a smooth recovery. Your surgeon will also explain about any medications you may have to take after the procedure.
Below are some general cataract surgery aftercare tips:
Directly after the surgery
In most cases, the surgeon uses a local anaesthetic. You may experience altered sensation on and around your eye but this will wear off over a few hours. If you also had sedation, you might feel a bit groggy or disorientated but this will also wear off. You may not be able to see clearly immediately after the surgery, this is normal and not something to worry about.
You will usually be able to return home on the same day. You will be unable to drive so you should arrange for someone to collect you from the hospital.
Before you leave the hospital, your surgeon will arrange for you to return within 1 to 2 weeks for a follow-up appointment. They will examine your eyes, check your vision and get you new glasses if necessary. They will also advise you on the next steps of your care, such as when you can have the other eye treated if you have cataracts in both eyes.
You should expect to experience a little pain and swelling around your eyes after your cataract surgery. This can take up to a month to settle down. In the meantime, you can manage it by using over-the-counter pain relief. You should also avoid sleeping on the side of the eye that was operated on. This will help to reduce swelling and in turn, pain.
Returning to work
After your procedure, your doctor may recommend that you take around 3 to 5 days off before you return to work. In addition, it is essential that you avoid driving until your doctor says it is ok to do so. They will give you specific timeframes for when you can drive and return to work, which you must follow.
Returning to exercise
Your doctor may recommend that you avoid strenuous activity, heavy lifting and contact sports for at least 4 to 6 weeks. Swimming must be avoided for at least 4 weeks after cataract surgery.
You must use the eye drops that your doctor gives when you leave the hospital. These help to prevent any infections and allow your eye to heal. Your doctor may also advise that you avoid rubbing your eye, wearing eye makeup and getting the eye wet, such as in the shower or bath.
You may have to use the protective eye shield at night and when washing for at least the first week. Your doctor will go through all of this advice in detail so that you have all the information that you need in advance.
Finally, be aware that you should not bend forwards for the first week after the surgery. This is because of the increase in pressure inside the eye which could cause the stitches to come undone.
You may initially feel that your vision is worse after the surgery. This is quite normal and not a cause for alarm! You should see improvements after the first few days and the eye should heal fully within 4 to 6 weeks.
If you have any questions about your cataract surgery aftercare, you should speak to your doctor directly.
Cataract surgery FAQs
What are some common cataract surgery FAQs?
We have listed some of the most common cataract surgery FAQs below. These may answer some questions you have or may help you to think of more to ask at your consultation.
Will the NHS pay for my cataract surgery?
Yes, this procedure is available on the NHS. However, the NHS usually only enables you to have a monocular lens whereas privately there are more available lens options.
Will I be able to see anything during the surgery?
As mentioned before, you will be given a local anaesthetic before your surgery to numb the eye. Whilst the operation is happening, you will be staring into the bright theatre or microscope lights and so you will not be able to see any of the tools used in and around your eye. You may see some shadows and unusual lights, like if you accidentally look into the sun. Your surgeon will talk to you during the surgery to make sure that you are ok and aware of what is going on.
What are the limitations of cataract surgery?
Whilst cataract surgery is very successful, there may be a limitation to the improvement in your vision that it can provide, especially in people who have other medical conditions or prior eye damage.
In addition, it is possible that you will develop another unrelated eye problem at some point in the future. For example, age related macular degeneration is a common condition that can affect us as we get older. This condition would still affect your vision even though you no longer have a cataract. If you have another condition such as this as well as a cataract, the surgery will not help to solve the problems caused by the other condition, just those from the cataract.
When can I wear glasses again?
Your doctor will advise you on exactly when you can wear your glasses again. You may need to wait for at least 6 weeks after the surgery before getting new glasses. This will ensure that the treated eye is fully healed and your vision is stable. Despite this, you should ensure that after the surgery your glasses are still the right strength for you. You can speak to your ophthalmologist and optician to ensure you are wearing the correct glasses.
What effect do smoking, alcohol, and drugs have on cataract surgery?
Smoking, drinking alcohol and taking recreational drugs can all increase the risk of complications. It is therefore vital for you to follow the specific instructions that your doctor has given you on stopping smoking, alcohol and drug use.