Cataract Surgery

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Cataract Surgery

Eye Clinic

A cataract is clouding of the lens inside the eye. A cataract is not, as many people believe, a skin that grows over the eye.

The lens

The lens is a transparent structure that sits behind the iris (see diagram below). The human eye is rather like a camera: both depend on the lens being clear. If the lens becomes cloudy, the picture becomes blurred and hazy. Therefore, as a cataract develops, the vision will become increasingly poor. You may experience problems, such as blurred vision, glare or colours fading.

Causes

Usually, cataracts are caused by the ageing process. Less commonly, cataracts can be caused by injury to the eye, prolonged inflammation, an illness such as diabetes, certain drugs, or, occasionally, people are born with them.

Treatment/operation

The only treatment for cataracts is surgery which is performed by an experienced eye surgeon or a doctor in training under the supervision of senior eye surgeon. The operation is usually done under a local anaesthetic, though in some cases a general anaesthetic is given. Under a local anaesthetic, you will be awake during the surgery, but will not feel the operation.

A tiny incision (cut) is made at point A on the diagram. Using special micro-instruments, the cloudy lens is gently broken into smaller pieces and sucked out of the eye. The new lens implant is then inserted. This is permanent. On occasions, stitches are used to close the incision, but most wounds heal themselves without stitches and some irritation due to the healing incision is not unusual.

The operation will take about 20 – 30 minutes to complete and is performed while you are lying down on your back and your face is partially covered by a sterile sheet. If you have difficulties lying flat or are claustrophobic, please tell the staff during your pre-assessment so that we can plan accordingly.

Special tests are required to determine the strength of artificial lens implant that would replace the cataract. These tests are done as a part of the pre-assessment process before the day of the operation. If you have had laser refractive treatment for short or long sight, it is very important that you inform the doctors and nurses during assessment. Excimer laser (LASIK or PRK) affects the calculations that are essential to know the power of lens implant used during cataract surgery.

Even if all the pre-laser information is available and extra calculations are done, such eyes are at higher risk of being more or less long/short sighted than anticipated. This may require spectacles, contact lenses or further procedures including removal of the artificial lens implant.

You may also require additional tests especially if you need sedation or general anaesthetic.

If you wear contact lens, you must leave them out for a specific time to be able to have the best possible outcome from the operation. The amount of time you have to leave them out is as follows:

  • Soft contact lenses: 2 weeks (one week minimum)
  • Gas Permeable (Hard) lenses: 4 weeks (2 weeks minimum)

Types of Artificial Implants available

The cataract is replaced by an artificial lens implant and there is a choice of lens implants available.

1. Standard Monofocal Lenses

This is the standard lens implant that is used for almost all NHS patients. This aims for good distance vision after the operation and you will need glasses for reading/fine focusing.

Some patients may prefer to read without reading glasses and although this lens can be used to help you achieve this; you will then need glasses to get clear distance vision.

Some patients who are used to having monovision, may be able to deliberately aim for distance vision in one eye and near vision in the other eye.

2. Toric lenses

Toric lenses are available on NHS and are suitable for some patients with moderate to high astigmatism. These lenses are similar to the standard lenses but it corrects corneal astigmatism which is present in some patients especially in patients who have had corneal transplant operations.

The aim is to reduce astigmatism to improve vision so that the dependency on thick glasses or contact lenses can be improved. You will still need glasses to read as with standard monofocal lenses.

Toric lenses are not suitable for every eye and are not required if you are happy wearing glasses for all distances. The operation is the same as standard surgery but the toric lens has to be placed in correct position for it to work and is used by specialist eye surgeons.

There are some potential risks with toric lenses:

  • It may not fully correct astigmatism
  • It can only be used if operation is uncomplicated
  • It may move in the eye requiring another procedure to rotate it to the correct position
  • It may have to be removed in some cases

3. Multifocal lenses

Multifocal lenses aim to correct vision for near, intermediate and far helping you to reduce your dependence on glasses for all distances. These are not currently available routinely on NHS and cannot be purchased separately and implanted during NHS operation. These lenses are not suitable for all patients and may cause specific visual symptoms affecting quality of life of some patients.

If you wish to explore these lenses further, at present it has to be done privately.

Complications associated with the operation

All operations carry a degree of risk. Complications could arise at any stage. Our staff do their best to minimise these risks. Problems that can occur during the operation are rare but can include:

  • when trying to release the cloudy lens, the capsular membrane could tear, causing the cataract to fall to the back of the eye. Further surgery is required to remove it
  • a large haemorrhage could occur inside the eye (this is rare)
  • the operation could be unsuccessful, resulting in poor vision or even blindness in the operated eye (this is very rare). There is a 1 in 1,000 chance that this could happen.

Problems that can occur after surgery are:

  • you may need thicker glasses than expected to achieve good vision or to correct astigmatism
  • lens capsule clouding, treatable with laser
  • infection, which may severely reduce sight
  • increased pressure inside the eye
  • wound leak requiring a stitch
  • macular oedema causing prolonged blurred vision
  • surface scratches causing pain
  • allergy to eye drops
  • post‑operative inflammation
  • retinal detachment up to a year afterwards
  • rare corneal clouding requiring further surgery

Local anaesthetic

If your operation is performed under a local anaesthetic, you will be able to eat and drink normally before the operation. You will be able to take your normal medication, and you will be able to go home on the same day.

Local anaesthetic types include:

  • Sub‑tenons local anaesthetic (injection under membrane)
  • Strong anaesthetic eye drops
  • Peribulbar injection (rarely required)

Potential risks include:

  • large haemorrhage
  • puncturing of the eye
  • allergic reaction
  • permanent eyelid droop
  • feeling unwell

General anaesthetic

A general anaesthetic means that you will be asleep for your operation. You may need to stay overnight.

Fasting instructions:

  • No food for 6 hours before surgery
  • Clear fluids allowed until 4 hours before
  • No gum or sweets

Risks include:

  • allergic reactions
  • worsening of other medical conditions
  • death (very rare)

Preparation for surgery

Before attending for surgery please ensure you have washed your face. Patients with Blepharitis must clean eyelashes as instructed.

Nurses will place drops to dilate your pupil. During the procedure, you will lie flat, be draped, and receive airflow under the drapes. A nurse may hold your hand for reassurance.

After the operation

You will stay for about one and a half hours before discharge.

  1. You must have someone collect you — do not use public transport.
  2. You will need eye drops four to six times a day.
  3. You may have a follow‑up appointment within 24 hours to one week.
  4. You must visit an optician 4–6 weeks after surgery before second‑eye surgery.

Discharge advice following eye surgery

  • wash your hands before putting in eye drops
  • do not press or rub your eye
  • do not use an eye bath
  • avoid strenuous exercise and swimming for 4–6 weeks
  • avoid driving until advised (usually 4–6 weeks)
  • resume normal sex life
  • ask when you can return to work
  • bathe the eye with cool boiled water if needed
  • wear old glasses until new prescription at 4–6 weeks
  • normal activities like TV and shopping are fine

How to instill your eye drops

  • wash your hands first
  • tilt your head back
  • pull down lower eyelid
  • avoid touching the eye with the bottle
  • blot excess with clean tissue
  • replace the cap immediately

Complications

Contact the Eye Clinic immediately if:

  • vision suddenly becomes increasingly blurred
  • you have severe pain (a gritty feeling is normal)
  • your eye becomes red and sticky
  • you see a sudden increase of floaters or a “veil”

Contact numbers

The Eye Clinic at Doncaster Royal Infirmary
Tel: 01302 644141 (Mon–Fri 8:30–18:00)

Ward S12 at Doncaster Royal Infirmary
Tel: 01302 642412 (out of hours)

Patient Experience Team

Telephone: 01302 642764 or 0800 028 8059
Email: dbth.pals.dbh@nhs.net

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