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Cataract Surgery:
Your Questions Answered
You are soon to be admitted to hospital to have your cataract removed. This booklet is designed to help you understand about your admission to hospital, the operation and your aftercare.
Having a cataract removed should not disrupt your life greatly, but some extra care is required for at least three weeks after surgery. During this time your eye is still fragile and could be vulnerable to the smallest knock.
We suggest, if possible, that you arrange for someone to help at home during the first week following discharge. Here are some guidelines to help identify your limitations and understand why these are necessary.
What is a cataract?
The natural lens of the eye is a transparent flexible structure suspended in the middle of the eye; a muscle in the eye pulls on the lens, changing its shape slightly, and this allows the eye to change focus.
In many older people, however, and in a few younger people, the lens becomes cloudy and discoloured, preventing clear vision. This tends to become worse, usually over a few years. Often both eyes are affected, and the patient will become more visually impaired. In the early stages, a change of glasses may help, but eventually a cataract operation is needed.
How is cataract surgery done?
These days, a keyhole operation is almost always used. The surgeon makes a very small wound (2.5 – 3.0 millimetres wide) at the junction of the white of eye and the cornea (the clear front window of the eye). The cataract is broken up into small pieces which are gradually removed. Then a clear plastic artificial lens is put inside the eye, and left permanently supported in the same place as the cataract used to be. The plastic lens implant lets the light through into the eye again. Usually the keyhole wound is self-sealing, and often stitches are not needed.
The operation takes about half an hour, and is usually done under local anaesthesia (the patient remaining awake throughout) and in that case the patient is usually able to go home about an hour after surgery.
Where possible cataract surgery takes place on a day-care basis. You may need to arrange for someone to stay with you for the first night (the nurse will advise you of this at the pre-op clinic)
Pre-operative assessment
Before the operation you will be called to a pre-operative assessment clinic. This is to assess your fitness for surgery, any special factors that may affect the way the operation is done and also to allow your eye to be measured so that the power of the plastic lens implant can be calculated. You will need to bring a list of all your medications. Ideally someone should come with you. The practical arrangements for your hospital admission, transport details, and plans for your post operative care will be sorted out. You will have the opportunity to ask questions.
Post operative assessment and recovery
At the end of your operation you will be taken back to the ward. Tea and biscuits are offered prior to going home.
When you remove your eye shield the next morning, you may notice an improvement in brightness and colour. At first, quite often the vision is somewhat misty or out of focus. Usually there is very little post operative pain, the eye may feel bruised at first and a gritty feeling is common in the first few days. Take Paracetamol or your normal pain killer if needed. A period of healing is then required.
The area around the eye may look bruised, and the white of the eye may look red at first. This is to be expected and will soon improve. Eye drops will be supplied to you along with a plastic eye shield. After the operation, secure the eye shield over your eye every night for a month. You will need to supply your own surgical tape (from the chemist). You can return to most ordinary activities straight away and bending and light lifting are usually permitted.
Things to avoid
1. Touching or rubbing the eye
2. Swimming and strenuous activity or exercise
3. Getting soap or shampoo in the eye
4. Driving until you are able to read a car number plate at 20 metres. Remember until you have your new glasses, judgement of depth and distance may be poor.
5. Travelling abroad before your first follow up appointment
6. Eye make up for 3 weeks.
When can I return to work?
This really depends on the work you do. Office work is safe as soon as you feel comfortable. Discuss this at your pre-operative assessment clinic visit or with your surgeon. Your sight will not be at its best until you have your new spectacle lens.
Things that are allowed
· Walking (but be careful on the stairs)
· Watching television
· Reading
· Most normal daily activities
What are the risks?
All operations carry some element of risk; with cataract surgery we find about 97% get an improvement in sight, 2% end up with the same level of sight as before, and 1% are sadly worse off because of complications. One in a thousand may actually lose all of the sight in the eye (usually through infection). Other complications include: detachment, haemorrhage and water-logging of the retina, and corneal problems.
If you have any other pre-existing eye disease as well as the cataract, this could have some affect on the final visual result.
We hope you will gain lasting benefit from your cataract operation, and we will try make it as ‘stress free’ as we can.
How to apply your eye drops
Wash your hands before applying eye drops.
1. Gently pull the lower eyelid down until there is a small pocket
2. Squeeze the upturned dropper bottle to release a drop into your eye. Avoid touching the tip of the bottle against your eye.
Do not rub your eyes after applying the drops
Storage of eye drops and ointment
· Store eye drops and ointments in a cool place out of children’s reach.
· Only store drops in the fridge if requested to do so.
· Dispose of all opened eye drops and ointments after one month.
· Never share your eye drops with anyone else.