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Frequently asked questions

Cataract surgery – Frequently asked questions.

Do I have to wait for a cataract to be ripe before surgery?

No. The time to have surgery is when the vision is bothering you. This varies for different people depending on their visual requirements. A common reason for cataract surgery is to enable people to continue driving.

Do I have to have surgery when I first develop a cataract?

Not necessarily. In very early cataracts all that may be required is a change in glasses. The cataract itself will not harm your eye. If you are happy with your vision, you don’t need surgery. Your optometrist will recommend when it should be done, taking into account such things as your vision being up to the driving standard if you’re a driver.

What are the risks of cataract surgery?

Cataract surgery is a very successful operation and one of the most common procedures in the world. An improvement in vision can be expected in 95% of cases. Like all operations however, things can go wrong.

Serious complications include severe bleeding during the operation and post operative infection. These can blind the eye. Other serious problems are losing the cataract into the jelly of the eye during the surgery, retinal detachment and water logging in the central retina after the surgery. These seriously affect the vision and sometimes require a second operation. There is approximately 1:1000 chance of severe visual loss and 1:200 chance of a complication requiring further surgery. Compared to most other operations, these are very good odds.

Are some cataract operations more difficult?.

They can be. Many factors can make the operation more difficult ranging from pupils that won’t dilate properly to drugs that you may be taking. Your surgeon will discuss these with you beforehand

Does cataract surgery always work?

Even uncomplicated surgery can result in no visual improvement. This is rare and is usually due to there being other pre-existing problems with the eye such as retinal disease, glaucoma, lazy eye and macular degeneration (links). In most cases your surgeon will have seen these and warned you that these problems may affect the outcome. Sometimes, particularly if the cataract is very dense, the surgeon may not be able to see your retina and therefore cannot see if there is other disease within the eye.

What types of local anaesthetic are used?

There are two options, an injection or just drops. 

In the injection method a nick is made in the conjunctival membrane and through this local anaesthetic is injected using a blunt tube. No needle is used. This makes the eye go numb very quickly and usually stops it moving and seeing. There is usually some bleeding on the outside of the eye making it appear red and bruised for a little while after the surgery. This is called sub tenons anaesthesia.

The other option is to just use drops to make the eye go numb. It works very well and avoids the need for an injection. Also there is no bleeding and bruising afterwards. It does not stop the eye moving so you would be asked to look at a bright light during the operation. This is called topical or no needle anaesthesia. Cataract surgery using no needle topical anaesthesia is available in Derby.

Will I see the operation?

No.  Whatever type of anaesthetic is used, the microscope light that the surgeon uses is so bright you cannot see the surgery.

Will it hurt?

The “sub tenon” injection can be uncomfortable. After that you should feel very little.

With drops alone most people  feel very little. Younger people, especially if short sighted can be more sensitive so some extra anaesthetic is put into the eye to avoid this once the surgery has started.

Whatever method is used, if you are in discomfort you will be given more anaesthetic.

Will it hurt after the surgery?

You can expect a little discomfort, usually in the form of grittiness. This can last a few weeks. Severe pain is rare and can indicate an infection is starting. If this occurs you will be asked to contact the eye department so they can check for this.

How soon can I drive after surgery?

Assuming your vision is to the required standard, you can drive after a week..

How long do I need to take off work?

A minimum of a week, most people take two weeks. Manual workers may need longer.

How do I know if there is something going wrong after the surgery?

You will be told what to look out for and given a number to ring if you are worried. Increasing and severe pain in the eye may mean an infection is starting. Another worrying sign would be if the vision is getting worse. If either of these occurs you need to seek advice. 

Will I still need glasses?

In most cases, you will. In the UK the lens implant that replaces the old cloudy natural lens (the cataract) is set to focus at one distance only. This is known as a monofocal implant.  So in most cases you will be able to see clearly in the distance but still require reading glasses for close up. 

If you were very long or short-sighted before the surgery in most cases you will be made less so. If both eyes are operated on, most surgeons will aim to make people very slightly short-sighted after surgery. You will be much less reliant on glasses than you were previously (so you gain two things from cataract surgery) but will still need them for absolutely clear vision especially reading small print.

Some people elect to have multifocal implants. They should be even less reliant on glasses than before their cataract started. (See different types of implant)

If only one eye had a cataract and the other eye was very long or short-sighted, then the surgeon will deliberately keep the operated eye at a level of long or short sight to match the other eye. In these cases you will still need glasses. See “Do both eyes always need surgery?”

Some people have a type of refractive error called astigmatism (see childhood eye problems). This can be reduced  by an additional procedure during cataract surgery where small cuts are made on the cornea (limbal relieving incisions or LRI). This can further reduce your reliance on glasses if you have a significant amount of astigmatism prior to cataract surgery. Another option is a type of implant designed to correct astigmatism, this is called a toric implant. Your surgeon will discuss this with you before surgery.
 
Do both eyes always need surgery?

Cataract usually affects both eyes, often one side more than the other. In these cases surgery on both eyes is recommended.  There is usually a gap of at least four weeks between operations. We never operate on both eyes at the same time.

If only one eye is predominantly affected by cataract and the other eye sees reasonably well; it makes sense only to operate on one eye. However if you are very long or short-sighted it becomes more difficult.  Cataract surgery gives you the opportunity to be made less long or short-sighted and subsequently less reliant on glasses. However if the worse eye had cataract surgery and was also made less long or short-sighted, you would have difficulty using your eyes together as the other eye would still require a strong glasses lens. To be truly less reliant on glasses you would therefore have to have surgery on the better seeing eye as well, in order for both eyes to match up with glasses requirement. This means you would be subjecting the better seeing eye to an operation and that means accepting the albeit low risks of surgery on that eye. Alternatively you could only have one eye operated on keeping it long or short-sighted so as to match the other eye. You will of course end up still being as reliant on glasses as before the surgery. In these cases the surgeon will discuss your options but the decision will be yours. 
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What are the different types of implant?

Also see section on premium cataract surgery)

In the UK the majority of implants are known as monofocal. That means they have a set focus that cannot change. Eyes with this type of implant cannot change focus. Normally they are set to see best at distance, so reading glasses are required. For most people undergoing cataract surgery this is what they were like before the onset of cataract. Their natural lens also couldn’t change focus when they reached a certain age (see presbyopia) and they needed reading glasses. Most people are very happy with this situation after cataract surgery, their vision is better and they are used to needing reading glasses anyway.

There is another option however. There are implants available that can change focus (see section on premium cataract surgery). These implants (multifocal or accommodating implants) potentially can reduce the need to use reading glasses after cataract surgery. These implants are becoming increasingly popular. Multifocal implants to correct presbyopia are available in Derby. 

These implants can have their problems however. The multifocal implants often cause glare and haloes especially at night. Whilst many people adapt to this some do not and the implant has to be removed. This is less of a problem with the alternative accommodating implants, but their drawback is that they tend not to be as effective as the multifocal implants. In the UK, if somebody wants these types of implants, they are not available on the NHS.

Does the cataract grow back?

No, What can happen is that the membrane the implant rests on can thicken up. This can affect the vision. It is called posterior capsule opacification.  It can happen many years after cataract surgery. Your optometrist will be able to pick this up. This capsule opacification is easily treated with a laser that breaks up this membrane. It is a painless procedure that only takes a few minutes.

Useful link: www.eyecareamerica.org

Useful link: www.eyecareamerica.org

General eye problems

Adult Squint
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AMD
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Presbyopia and normal ageing of the eye
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Cataract
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Cataract FAQ's
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Refractive surgery of the lens and correction of presbyopia
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Dry eye
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Glaucoma
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Retinal Vein Occlusion

 

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Email. rhoeyes@googlemail.com

 
 
 
 Roger Holden Eye Surgeon
 
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