Cataract surgery

Cataract surgery is an operation to remove a cloudy lens (cataract) in your eye and replace it with an artificial lens. This will help you to see more clearly. For most people, cataract surgery is a very successful procedure that can significantly improve your quality of life.

About cataract surgery

If you have a cataract, the lens inside your eye has become cloudy. This can start to affect your vision and interfere with activities, such as reading, watching television, and driving. Surgery for cataracts is the only way to restore your sight.

When to have cataract surgery

You can have cataract surgery at any time – you don’t necessarily need to wait until your eyesight is bad. If you drive, for example, you may wish to have surgery sooner than someone who doesn’t. If you have cataracts that are starting to affect your vision, your optometrist may suggest you have surgery. They’ll talk to you about what’s involved, and the risks and benefits of surgery. If you decide you’d like to go ahead, they can refer you to an ophthalmologist. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.

If you have cataracts in both eyes, you may be offered surgery to remove a cataract in one eye at a time, or both eyes together.

Preparation for cataract surgery

You’ll need to have a pre-operative assessment before cataract surgery. This will involve some tests to examine and measure your eye and check your vision. Your surgeon will use this information to plan which type of artificial lens will be best for you. You’ll also be asked about your general health and if you have any other problems with your eyes or vision. This will help to assess your risk of complications after surgery.

Your healthcare team will discuss with you exactly what to expect before, during, and after surgery. This will include the potential risks and benefits involved. If you’re unsure about anything, don’t be afraid to ask. If you decide to go ahead with the operation, you’ll need to sign a consent form, so it’s important to make sure you feel fully informed.

Types of lens

In cataract surgery, your surgeon will replace the lens in your eye with an artificial lens. There are different types of artificial lens. They come in different strengths, just like the lenses in glasses. They also vary in how well they focus on objects at different distances. The main types of lens include the following.

• Monofocal lenses. Most people have these. They’re set at one level of vision – usually on things that are further away. This means you’ll probably need to wear reading glasses to focus on things that are closer up.
• Multifocal lenses. These allow you to see things that are both near and far away without glasses. You can normally only get multifocal lenses through private treatment.
• Toric lenses. These are used to correct astigmatism and also reduce the need for you to wear glasses. Astigmatism is when the shape of your eye is more like a rugby ball than a football (what it should be). It can cause blurred vision.

Anaesthesia

Cataract surgery is usually done as a day-case procedure, which means you’ll have the operation and go home on the same day. You won’t be able to drive straight after surgery though, so you’ll need to arrange for someone to take you home.

You’ll usually have cataract surgery using local anaesthetic eye drops. Sometimes, you may have a small injection of local anaesthetic around your eye too. The anaesthetic numbs your eye so you won’t feel any pain from cataract surgery, and you’ll be awake during the procedure. Sometimes, you may be offered a sedative. This will make you drowsy and relaxed during the operation, so you’re not fully aware of what’s happening. Under certain circumstances, you may have a general anaesthetic, which means you’ll be asleep during the operation. But this is less common.

Cataract surgery procedure

Almost all cataract surgery in the UK is done using a technique called phacoemulsification (pronounced fa-co-emul-se-fa-cation). This involves using sound waves (ultrasound) to gently break down the cloudy lens and replace it with a new, artificial one. Cataract surgery usually takes about 20 to 45 minutes. But expect to be at the hospital for between four and six hours (longer if you need a general anaesthetic).

You’ll need to lie down and stay as still as possible during cataract surgery. Your surgeon will put some drops in your eye to widen your pupil and relax your eye muscles. They’ll also put local anaesthetic eye drops into your eye to numb it. Your eye may sting for a few seconds after the anaesthetic.

Your surgeon will place a clean sheet over your face, and just leave it open at the eye you’re having treatment on. They’ll use a small clip to hold your eyelid open so you don't need to worry about blinking.

Your surgeon will make a tiny cut on the surface of your eye. They’ll then insert the ultrasound probe and use it to gently break down your lens. Your surgeon will remove the broken lens from your eye and insert your new artificial lens. You’ll be awake and may see some movement and lights during the procedure, but you won’t be able to see anything in detail. You won’t feel any pain but you may feel some touch and pressure.

Your surgeon will usually leave your eye to heal naturally without using stitches. They may cover your eye with a dressing.

Recovery following cataract surgery

Most people recover quickly from cataract surgery and you may feel normal the day after your operation. But you may feel more tired and unsteady than usual for a few days. Your eye may look red and bruised at first and feel a bit itchy and gritty. This should start to improve after a couple of days. Lights and colours may seem unusually bright at first too. This should also settle down within a day or two. You should feel comfortable reading or watching TV the day after your surgery (although you may need reading glasses).

Within the first week of your operation, your eye should feel back to normal, and your vision should start to get better. But it may take a few weeks for your eye to heal completely. If you work, you can go back as soon as you feel ready, depending on what your job involves.

Looking after your eye

There are certain things you should avoid while your eye is healing, especially in the first week or so after surgery. These include:

• touching or rubbing your eye
• getting soap, shampoo, or dirty water in your eyes
• heavy lifting, bending and strenuous exercise, or contact sports like rugby (gentle exercise is fine)
• wearing eye make-up
• windy or dusty environments – wear an eye shield or glasses to protect your eyes if you’re going out in windy weather
• swimming (even with goggles)

Your surgeon will tell you exactly when you can get back to these activities.

Your vision after cataract surgery

Once your eye has healed, you’ll need to have an eye test. This will usually be with your optometrist, around four weeks after your operation. If you’ve had more complex surgery or developed complications, you may need to have several follow-up appointments at the hospital over the first days and weeks after surgery.

Cataract surgery usually works well and makes your vision less blurry. But you’re still likely to need glasses afterwards. The artificial lens that’s put in your eye will usually help you to see things further away more clearly. But you may need glasses to improve this even more. You’ll almost definitely need reading glasses too. If you have a multifocal lens, it can correct both your near and far vision, so that you won’t need to wear glasses.

Driving after cataracts surgery

Most people’s vision will meet the minimum UK driving requirements after cataract surgery. You’ll usually be able to drive within a few days of your cataract operation. But it may take longer. You should be fully recovered from your surgery and your sight should meet the DVLA standard. You may need to wait until you’ve been prescribed glasses at your post-surgery sight test. Contact the Driver and Vehicle Licensing Agency (DVLA) if you’re unsure.

Complications of cataract surgery

Complications are unexpected problems that may happen during or after the surgery. The chance of having serious complications after cataract surgery is low. Most people have a successful procedure and can see well afterwards.

Complications of cataract surgery are rare but include:

• a tear in your lens capsule
• problems with the position of the new lens in your eye
• an eye infection
• a detached retina (the thin lining at the back of your eye pulls away from the blood vessels that supply it)
• bleeding inside your eye (suprachoroidal haemorrhage) – this can happen during surgery
• macula oedema (fluid builds up in your retina) – this usually goes away on its own, but it can make your vision blurry
• dysphotopsias – these may be glares, starbursts and haloes or dark areas and shadows – they usually get better with time but occasionally may need treatment

Posterior capsule opacification (PCO) is common after cataract surgery. This is when your lens capsule, which holds the lens in place, becomes cloudy, similar to having a cataract again. It can happen weeks, months, or even years after your cataract surgery. You can have laser treatment to correct this, and the artificial lens won’t need to be replaced.

It’s important to be aware of any new or unexpected symptoms after your cataract surgery. For example:

• blurry vision
• other problems with your vision, such as flashing lights or floaters
• increased sensitivity to light
• redness
• severe pain

If you develop any of these symptoms, contact the hospital straightaway because they could be signs of complications. If you do develop a complication, the sooner you get treatment, the better.

Alternatives to cataract surgery

If you have a cataract, surgery to replace your cloudy lens with a new one is the only way to restore your vision. But you may not need or want to have surgery straightaway.

If your vision is only slightly affected or not affected at all, your surgeon may recommend putting off cataract surgery for a while. They may suggest you have an eye examination once a year instead. This will monitor both how your cataract develops and any changes in your vision. Your vision will become increasingly cloudy and eventually you may decide to have cataract surgery. Delaying surgery won’t make a difference to the results of your surgery.