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Cataract surgery

Published by Bupa's health information team, November 2008.

This factsheet is for people who are considering having cataract surgery, or who would like information about it.

Cataract surgery involves the lens of your eye being broken down into tiny pieces which are removed through a small cut in your eye. The lens is replaced with an artificial one.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

Animation - How cataract surgery is carried out
About cataract surgery
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from cataract surgery
What are the risks?
Further information
Questions and answers
Related topics
Sources

How cataract surgery is carried out

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About cataract surgery

A cataract is a painless clouding of the lens inside your eye that develops over a long period of time. Surgical removal of your cataract is the most effective way to restore or maintain your vision.

Cataracts are usually removed using a technique called phacoemulsification. However, in certain circumstances it may be necessary to use an alternative technique.

What are the alternatives?

So far, no medication or diet has been found to slow down the growth of cataracts and there is no medication that can clear a clouded lens.

Left untreated, the lens will eventually become so clouded that it's impossible to see any detail at all, although you will always be able to see some light.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. He or she will also discuss your options for the type of artificial lens replacement you will have fitted.

Phacoemulsification is usually done as a day case under local anaesthesia, which can be given as drops into your eye or an injection into the tissue around your eye. This completely blocks the feeling from the area and you will stay awake during the operation. A sedative is sometimes given with a local anaesthetic to help you relax. Less commonly, the operation is done under a general anaesthetic. This means you will be asleep during the operation.

Your surgeon will place drops in your eye to widen (dilate) your pupil, making it easier to see the lens inside your eye. You won't be able to see out of your eye as it's being treated, but you may be aware of light and movement.

At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

The operation usually lasts around 15 to 20 minutes.

During the operation, you will lie in a special chair. The surgeon will work with very fine instruments while looking at your eye through a microscope.

Once the anaesthetic has taken effect, your surgeon will make a tiny cut on the surface of your eye.

Your surgeon will use ultrasound energy to break up the cloudy lens (cataract), which is then removed through a small tube.

The lens sits inside a sac of thin tissue called a capsule. This is kept in place to support an artificial replacement lens (intraocular lens), which will be inserted through the same cut after the cataract is removed. It's folded to help insert it through the cut.

The intraocular lens will unfold once it's in your eye. The lens is made from plastic or silicone and remains permanently in your eye. The most common type of lens is a monofocal lens (a lens that can only focus at one distance) but other lenses are available that can focus at more than one distance. Your surgeon will discuss which is the best option for you.

What to expect afterwards

After surgery you will be given anti-inflammatory eye drops and antibiotics to ensure that your eye doesn't get infected.

You will be able to go home when you feel ready.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

After the operation, your eye is likely to be covered with a protective pad. You will need to wear this for a few hours.

Your nurse will give you some advice about caring for your eye before you go home. You may be given a date for a follow-up appointment.

It may be helpful to wear sunglasses or a hat when you leave the hospital as your eye may be sensitive to light.

Recovering from cataract surgery

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Don't take aspirin as this can cause bleeding. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Take it easy for the first two or three days after the operation. If you have questions about what you can and can't do, ask your surgeon or nurse for guidance.

You can resume normal activities such as moving around and bending down, but be careful because it's hard to judge distances with one eye covered.

There are some important things to remember while recovering from cataract surgery.

Don't touch or rub your eye.
Keep soap and shampoo out of your eyes (it's sensible not to wash your hair for the first few days).
In the first few weeks after the operation, don't lift anything heavy or exercise strenuously as this can increase the pressure in your eye and could put strain on your healing scar.
If you suffer more than mild pain, or have loss of vision or increasing redness of your eye, you should contact your hospital for advice.

Sensation usually returns to the eye within a few hours. Vision normally improves within a few days. Healing normally takes two to six weeks, although complete healing may take several months. Once your eye has healed, you will be able to have your eyes tested again and have new glasses prescribed.

What are the risks?

Cataract surgery is commonly performed and generally safe. For most people, the benefits in terms of improved vision are greater than any disadvantages. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary, effects of a successful treatment. Following cataract surgery, you may have:

an itchy or sticky eye and blurred vision for a few days after the operation
aching of the eye, which usually settles down within a few days
bruising of the eyelid or eye, which will heal normally

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of cataract surgery are rare but can include the following.

The capsule that is left in your eye to support the artificial lens may thicken and become cloudy. This results in reduced vision similar to a cataract that can be corrected with laser treatment.
Your capsule may tear, which can result in reduced vision.
A part of your lens with the cataract may move into the back of the eye, requiring another operation to remove it.
You may have bleeding inside your eye.
The implant may move, requiring a further operation.
Your retina (the light-sensitive lining at the back of your eye) may be damaged during the operation, which could make you blind in that eye, but this is rare.
You may experience disturbances in your vision such as halos, flare and glare.

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

Royal College of Ophthalmologists
www.rcophth.ac.uk
Royal National Institute of the Blind
0845 766 9999
www.rnib.org.uk
The Eyecare Trust
0845 129 5001
www.eye-care.org.uk