Q: How safe is cataract surgery?
Modern cataract surgery is the most commonly performed type of surgery in the UK. Like all types of surgery, despite every effort, complications can rarely occur. The risk of complications is significantly lower when your surgery is performed by an experienced surgeon. In the rare event that a complication does occur the long term effects of the complication can be minimised by appropriate management by an experienced surgeon. The risk of complications are as follows:
1 in 1000 (0.001%) risk of a serious complication such as an infection within the eye (which can occur a few days after the surgery) or bleeding within the eye (which can occur at the time of surgery).
1 in 100 (1%) patients may require a second operation on the same eye. This may be to re-position or insert an intraocular lens. Occasionally the lens can't be placed in the eye at the time of initial surgery and requires a second operation to do so.
1 in 20 (5%) patients may need distance glasses for driving.
1 in 10 (10%) patients can develop a membrane over the new intraocular lens. This is called posterior capsular opacification. This can result in vision becoming blurry again. If this does occur it can be treated by a simple outpatient laser procedure called a YAG laser capsulotomy.
Q. Is it better to have cataract surgery early
The best time to have surgery is when the cataract is causing symptoms or your vision restricts your day to day lifestyle. More energy is required to remove a very advanced cataract and some very advanced cases may not be amenable to small incision surgery, requiring a larger incision and stitches. Having said that most patients in the UK have moderate cataracts and can have small incision cataract surgery.
it is better to have early cataract surgery in cases of Fuch's dystrophy and angle closure glaucoma.
Q: How long does the surgery take?
Modern cataract surgery is performed as day case surgery and takes 20-25 minutes per eye.
Q: Will I feel or see anything during the surgery?
You will be given a local anaesthetic before your surgery to numb the surface of the eye. Mr Angunawela usually operates using anaesthetic drops. Injections are generally not required. The anaesthetist may also give you some sedation through a small needle in your arm. This is great if you are feeling anxious or worried as it will relax you during the surgery.
During the surgery you will be staring at a bright light and you will not be able to see any instruments near your eye. You may see shadows and some people describe rainbow like coloured lights. None of these are scary. Mr Angunawela will talk to you throughout the surgery to put you at ease.
Q: Will my eye hurt after surgery?
Your eye may feel a little sore after surgery. Patients often feel like they have an eyelash or grain of sand under their lid for a couple of days after surgery. Some patients feel no discomfort at all. Cataract surgery is not a painful operation and most patients will not experience any major discomfort.
Q: What will my eye feel like after cataract surgery?
Severe pain after cataract surgery is rare. Most patients will minor discomfort. Some patients experience this as a tight feeling or an itchy feeling. Some feel like there is a eyelash in the eye. Your eyes may be sensitive to bright light as the pupil which is dilated at the time of surgery may take a day or two to return to normal function. Most of these symptoms settle within a few days.
Q: What will my eye look like after surgery?
It is not unusual for the eye to be slightly red after surgery. You may notice little red areas next to the coloured parts of the eye after the surgery. If you take medications to thin the blood such as aspirin and warfarin, bruising is more common after surgery. This does not in any way affect the success of the operation.
Q: Do I need to wear a dressing over my eye?
Typically you'll have a clear plastic shield placed over your eye after the surgery. You will be able to see through this. You can take the shield off the day after the operation but you need to wear it at night only for 7-10 days after surgery to prevent you touching or pressing your eyes whilst you sleep
Q: How soon will I be able to see after the operations?
You'll be able to see immediately after surgery if you have had drop anaesthesia but your vision will be a little hazy. If you had an injection anaesthetic vision will return the next day. Vision will continue to improve over the next 48-72 hours
Q: What will my vision be like in the week between the first and second eyes being operated on
If you have a high prescription you may feel a little off balance after the first eye is operated on. One thing you can do is to remove your glasses lens on the side of the operated eye and only have a lens on the un-operated side. Alternatively you may be able to manage without any glasses at all. If you are having a multifocal lens you will not enjoy the full benefit of the lens till the second eye is done. The week usually passes quickly and most patients manage without too much of a problem.
Q: What drops will I need to use after surgery?
You'll need to use 2 types of drops after surgery. An antibiotic drop which you'll use 4 times a day for 2 weeks, and a steroid drop, the frequency of which will vary dependent on race. Diabetic patients may be given additional drops.
Occasionally your drops may need to continue for longer.
Q: When can I go back to work after surgery?
You should be able to return to work within 1-2 weeks after surgery. If you work from home and simply use a computer you can resume work as soon as you feel comfortable to do so.
Q: When can I resume normal activities?
You can resume normal activities with some restriction within a few days of surgery. You can read and watch TV as soon as you feel comfortable to do so. You can bath and wash your hair as soon as you like as long as you do not get any water splashed into the operated eye.
You can resume gentle exercise and stretching 2-3 days after surgery if you wish. You can lift and bend after surgery. You can resume cooking day or two after surgery. You can return to yoga and aerobic exercise a week or so after surgery if you wish to. You should avoid headstands, heavy lifting and swimming for 2 weeks after surgery.
You can drive as soon as you feel comfortable and can read a number plate at 20.5 meters . You are ok to fly within 24 hours of your surgery if you need to.
Q: When can I shower normally after cataract surgery?
You can resume normal showering a week after cataract surgery. If water goes into the eye at this stage there is no need to panic. Avoid eye rubbing even at this stage and until your eye surgeon has seen you.
Q: When can I wash my face after cataract surgery?
The same rules as per showering apply, You can wash your face normally 1 week after cataract surgery. Avoid eye rubbing. Be gentle.
Q: When can I cook after cataract surgery?
You can return to cooking a day or two after cataract surgery. Always wash your hands before you touch your eyes or the area surrounding the eye in the week after cataract surgery.
Q: When can I wear eye makeup after cataract surgery?
Mascara and makeup around the eyes should be avoided for a 10 days after cataract surgery. It may be advisable use disposable mascara brushes or even start with a new bottle of mascara to avoid risk of infection.
Q: When can I have sex after cataract surgery?
You can resume sex 2-3 days after surgery. Hygiene is important and you should not touch or rub your eyes for the first week or so after surgery.
Q: How is the correct lens chosen for my eye?
The correct choice of lens for your eye is determined by a number of measurements made before the time of surgery. These pain free measurements are called biometry and will be performed by Dr Marie Restori, a medical physicist that specialises in imaging of the eye.
The biometry is entered into formulae that predict the lens power required for the prescription of your eye. These formulae vary depending on the type of lens that is implanted (mono or multifocal) and whether you've had previous laser eye surgery.
Q: How accurate is the lens prediction?
90% of patients have driving standard vision after cataract surgery. Measurements are now more accurate than ever and use a technology called laser interferometry to perform biometry. With this technology 60% of patients are within +/- 0.5 dioptres of their intended post operative prescription and 90% within +/- 1 dioptre.
The prediction accuracy of lens formulae follow a normal distribution (a bell curve) and within these constraints refractive surprises can occur in a small number of patients.
Q: What happens if my glasses prescription after surgery is very different to what was aimed for?
If you have a true refractive surprise greater than 1 dioptre from the target refraction aimed for at the time of surgery, there are several options available. The simplest, if you don't mind wearing glasses, is to see the optician for a new pair of spectacles. You won't have a cataract any longer and should get very clear vision with a new spectacle prescription.
Alternatively, if your post operative prescription is very different to what was aimed for you can have either a lens exchange (the intraocular lens is removed and replaced with a new one) or laser eye surgery performed to correct any residual refractive error.
Consulting a surgeon such as Mr Angunawela or Ms de Benito who perform laser eye surgery as well as cataract surgery has the added benefit of having the option of laser eye surgery in case it is needed. Most cataract surgeons will not be able to offer this option.
Q: What should I do if I want to guarantee that I won't need distance glasses after cataract surgery?
95% of patients have driving standard vision or better after cataract surgery (6/12) and there is a very high chance that you will be independent of glasses for distance vision for the majority of time. If you really hate wearing glasses the best option is to consider Bioptics.
Bioptics is the combination of laser eye surgery with cataract surgery. The laser eye surgery is performed a month or so after the cataract surgery and the laser is used to correct any residual spectacle correction.
Speak to your surgeon about Bioptics.
Q: What will my vision be like with a multifocal lens?
Multifocal lenses are designed to give you as much independence from glasses as possible. The lens works by splitting the light that enters the eye and passes through the lens into images for distance, intermediate and near vision. For most patients this means that they don't need to wear glasses for the majority of time. There may be some occasions when you do need to pop on a pair of glasses, for instance when reading in a dim environment or when driving at night. Depending on the type of lens that you have, you will be able to read at intermediate or near distances or both. You do not need to tilt your head as you would with a pair of reading glasses. Your brain goes through a period of adjustment to this new type of vision called neural adaptation.
Q: Do multifocal lenses cause any problems
Multifocal lenses are well tolerated which is why they have been such a huge success.
These lenses work by splitting the light that enters the eye and passes through the lens into images for distance, intermediate and near vision. Symptoms that occur in some patients with these lenses include haloes or star bursts around bright light sources such as headlights at night, difficulty reading in dim light situations and reduction in contrast sensitivity. These symptoms are rarely severe and very few patients request removal of the lens after insertion.
In the rare occasion where symptoms are difficult to tolerate the lens can be removed and replaced with a standard monofocal lens. The chance of needing lens exchange due to multifocal lens intolerance is roughly 1 in 200 or 0.5%.
A multifocal lens is an optical device like a glasses lens, and even if you do not tolerate the lens well and need to have it removed the lens does not cause any damage to your eye or loss of vision.
Q: Does cataract surgery get rid of floaters?
Cataract surgery does not get rid of floaters. Vitreous floaters are a common problem which you may experience as a blob or dark spot thats drifts across your vision. Floaters generally increase with age and are more common in shortsighted patients. These blobs are stuck in the back of the eye and are not removed during cataract surgery. Floaters may become more obvious immediately after cataract surgery as more light floods into the eye but this generally diminishes after some time.
Q: What is the risk of retinal detachment after cataract surgery?
Intraocular surgery increases the risk of retinal detachment compared to un-operated eyes. The estimate of retinal detachment over a 10 year period after surgery is roughly 0.3% based on large population studies. This may be slightly higher (2-3%) in very highly shortsighted eyes. The rate of retinal detachment in the general population is estimated at 0.1%. Cataract surgery in younger patients (below the age of 50) is also associated with an increased risk of retinal tears or detachments in the 10 years after surgery. Intra-operative complications such as a tear in the capsule of the natural lens can also increase risk.