Cataract surgery – what you need to know

Cataracts are a common eyesight problem as we grow older. The treatment for cataracts is to have surgery to remove the part of the eye that has a cataract – the lens – and replace it with a new, artificial lens.

Cataract surgery is now the most commonly performed surgery in the UK. Around 400,000 operations are carried out in the UK each year, and they have a high success rate..

Your first step will probably be to make an appointment with your high street optician. If they see that you have, or are developing cataracts, thy will probably refer you on to an ophthalmologist (eye specialist). You would normally see them for an eye test every one or two years, or see your GP, to find out why your sight is becoming increasingly blurry.

Before your cataract operation

Your cataract surgery will be carried out by an ophthalmologist - a specialist in eye health and surgery. You’ll have a pre-operative assessment with them before the operation. This is so that they can examine your eye(s), and your vision.

They will also check the shape of the front of your eye, and the length of your eyeball. This helps them make important decisions about your operation, such as the right lens to use to when replacing your cloudy lens.

Your ophthalmologist will explain what will happen when you go into hospital for your operation.

Put simply, the surgery involves removing the cloudy lens, which has the cataract, and replacing it with an artificial lens.

It is understandable that you might feel a little nervous at the prospect of this operation. If you do, talk to your ophthalmologist and their team. They’ll be able to explain what happens during the surgery, and afterwards.

The operation normally takes about 40 minutes. You’ll be awake for the operation, unless there are particular reasons why you should have a general anaesthetic. Talk to your ophthalmologist about this during your pre-operative assessment.

Cataracts can develop in one eye, or both eyes at the same time. If both your eyes have cataracts your ophthalmologist will look at the results of the assessment to decide which eye needs to have a replacement lens first. This is usually the one that has least vision.

The day of the cataract operation

Make sure that you have arranged for a member of your family, or a friend, to drive you to and from your hospital appointment, and to stay while it is carried out.

Before you have the operation you’ll have drops in the eye that’s going to be operated on. This is to dilate your pupil, and is part of the normal process of the operation. You’ll also have a local anaesthetic – in the form of drops or an injection, or both – so that you don’t feel any pain.

The surgeon or one of their team will drape a sheet of fabric over your face, with an opening so that they can access your eye. This covering is to help keep this part of your face clean.

The surgeon or one of their team will drape a sheet of fabric over your face, with an opening so that they can access your eye. This covering is to help keep this part of your face clean.

To remove the lens that has the cataract, your ophthalmologist will need to make very small cuts through the outer layer of the lens – known as a lens capsule - so they can access the lens itself.

Using high frequency sound from an instrument designed for this purpose, the ophthalmologist can break up the lens and cataract and remove them. This is known as phacoemulsification. The whole procedure should be painless.

The artificial lens is then put into the lens capsule, and checked to make sure that it is in the right position.

Before you leave, your ophthalmologist will check that everything has gone smoothly, and cover your eye with a dressing and a plastic shield, which you will probably need to keep on overnight.

If you feel anxious at any time during the operation, let your ophthalmologist or one of the team know. They’ll be able to explain what is happening, and how far through the operation you are.

After the cataract operation

You may feel some discomfort after a while – especially once the anaesthetic wears off. Check with your ophthalmologist, but you should be able to take a simple painkiller, such as paracetamol. (Make sure that this doesn’t react with any other medication you’re taking.)

You’ll usually have to wait one to two hours before you go home.

Understanding drug interactions

Looking after yourself at home after a cataract operation

Your ophthalmologist will give you eye drops to stop infection in your eye, and to help it heal well. You will probably need to start taking these the day after your operation, once you can take your eye shield off, and use them for about four weeks. Make sure you follow the instructions for use.

If you live on your own, or with someone you take care of, it might be a good idea to ask a relative or friend to help you at home for the first few days after the surgery.

To give your eye the best chance of healing, try not to rub it for the first couple of weeks. You should also avoid contact sports, which might cause damage to your eye, swimming, lifting anything heavy, and putting on make-up.

Recovery can be different for everyone, but you’re likely to have some of these symptoms:

• grittiness
• mild pain in your eye
• blurred vision
• mild pain if you look at bright lights
• a slight headache
• fatigue

These are quite common symptoms, and shouldn’t last for long. If bright light makes the pain more uncomfortable, wear sunglasses or stay indoors with the curtains closed.

There are more serious symptoms that you mustn’t ignore. These include:

• Your eyesight suddenly becoming worse, or failing in the eye that has been treated
• very bad or throbbing pain in the treated eye
• very bad headache at the front of your head,  which may also come with feelings of nausea, and throwing up.

If you have any of these serious symptoms, see a doctor, or call the hospital department where you had the operation, as soon as possible.

New glasses after your cataract operation

In some cases it may be possible that the new lens you’re given during this surgery will give you good distance vision without the need for glasses. This isn’t always possible and in this case you’ll need a pair of distance glasses.

Most people also need reading glasses after a cataract operation, and these will usually be a different prescription to the ones they had before.

There are multi-focal lenses available that can give you good close up and distance eyesight. However in most cases you will have to pay to have these lenses as they aren’t usually available through the NHS.

You’re likely to need new glasses after having cataract surgery. If you have cataracts in both eyes this will mean waiting until you’ve had surgery on both eyes before getting new glasses. This can mean you have to wait for up to three months before you can have new glasses. This is because you’ll have to wait for the second operation to be done, and for the sight in that eye to adjust to the new lens. Talk to your optician and/or ophthalmologist about this before buying new glasses.

What are the replacement lenses made out of?

Various substances have been used over the years to replace the eye’s natural lens, when it has been affected by cataract. Typically these are now made from acrylic or silicone, and the kind to receive will depend on your pre-surgery assessment.

In 1949, Perspex was used for the first replacement lens. This was chosen because ophthalmologists treating eye injuries in wartime RAF pilots, who often had fragments of shattered windscreens in their eyes, noticed that the eye did not react against this substance.

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