Cataract Surgery

You have been referred for an assessment in clinic

Your optician or GP has referred you for a specialist opinion on whether you need cataract surgery. Please read this page carefully. It contains important information about cataract surgery that you need to know before your appointment with us.

Before we can add you to the waiting list for surgery, you will need to sign to confirm you have read and understood this leaflet. Please ask the surgeon or nurse you see in clinic if there is anything you are not sure about, or you would like further information on.

Before your clinic appointment

Before attending your assessment in clinic, please complete the enclosed health questionnaire and bring it with you on the day. You can have a family member or carer help you with this if you would like.

During the clinic assessment you will meet several people including a cataract surgeon. The aim of this assessment is to find out what problems you are having with your vision and to obtain measurements of your eye which help us to plan surgery. It is important that you do not drive to your appointment as you will need to have your pupils dilated with eye drops. These cause blurred vision for a few hours.

What if I normally wear contact lenses?

To ensure we get the most accurate measurements of your eyes when planning surgery, you must leave your contact lenses out before your appointment:

• soft lenses: leave them out for at least one week
• hard lenses: leave them out for at least four weeks.

What is a cataract?

A cataract is usually part of the ageing process, but it can be caused by other conditions including diabetes and trauma. The cataract usually causes blurred vision, but other symptoms include glare from bright lights (for example, car headlights) or seeing a double image.

What is the treatment?

The treatment for cataracts is surgery to remove the cloudy lens. This is done in an operating theatre with the help of an ultrasound machine. Although some parts of cataract surgery can be done with a laser, there is little evidence so far that this improves results and so it is not widely available on the NHS. This is not an urgent procedure and is usually carried out when the cataract is affecting the patient’s quality of life. You do not need to have surgery just because you have been told you have a cataract. There is always the option to leave things alone. You should only proceed when you feel your eyesight has become bad enough to justify having an operation. This may vary according to your lifestyle, occupation, or hobbies.

What happens during cataract surgery?

During surgery a small incision is made into the front of the eye through which the cloudy lens is removed. The capsule which contained the cloudy lens is left in place to support the artificial lens, which is then put into the eye through the small incision. Stitches are not usually needed as the incision is so small and seals itself. The operation usually takes around twenty minutes but may take longer. Most patients have this surgery under local anaesthetic. You will be awake, but the anaesthetic will numb your eye. You will not be able to see what is happening, but you will be aware of bright lights. You may also feel some movement and pressure, as well as cold water around the eye from time to time. You should not feel any pain, but you should tell your surgeon if you are in any discomfort.

During your operation, your face will be covered with a drape, so it is important that if you are claustrophobic, you tell someone before the day of surgery.

In some circumstances, sedation or a general anaesthetic is appropriate, and your doctor will discuss this with you if this is the case.

The implanted artificial lens

NHS cataract surgery aims to provide clearer vision, but you are likely to need glasses afterwards for some or all tasks. Your glasses prescription will change after cataract surgery but should usually be a less strong prescription than you needed before.

The artificial lens is a fixed focus lens, usually made of acrylic. This lens will normally last a lifetime. The focus of the lens will be chosen for your needs and your surgeon will discuss this with you. Although we take great care to measure the eye accurately and perform precise calculations based on these, we cannot guarantee a specific outcome in terms of what kind of glasses you will need after cataract surgery. You may still need distance and reading glasses after the procedure.

Variable focus lenses and toric lenses, which are specially shaped to correct astigmatism, are available privately. The benefit of these is to reduce your need to wear glasses. If this is something you might be interested in, you may choose to explore this in the private sector.

What are the benefits or risks of cataract surgery?

Removing the cataract improves colour vision and makes the vision clearer. Most cataract operations go smoothly and give excellent results. There are, however, some risks that you must be aware of when deciding whether or not to go ahead with the operation.

Some possible complications during the operation:

• a weakness in the capsule that holds your lens with disturbance of the gel inside the eye that may sometimes result in reduced vision
• loss of all or part of the cataract into the back of the eye. This would need a further operation which may require a general anaesthetic
• bleeding inside the eye
• inability to implant the artificial lens. This may require a second operation a few weeks later, during which time your vision will be very blurred.

Some possible complications after the operation:

• bruising of the eye or eye lids
• high pressure inside the eye
• clouding of the cornea
• swelling of the retina – macular oedema
• detached retina which can lead to loss of sight
• infection in the eye-endophthalmitis – which can lead to loss of sight or even loss of the eye (very rare)
• allergy to medication used.

While these problems may settle with further treatment or surgery, there is a chance they may not. Although very unusual, this may leave you with worse vision than you had before. The worst-case scenario involves losing all vision in the eye. In extremely rare cases, surgery on one eye can cause inflammation and loss of vision in the other eye.

The success of the operation will also depend on whether you have any other pre-existing eye conditions.

When there is no other eye disease present:

• 2:100 chance that your vision is no better
• 1:100 chance that your vision becomes worse
• 1:1000 chance of bleeding or infection causing loss of vision
• 1:100 posterior capsule rupture, which can increase the risk of retinal detachment.

How long will I need to stay in hospital for?

Most cataract operations are carried out as a day case, which means you will not have to stay in overnight. You will be in the hospital for up to six hours. If you have a general anaesthetic you may have to stay in hospital overnight, particularly if you live alone.

What happens on the day of surgery?

Eating on the day of surgery
Local anaesthetic
If you are having a local anaesthetic, you can eat and drink as normal on the day of your surgery.
General anaesthetic
If you are having a general anaesthetic, then you must follow these rules:

• Morning operation: You cannot eat after 2am but can drink water until 6am then nothing
• Afternoon operation: Have breakfast before 8am, drink water until 11am then nothing.

Please take your tablets as usual before you come into the hospital.

If you have any of the following problems on the day before the operation, then it is important that you call us:

• red eye
• discharge from the eye
• are unwell
• vomiting/diarrhoea
• cold/cough

When you come in please:

• Do not wear make-up or nail varnish
• Do not bring in any valuables including your watch, any jewellery – except wedding rings
• Do not bring large amounts of money, credit cards or mobile phones.

The Royal Bournemouth Hospital Eye Unit

Please report to the day ward which is located on the first floor of the Eye Day Surgery Unit.

Dorset County Hospital Eye Department

Please report to the Eye Day Unit by using East Wing Entrance 1. Take the lift to the second floor and turn left as you exit the lift to the ward. If a relative has brought you to the hospital we will take their phone number and contact them when you are ready to go home. Unfortunately it is not possible for relatives or carers to wait with you as there is limited space in the Eye Day Surgery Unit. However, they are welcome to wait in the Eye Outpatients Department.

When you arrive, a nurse will check your details, take your blood pressure, and instil some eye drops. You will not need to undress if you are having a local anaesthetic, so please wear comfortable clothing. Please bring a dressing gown and slippers if you are having a general anaesthetic.

When it is time for your operation, a nurse will accompany you to the anaesthetic room for your anaesthetic and to the theatre for your operation. The eye unit has its own dedicated theatres so you will stay within the unit for your operation. This whole process takes around 20-30 minutes. There will be a nurse available to hold your hand throughout the operation if this would help you.

After your operation, you will be taken back to the day ward where you will have your blood pressure re-checked and be offered light refreshments.

A nurse will explain to you how to look after your eye when you get home and will contact your relative or carer to pick you up. You will be in the unit for up to an hour after your operation. Neither of the eye wards are on the ground floor. Please use the lift and not the stairs when
leaving the hospital after your cataract surgery.

How do I look after my eye?

A protective covering will be put on your eye after your operation. You should wear this until the morning after the operation. You should then bathe the eye with the sterile swab provided and cooled boiled water. Start the eye drops provided by the hospital and use these exactly as directed. This is usually for four weeks but may vary depending on certain features of your eye or the surgery. Do not stop them unless directed.

Please speak to your GP for further supplies if you run out. If you are on drops for any other eye condition, please ask nurse for advice before leaving the day ward.

Please contact the eye unit if you have any queries or worries.

What should I expect after the operation?

It is normal to experience a scratchy, gritty sensation in the eye. Blurred vision on the first day after the operation is to be expected. If your vision gradually improves during the day and does not get worse, you do not need to worry.

Your eye may be a bit red and eyelids slightly swollen. After your operation your distance vision may improve without glasses, but it is often necessary to wear glasses to get the best result. At first your reading vision may be affected, and new reading glasses may be needed.

What if I experience problems?

Please call the hospital switchboard and ask to speak to your consultant’s secretary if, after surgery:

• your vision isn’t good or worsens
• your eye remains sensitive to the light
• your eye remains sore and/ or red or sticky for more than a few days

If your eye becomes very painful and painkillers are not relieving the pain, if you experience a shower of floaters and flashing lights, or if your eye is red and/or your vision worse or cloudy less than 10 days after surgery, please contact the eye emergency number:

• The Royal Bournemouth Hospital Eye Emergency Department: 0300 019 4181
• Dorset County Hospital Casualty Triage: 01305 255192

What can I do afterwards?

The most important thing is to not rub the eye and ensure you use your eye drops as instructed.

You can:

• resume normal daily activities such as bending down
• watch television and read straight away.

Most people return to work around a week after the operation. This may be longer if your job involves heavy manual duties or a dusty, dirty environment. Driving after your operation depends on your individual vision. Please ask the nurse for more information.

• avoid getting soap and water in the eye when hair washing and showering for two weeks
• do not wear eye make-up for two weeks after surgery
• avoid physical activities such as gardening, heavy lifting, golf, bowls, dancing and keep fit for two weeks after the operation
• do not go swimming until six weeks after surgery.

Will I need a check-up?

You will have a check-up approximately four weeks after your operation. This will either be at a specialist optician, or at the hospital. You will be given this information on the day of surgery before you leave. Occasionally patients may need to be seen the day after the operation.

About this leaflet

This leaflet has been developed by the Dorset eye units at Dorset County Hospital and Bournemouth Hospital. If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please contact the Patient Experience team.