Traditionally, cataract surgery has been performed when the patient starts to experience vision loss. However, we now also take into account subtle changes to vision, such as loss of contrast sensitivity and loss of colour perception. You may notice that colours are faded and dull, and also that you have trouble seeing in low-contrast situations (e.g. at night). These are early signs that the cataract is having an effect on your vision and you may want to consider surgical removal.
That was the case in the past when cataracts had to be removed in one piece. Now, we use ultrasound and laser technology to break the cataract into smaller pieces for removal – this means it is better that the lens is softer (i.e. immature) to aid the fragmentation process. In fact, the length of the patient’s surgery and recovery are both shorter if the cataract is immature when operated on.
Cataract surgery is not at all painful. Most patients describe a mild sensation of pressure around the eye. In some cases, we may use local anaesthesia (administered via eye drops) or perform a small anaesthetic block around the eye. I have previously published a scientific paper investigating the levels of pain and light sensitivity during cataract surgery, and the majority of patients did not find the operation particularly painful or distressing.
We also have the option to offer patients a general anaesthetic if they prefer to be asleep during the procedure or if there are other medical issues that need to be taken into account (e.g. patients with tremors who cannot lie flat for ten minutes).
Most patients can drive within 48 hours after the operation – the general advice is that they can start driving when they feel comfortable doing so. It is a good idea to avoid driving long distances in the first week, as the eye will feel strained after the surgery. I also recommend wearing sunglasses to minimise the effect of sensitivity to bright lights and sunlight.
Most patients can resume normal house work within a day or so – it is really up to the individual. I recommend avoiding heavy lifting and vigorous household duties for the first week.
As a general rule, it is best to avoid swimming for the first month after surgery to reduce the risk of infection. The problem is that pools are often full of viruses and germs that can infect the eye in the immediate post-operative period. Heavy gym workouts are also generally not recommended for the first week. There is no issue with gentle treadmill use or walking.
The results are almost immediate in most cases. However, not all patients and cataracts are the same so some patients may take longer than others to recover. Other medical conditions (e.g. diabetes) can also affect the healing response following surgery. Vision will generally stabilise within one month after surgery for most patients.
There are a number of options available to correct presbyopia during cataract surgery. We now have multifocal intraocular lenses (IOLs) that give us the option to correct distance and near vision, while the latest lenses (trifocal IOLs) correct vision at far, intermediate and near distances. Trifocal IOLs are the lens of choice if your goal is to be as independent from glasses as possible – indeed, many patients can get rid of their glasses completely with trifocal IOLs.
Alternatively, monovision lenses can allow one eye to be set for distance vision and the other for near vision (known as blended monovision), or you can have both eyes set for distance vision and still use a pair of reading glasses. It all depends on your specific needs and the state of your eyes. It’s important that you understand the advantages and disadvantages of each option prior to the surgery taking place.
We now have the ability to correct/reduce astigmatism at the time of cataract surgery. This involves using a special intraocular lens called a toric lens. The severity of pre-operative astigmatism will determine whether we can correct it completely.
Once infected, the herpes virus becomes resident in the eye and can reactivate following cataract surgery. This means that you will require post-operative antiviral medication to prevent any virus-related complications. The medication is usually taken for a period of four weeks after the operation.
There is no issue provided your glaucoma is under control prior to the surgery. We now offer patients the option of inserting a micro-stent (iStent inject) at the time of cataract surgery to improve fluid drainage from the eye. The iStent can reduce the amount of glaucoma medication required – in many cases, patients can stop eye drops completely.
Patients with keratoconus do very well after cataract surgery. In fact, many find that they can actually get rid of their contact lenses altogether. One of the features of keratoconus is astigmatism and this can also be addressed at the time of the operation (see question 9 above).
A cataract operation is a once-off procedure in the sense that the cataracts themselves do not return. However, sometimes a thin membrane develops behind the lens implant – this can be removed with a quick and painless laser procedure in the clinic (YAG laser capsulotomy).
Patients who have had corneal transplants can have their cataracts removed quite safely. However, they do need to be aware that there is a small risk of developing a rejection of the graft following cataract surgery – this can be treated with steroid drops. There is also a small risk that the cornea may be damaged and that a second graft will be required.
Modern cataract surgery does not routinely require stitches, as it is a keyhole procedure and the main incision is about 2 mm in length (i.e. tiny). The intraocular lens is inserted via a thin cartridge and is designed to unfold once it has been placed inside the eye. Some cases of complicated cataract surgery may require one or two small stitches. These are removed a few weeks post-operatively, when the tissue has healed.
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Any surgical or invasive procedure carries risks. You should have a comprehensive discussion with your ophthalmologist before making a decision to proceed