What is a cataract?

 

​A cataract (Greek, meaning waterfall) is a cloudiness or opacity of the lens inside your eye. 

 

When we are young, the lens is clear, and can change shape so we can see up close and far away.

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​As we age, the protein structure in the lens changes, so that the lens becomes stiff and then cloudy (like an egg white when it is cooked). In the early stages, we have trouble seeing up close, so that we need reading glasses. As the process progresses, we can experience glare in bright lights or while driving at night, with trouble reading in dim light.

 

In the early stages of cataract, glasses may help for reading, and then for distance. As the cataract becomes cloudier, you may reach the stage where you cannot see as well as you would like, even with glasses. This is when we start considering cataract surgery as an option.

 

​What is cataract surgery?

 

​As the cloudy lens or cataract is inside the eye, surgery involves making cuts in the eye, removing the cloudy lens, and replacing it with a clear plastic lens, so that the eye can see clearly again.

 

When do I need cataract surgery?

 

​You almost never need cataract surgery. The cataract is just a change in the structure of your lens. It cannot harm your eye, except in very rare cases. The only time you need surgery is if your vision has dropped to the point where you can no longer legally drive, but even then, you can choose to stop driving, if you really don’t want surgery. The benefits of the surgery are great though, so you may well want it way before then!

 

Will I be able to see without glasses?

 

​The standard lens power is usually selected so that your eye is in focus for distance. You will usually still need reading glasses to see fine print up close, and may need glasses to fine tune your distance vision. There is no perfect lens and whatever we choose, you may still be unhappy with some aspect of your vision, particularly if you have other eye conditions.

 

There are three ways to see near and far without glasses using intraocular lens implants:

 

• Monovision, in which one lens is in focus for distance, and the other lens is in focus for near. This means that only one eye is in clear focus at any point in time and most people prefer to have their two eyes working together.

• Multifocal lens implants are also available. These offer clearer vision at all distance, but it may not be as clear as with the single vision lenses. They are more expensive and while many people are happy with them, they can cause problems with blurred or distorted vision, glare, haloes and trouble driving at night (like cataracts can!).

• Spiral Galaxy lenses. These do not have the disadvantages of multifocal lenses in terms of glare and haloes, and they give you clearer vision in the distance, with clear near vision as well. You may still need magnifying glasses to see very fine print and there may be an adjustment period before you can see clearly with these lenses.

 

What are the risks and benefits of cataract surgery?

 

 Before deciding whether to have cataract surgery, you will need to discuss with your doctor all the risks and benefits involved, to find out what is the right decision for you.

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•  Benefits of the surgery include clearer, brighter vision and the ability to see in the distance without glasses. If you needed glasses to see before the operation, this can be a very happy experience.

• The risks of the surgery are small, and the surgery is successful in over 95% of cases, but not 100%. The risks of severe problems are very small, but they do include haemorrhage and infection, potentially with loss of vision and even loss of the eye, so it is important to understand that surgery should only be considered if you are unhappy with your vision, even with the use of glasses. There are risks of less serious problems, even if the surgery itself goes perfectly. 

• This is why we don’t operate on both eyes on the same day... just in case there are any problems.

 

What happens on the day of cataract surgery?

 

​The operation is microsurgery, performed as a day case procedure in hospital, under local anaesthetic with sedation (twilight anaesthesia). We do it this way so that a team of people can care for the whole of you, while doctor focusses her full attention on you and your operation.

 

The operation only takes minutes, but the whole process takes hours. Drops are put in your eyes beforehand to dilate the pupil, and we like to make sure you are settled before the operation and recovered afterwards before we let you go home. The anaesthetic can affect your vision for several hours afterwards, which is why you need assistance.

 

It is illegal to drive for 24 hours after any anaesthetic. You will need someone to drive you to the hospital and back home again, to care for you at home afterwards, and drive you to see doctor in the rooms the next day.

 

What can I do after cataract surgery?

 

​There is little to no pain afterwards, and you can usually see clearly by the next day, but it is important to take at least a week off work and to care for yourself tenderly in the weeks after the surgery, to allow the eye (and you) to rest and heal. You can read, watch TV, go for gentle walks and move around the house, but no heavy lifting, bending, gardening, straining or swimming for 2-4 weeks, depending on what it is you want to do. Please ask doctor before doing anything extreme!

 

Doctor sees you again the next day, then a week later and again at the end of a month, and you are to use eye drops this whole time.

If you have a cataract in the other eye (which you usually do), we can operate the second eye one week after the first one. We particularly advise this if you used to wear strong glasses, as the two eyes will be out of balance and may affect your balance too.

If you used to wear strong glasses, these will need to be changed, but we wait a month for the eye to heal completely before doing the final glasses test.

 

Cataract surgery is the safest, most effective and most commonly performed operation of all. It is generally great, but it is important that we attend to all the details together to make sure you have the best possible outcome for you.

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