Cataract Surgery

Consent for cataract surgery - information for patients

• This leaflet gives you information that will help you decide whether to have cataract surgery. You might want to discuss it with a relative or carer. Before you have the operation, you will be asked to sign a consent form and so it is important that you understand the leaflet before you decide to have surgery. If you have any questions, you may wish to write them down so that you can ask one of the hospital staff.

The cataract

• Your eye surgeon has recommended cataract surgery because the lens in your eye has become cloudy making it difficult for you to see well enough to carry out your usual daily activities. If the cataract is not removed, your vision may stay the same, or it may get worse. Waiting for a longer period of time may not make the operation more difficult, unless your eyesight becomes so poor that all you can see is light and dark.

The operation

• The purpose of the operation is to replace the cloudy lens (cataract) with a plastic lens (implant) inside your eye. An experienced eye surgeon will carry out the operation or may supervise a doctor in training who also performs some operations. With a local anesthetic you will be awake during the operation. You will not be able to see what is happening, but you will be aware of a bright light. Just before the operation, you will be given eye drops to enlarge the pupil. After this, you will be given an anesthetic to numb the eye. This may consist simply of eye drops or injecting local anesthetic solution into the tissue surrounding the eye. During the operation you will be asked to keep your head still, and lie as flat as possible. The operation normally takes 1520 minutes, but may take up to 45 minutes. A nurse will hold your hand the whole time to make sure that you are all right. Most cataracts are removed by a technique called phacoemulsification. The surgeon makes a very small cut in the eye, softens the lens with sound waves and removes it through a small tube. The back layer of the lens is left behind. An artificial lens (implant) is then inserted to replace the cataract. Sometimes a small stitch is put in the eye. At the end of the operation, a pad or shield may be put over your eye to protect it.

After the operation

• If you have discomfort, we suggest that you take a pain reliever such as Paracetamol every 46 hours (but not aspirin - this can cause bleeding). It is normal to feel itching, sticky eyelids and mild discomfort for a while after cataract surgery. Some fluid discharge is common. After 12 days even mild discomfort should disappear. In most cases, healing will take about two to six weeks after which new glasses can be prescribed by your optician. You will be given eye drops to reduce inflammation. The hospital staff will explain how and when to use them. Please dont rub your eye.
• Certain symptoms could mean that you need prompt treatment. Please contact the hospital immediately if you have any of the following symptoms:
• • Excessive pain
  • Loss of vision
  • Increasing redness of the eye

Likelihood of better vision

• After the operation you may read or watch TV almost straight away, but your vision may be blurred. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. The vast majority of patients have improved eyesight following cataract surgery Please note that if you have another condition such as diabetes, glaucoma or agerelated macular degeneration your quality of vision may still be limited even after successful surgery.

Benefits and risks of cataract surgery

• The most obvious benefits are greater clarity of vision and improved colour vision. Because lens implants are selected to compensate for existing focusing problems, most people find that their eyesight improves considerably after surgery but will need to replace their glasses. However, you should be aware that there is a small risk of complications, either during or after the operation.

Some possible complications during the operation

• Tearing of the back part of the lens capsule 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 requiring a further operation which may require a general anaesthetic
• Bleeding inside the eye

Some possible complications after the operation

• Bruising of the eye or eyelids
• High pressure inside the eye
• Clouding of the cornea
• Incorrect strength or dislocation of the implant
• 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 the eye
• Allergy to the medication used

Complications are rare and in most cases can be treated effectively. In a small proportion of cases, further surgery may be needed. Very rarely some complications can result in blindness.

The most common complication is called posterior capsular opacification . It may come on gradually after months or years. When this happens, the back part of the lens capsule, which was left in the eye to support the implant, becomes cloudy. This prevents light from reaching the retina. To treat this, the eye specialist uses a laser beam to make a small opening in the cloudy membrane in order to improve the eyesight. This is a painless outpatients procedure which normally takes only a few minutes. We hope this information is sufficient to help you decide whether to go ahead with surgery.

Please use the space below to write down any further questions to ask the doctor or nurse when you come to the hospital for your appointment. Dont worry about asking questions. Our staff will be happy to answer them.