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Cataract Removal

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Your specialist has recommended that the cataract affecting your eyesight is removed. This leaflet provides some information and advice about the procedure. However, you should always follow the instructions of your own specialist.

If you have any unanswered questions, please do not hesitate to ask your specialist or nurse for more information. Its natural to feel anxious, but often knowing what to expect can help.

This involves taking out the cloudy lens and replacing it with a clear, artificial implant.

The most common cataract operation is known as phacoemulsification. The procedure usually takes 15-20 minutes and is most often performed as a day case, without the need for an overnight stay.

Cataracts typically occur in both eyes, but they are usually treated one at a time, to allow the first eye to recover.

Cataract Removal

You will normally move from your room to the operating theatre on foot or in a wheelchair, depending on your fitness.

Anaesthetic

Your operation usually takes place under a local anaesthetic. This means you will not feel any pain during the procedure, but you will be awake.

In some cases, anaesthetic drops are applied to the outer part of the eye. This causes the eye to sting briefly. In others, an injection into the eye or the area around the eye is used. This will be a sharp sensation that passes quickly.

During the operation you will be asked to lie on the operating table with your head held in a fixed position. You will not be able to see out of the eye that is being treated, but you will be aware of a light.

A nurse will stay with you to provide reassurance and to ensure that you feel as relaxed and comfortable as possible.

During the operation, the surgeon works with very fine instruments while looking at the eye through a microscope. The procedure involves a tiny incision at the edge of the cornea. This incision is often so small that no stitches are required.

Preparing for your operation

Once at the hospital, you may be asked about your medical history and any previous experience of hospital treatment. Your answers will help them in planning your care whilst you are in hospital.

Before you come into hospital, you will be asked to have a bath or shower and remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape.

If you are having a local anaesthetic, there is no need to go without food and drink.

At the hospital

After your admission, a nurse will explain how you will be cared for during your treatment. Your surgeon may also visit you to explain the procedure in more detail. This is a good time to ask any outstanding questions about your treatment.

The nurse will help you get ready for theatre. This will include giving you some eye drops that dilate the pupil. These may temporarily affect your vision.

Consent

You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead. Many patients feel uncomfortable with the idea that a procedure may involve risks, but to make an informed choice, you need to know about the possible risks before you give consent.

Having a cataract removed commonly performed and generally safe operation. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.

These are the unwanted but mostly temporary effects of successful treatment. Examples of side-effects include an itchy or sticky eye and blurry vision for a few days after the operation. The eye may also ache, but this generally settles down within 10-14 days. Its also possible that the eyelid or eye will be bruised, but this will heal in the normal way.

This is when there are problems during or after the procedure. Most people are not affected. Possible complications of a cataract operation include tearing of the structure behind the lens. This may sometimes result in reduced vision. Its also possible for the cataract to be lost into the back of the eye, requiring a further operation.

The most common complication occurs when the lens casing, which is left in the eye to support the implant, becomes cloudy. This is called posterior capsular opacification and results in reduced vision similar to a cataract. The condition begins gradually, about two years after the operation. A relatively simple laser treatment can be used to correct it.

Your risk of complications will depend on your general health and on any other eye conditions that you may have. You should ask your surgeon to explain how these risks apply to you.

You will be taken back to your room or the day care ward where you can rest on a chair or bed. When you feel ready, you can drink and eat as normal and light refreshments will be provided. You should regain feeling in your eye within a few hours.

Once you are comfortable, you will be able to go home. You will need to be careful when moving around because its hard to judge distances with one eye covered.

Going home

It is preferable to have someone to take you home and stay with you for the first 24 hours, especially if its your only good eye that has been treated. On discharge, your nurse will give you some further information on caring for your eye and putting in the eye drops that your surgeon will prescribe for you.

It is important to continue using these as advised as they help to prevent infection and promote healing.

You will be given a 24-hour contact telephone number for the hospital and a follow-up appointment. Most surgeons see their patients again within week of the operation.

After you return home

Your surgeon will give advice that is specific to you. This may include how long to use eye drops and, if applicable, when you can resume driving.

In general, you should take it easy for the first two or three days after the operation. However, you will be able to perform your normal activities including moving around and bending down. Try not to touch or rub your eye.

As you must keep soap and shampoo out of your eyes, its sensible to avoid washing your hair for the first few days.

In the first few weeks after the operation, avoid heavy lifting as this can increase
the pressure in the eye and could put a strain on the healing scar.

If you suffer more than mild pain, or you experience loss of vision or increasing redness of the eye, you should contact the hospital for advice.

1. Can I drive if I have cataracts?

This depends on how advanced your cataract is, and whether just wearing glasses is enough to help with your vision.  

By law, your vision must meet set standards in order to hold a driving licence. These criteria are set by the Transport Department.  

The Transport Department requires you to be able to read a registration mark in good light, while wearing glasses or contact lenses if you use them, from 23 metres away. You shouldn't drive if you can't read from this distance. You may find that glare is a problem (for example, from oncoming vehicle headlights when driving at night), even if your vision is otherwise fine.  

If you're concerned whether your vision meets the Transport Department, book an eyesight test with your optometrist. If your eyesight isn't good enough to drive but you wish to keep driving, you will need cataract surgery. If the vision in your other eye is good, you can still meet the driving standards (although it can take time to adapt to driving with good vision in only one eye).

2. How quickly will I lose my sight?

This varies considerably from person to person.

Your vision will probably keep getting worse if you don't have your cataract removed. In most people, this happens slowly, over a matter of years. People often don't know they have cataracts because the changes are gradual. Occasionally, cataracts develop quickly. The speed at which your sight gets worse varies from person to person, and may be faster in one eye than the other.

The good news is that as long as your visual loss is only caused by the cataract, then even if you do reach a level where you have almost completely lost your sight, your vision can usually be restored with surgery.

3. Can my cataract come back if I have it removed?

No, a cataract can't come back once it has been removed.

Once you have had your cataract surgically removed, it won't come back again, although it's possible to get a cataract in your other eye.

However, it's not uncommon to develop a condition after surgery called posterior capsule opacification (PCO). This makes your vision cloudy, but it isn't the same as having a cataract. It's caused by a thickening of the natural lens casing - the part of your eye that holds your lens in place. This lens casing isn't usually removed during surgery but holds the new lens which replaces the cataract.

PCO generally develops within two years of having surgery, but can sometimes come on many years later. You will need a relatively minor procedure using a laser to correct your vision. The procedure (known as a capsulotomy) is quick and painless. Your pupil will be dilated with eye drops and anaesthetic drops will be given. You will be asked to sit with your chin rested on a machine and a special contact lens will be applied to the surface of the eye. The surgeon directs the laser with the aid of the contact lens to break the cloudy centre of the lens casing. Your vision will usually be restored straight away, although very occasionally you may get inflammation, which will require further treatment.

Further Information

Sources

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