A cataract is when the lens in your eye, which is normally clear, becomes cloudy with age affecting your eyesight. An operation is performed to remove a cataract if your vision becomes reduced to the extent that you are unable to carry out your usual daily activities.

During the operation to remove a cataract, your own cloudy lens is replaced by an artificial lens. This is called an intra-ocular lens implant. This stays inside the eye permanently and cannot be felt once in place.

At your pre-operative check nursing staff will ask for details about your general health, your home circumstances and about any medication you are taking. They will also explain the operation and the type of anaesthetic you will be given.

Some special measurements (biometry) will be carried out on your eye in preparation for your operation. You will also be taught how to put your own drops in or a relative or carer can be shown how to do this.

If you have any questions or worries about the operation, our nursing staff will be very happy to discuss these with you.

Most patients have their cataract operation under local anaesthetic. If you have your operation under local anaesthetic, you may see something during the surgery. 

Vision during the operation varies from not being able to see anything at all to seeing lights or colours, vague shapes or flashes of light. If you have a very light (topical) type of local anaesthetic you may see blurred images of the surgeon’s hand or instruments. Seeing these images during the operation is entirely normal.

Before your operation the nurse will put some drops into your eye. These are to widen (dilate) the pupil to ease the removal of the cataract.

A nurse will take you to the reception area in theatre. You will not be asked to change out of the clothes you are wearing. 

Relatives will be invited to wait for you in the waiting area of Ward 21.

A venflon (a fine plastic tube) will be put into a vein, usually in the back of your hand.

The operation usually takes about 30 minutes and you will need to lie on your back as flat as you can. A nurse is usually available to hold your hand should you wish.

In order to reduce the risk of infection, sterile towels will be placed over part of your face with a supply of fresh air circulating beneath them.

If you are having a local anaesthetic you will be awake during the operation, but the area around the eye will be made numb either with injections around the eyelid, or drops in the eye.

You will be able to hear people talking during the procedure. You may also be aware of a pressure sensation inside your eye during the operation. Some people can see shapes and colours while others find that their vision becomes very dim during the operation. All that it is required is that you keep your head still until the operation is over.

Most cataracts are removed by a technique called ‘phacoemulsification’ in which the surgeon makes a very small opening into the eye and removes the lens though a small tube. The thin outer layer of the lens (the lens capsule) is left behind and an artificial lens (lens implant) is inserted to replace the cataract. Sometimes a small stitch is put in the eye. At the end of the operation a pad or shield will be put on your eye to protect it.

The Royal Victoria Infirmary is an important training hospital. Some operations are performed in full or in part by surgeons in training who are supervised by an experienced surgeon. It is not possible to guarantee in advance which particular surgeon will carry out your operation, but it will be carried out under the direction of a consultant eye surgeon.

A nurse will examine your eye on the day of the operation before you leave the ward, or you may be asked to return to the Eye Outpatient Department within the next few days to see a doctor.

You will be given a clear plastic shield to wear over the eye during the night for two to three weeks. The nursing staff will give you a supply of eye drops with instructions on how often to put them in. They will also tell you the date of your next outpatient appointment.

Some people find the eye may become uncomfortable a few hours after surgery. If this happens you should take a mild painkiller such as paracetamol. Usually, however, the eye is comfortable by the following day, and after a week or so after your eye should feel almost normal, with no pain.

You will probably notice that everything seems much brighter but do not expect your eyesight to be clear at this stage.

It is important to wash and dry your hands before using the drops. Ideally the drug should be instilled by someone for you, but if you live alone the nurses will be happy to show you how to do this yourself or, teach a relative or friend.

You will be advised to take life easy following your operation but it is not necessary to restrict your activities. You can bend and wash your hair. It is advisable however not to swim or lift heavy weights for the first few weeks, and it is important that you take special care when putting on glasses to ensure that these do not accidentally catch eye. Never rub your eye.

If, after leaving hospital, you experience any of the following symptoms:

R - Redness
S - Sticky runny eye
V - Visual loss
P - Pain 
 
You should immediately phone the following numbers for further advice:
 
Ward 21 (7.30am - 8.00pm) - Telephone: 0191 282 5421
 
Ward 20  (24 hrs) - Telephone: 0191 282 5420
 
What Happens Next?
 
In most cases, you will be given a form to take to your optometrist (optician) for a glasses check 1 or 2 days before your next outpatient appointment. Please bring the form back to the clinic with you. We suggest that you do not buy your new glasses until you have been seen in the clinic. Your appointment will usually be 2 to 4 weeks after your operation.
 
The doctor there will tell you how your eye is progressing, advise you on what drops to use and also tell you when you can return to work if applicable. They will also advise you on changing your glasses.

How safe is cataract surgery?

Cataract surgery is a remarkably successful operation.  The vast majority of people achieve an excellent result but most will still need to wear glasses at least some of the time.

However, as in any surgery, there is always a risk of complications.  In cataract surgery, the risk is small and complications in most cases can be treated effectively. In some cases, further surgery may be needed. 

Overall, there is approximately a 1 in 400 risk of a complication that would permanently impair your vision and a 1 in 1000 risk of severe complication such as infection that could lead to blindness.

Some possible complications during the operation

• Tearing of the back part of the lens capsule which may require removal of some of the gel (vitreous) from the inside of the eye. This may sometimes result in reduced vision.
• Loss of all or part of the cataract into the back of the eye during the operation. This may require a further operation to remove the rest of the cataract.
• Bleeding inside the eye during the operation. This may result in reduced vision.

Some possible complications after the operation

• Bruising of the eye or eyelids  -  High pressure inside the eye which may need treatment with drops or tablets
• Haziness of the cornea (the clear front of the eye). This usually clears over several days or weeks.
• Unexpected long- or short- sightedness. In most cases this only requires a change of glasses. However, if there is a big difference in glasses prescription between your eyes it may be necessary to change the lens implant with another operation or to wear a contact lens.
• Swelling of the centre of the retina at the back of the eye (macular oedema). This is usually treated with extra drops or tablets but can result in reduced vision in some cases.
• Detached retina. This requires laser treatment or surgery and can lead to loss of sight
• Infection of the eye (endophthalmitis). This is a rare complication but can lead to loss of sight or even loss of the eye.
• Allergy to the medications used.  It is important that you have discussed the risks of surgery to your satisfaction before the operation.  The doctor who first sees you will generally discuss this but please ask the doctor or nurse if you have any further queries.

Will I need to wear glasses after cataract surgery?

Most people will need to wear glasses for reading, distance or both after cataract surgery.

Before the operation the nurses in the pre-assessment clinic will perform measurements of your eyes (biometry) to determine the strength (power) of lens implant to put into your eye.

The strength of the lens implant can be chosen to leave you either short-sighted (focused for near), long-sighted (focused for distance) or neutral (you would still need glasses for reading).

The surgeon will often choose the strength of lens implant to leave you with a similar glasses prescription in both eyes.

However, sometimes a surgeon may plan to make your eye much less long or short-sighted than it was before so that you do not need to wear such strong glasses. In this case, the glasses prescription will be different between your two eyes until you have cataract surgery on the other eye and they can be matched up. You surgeon would discuss this with you before the operation.

The biometry measurements are not accurate in all patients and some patients may have a more long or short sighted eye than predicted by the measurements. In most cases a pair of glasses will correct any small differences in a long or short-sightedness between your eyes.

You will be advised about your new glasses at one of your clinic visits after the operation. You may be able to get your new glasses as soon as 2-3 weeks after the operation, but in some cases it may be necessary to wait as long as 2-3 months, when you finally see how much your sight has been improved by your cataract operation.

Can a cataract come back again?

A cataract cannot form again after cataract surgery.  However, in some patients the back part of the lens capsule which has been left in place to support the implant can become cloudy.

This may come on gradually over months or years after the cataract operation and is called 'posterior capsule opacification.' You may also hear this called a 'secondary cataract'.

Your optician will advise you if you have posterior capsule opacification which is affecting your sight. If you wish, your own doctor can then refer you back to the hospital where the eye specialist will discuss whether treatment is necessary.
This is easily done in the outpatient department using a special laser, which makes a small opening in the cloudy lens capsule to clear the centre of your vision and improve your eyesight.

The staff on the Eye Unit hope that your stay will be a comfortable one and that your sight will be greatly improved by your cataract operation. If you have any complaints or suggestions as to how we can improve the service, please let one of the nursing or medical staff know.

The TYNESIGHT fund supports research and has enabled the purchase of some of the equipment currently in use in the operating theatre and in the Eye Outpatient Department. If you wish to make a donation please ask a member of staff for the TYNESIGHT leaflet available on the wards and in the Outpatient Department.