Seeing eye to eye with cataract surgery

Cataracts are a condition that affects the eyes, where the lens, which sits behind the cornea and allows our eyes to focus, gradually gets cloudier as the proteins in the lens break down. They are a normal, expected side effect of getting older. It’s a condition that has a slow, steady onset and affects many older people from 40 years and upwards, and while rare, it can happen to younger people and even babies. The cataract can cause vision to become indistinct and blurry, shortsightedness, and difficulties with colour perception. In this article, experienced consultant ophthalmologist Mr Sumith Perera opens our eyes to the wonders of cataract surgery.

Cataract cases can be mild and may not impede too much on everyday life. Although not dangerous for health, it can be visually impairing to the point that it can affect the quality of life. Leisure activities like reading or watching a film are disrupted, and it may no longer be safe to drive. For some patients, their vision can deteriorate completely to the point of legal blindness. At that point, many patients may consider cataract surgery, which is the only treatment option available to permanently address cataracts. Around 400,000 people in the UK undergo cataract surgery every year, with 95 per cent of procedures having positive results of improved vision without complications.

What happens during cataract surgery?

Cataract surgery is a short procedure that on average takes 30 minutes and the patient can go home afterwards, though it is not recommended that they drive themselves. If both eyes are suffering from cataracts, then there will need to be two separate surgeries to ensure the patient still can partly see during the healing process.

A local anaesthetic is applied in the form of eyedrops and the patient has to be awake during the procedure so that they can perform on the eye, which is held open with clamps. The surgeon makes small incisions on the surface of the eye so that there is space for the cloudy lens to be destroyed with the tip of a high-frequency ultrasonic tool in a process called phacoemulsification. The old lens is vacated from the eye, and then replaced with a new, artificial one called an intraocular lens (IOL).

The biggest benefit of IOLs is that they cannot form cataracts again, as they are artificial, and thus the cataracts are cured for the rest of the patient’s life, though there is a possibility of post-operative issues, however, they are exceedingly rare. The IOL can also act like a corrective contact lens or glasses and can correct pre-existing refractive issues (like astigmatism, long-, or shortsightedness). This can differ for patients, and though the procedure might be successful in clearing up vision, around 10 per cent of patients still required a seeing aid for distance afterwards.

What are the risks of cataract surgery?

The chances of complications after cataract surgery are low, but should still be taken seriously. The eye could reject the IOL, or there could be retinal detachment and infection like endophthalmitis, though the reported cases are 0.3 per cent of cataract surgery patients. Patients may occasionally “see” light phenomena like bursts of light, glares, or haloes, but this will settle with time as the eye heals around the IOL. Some patients may notice a return of blurry, hazy vision within the first five years, but this can be corrected with a laser in a minor procedure.

What happens after cataract surgery?

After the surgery, there will be some sensitivity to light and some fluid discharge in the first few days. Patients will be prescribed eye drops to help stave off infection and will be provided an eye patch or shield to protect against dust and debris, and help facilitate sleep for a week or so. It will take two months for the eye to heal, during which patients should not get the eye wet, which means no swimming and being diligent when bathing or washing their face. They should also take care to not rub their eye. Further care should be to avoid bright or strobe lights and to avoid lifting heavy objects for a couple of weeks.

If you’re suffering from cataracts or from other vision problems, Mr Sumith Perera is available for consultation which can be booked via his Top Doctors Profile.