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 change consistency. They are a normal, expected side effect of getting older. It’s a condition that  normally has a slow, steady onset and affects many older people from 50 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 nor are they dangerous to health —  but they can be visually impairing to the point that they 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. 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 20 minutes and the patient can go home afterwards, though it is not recommended that they drive themselves. If both eyes are suffering from cataracts, usually one eye is done at a time, although in some instances both eyes are operated  on the same day.

As  strong local anaesthetic is applied in the form of eye drops  to numb the eye, cataract surgery is usually a painless procedure. The eye is held open with the help of a speculum to prevent blinking. The surgeon makes a small incision on the cornea, enabling the insertion of a needle like ultrasound probe to be inserted into the natural lens of the eye to break  the cataractous  lens into small pieces by a  process called phacoemulsification. The opaque lens is removed 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. Although there is a possibility of post-operative issues, they are 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). Whilst the normal intra ocular lenses give good vision for one distance, premium lenses can correct astigmatism and give good vision for all distances(Multifocal Lenses, EDOF lenses) thereby achieving spectacle independence. Experienced surgeons can guide you in selecting the type of lens that suits you best.

What are the risks of cataract surgery?

The chances of complications after cataract surgery are low but should still be taken seriously as some complications can be sight threatening. Whilst most complications are not sight threatening, sight threatening complications can occur in about 2-3 %. These include infection, inflammation, retinal detachment, macular oedema and corneal decompensation.

It is not unusual to get a thin membrane growing behind the implanted IOL, months to many years after successful cataract surgery. This is called posterior capsular opacification and can be easily treated by a  laser procedure. Glare and halos are commonly seen after multifocal lens implantation, but most patients do not experience these symptoms after a few months.

What happens after cataract surgery?

You will be discharged from hospital with instructions to use eye drops for 4 weeks.

You will also be given an eye shield to wear at night over the operated eye for 2 weeks.

Unlike in the past, modern cataract surgery is performed through a very small incision (2.2-2.4 mm). Therefore it is possible to lead a normal life after cataract surgery. However you should avoid strenuous exercise and   avoid any situations where there is an increased risk  of reflexively rubbing your eye, like  getting irritants into your eye. It is best to avoid crowded dusty places and swimming for about 4-6 weeks. Usually, following uncomplicated cataract surgery, you should be able to fly the day after surgery.  If the vision in the unoperated eye is poor, you should check your vision in the operated eye, before driving to ensure that it is within the legal limits.

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.