About your cataract operation
Preoperative visit for cataract surgery
Cataract surgery has changed dramatically in the last few decades. It is now safer and more precise than ever before.
Please bring the following items to your initial visit in order that Mr Modi will have the most complete information with which to plan your surgery:
A list of medications
Most recent optical prescription
GP referral if referred by GP
At the first visit, Mr Modi will go through your symptoms and enquire about your other medical complaints and allergies in order to make any necessary provisions for surgery.
Please feel free to ask as many questions as you need to feel completely happy with your decision and if necessary please bring a list of questions with you.
At your first visit or subsequently you will need to have a measurement called a BIOMETRY. This measures a number of parameters in each eye which allow Mr Modi to plan what lens will be put into the eye to replace the natural lens that is removed due to cataract.
If there is a greater degree of astigmatism or if an alternative lens will need to be used, a PENTACAM measurement will need also to be taken.
The selection of lens and the various benefits of different lenses will be discussed at this visit.
Do I have a choice in which lens is used?
Yes. After your natural lens is removed, a replacement lens is implanted. There are a number of different lenses available and your surgeon will talk you through the options, which depend on your eye and your visual requirements. Generally speaking, lenses can be categorised as:
Monofocal - These allow clear vision and are usually set to provide distance vision. Reading glasses can be worn to allow near vision or alternatively monodical lenses of differing powers can be used for the two eye to achieve mono vision.
Multifocal - The latest generation of trifocal lenses allow patients to enjoy clear vision over a range of distances with maintained contrast sensitivity and reduced haloes and glare.
There are a range of lenses and Mr Modi will discuss these in detail with you to select the best option for your needs.
On the day of cataract surgery
Relax! You will soon be getting back to your hobbies and things you love doing.
If the procedure is under local anaesthetic, you can eat and drink normally and take any medications any eye drops as normal.
Local anaesthetic surgery can be performed under topical anaesthetic, meaning eye drops alone; or with sub-tenons anaesthetic or 'an injection' whereby a cannula is used to place some anaesthetic solution around the eye. No needle is used so it is not intact 'an injection.'
Both are effective at providing pain relief but the sub-tenons method prevents eye movement, which can be of benefit in some cases.
For general anaesthetic, a pre-operative assessment is often completed and you must remain starved from midnight the previous night.
You will be asked to attend one to two hours before the actual time of the operation. This is because a pellet is inserted under the lower eyelid which causes the pupil to dilate. This takes up to one hour to work and allows the surgery to be performed.
If the consent form has not already been completed, this will also need to be done before the operation. During the consent process, your surgeon will explain the risks and benefits of the surgery and invite any questions. The eye to be operated will be marked.
After the pupil is dilated, you will be accompanied to the operating theatre. Here, you will be asked to lie down on a bed and at this stage you will again meet your surgeon who will once again run through a series of checks to ensure that the correct procedure and lens has been selected. You will have some numbing drops and iodine drops placed in the eye to prepare for surgery.
Your surgeon will cover over the eye with a blue sheet and then use a clip to open the eye ready for surgery. A microscope with a bright light will then be positioned above you to allow the surgery to commence.
The operation will take between 10 to 20 minutes, during which time you must remain still. A handhold will usually be available if you are anxious. If you need to move then you must either raise your hand or squeeze the handholder's hand. Your surgeon will then pause surgery to allow you to get more comfortable, cough etc.
After your cataract operation
Once the surgery is complete, the blue sheet will be removed and a plastic shield will be placed over the eye. This is to protect the eye and must be worn until the next morning and then at night for the first few weeks after surgery.
You will be given some eye drops after you return to the ward. These usually include a steroid (Maxidex or Dropadex), an anti-inflammatory (Acular or Nepafenac) and an antibiotic (Chloramphenicol). The frequency and duration can vary but you will be informed on the day.
You can go home soon after the surgery if you have had local anaesthetic and usually a couple of hours after general anaesthetic. Follow up will be arranged as required and should there be any problems, the hospital will give you contact details for an emergency or feel free to contact Mr Modi through his secretary any time.
What are the risks of cataract surgery?
The following are possible after effects from cataract surgery. The more minor problems are more common whereas the more serious problems tend to be less common.
Dry, red, irritable eye - 'feeling of a rain of sand in the eye.'
Glare/haloes/starburst around lights
Refractive error - being more long/short sighted than expected
Inflammation or swelling of the retina (cystoid macular oedema) requiring an extended course of anti-inflammatory drops or even injections (1 in 50)
Capsular rupture requiring second operation to remove the lens or insert secondary lens (1 in 200)
Severe infection causing loss of sight (1 in 1000)
Decompensation of the cornea requiring surgery (1 in 1000)
It is important to remember that the vast majority of patients undergoing cataract surgery will have an improvement in vision without any more than minor transient side-effects (if any).