Cataract Surgery

What is a cataract?

A cataract doesn’t form on the surface of the eye; it’s actually inside the lens. This sits behind the pupil and helps you to see clearly by focusing the light rays entering your eye onto the retina. If you have a cataract, it means the lens has become cloudy, making it unable to focus and create a clear picture. This causes your vision to become blurry, making it difficult to see properly.

Cataracts occur gradually over time and can develop at any age, but typically occur as you get older. They can also be due to:

• diabetes
• steroid medication
• trauma
• genetics.

Is cataract surgery right for me?

Your consultant may recommend cataract surgery if the changes in your vision caused by the cataract are significantly impacting your daily life. Common symptoms include:

• Blurred or misty vision: Your sight may seem cloudy, as if you are looking through a frosted window or a dirty film. This can make everyday tasks like reading small print, watching television, or seeing facial expressions clearly much more difficult.
• Glare or halos around lights: You may find that bright lights feel dazzling or uncomfortable. Oncoming car headlights at night can create distracting starbursts or halos, making driving feel unsafe.
• Colours appearing faded or yellowed: The cataract can act like a yellow-brown filter, making colours appear dull, washed out, and less vibrant than they used to.
• New glasses no longer provide clear vision: You might find that your glasses or contact lens prescription changes more frequently than they used to.
• Needing brighter light for daily tasks: You may find yourself needing a much stronger, more direct light source for activities like reading, sewing, or cooking, even during the daytime.
• Seeing double or 'ghost' images: In some cases, a cataract can cause you to see a double image or a faint second outline of things when looking with just one eye.

How long does it take to go blind from cataracts?

The time it takes cataracts to significantly impair vision or cause blindness can vary depending on several factors, but particularly on the type of cataract you have. Here’s an overview of the different types of cataracts and their typical progression rates.

Nuclear Sclerotic Cataracts

These cataracts usually develop slowly over several years, which means it can take many years before they significantly impact your vision or cause total blindness.

Cortical Cataracts

This type of cataract can also take several years to develop, meaning it may not cause blindness or severe vision impairment for many years.

Posterior Subcapsular Cataracts

These cataracts develop more quickly than others, sometimes within a few months, which means severe impairment or blindness can occur within a few years if left untreated.

Congenital Cataracts

Present from birth, they may not change much over time, but immediate treatment may be needed to prevent permanent impairment or blindness.

Traumatic Cataracts

As these cataracts occur after a traumatic injury, they will develop incredibly quickly. This means that immediate treatment after the incident will be necessary to reduce the risk of blindness.

Radiation Cataracts

Developing after sustained exposure to radiation, they can lead to significant vision impairment within a few years if not treated.

Learn more about the different types of cataracts.

What is cataract surgery?

It involves removing the cataract-filled lens and replacing it with an artificial lens implant. Although quite complex, it’s one of the most common and safest procedures in the UK.

Types of lens implants

There are a range of different lens implants and your consultant will be able to recommend the best one for you:

• Monofocal lenses: These improve your long-distance vision, but you may need glasses for near distances
• Multifocal lenses: These allow you to see far and near distances, so you might not need glasses at all.

Premium intraocular lenses (IOL) are a newer type of lens implant designed to address various vision issues – they may correct for near, intermediate, and far vision, as well as for astigmatism:

Toric monofocal lenses

Toric monofocal lenses are to offer clear vision for either long or near distance or nearby, reducing the astigmatism a patient has after cataract surgery.

Extended depth-of-focus (EDOF) lenses

EDOF lenses are a type of multifocal lens to improve intermediate and long-distance vision with less glare than other multifocal lenses – ideal for those who play sports or drive a lot, but you still may need glasses for very near distances, for example, when reading fine print. These can be both toric and non-toric, depending on your level of astigmatism.

Trifocal lenses

Trifocal lenses are designed to improve vision equally across long, intermediate and near distances; however, there may be a higher risk of glare compared to EDOF lenses. These can also be toric and non-toric, depending on your level of astigmatism.

How long is the wait between cataract surgery on each eye?

If you have cataracts in both eyes, you’ll need to have two separate operations, spaced a few weeks apart. This can vary from patient to patient, but it will allow your eye to heal fully and your vision to recover sufficiently so that you can adjust for your second eye to be treated.

Occasionally, some patients will have both eyes treated at the same time with a procedure called immediate sequential bilateral cataract surgery (ISBCS). However, this is usually only recommended for people where the risk of complications is very low. Your doctor will discuss this option with you if it is suitable.

Is cataract surgery right for me?

Not everyone with cataracts needs cataract surgery. If you can go about your daily life without sight loss affecting your independence, then you probably don’t need to think about surgery just yet.

That said, cataracts generally worsen over time, and it may be something you want to consider in the future. If you’re unsure, consider getting an eye test or ask your GP to refer you to a specialist.

Your consultant may recommend surgery if a cataract prevents you from reading, driving, or going about your day-to-day activities. Together, you’ll weigh up the risks against the potential gains.

What are the benefits of cataract surgery?

Cataract surgery can be a life-changing operation as you’ll be able to see much more clearly. People who have this surgery are often overwhelmed by the results, with vision returning to them after just a few days. Cataracts often develop slowly over time, and people forget how good their vision once was. Some patients even find that they would like their other eye operated on to bring it up to the same standard.

However, the eye is extremely complex and is made up of a range of different parts – so if other parts of the eye aren’t functioning properly, the results might be underwhelming.

How long do the benefits last?

The lens implant should last a lifetime.

What happens during cataract surgery?

Cataract surgery takes around 45 minutes. It’s usually done under local anaesthetic, so you should be able to go home on the same day.

The idea of having an eye operation awake may be daunting, but it’s much safer than being put to sleep. There are different levels of local anaesthetic available, ranging from strong eye drops to injections administered around the side of the eye. You can also opt to have a sedative to help you relax during the procedure. General anaesthetic is another option, but it takes a bit longer to recover from.

We’ll make sure you understand the experience you can expect beforehand. If you’re under local anaesthetic, you won’t feel any pain, but you may feel a bit of pressure and the sensation of fluid running over the eye. Some patients who only take eye drops report seeing a dazzling multicoloured light show during the procedure, while in others, the eye will simply go blank until the anaesthesia wears off.

Preparing for cataract surgery

There are a few things you can do in the lead-up to the procedure to make sure everything goes as smoothly as possible:

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly.

During the procedure

To prepare your eye for cataract surgery, your surgeon will:

• Place eye drops in your eye to help relax the muscles and widen your pupil
• Apply local anaesthetic eye drops
• Inject local anaesthetic close to your eye.

You may feel some discomfort, pressure, or stinging as the anaesthetic takes effect. Once your surgeon is happy that you can’t feel anything in your eye, they’ll begin the operation.

You’ll need to lie still, so let your surgeon know if this is a problem for you. Your face will be covered with a cloth, and air will be blown gently towards your nose. If you’re claustrophobic, please let your surgeon know.

You may feel some pressure and see some movement or bright lights, but you won’t feel any pain or see anything in detail.

The most common form of cataract surgery is phacoemulsification:

1. Your surgeon will make a tiny cut in your cornea (the outer layer of your eye) and dilate the pupil to access the lens.
2. Using a tiny probe that emits ultrasound waves, they’ll break up the cataract and remove the pieces from your eye.
3. Finally, they’ll insert the lens implant, with a strength customised to you using a formula based on a biometric measurement of your eye.

After the procedure

Your surgeon will place a protective pad and plastic shield over your eye, which you’ll need to leave on for a few hours. You’ll be taken to the recovery room and then to your room on the ward.

Recovery from cataract surgery

It may take a few days for your eyesight to return, and it can take 4–6 weeks for your eye to recover fully. At this point, you’ll be able to get a new glasses prescription if needed.

Short-term recovery

Your eyes may feel a bit uncomfortable when the local anaesthetic wears off after a few hours. We’ll provide you with some painkillers to help relieve any discomfort. You’ll also be given eye drops containing a steroid to reduce inflammation and antibiotics to prevent infection.

Try not to touch your dressings as this can lead to an infection. If you notice any discharge or if you’re in any pain, don’t hesitate to speak to one of the nurses. When you’ve recovered from the effects of the anaesthetic, you’ll be able to go home.

For the first 24 hours after your operation:

• You’ll need someone to take you home and stay with you overnight.
• Don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and coordination.
• If you’ve had a sedative, you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

To begin with, you may experience blurred or double vision, and your eye may be red, watery, gritty, and sensitive to light. It’ll take a few days for these side effects to improve.

Here are a few things you can do to help you recover:

• Use your eye drops as instructed (and see guidance below on using your eye drops).
• Wear your eye shield at night for 1–2 weeks to prevent accidental rubbing of your eye while you’re asleep. Keep the shield clean by washing it with soap and water.
• If your eye becomes sticky from watering, gently wipe your eyelids with cotton wool dampened in cool water that’s been boiled.
• Wear your eye shield, glasses, or sunglasses outside to protect your eye(s) from dust.
• Wearing sunglasses can also help when your eyes are sensitive to bright light.

What activities should be avoided after cataract surgery?

• Don't rub your eye.
• Don't go swimming for 4-6 weeks.
• Avoid excessive bending, heavy lifting and strenuous activity for 4–6 weeks after the operation.
• You can shower or bathe after 48 hours, but be sure to avoid getting soap or water in your eyes and wear your eye shield when washing your hair.

Using your eye drops

1. Wash your hands thoroughly.
2. Tilt your head backwards, look up and pull down the lower eyelid.
3. Squeeze the dropper so that one drop goes in the pocket between your lower lid and your eye – try not to let the nozzle touch your eye or eyelid.
4. Close your eye(s) and blink several times..

To keep your eye drops clean, make sure you:

• Keep the bottle tightly closed when you’re not using it.
• Keep the eye drops in the fridge if you’re told to.
• Don’t put the dropper down on any surface.
• Don’t let the nozzle of the dropper touch your eye or fingers.
• Never lend your eye drops to anyone else.
• Throw away your eye drops after 4 weeks.

How long after cataract surgery can you drive?

As long as your eyesight meets DVLA standards, you can drive. That means being able to read a number plate from 20 meters away. It can take anywhere from a few days to several weeks for your eyesight to return to normal. Always check with your doctor and insurance company first.

How long after cataract surgery can you bend over?

It is generally recommended that you avoid bending over for 1 to 2 weeks. This will help to prevent a buildup of pressure, which can affect the healing process.

For the first few days after your surgery, be particularly careful to avoid any bending over at all, and continue to avoid any excessive bending or strenuous activity for 1-2 weeks post-surgery.

In some cases, it is recommended to avoid this for as long as 4 to 6 weeks after your operation.

Time off work

You should be able to return to work as soon as your vision returns, but you may need extra time off if you’re waiting for new glasses or another operation in your other eye.

Follow-up appointments

We’ll arrange for you to come back 1 to 4 weeks after your operation. Your doctor will determine whether you need to continue using your eye drops and when you can schedule an eye test for a new prescription, if necessary.

What are the risks of cataract surgery?

Thousands of cataract surgeries are carried out without incident in the UK every year. But this complex micro-surgery doesn’t always go to plan.

The pocket where the lens sits can be torn, allowing all or part of the cataract to fall back into the eye as it’s being removed, or an infection can develop.

Even if the surgery goes smoothly, there’s a small chance of posterior capsule opacification (PCO). In this condition, a membrane grows over the back of the new lens months or even years after the surgery is completed.

In most cases, complications like these can be treated with medication or further surgery. Very rarely, in one out of every 1000 cases, surgery is directly responsible for permanent sight loss in the treated eye.

Alternative treatment options to cataract surgery

New glasses may improve your vision to some extent, but if the cataract is too advanced, glasses won’t help. Surgery is the only option to restore your vision.