Cataract Surgery at Edinburgh Hospital

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 makes your vision blurry, so it’s difficult to see properly.

Here are some signs you may have cataracts.

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

• diabetes
• steroid medication
• trauma
• genetics.

How long does it take to go blind from cataracts?

The time it takes cataracts to significantly impair vision or cause blindness can vary on a number of 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 a number of years, which means it can take many years before they will significantly impact your vision or cause total blindness.

Cortical Cataracts
This type of cataract can also take several years to develop meaning it will take many years before they can cause blindness or severe vision impairment.

Posterior Subcapsular Cataracts
These cataracts develop more quickly than others, sometimes within a few months, meaning severe impairment or blindness can occur within a few years if not treated.

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 immediate treatment after the incident will be needed to reduce the possibility 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.

There are a range of different lens implants and your consultant will be able to recommend the best one for you. If you have a standard monofocal lens implant, you may need reading glasses and glasses for long distances. If you have a multifocal lens implant, you might not need glasses at all.

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 a few weeks apart. This can vary from patient to patient, but it will allow your eye to fully heal 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 (IBCS). However, this is usually only recommended for people where the risk of complications is very low. Your doctor will discuss this if it could be an option for you.

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 get worse over time, and so it may be something you want to consider in the future. If you’re not sure, get 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, from strong eye drops to an injection 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’re likely to have 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 just take eye drops report seeing a dazzling multicolour light show during the procedure, and in others the eye will simply blank out until the anaesthetic wears off.

Before the procedure

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.

To prepare your eye, 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 gets to work. Once your surgeon is happy that you can’t feel anything in your eye, they’ll begin the operation.

During the procedure

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, so if you’re claustrophobic, 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 biometrical 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

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

Short-term recovery

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

Try not to touch your dressings as this can lead to an infection. If you notice any discharge or 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 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 co-ordination
• If you’ve had a sedative, you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

To begin with, you might have 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 so you don’t accidentally rub 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 from dust
• Wearing sunglasses can also help while your eye is sensitive to bright light

What activites 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 make sure you don’t get soap or water in your eye and wear your eye shield when you wash 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 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 anything from a few days to several weeks for your eyesight to go back 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 1-2 weeks. This will help to prevent a build up 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 4-6 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 1–4 weeks after your operation. You doctor will tell you whether you need to keep using your eye drops, and when you can get your eyes tested for a new prescription, if needed.

Risks

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 that the lens sits in can be torn, all or part of the cataract can fall back into the eye as it’s being removed, or infection can develop.

Even if the surgery goes smoothly, there’s a small chance of posterior capsule opacification (PCO) – a condition where 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

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.