Your cataract operation

As with any operation, there are risks associated with cataract surgery, including the possibility of reduced or loss of sight.

Risks vary from person to person and are affected by the type of cataract, how easily the pupil of the eye dilates, certain medication you may be taking, pre-existing health conditions (including eye problems), and the experience of the surgeon. He/she will speak to you beforehand about any risks specific to you.

Cataract surgery improves vision in more than 95% of cases (95 of 100 cases). However, there may be no improvement, or vision may become worse. In a large survey of cataract operations in the UK between 2006 and 2010, vision was worse in the operated eye in 1.52% of patients.

Other risks include:

• 2% (2 in every 100) risk of a tear in the capsule (bag) which holds the lens in your eye. This can require further surgery and result in reduced vision.
• Infection, which can result in loss of vision (about 0.1% or 1 in every 1000)
• Retinal detachment, which requires further surgery and can result in reduced vision or loss of vision (about 0.2% or 2 in every 1000)
• Less than 0.1% (1 in 1000) risk of severe bleeding inside the eye
• 2% (2 in  100) risk of macular oedema (swelling of the retina at the back of the eye)
• Capsule thickening, which occurs after the operation in about 1% (1 in 100) cases. This may make vision misty again, but can be treated by laser as an outpatient procedure in a few minutes
• 0.1% (1 in 1000) risk of a serious problem occurring and making sight much worse

In some cases, there will be a large change in the prescription for your glasses. We will tell you whether this can be dealt with by your optician or whether you will need to have surgery on your other eye as well.

Surgery is the only known effective way to improve vision in people with a cataract. Once your optician has confirmed that no further improvement is possible by changing your glasses, the only alternative is to work around any visual difficulty. For example, you could try improving lighting at home, or using dark glasses or a hat with a brim to reduce the effects of glare.

Will I be awake during the operation?

Yes, you will be awake. However, the surgeon and theatre team will make sure that you are comfortable during your operation.

Will it hurt?

Not usually, although you may be aware of some discomfort. Please let the surgeon know if you feel uncomfortable during the operation so that they can give you some more local anaesthetic.

Will I be able to see during the operation?

You will be aware of a bright light and be able to see movements, but you will not be able to see the operation taking place.

Will I be able to read straight away?

Some people may be able to use their old glasses to read or use ‘off the shelf’ reading glasses. The optician will be able to test you for new glasses about six weeks after your operation.

Will my eye be painful after the operation?

Some soreness is usual and can normally be relieved by paracetamol. If you would normally take a different painkiller, such as aspirin, please check with your doctor first. Your eye may look red for a week or so, but this is usual after surgery and should gradually return to normal. It is also quite common for the eye to feel gritty or uncomfortable and this can sometimes last for more than one week after surgery.

Please do not wear contact lenses for two weeks before your pre-operative assessment appointment. This is because contact lenses can temporarily change the shape of your cornea and if worn, would result in an inaccurate measurement of your eye for the lens implant.

Pre-operative assessment

At this appointment, one of our nurses will take measurements of your eye and tell you about arrangements for the day of surgery. We encourage you to ask questions and to take part in the planning of your care.

We will ask you about:

1. Any medication you take regularly (please bring a list with you)
2. Who will put in your eye drops when you get home
3. Whether a relative or friend will be escorting you home after your operation

You may also tell us if you had had laser refractive surgery (such as LASIK).

On the day of surgery     

• Please have a bath or shower
• If you are having a local anaesthetic, please only have a light breakfast and a drink on the morning of the operation. This is because some patients need sedation to be fully comfortable. It would not be safe for the anaesthetist to administer sedation if you had a full stomach.
• If you are having a general anaesthetic, we will give you instructions on when to stop eating and drinking when we see you at your pre-assessment appointment.
• To reduce the risk of infection, please do not wear make-up or jewellery on the day of surgery

Remember

• Bring with you any medicines that you are currently taking
• You will not need to undress for the operation, but we do suggest that you wear comfortable clothes
• If you wear dentures or a hearing aid, you can keep them in if you wish

Please arrive at the day surgery ward at the time shown on your appointment letter. We advise you to make your own travel arrangements, as hospital transport is only available in exceptional circumstances.

We will ask you to sign a consent form for your operation. You will also have the chance to ask your surgeon any questions you may have.

We will mark your forehead to show which eye is to be operated on and put in eye drops to dilate your pupil (make it bigger).

The anaesthetic

A few minutes before your operation, the anaesthetist will put drops into your eye to numb the surface of it. He/she may then give you a small injection of local anaesthetic into the skin beside your eye. During the operation, you will be awake and may be able to see the operating light. However, you will not be able to see the operation taking place.

If you are having a general anaesthetic, the anaethetist will see you beforehand and explain what will happen. In this case, you will be asleep throughout the operation.

The operation

We will clean the area around your eye and place a drape around your face to keep the equipment sterile. Fresh air will be piped under the drape throughout the operation to help keep you comfortable. During the operation, the surgeon will make a small incision (cut), use an ultrasound device to break up the cataract before removing it, and then insert a plastic lens implant. Please see the diagram. The advantage of this method is that it allows for rapid healing without needing to use stitches.

Please note that laser-assisted cataract surgery is not yet in widespread use in the NHS, nor is it used in our department.

The nurse will check your eye before you go home.

We will give you some drops to use at home four times a day for about three weeks. It is not always easy to put drops in your own eye, so please talk to the nurse if you have any concerns about this.

How to apply the eye drops

• Always wash your hands before putting drops in your eye
• Apply drops as stated on the bottle
• If there is crusting around the eyelids, wash it off gently with previously boiled and cooled water

Your vision may be quite blurred for the first 24 hours, sometimes longer, and you may experience double vision for the first few hours. This is normal and is nothing to worry about.

You can return to your usual activities immediately after your operation. However, for the first two weeks we advise you to avoid any activities that might lead to your eye getting knocked or poked by accident, such as contact sports or gardening. You should also avoid swimming for four weeks. You can start driving again as soon as your vision has recovered. Please contact us if you need more information about this.

If your eye becomes painful or your vision worsens, please telephone Wainwright Ward on 01962 825703 or 01962 825708 immediately for advice, or for Basingstoke 01256 313572.

After 5pm or at weekends, please telephone Southampton eye casualty on 02381 206592 or Frimley Park Hospital eye unit on 01276 526859.

The lens implant will allow you to see well under a range of lighting conditions but you will normally need reading glasses or varifocals following surgery. You will need to see your optician for a sight test and new glasses about six weeks after surgery. If you are unsure of what glasses you may need, please ask us for advice.

Yes. We will arrange to see you in the outpatient clinic three weeks after surgery. At this appointment, the doctor will check that the operation has been successful and will answer any questions you may have. In most cases, you will not need to return unless you are having cataract surgery on your other eye.

Comments, concerns, compliments and complaints

If you have any comments, concerns, compliments or complaints about your care, please let us know as soon as possible. Please speak to the nurse in charge so that we can help to resolve your concerns quickly.

PALS and complaints team

If you would like to contact the PALS and complaints team, please tell your nurse. Alternatively you can visit them on B floor at Basingstoke and North Hampshire Hospital or on the ground floor of Ashley Wing at Royal Hampshire County Hospital. You can also contact them via telephone on 01256 486766 or via email at PALSandcomplaints@hhft.nhs.uk