Cataracts make your vision blurry or dim. Cataract surgery restores clear vision by replacing the misty lens inside your eye with a new, clear implant
Cataract surgery is an operation used to treat cataracts that are affecting your daily life. More than 300,000 procedures are carried out each year in the UK, making it the most common operation of any specialty performed in the country.
Cataracts can usually be treated with a routine day case operation where the cloudy lens is removed and is replaced with an artificial plastic lens. Lens surgery is a very established procedure and was first performed in 1950.
Cataract surgery takes 10-15 minutes to complete
Since then the operation has consistently evolved; current techniques using ultrasound and a keyhole approach have demonstrated an excellent safety track record.
What is a cataract?
A cataract is a clouding of the normally clear lens inside the the front part of eye. It causes a loss of vision that cannot be fixed with glasses or contact lenses. Cataracts are very common, especially among those aged 70+.
A cataract blocks light from passing through the lens, reducing the brightness and clarity of vision. You can think of a cataract as frosted rather than clear glass; the whitening of frosted glass doesn’t allow a clear image to be seen. The whitened opacity of a cataract affects sight in the same way, preventing a clear image being made on the retina inside the eye. Laser refractive surgery, such as LASIK, is not effective.
Symptoms of cataracts
Cataracts can develop over a number of years and may initially cause no symptoms. They usually develop in both eyes, although one eye may be more advanced than the other.
You can think of a cataract as frosted rather than clear glass, preventing clear vision
Your vision can become misty or blurred, or you may have small patches where your vision is fogged, even when wearing your glasses. Common visual symptoms from cataracts include the following:
- difficulty to see in low or very bright light
- development of (or an increase in) short-sight
- glare from strong lights may be uncomfortable or dazzling
- colours can appear washed out or have a yellow or brown hue
- double vision
- glasses no longer correct your vision
- headlights or street lights appear to have a halo around them
Cataracts are very treatable and Focus offer modern, minimally invasive surgery. Contact us for more information on our advanced cataract removal procedures.
What causes cataracts?
Precisely why cataracts occur is not known, although they appear to be caused by alterations in proteins within the lens that develop over many years, changing it from clear to cloudy. Cataracts are linked with:
- age – cataracts will eventually affect most people and become more common as we get older
- family history of cataracts increases your chances of developing them
- severe trauma or previous eye surgery
- inflammation in the eye, e.g. iritis, uveitis
- excessive ultraviolet light (UV) over a long period
- smoking and excessive alcohol intake
- oral, topical, or inhaled steroids
- long-term use of statins and phenothiazines
- congenital – cataracts can occasionally be present at birth or during early childhood from metabolic, genetic or infectious causes
Irrespective of the cause, when cataracts affect vision to the point of interfering with daily activities they are treated by surgical removal. Apart from avoiding removable causes above, there is no known prevention.
How are cataracts diagnosed?
Cataracts are often detected during an eye examination, either with your local optometrist or an eye doctor. You may or may not have noticed a drop in vision, depending on how far the cataract has progressed. The opacified areas of the lens can be most easily seen using a slit-lamp microscope (a vertical microscope controlled by a joystick, shining a bright slit of light at your eye while your chin sits upon a chin-rest).
Using a variety of tests, a doctor is able to tell how much a cataract may be affecting vision. Usual eye tests include:
- testing visual acuity for distance and reading
- glare sensitivity (does a bright light decrease your vision)
- colour vision
- contrast sensitivity (distinguish between shades)
- complete examination of all other parts of the eye
A full eye examination will confirm that the loss of sight is not because of other common eye problems, such as diabetes, glaucoma, or age-related macular degeneration (AMD).
Preparing for your cataract surgery
Prior to cataract operation, your ophthalmologist will perform a complete eye health examination to check the overall condition of your eyes, determine any risk factors, and exclude any reasons why you should not have surgery.
A measurement of any glasses prescription, called a refraction, will be performed to accurately determine your degree of short-sight, long-sight and any astigmatism you have prior to surgery. Additional measurements include biometry (a detailed ultrasound scan to measure all the anatomical dimension, including the length of your eye) and topography to determine the curvature of your cornea.
Your surgeon needs all these measurements to select the proper power of the intraocular lens implant to give you the most detailed vision possible after the operation.
Your surgeon will also discuss the various types of lens implants available prior to your cataract surgery, as well as describing what to expect before, during and after your procedure.
If you have cataracts in both eyes, your surgeon may treat your right and left eyes on the same day, or may ask that you wait 1 to 3 weeks between procedures. For those patients who are having both eyes treated on the same day, you will typically have a check-up one or two days later. The choice will depend on your prescription and surgeon recommendation.
What happens after cataract surgery?
How quickly will I see after surgery?
Normally the vision is soft focus immediately after surgery and the next day vision is often good.
When can I drive?
We will advise you depending upon your individual circumstances, with most people driving again only after both eyes have been treated. When only one eye is being treated driving usually commences a few days after surgery.
When can I work?
This depends upon your occupation. Most people with office-based occupations resume work within a few days or a week. Those who work in a dusty environment may need two to four weeks off work.
Are activities restricted after surgery?
Common sense needs to be applied but people can bend over, wash, shop and carry out general activities. On the day following surgery you can take a bath or shower and use a computer. Sports can be resumed after a few weeks or a month. Flying as a passenger can be done the day after surgery but as a pilot the necessary licensing needs to be completed before flying resumes.
Will I still need to wear glasses?
Many people do not need to wear distance glasses after modern cataract surgery, but this is not guaranteed. If there is clear distance vision, reading glasses are normally required unless there is a multifocal lens implant or monovision. For those with a multifocal implant or monovision, glasses may still be required for some tasks.
Further information on cataract surgery recovery can be found here.
How are cataracts treated?
Surgery for cataract is very effective at restoring vision. The misty or opaque cataract needs to be removed and replaced with a new clear implant, known as an intraocular lens (IOL). The procedure takes 10-15 minutes per eye and is typically is performed as a day case, without needing an overnight stay in hospital.
Modern cataract operations include the use of high-frequency ultrasound, known as phacoemulsification, or ‘phaco’
In most cases, treatment will be performed under local anaesthetic (you are awake but the eye is numbed). Modern cataract operations include the use of high-frequency ultrasound, delivered via a special hand-piece, that breaks up the misty lens into very small pieces. These fragments are then gently removed from the eye with minimal suction.
This surgical approach is known as phacoemulsification or “phaco” for short. It can be performed with much smaller incisions than prior techniques for cataract removal, allowing quicker healing and reducing some of the risk of cataract surgery complications, such as retinal detachment.
Once all of the cloudy lens has been removed, your surgeon inserts a clear specially designed implant, called an intraocular lens (IOL), placing it securely in the space created after removal of your natural lens.
The final step is for your surgeon to close the incision in your eye, usually without the need for a stitch. A protective plastic shield protects your eye while it heals in the post-op recovery phase.
Choosing the right lens implant for your vision
With private surgery, you have a wide choice for which IOL you would like implanted. Your options though come under three main lens choices, depending if you would like to minimise the need for reading glasses after surgery:
- Standard mono-focal IOLs
- Mono-focal IOLs with monovision
- Premium multi-focal IOLs
IOLs that correct short-sight and long-sight are standard mono-focal implants, and the type used in the NHS. There are now toric IOLs that correct astigmatism as well.
If you don’t mind wearing glasses after cataract surgery, a monofocal lens implant usually is used. You will need reading glasses after cataract surgery with monofocal IOLs. New glasses can be prescribed for you approximately one month after surgery.
If you like the idea of being less dependent on glasses after cataract surgery, one way to correct presbyopia and reduce your need for reading glasses is to have your cataract surgeon adjust the power of one of your monofocal IOLs (assuming you have cataract surgery performed in both eyes) to give you a monovision correction, similar to monovision with contact lenses.
Another option is to choose one of a variety of advanced presbyopia-correcting IOLs to improve your reading vision without sacrificing your distance vision. Presbyopia-correcting IOLs include bifocal and trifocal IOLs; both types are designed to provide a greater range of vision after cataract surgery than conventional monofocal IOLs.
Be aware that not everyone is a good candidate for these premium IOLs, and choosing a presbyopia-correcting IOL is only available privately.