Q. What is a Cataract

Q. What are the Symptoms?

Q. How can it be treated?

Q. How is the surgery done?

Q. When is the Laser used?

Q. Will surgery improve my vision?

Q. How safe is it?

Q. Can the Cataract grow back?

One of the team performing a Cataract operation   

What is a Cataract?

A Cataract is a cloudy or opaque area in the normally transparent lens of the eye. As the opacity thickens, it prevents light rays from passing through the lens and focusing on the retina, the light sensitive tissue lining the back of the eye. Early lens changes or opacities may not disturb vision, but as the lens continues to change, several specific symptoms including blurred vision, sensitivity to light and glare, increased nearsightedness or distorted images in either eye may develop.

Approximately 50% of people in the UK aged 65 to 74 have cataracts. About 70% of those ages 75 and over have cataracts. Although cataracts usually develop as part of the aging process, they can also result from Eye Injuries, Certain disease such as Diabetes, medication such as Steroids or Genetic Inheritance.

Currently, there are no medications, eye drops, glasses or exercises that will cause cataracts to disappear. If cataracts don't interfere with your life, y may decide not to do anything about them. However, when cataracts do interfere with daily activities, such as driving, they can be treated surgically. Cataract surgery is the most frequently performed surgical procedure in the UK. New advances and techniques promote patient convenience and comfort, making it one of the safest and most effective operations available today.

Some of your symptoms may include:

1. Painless cloudy, blurry, or filmy vision
2. Sensitivity to light and glare
3. Double vision in one eye
4. Poor night vision
5. Fading or yellowing of colors
6. Frequent changes in eyeglass or contact lens prescriptions

Remember, these symptoms may be signs of other eye problems.

If your Cataract is minor, and not causing any particular problems, then leaving it alone is a good option! If however it is causing difficulties then surgery may be advised. This may sometimes be necessary to maintain the DVLA Driving Standard even if your Cataract isn't giving any other trouble.

Contrary to popular belief, the Cataract cannot be removed with the laser. There are some machines in development using a Laser to remove Cataracts, but they are still in development.

How is the Surgery done?

The surgery is performed using an ultrasonic needle to soften the cataractous lens and remove it. This is done through a tiny incision that is so small it doesn't need any stitches. The technique is known as "Phakoemulsification" (From the Greek: Phakos = lens, and Latin: emulsification = to turn into milk!). This is the most modern way to perform Cataract Surgery. The Laser is not used for surgery. There are some machines that use a laser to remove cataracts, but they are in development, and not widely used. The YAG laser is used sometimes to treat the eye if it develops an "after-cataract".

An Intra-ocular lens implant (or I.O.L) is then inserted, folded, into the space left where the natural lens used to be. The lens membrane, or capsular bag, is left intact to provide support for the new lens.

When is the Laser used?

Normally, the back of the lens capsule left behind to support the new lens remains clear, but up to 30 percent of patients may develop a clouding of the capsule, usually within a few months or a few years. The appearance is rather like frost on a window. If it is minor, and no symptoms are noticeable, then it is best left, but if vision is affected then it can be treated with a YAG laser, which allows the surgeon to make a hole in the cloudy capsule and clear the vision. This simple out-patient procedure takes only a few minutes to complete. Most patients don't have any after effects, but complications can occur. These include: raised internal eye pressure, retinal tears or detachment, and rarely, dislocation or movement of the lens implant.

Will surgery improve my vision?

Cataract surgery is an extremely safe and effective procedure, with generally pleasing results. If however you have other problems with the eye, such as Age Related Macular Degeneration or Glaucoma for example, then your expectations may have to be modified. This forms part of the important discussion that takes place before surgery.

Risks and complications are an unavoidable part of every surgical procedure, and it is important that patients are aware of these before deciding on surgery. This is part of the process of consent. (Please see "How safe is it?" below).

How safe is it?

As far as surgical procedures go. Cataract surgery has an enviable safety record. It is however, rightly classified as a major operation, with potentially serious complications. Fortunately, these are very rare, but it is vital for each patient to understand before surgery what the benefits of surgery are, and also to know what frequent or serious risks exist.

Complications can be divided into those that may occur during the surgery, and those that could occur afterwards. The following text only discusses frequent or serious risks, and is not exhaustive. If you decide to have surgery, we will of course discuss the operation with you, and provide you with a detailed consent form. If you have any questions arising from that, We will be delighted to answer them for you.

During Surgery:

One of the more common complications that could occur during surgery is tearing of the lens capsule; this thin cellophane-like membrane is left intact to support the new lens. It is very delicate, and sometimes is torn during surgery. This can make lens implantation more difficult, and can disturb the vitreous gel inside the eye (see below). The risk of this happening is very low (audited results of our Cataract Surgery indicate a rate of 1%). Bleeding at the back of the eye may occur, and can result in loss of vision, but is also extremely uncommon.

After Surgery:

Serious risks include infection inside the eye (1 in 1000 approximately), and retinal detachment (1 in 1000 approximately). Although these conditions are potentially treatable, they could result in blindness in the affected eye.

Other less serious complications include inflammation greater than normal, bruising around the eye (self-limiting), and swelling of the cornea (again, usually self-limiting).

Swelling of the central retina, (or Cystoid Macular Oedema as it is properly known) occurs in 3-4% of patients. It is generally self limiting with additional drop treatment, but can on occasions lead to reduction in the quality of vision.

Can the Cataract grow back?

The cataract can never recur. However, the clear membrane at the back of the lens is left behind during surgery to support the lens implant. This membrane can thicken and caused blurred vision, rather like frost developing on a window. If this “frosting” causes symptoms, then it can be quickly and easily treated with a special laser, the YAG laser, as an out-patient. This treatment can be required in up to 10-15% of patients, and is more common the younger the patient.

What can I expect if I decide to have Surgery?

Before surgery

Once you and I have decided that you will have your cataract removed, your eye will be measured to determine the proper power of the intraocular lens that will be placed in your eye during surgery. This lens replaces your natural lens (see below). This measurement is done using the latest technology, which employs a laser beam to accurately measure the eye.

The day of surgery

Surgery is usually done on a day case basis. Upon arrival for surgery, you will be given lots of eye drops to make the pupil of your eye dilate. When you come down to theatre, a local anaesthetic will be administered to make the operation painless. Though you may see light and movement, you will not be able to see the surgery while it is happening, and will not have to worry about keeping your eye open or closed. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head. The operation usually takes about fifteen minutes, sometimes a little longer. When the operation is over, the surgeon will usually place a shield over your eye. After a short stay back on the day case unit (and some refreshment!) you will be ready to go home. You should plan to have someone else drive you home.

Following surgery you will need to:

• Use the eye drops as prescribed
• Be careful not to rub or press on your eye
• Use over-the-counter pain medicine if necessary
• Avoid very strenuous activities for a couple of weeks
• Continue normal daily activities and moderate exercise

Please also remember that the Bath Eye Care team are NHS Consultant Ophthalmologists, and are able to provide 24 hour cover for you in the event of a problem. Not all providers of Cataract Surgery can offer this.