About cataract surgery
Cataract surgery is a day surgery procedure where the cloudy lens from your eye is removed, and replaced with an artificial lens implant. It can be carried out at any age and usually requires only a local anaesthetic and light sedation.
What is a cataract?
A cataract is when the lens inside your eye becomes cloudy.
When the lens develops into a cataract, symptoms include blurred vision, dullness, and glare. Common problems are trouble reading, loss of sharp distance vision, and difficulty driving at night.
Cataracts develop as a normal part of ageing. Other factors can make cataracts worse, including diabetes, steroid medications, smoking, and certain eye conditions.
Cataracts do not improve spontaneous or with eye drops, but can be permanently removed with a day surgery cataract operation.
How is cataract surgery done?
Cataract surgery is performed in an operating theatre. It is a day surgery operation carried out under local anaesthesia with sedation.
The operation involves making an opening in your natural lens capsule and removing the cloudy lens inside. The lens is removed using high-frequency ultrasound energy that breaks the lens into small pieces.
Once the cataract is removed, the next step of surgery is implantation of an intraocular lens implant (IOL) inside the lens capsule. This new lens stays inside the eye forever. Because the IOL is inside the eye, your eye will look and feel no different after you have recovered from the operation.
How will my eye feel after surgery?
In the first 24 hours after surgery, your eye may feel stingy or watery as the local anaesthetic effect wears off. This improves rapidly.
In the first 4 weeks after routine surgery some short-term side effects include:
Red eye: Your eye will be red or bloodshot, which gradually improves each day.
Irritation: Your eye will initially feel irritated and watery, as if there was an eyelash in it. The worst of this will settle down in the first week, although minor grittiness can persist for 1–2 months in people prone to dry eye. Lubricating artificial tear eyes drops can help a lot.
Adjusting to the new lens: Most people see improvement soon after surgery, but others can take a few weeks to adjust. If you plan to wear prescription glasses after surgery you’ll need to give your eyes 4-6 weeks to fully recover before updating your glasses. It’s safe to wear over-the-counter reading glasses during this time.
If you have any side effects that are severe or getting worse call Eyemedics. If you have blurred vision, pain, or redness that is severe or getting worse, call me immediately.
What are the risks of surgery?
The risks of cataract surgery are small, but serious complications can still occur. Overall, the chance of the operation causing you to permanently lose your sight in that eye is less than 1 in 2000. Important complications include:
Infection: A serious eye infection (called “endophthalmitis”) requires hospital treatment and can lead to blindness, or rarely losing the eye (1 in 2000 risk).
Retinal damage: A retinal break would need laser treatment, usually in the outpatient clinic. A retinal detachment is rarer but more serious, requires surgery, and can cause permanent low vision.
Swelling: Swelling is normal after every operation, including eye surgery. Excessive swelling is uncommon, but can blur vision by affecting the front of the eye ("corneal oedema") or the back of the eye ("cystoid macular oedema"), and may take several weeks and extra treatment to resolve
High pressure: If the pressure in your eye is too high in the first few days after surgery, your specialist might prescribe tablets or eye drops to bring it down and prevent damage to the optic nerve.
Posterior capsular opacification: Also called PCO, this refers to a cloudy film growing on the capsule behind the IOL. Up to 10% of people with this develop blurred vision, which can be fixed with a quick laser procedure in the clinic.
Bleeding: Bleeding inside the eye can cause floaters or blurred vision. It usually clears on its own (even when severe) but occasionally needs surgery. Bleeding under the wall of the eye is a very serious but extremely rare complication.
Intraoperative complications: If the back of the lens capsule is punctured, it may be impossible to remove the cataract in the normal way. This is usually managed at the time of surgery, but if parts of the cataract cannot be removed you may need a second emergency operation, sometimes in a different hospital.
Droopy eyelid: Permanent eyelid droopiness is a rare complication of cataract surgery and other eye operations. Patients with any droopiness before surgery are at highest risk of this problem.
Refractive surprise: Before surgery I will talk to you and use calculations to predict the best IOL for your visual needs. The best calculations are 90–95% accurate, meaning there is a chance you need to use glasses for some tasks after surgery even if we were aiming to avoid this. In this case your optometrist will help you to achieve excellent vision with glasses, but if you strongly wish to not wear glasses then further surgery or laser may be needed. Glasses-free vision is aimed for, but cannot be guaranteed.
Who can I contact if I’m having problems?
In case of emergency, it is possible to access an eye specialist 24 hours a day in South Australia.
During business hours contact Eyemedics on 8273 1600 (Wayville), 8326 6900 (Morphett Vale & Seaford), or 8294 5222 (Glenelg). If you are worried and it’s outside of normal hours, call me on my mobile (supplied in your surgery info pack).
If you can’t reach me, call your local public hospital and ask to speak to the on-call ophthalmologist, or attend the hospital emergency department.