About Cataract Surgery

WHAT IS A CATARACT?

A cataract is a clouding of the normally clear lens inside the eye just behind the pupil. When the lens becomes cloudy, the light rays cannot pass easily through it and vision becomes blurred, both for near and distance objects. Sensitivity to glare in bright sunlight, and distortion or ghosting of images may also occur.

Cataracts are the commonest cause of failing vision over the age of 60 in Australia. They are a normal part of the aging process in both eyes, but usually develop at different times. Less commonly, cataracts can occur in babies, children and young adults. Other causes include eye and systemic diseases, eye trauma and as side effects of medication, such as Prednisone therapy for severe bronchitis.

Cataracts are not a growth or film over the eye, and are not caused as a result of overusing the eye, or eyestrain. You generally can't see your cataract in the mirror.

WHEN DO CATARACTS NEED TREATMENT?

Cataracts may need no treatment at all, if the vision is only a little blurry, and often a change in glasses will help. It's when a cataract interferes with the things you like to do that surgery should be considered. Surgery is the only way to remove a cataract, and provided you do not have any other eye problems, there is a 95-98% chance that you will see better after cataract surgery.

Complications, although rare, can occur. This is why you should wait until the symptoms frustrate your enjoyment of life. The benefits of properly timed cataract surgery greatly outweigh the risks, making cataract surgery so popular today. If you have any concerns, please talk to our staff whilst you are at the rooms or phone one of our Orthoptists.

MEASUREMENTS AND THE IMPLANT LENS (IOL)

Once cataract surgery has been decided, your eye will be measured with ultrasound to determine the power of the intraocular lens (IOL) that will be permanently implanted in your eye during surgery. The IOL has been a major advance of medical science that has freed post cataract patients of the need for "coke bottle" glasses without which they used to be functionally blind. Virtually everyone having cataract surgery receives an IOL.

A little appreciated but important feature of IOL implantation is that the power of the IOL can be chosen so that pre-existing long or short sightedness can be corrected as well.

Glasses will still be necessary for some activities, particularly reading and possibly night driving.

ANAESTHESIA

Adult eye surgery is done under local anaesthesia. A specialist anaesthetist numbs the eye locally and you may also have a mild "twilight anaesthetic" if you are very nervous or tense. You can talk and answer questions throughout the procedure.

You will be asked to see your local doctor prior to surgery so that we may be alerted to any special medical risks before undertaking cataract surgery.

When you make a booking for surgery you will be given detailed information about the planned surgery and sometimes, a prescription for antibiotic drops to use during the 24 hours prior to surgery.

THE OPERATION

Surgery is performed under local anaesthetic at our Day Hospital, and your total stay is usually 2-3 hours. You do not need to change out of your clothes at our Day Hospital, although you may be asked to change into a hospital gown if you go to John James Hospital.

Cataracts are removed by "SMALL INCISION, NO STITCH TECHNIQUE", using a "Phaco" machine. It is the most advanced surgical procedure for removing cataracts, with the entire procedure taking place through a small tunnel incision in the eye. A small incision is much gentler to the eye and usually requires no stitches. Occasionally, a stitch may be necessary for safety reasons.

Rarely, cataracts may be removed by the 'extracapsular' technique. This is also a very safeand longstanding procedure suitable for advanced or dense cataracts where the 'phaco' technique is considered more hazardous. A longer incision is made which is closed by multiple sutures. Post-operative comfort is the same as in 'phaco' surgery but vision return is delayed for up to two months.

When you come to the Day Hospital you will be given eye drops to dilate the pupil. A regional local anaesthetic will be administered by the Anaesthetist. You need not to worry about keeping your eye open or still during surgery. Typical concerns such as the need to cough or inability to lie completely flat are rarely a problem.

After your operation, you stay in our recovery area for half an hour's observation prior to going home. YOU MUST BE ACCOMPANIED HOME. DO NOT DRIVE YOURSELF.

You will be given a prescription for eye drops to be used following your surgery. Our staff will explain these to you and show you how to put them in at your consultation the day after surgery.

AFTER YOUR CATARACT OPERATION

The old much quoted advice of not bending down or lifting does not apply to modern 'phaco' cataract surgery. Simply avoid strenuous or violent activity and keep the eye and lids very clean.

If the eye is healthy, the chances are excellent that you will have good vision following cataract surgery. Even if the surgery itself is successful the eye may not see as well as you would like if there are other problems such as macula degeneration (aging of the back of the eye), glaucoma or diabetic retinal changes. It is important to remember that cataract surgery will not correct poor vision caused by other eye problems. However, even with such problems, cataract surgery may still be worthwhile to improve overall vision.

POSSIBLE LATE COMPLICATIONS

Over 95% of patients will have improved vision after cataract surgery. A small number may have problems. Infection, bleeding and detachment of the retina are some of the more serious complications. Uncommonly, moderate blurring of central vision between 3 and 12 weeks post-operatively may develop even with uncomplicated operations. This condition, cystoid macula oedema, usually recovers over many weeks and necessitates additional treatment. It is more common in those with a history of retinal inflammatory disease, previous or surgical eye trauma or systemic inflammatory conditions.

Any sudden change in the nature of your sight or eye should be reported to us immediately. Please don't wait until your next scheduled appointment.

Post-operative visits

• Normally, we check your eyes at one day, 10 days and two months. Glasses can be changed after about three weeks.
• You will be given another information brochure with detailed post-op instructions.
• Remember our staff are here to help and answer your questions.