- Eye-related Conditions
Cataract surgery maybe the most common surgery performed, but for you it is your eye that is going to be operated on and you would want full assurance that the surgeon operating on you is competent and will give you the best possible result, with the least amount of discomfort. This is what you can expect when you have cataract surgery under my care. Every patient’s needs are unique and need special consideration.
A cataract is when the normal crystalline lens of the eye becomes cloudy.
It is an operation in which the cloudy lens is removed, and an artificial lens is inserted into its bag. After appropriate anaesthesia (numbing of the eye) small cut is made at the edge of the cornea (the clear window of the eye). A probe is then inserted into the eye and the cataract is broken up with the aid of phacoemulsification (ultrasound waves). This emulsified cataract is then extracted through the cut made in the cornea via the probe. Once all the lens matter is removed a new artificial lens is inserted into the bag of the lens. No stitches are required after the operation. You will be given drops to instil into your operated eye 4 times a day for 4 weeks. You should continue with any glaucoma eye drops that you may have been prescribed prior to your cataract operation, starting the day after the surgery. You will be given a transparent shield to wear at night over your eye for the first two weeks following the operation. Click on the link to see an animation of how cataract surgery is performed.
The reason for having cataract surgery and a lens implant is to improve your vision.
Cataract surgery is not urgent and one can wait to have surgery until one is ready to have it done. If left untreated the vision in your eye is likely to worsen over time until you are unable to see with the eye. Leaving it too long may also make the surgery more complicated to perform increasing the risks of surgery. New Glasses may help upto a level.
Cataract surgery is in general a very safe and successful operation, with 95% of patients noticing improved vision following surgery, however it is not without risks.
The more serious complications are loss of vision either because of a severe infection or severe bleed in the eye.
The risk of permanent loss of vision due to an infection is 1:1000 and due to a severe bleed in the eye is 3:10,000.
There is a 1.5% risk of the bag of the lens breaking during surgery, needing further surgery to remove the jelly of the eye.
Sometimes lens fragments may fall to the back of the eye needing a second operation at a later date, the risk of this happening is 1:200.
Sometimes the bag into which the artificial lens is inserted may get cloudy over time and hence there is a 1:20 risk of needing laser in the form of a YAG capsulotomy to improve vision.
Retinal detachments are another known complication of cataract surgery especially if one is myopic (long sighted). The risk of this happening in a normal eye (not having high myopia) is 1:140 after 5 years.
The risk of a corneal abrasions or other smaller complications is 1:20.
Cystoid macular oedema or swelling of the retina can happen in 1:50 patients.
Refractive surprise, sometimes the intraocular lens power calculation may not accurately predict the outcome, especially of one has a very long or short eye or the corneal curvature is abnormal. Rarely it may necessitate the exchange of the lens or cataract surgery in the fellow eye.
If a patient has pre-existing eye conditions like age related macular degeneration, then even though the operation was successful, the vision may not improve completely. We call this a guarded visual prognosis, because the true extent of the visual potential will be realised only after the cloudy lens has been removed. Only then will we know how much of the visual loss was due to the pre-existing problem.
Mild pain and grittiness is expected after the operation for about 4-5 days, and paracetamol should help relieve the pain, but if your eye becomes red & increasingly painful and your vision becomes blurred, you need to get in touch with the hospital immediately.
Bleeding especially in the inner corner is quite normal (white of the eye looks red) and this generally settles in a week. Any severe bleeding needs to be brought to the notice of the hospital soon.
It can take upto 7-10 days for the vision to improve following cataract surgery.
Blurred vision occurring a few months after the operation, may be due to opacification of the lens bag needing laser. See your optician in the first instance.
If you notice floaters, flashing lights or a curtain like shadow in your vision, this may be the sign of a retinal detachment. Please let the hospital know immediately or go to your nearest eye casualty as soon as possible.
It’s natural to feel anxious when it comes to treatment and surgical procedures especially in relation to your eyes. I encourage you to ask questions about your condition, so I can help you to be better informed of your condition, the treatment options available and allay any fears that you may have. During the consultation I will explain the procedures to you and help you to make positive choices, and remember there is always the option of doing nothing, so you have nothing to worry about.