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Cataract Extraction

Cataract surgery is one of the most common procedures in the UK. Cataracts are cloudy areas that develop in the lens of the eye as we get older, which initially result in blurry vision (even when wearing the correct spectacles), and eventually can lead to sight loss.

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Everything you need to know

Cataracts are cloudy areas that develop in the lens of the eye. In a normal eye, light is focused by the cornea (the clear window at the front of the eye) and the lens to form a sharp image on the retina at the back of the eye. As we get older, the lens can develop cloudy patches, which initially result in blurry vision (even when wearing the correct spectacles), and eventually can lead to sight loss.

 

There are different types of cataracts:

Age-related cataract

This affects older people and is by far the most common form of cataracts. In the UK, about 1 in 3 people over the age of 65 has a cataract, with men and women being equally affected. Often both eyes are impacted, although one eye may be worse than the other. Age-related cataracts often form gradually over many years. As the effects are gradual, many people with an early stage cataract do not realise. Cataracts become progressively worse however and can eventually result in total vision loss.

It isn’t known why cataracts are more likely to appear as we get older. However, some factors may increase your risk:

  • Smoking
  • Diabetes
  • A family history of cataracts
  • Drinking too much alcohol
  • Long-term steroid use

Congenital cataracts (present at birth)

These are uncommon but it is important they are diagnosed early, as vision is learned very early in infancy. A congenital cataract stops the eye from learning to see and can cause blindness that persists even once the cataract has been removed. As such, it is vital for congenital cataracts to be removed as soon as possible after birth.

Other types of cataracts

Other uncommon causes of cataracts can stem from an injury to an eye, or as a result of radiation exposure. Cataracts can sometimes develop as a secondary problem for people with conditions such as diabetes.

When you first develop cataracts, you may notice your vision is a little blurred. With time, you may notice further symptoms, such as:

  • Distortion in your vision
  • Lights feel too bright
  • Seeing halos around bright lights – e.g. streetlights
  • Double vision
  • Not being able to see as well in brightly lit rooms or in sunshine
  • Poor night vision
  • Colours appear faded

Cataracts cannot be treated with medicines, eye drops or lasers. The only way to treat cataracts is with surgery. Around 300,000 cataract operations are performed in the UK each year. The operation involves removing the cloudy lens and replacing it with an artificial plastic lens or intraocular implant. This routine operation usually takes 30-45minutes and is performed under local anaesthetic as a day case, meaning you can be treated and go home the same day.

Before

A cataract is normally easily detectable during a routine eye examination. Indeed, a cataract may be diagnosed during a routine eye check even before you have noticed a problem with vision.

Early cataracts may not cause any noticeable problems with your vision. However, the rate they develop will vary from person to person. In the early stages, stronger glasses and brighter reading lights should help. However, the only effective treatment for cataracts is replacing the cloudy lens with a clear one.

Consultation

If your optician has diagnosed cataracts, they will recommend you see an ophthalmologist (eye specialist) for further tests and treatment. At St John & St Elizabeth Hospital, we have an excellent eye clinic with a number of expert ophthalmologists. If you would like your cataracts treated, book an initial consultation with one of our ophthalmologists or ask your optician for a referral.

At your appointment, the specialist will ask you about your symptoms and medical history and conduct a comprehensive examination of your eyes. During the appointment, they will also take different measurements of your eyes and your eyesight. This helps determine the right type of lens implant for you. If cataract surgery is recommended, the specialist will explain the risks and benefits of surgery so you can make an informed decision. You can also discuss your lens preference, such as near sight or long sight, if you will need glasses after surgery and how long your recovery will take.

Good to know

If you have private cataracts surgery, you will be able to choose either a multifocal or an accommodating lens (rather than a monofocal lens), which will allow your eye to focus on both near and distant objects.

Pre-Assessment

Before surgery, you will need to have a pre-assessment, which is a ‘fitness for surgery’ check. This generally includes urine and blood tests. It’s also a good opportunity to ask any questions you may have.

Surgery day

Cataracts surgery is a day-patient procedure, which means you can be treated and go home the same day. The procedure is usually performed under local anaesthetic, so you will be awake but will feel no pain. You may also be given sedation to help you relax. If you are having sedation, you will need to stop eating six hours before surgery and stop drinking two hours before (including water). From two hours before, you should also not chew gum or suck hard sweets. If you are just having local anaesthetic, you do not need to fast.

On surgery day, do not wear any facial make-up or contact lenses, wear loose, comfortable clothes, and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications.

Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.

Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.

During

Typically, cataracts surgery is done on one eye at a time, 6 to 12 weeks apart. This allows the recovery of the eye before operating on the next one. The operation is performed with a microscope through a very small opening in the eye. Once the eye is numb, the surgeon makes a tiny hole in the front of the eye at the edge of the cornea. A tiny thin instrument is then pushed into the lens through the front part of the lens capsule. Ultrasound waves are emitted to break up the contents of the lens within the lens capsule and the contents of the lens are removed by suction. Once removed, a clear plastic lens is inserted in its place.

After

Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. Our nursing team will monitor your vital signs, such as blood pressure and oxygen levels, to make sure your recovery is going to plan. Your eye will be firmly padded and will feel uncomfortable when the anaesthetic wears off. Don’t worry as we will give you pain relief to help with the discomfort. You should be able to leave hospital the same day – please ask a friend or relative to collect you as you will not be able to drive.

You can remove the eye pad the day after surgery. You should expect to experience a dry-eye sensation and itchiness for a few days after the operation. Avoid rubbing your eye though as it will be very sensitive. Your vision will also be quite blurry for a few days as your eye heals. To ensure a good outcome, you should use the eye drops and any prescription medications your eye doctor has given you and avoid strenuous activities, heavy lifting, or bending over during the initial recovery period to prevent any complications.

Within a few days, you should already notice that your vision is clearer and colours are brighter. It may take some time for your eyes to adjust to your new lens, but you will notice your vision quality continues to improve over the next few weeks. Full recovery from cataract surgery can take around 4 -6 weeks.

Your surgeon will schedule follow-up appointments to monitor your progress and address any concerns.

Whilst rare, there is a small risk of infection, and it’s essential to report any signs of infection (redness, pain, increased swelling) promptly. Some mild discomfort and swelling is normal, but severe pain or a sudden decrease in vision should be reported to your doctor immediately.

Depending on your healing process and your surgeon’s recommendation, you will be able to resume driving and other normal activities within a few days to a few weeks.

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.