Cataract Surgery Explained: Part 2

Cataract surgery is one of the most commonly performed and highly successful procedures in ophthalmology.

In part 2 of a series of articles on cataract surgery, Mr Venki Sundaram, leading consultant ophthalmologist, delves into the key aspects of cataract surgery, including the surgical process, risks and complications, and postoperative care.

Why choose private cataract surgery?

Cataract surgery is an operation with results that will last a lifetime. Therefore, choosing the right surgeon to meet your specific needs can be highly beneficial.

Private cataract surgery generally provides greater opportunities to discuss the procedure in detail with the specialist, address any concerns or questions about the operation, and choose from a range of lens implants offering a wider range of vision that aren’t available in the public sector.

In addition, you are likely to have more flexibility regarding the timing of your surgery and have the operation performed in a more private and comfortable setting. Additionally, your follow-up care will be with the surgeon who performed the operation, ensuring continuity and personalised care.

What to expect during cataract surgery

You will be asked to arrive at the hospital approximately 1 hour before your operation. It’s advisable to have someone accompany you, as you won’t be able to drive home after the procedure. You will then be taken to your room and have a tiny pellet inserted under your lower lid to dilate your pupil in preparation for the operation.

The operation normally takes 5-10 minutes and is performed under local anaesthetic eye drops whilst you lie on your back. A transparent sterile plastic drape covers the area around your eye. A small incision is made in the eye, the cloudy lens is removed, and then a new, clear artificial lens is inserted. During the surgery, you are likely to notice bright lights and feel some water on the eye. A plastic shield is placed over the eye at the end of the operation.

You will then be taken back to your room, where you will receive postoperative instructions and guidance on eye drop use. Normally, you can go home about 1 hour after your operation. You will also be given a follow-up appointment and advice on who to contact in case of an emergency.

Is cataract surgery safe?

Cataract surgery is one of the most common operations performed, and the procedure has advanced tremendously in recent years. The surgery today is usually performed under local anaesthetic as a day case. The operation typically takes 5-10mins, with vision restored and patients able to return to most normal activities with a few days.

Using micro-incisional techniques with advanced technology to remove the cloudy lens, the operation has a very high success rate. The chance of a serious complication that could result in significantly worse vision is less than 1 in 1,000. There is approximately a 1 in 100 risk of complications during the surgery, which means that it might take slightly longer for vision to be restored. The vast majority of patients are very satisfied with the outcome of the surgery and enjoy their improved vision.

What are the risks of cataract surgery?

Cataract surgery is a very safe and effective procedure that has restored and improved vision for millions of patients. However, as with all operations, there are some risks involved that patients need to consider.

There is a less than 1 in 1,000 risk of a serious complication, such as infection, bleeding in the eye, or retinal detachment. These can occur either during the surgery or shortly after. Treatments are normally available to treat these complications, but in very rare cases, vision can be significantly worse than before.

There is approximately a 1 in 100 risk of a complication during the operation, such as a lens capsule rupture. If this occurs, the operation may take a little longer to perform additional steps, and sometimes a different lens from the one originally planned may need to be used instead. In about 1 in 500 cases, it may not be possible to insert a lens or a second operation may be required.

Following the surgery, there is a 1 in 100 chance of developing swelling on the central retina (macular oedema) - this normally responds well to further eye drops. Some patients may experience some shadowing in their peripheral vision, but this usually resolves after a few months. Patients can also experience a gritty eye, but this typically improves after a few weeks.

There are various pre-existing eye conditions, such as diabetic retinopathy, macular degeneration, glaucoma, and corneal issues, which can impact the success of your surgery. Therefore, it’s essential to have a thorough assessment and discussion prior to surgery, so that any of these conditions can be identified and optimised to give you the best chance of visual success.

What is the recovery time after cataract surgery?

The day after cataract surgery, you are likely to experience some blurring of vision and mild discomfort/light sensitivity. Occasionally, vision can be very blurred, especially if your cataract was thick and more energy was required to remove the lens.

Over the next few days, your vision will gradually improve and should reach most of its improvement after a week. It can take up to 5 weeks for the eye to fully heal and for vision to stabilise, at which point you will have had your follow-up visit, and can then see your optician if necessary.

Are there any restrictions after cataract surgery?

Cataract surgery has developed tremendously over the last 50 years. Where patients once had to lie flat on their back for a week after surgery with sandbags to stabilise their head, nowadays patients are able to return to most activities within a few days. This significant change has occurred because, in the early days of the operation, a large (10mm) incision was needed to remove the lens from the eye. Today, with advanced technology and instruments, this can be achieved with 2mm incisions.

The following is guidance on common activities:

Avoid rubbing or pressing on your eye for 4 weeks.
You can return to normal activities around the house and in the kitchen the next day.
Light exercise, such as walking or picking up babies/young children, can be resumed the next day.
You can wash and shower from the next day, but try to avoid getting water directly in the eye.
Gentle exercises, such as yoga, Pilates, and light weights, can be resumed after 1 week.

Furthermore:

More intensive physical activities (running, cycling, golf) and gardening should be avoided for 2 weeks.
Swimming should be avoided for 4 weeks ideally, or after 2 weeks whilst keeping your head out of the water and wearing goggles.
You can go on a flight after 1 week, but it’s advisable to wait 2 weeks for long-haul flights.
General makeup can be applied the next day, but avoid eye makeup (mascara, eyeliner, or eyeshadow) for 2 weeks.
Driving can be resumed as soon as you feel comfortable and can see a car licence plate at 20m with either eye.

Mr Sundaram is a highly skilled and experienced leading consultant ophthalmic surgeon who has performed thousands of cataract operations, restoring and improving the sight of many patients over the last 20+ years.

To book an appointment with Mr Sundaram, head on over to his Top Doctors profile today.