Cataract Surgery

Cataracts are most commonly due to ageing, but may also occur due to trauma, radiation exposure, be present from birth, or occur following eye surgery for other problems. Diagnosis is by an eye examination.

What is a Cataract?

A cataract is a clouding of the lens in the eye leading to a decrease in vision. Prevention includes wearing sunglasses and not smoking. Early on, the symptoms may be improved with eyeglasses. If this does not help, surgery to remove the cloudy lens and replace it with an artificial lens is the only effective treatment, but surgery is only needed if the cataracts are causing problems. Surgery generally results in an improved quality of life.

Cataract removal can be performed at any stage and no longer requires ripening of the lens. Surgery is usually ‘day-case’ and performed using local anaesthesia. About 9/10 patients can achieve a corrected vision of 20/40 better after surgery, that is, the driving standard.

Phacoemulsification is the most widely used cataract surgery in the developed world. This procedure uses ultrasonic energy to emulsify the cataract lens.

Phacoemulsifcation typically comprises 6 steps, but every operation may vary slightly:

  • Anaesthetic: The eye is numbed with either an injection around the eye or using simple eye drops.
  • Corneal Incision: Two cuts are made through the clear cornea to allow insertion of instruments into the eye.
  • Capsulorhexis: A needle or small pair of forceps is used to create a circular hole in the capsule in which the lens sits.
  • Phacoemulsification: A handheld probe is used to break up and emulsify the lens into liquid using the energy of ultrasound waves. The resulting ‘emulsion’ is sucked away.
  • Irrigation and Aspiration: The cortex, which is the soft outer layer of the cataract, is aspirated or sucked away. Fluid removed is continually replaced with a salt solution.
  • Lens Insertion: A plastic, foldable lens is inserted into the capsular bag that formerly contained the natural lens. Some surgeons also inject an antibiotic into the eye to reduce the risk of infection. The final step is to inject salt water into the corneal wounds to cause the area to swell and seal the incision, but sometimes a stitch may be used.
What causes a cataract?

Cataracts can be caused by a number of things, but by far the most common reason is growing older. Most people over the age of 65 have some changes in their lens and most of us will develop a cataract in time. Apart from getting older, the other common causes of cataract include:

• diabetes
• trauma
• medications, such as steroids
• eye surgery for other eye conditions
• other eye conditions

What are the symptoms?

Cataracts usually develop slowly and although symptoms vary there are some symptoms that most people experience. Most people will eventually develop a cataract in both eyes, though one eye may be affected before the other. When your cataract starts to develop, you may feel your sight isn’t quite right. Gradually, you may find your sight becomes cloudier and more washed out.

Another common symptom of a cataract is bright lights affecting your vision. You may also notice a slight change in your colour vision – things may appear more yellow than before. This often happens if one eye develops a cataract first and colours look different when you compare one eye with the other.

If a cataract isn’t removed, your sight will become increasingly cloudy. Eventually, it will be like trying to see through a frosted window or a heavy net curtain or fog. Even if your cataract gets to this stage, it can still be removed and your sight may be the same or almost the same as it was before the cataract developed.

What are the treatment options?

The only effective treatment for cataracts is surgery to remove your cloudy lens and replace it with an artificial lens
implant. This is done by an ophthalmologist (eye specialist). Lasers aren’t used to remove cataracts and there is no evidence to suggest that changing your diet, taking vitamins or using eye drops can cure cataracts.

What does the operation involve?

Anaesthetic: The eye is numbed with either an injection around the eye or using simple eye drops.
Corneal Incision: Two cuts are made through the clear cornea to allow insertion of instruments into the eye.
Capsulorhexis: A needle or small pair of forceps is used to create a circular hole in the capsule in which the lens sits.
Phacoemulsification: A handheld probe is used to break up and emulsify the lens into liquid using the energy of ultrasound waves. The resulting ‘emulsion’ is sucked away.
Irrigation and Aspiration: The cortex, which is the soft outer layer of the cataract, is aspirated or sucked away. Fluid removed is continually replaced with a salt solution.
Lens Insertion: A plastic, foldable lens is inserted into the capsular bag that formerly contained the natural lens. Some surgeons also inject an antibiotic into the eye to reduce the risk of infection. The final step is to inject salt water into the corneal wounds to cause the area to swell and seal the incision, but sometimes a stitch may be used.

What to expect after surgery?

You will be able to go home about an hour after your operation. You should of course go straight home and please remember that you have had surgery on your eye and rest as much as possible that day. Put your feet up! You will be given eye drops to reduce the inflammation and prevent infection. Staff will explain how and when to use them. Your eye will be covered with a clear plastic shield when you go home.

Your eye may begin to feel sore once the local anaesthetic starts to wear off. Usually the pain is not too bad and you can take a painkiller tablet, such as paracetamol, to help.

The dressing, which is put on in the clinic, usually needs to stay on your eye overnight, but you should be able to take it off the following morning. Your eye may look red and you might develop some bruises but these will improve over the next few days.
The vast majority of patients have improved eyesight within days after cataract surgery. Sometimes the vision may vary in quality for four to six weeks; after which your optician can prescribe your new glasses, if needed.

What are the possible complications?

No human activity is risk-free. It is possible to be injured crossing a road or possible to choke on a fish bone whilst eating fish. Surgery is no exception. However, serious problems with cataract surgery are relatively uncommon and results very good. The chances of a technically successful operation are well above 98% and the chances of losing eyesight completely because of the surgery is much less than 0.1%, i.e. one in a thousand.

However, it is important to follow post-operative instructions carefully to avoid infection and you will be made aware of what to look out for. The most important thing to do is to hygienically apply eye-drops which will be given to you after the surgery.

As with any surgery, there are some risks to cataract surgery and potential for complications to arise. These are all rare but will be discussed with you at your initial appointment.

What our patients say

  • Wonderful service from an excellent team. Please keep up the good work. Many Thanks.

    Cataract surgery - January 2017
  • Really nice to have someone to hold my hand when I needed it. Very happy with the fast treatment.

    Cataract surgery - January 2017
  • The service I have received has been first class and the treatment successful (though it is only a few days since the operation).

    Cataract surgery - January 2017
  • The surgery had nothing unpleasant about it. Mr Comaish himself is a national treasure. I came home hugely satisfied with the whole experience.

    Cataract surgery - January 2017

Available at the following clinics:

  • Westbury
  • Chippenham

The following staff perform Cataract Surgery:

  • Mr Matthew Wakefield