CATARACT SURGERY

Mr Edmunds is fully-trained in modern 'keyhole', micro-incisional cataract surgery (phacoemulsification), and provides a bespoke service to each individual patient.

Mr Edmunds has undertaken more than 3,000 cataract surgeries, with extremely low complication rates.

He continues to perform cataract surgery in his NHS practice in Worcestershire on a weekly basis, alongside his regular oculoplastic clinic and surgery commitments.

He will be able to tailor a treatment plan to your individual needs depending on your lifestyle, work and hobbies.

WHAT IS A CATARACT?

A cataract is cloudiness of the lens of one or both eyes. The lens is normally a clear structure located just behind the iris (the coloured part of the eye). The lens helps to focus light entering the eye on to the retina (the light sensitive layer at the back of the eye). If the lens becomes cloudy it can make it difficult to see. The cloudiness generally becomes worse over time.

Symptoms of cataracts include gradual reduction in vision, blurred and misty vision, glare (being dazzled by bright sunlight or car headlights at night). However, cataract does not typically cause pain or redness of the eyes.

Most cataracts develop with age, although they can be associated with diabetes, eye injury or inflammation, or the use of medications such as steroids. Rarely, babies are born with cataracts or children develop them while they are still young.

Cataracts are treated with surgery. This involves removing the cataract (cloudy lens) and replacing it with a new clear lens (intraocular lens implant or ‘IOL’).

WHEN IS CATARACT SURGERY RECOMMENDED?

Minor cloudiness of the lens is a normal part of ageing. Your optometrist may comment on the presence of a cataract in one or both eyes many years before any symptoms become apparent. When cataracts develop they generally get slowly worse over time. However, it is not necessary to have surgery if your vision is not significantly affected. Cataract surgery is recommended when your cataract is affecting your day-to-day activities or impeding your hobbies and the things that you like or need to do. For example, if you are a driver and your vision is approaching the legal requirement for driving.

If you do not have cataract surgery, the cataract will gradually get cloudier and your vision will gradually worsen. However this may take several years in some patients. It is safe to leave the cataract alone if it is not causing you any problems. You only need cataract surgery if you are having problems with your vision and you want to proceed with surgery.

WHAT DOES CATARACT SURGERY INVOLVE?

The purpose of the operation is to replace the cloudy lens with a clear artificial lens implant inside your eye. Cataract surgery is typically a day-case procedure under local anaesthetic. The local anaesthetic may be eye drops, although in many cases a local anaesthetic injection may be used. Surgery with sedation or under general anaesthetic can be discussed if this is important to you. With local anaesthetic you will be awake during the operation but you will not be able to see what is happening. Typically you will lie comfortably under a sterile cover and will only be aware of a bright light from the operating microscope the surgeon uses.

During the operation you will be asked to keep your head still, and lie as flat as possible. The operation normally takes 15-20 minutes, but in some cases may take up to 45 minutes. A nurse will hold your hand the whole time to make sure that you are feeling comfortable, but also to allow you to communicate with the surgeon. We generally ask you not to speak during the procedure.

Most cataracts are removed by a technique called phacoemulsification. A small incision (around 2.2mm) is made in the eye, the lens is broken up and removed. The back layer of the lens (the capsule or ‘bag’) is left behind. An artificial lens implant (intraocular lens implant or ‘IOL’) is then inserted into the bag to replace the cataract. These days, the majority of lenses are injected into the eye through the tiny incision. The lens implant then slowly opens up within the eye. In rare cases, a small stitch may be needed.

If you have cataracts in both eyes, this procedure will usually be carried out on separate occasions to each eye a few weeks apart. This gives the first eye time to heal and for your vision to return.

INSTRUCTIONS TO FOLLOW AFTER CATARACT SURGERY

You will normally be able to go home a few hours after having cataract surgery, although you will need to arrange for someone to collect you.

Take it easy for the first two or three days after the operation. If you have discomfort, a pain reliever such as Paracetamol every 4-6 hours is recommended. It is normal to have mild discomfort for a while after cataract surgery, although many patients are unaware of any unusual sensations at all. In the first few days after the operation your vision may be blurred. The eye is healing and will need time to adjust. However, you can still read or watch TV if you wish. In most cases, healing will take about four to six weeks, after which new glasses can be prescribed, if needed.

You will be given eye drops to reduce inflammation. Mr Edmunds will explain how and when to use them. You can carry on with most of your normal activities after cataract surgery. Please do not rub your eye, and avoid getting water into the eye in the weeks after surgery (e.g. avoid swimming). Certain symptoms could mean that you need prompt treatment. Please contact your surgeon immediately if you have any of the following symptoms:

Excessive pain
Worsening vision
Increasing redness of the eye

RESULTS OF CATARACT SURGERY

Most people will experience an improvement in their sight soon after cataract surgery, although your vision may be blurred for a few days. Please note that if you have another condition such as diabetes, glaucoma or age-related macular degeneration your quality of vision may still be limited even after successful surgery.

Eventually, you will usually be able to see things in focus (although glasses are often needed), look into lights without as much glare and tell the difference between colours, which will seem brighter.

Most people need to wear glasses for near or distance vision (or both) after cataract surgery. This is because most artificial lens implants cannot focus on a range of different distances. Normally, the surgeon will aim for more focused distance vision, with dependence on reading glasses for close-up work, although this depends on the strength of your glasses and individual circumstances.

Lens implants do exist that may increase the chances of both distance and reading vision without the need for spectacles. These are called multifocal lenses and can be discussed further with your surgeon. In addition, toric lenses may treat astigmatism, making vision without spectacles even clearer.

With glasses, most people have a good enough level of vision to be able to drive and carry out everyday activities without difficulty. Your vision may not be restored to normal if you also have another eye condition or in the rare event of a serious complication.

WHAT ARE THE RISKS OF CATARACT SURGERY?

The risk of serious complications as a result of cataract surgery is small.

Complications are rare and in most cases can be treated effectively. In a small proportion of cases, further surgery may be needed (the risk of this happening is approximately 1 in 300). Very rarely some complications can result in blindness. Overall the risk of severe loss of vision in the affected eye as a direct result of the operation is about 1 in 1000.

The most common complication is called 'posterior capsule opacification' (PCO). It may come on gradually after months or years. When this happens, the back part of the lens capsule, which was left in the eye to support the implant, becomes cloudy. This prevents light from reaching the retina clearly. To treat this, a laser beam is used to make a small opening in the cloudy membrane in order to improve the eyesight. This is a painless outpatient procedure, which normally takes only a few minutes to perform.

Other complications are much rarer and can include:

Tearing of the lens capsule (the "bag" that holds the lens in place) with disturbance of the gel inside the eye, which may sometimes result in reduced vision
All or a bit of the cataract dropping into the back of the eye
Inability to remove all of the cataract or insert a lens implant
Infection or bleeding in the eye

Other possible complications after the operation include:

Allergy to the medication used.
Bruising of the eye or eyelids
High pressure inside the eye
Clouding of the cornea
Incorrect strength or dislocation of the implant
Swelling of the retina (macular oedema)
Detached retina which can lead to loss of sight
Infection in the eye (endophthalmitis), which can potentially lead to loss of sight or even the eye

IMPORTANT POINTS TO CONSIDER BEFORE CATARACT SURGERY

Prior to cataract surgery you will need to see Mr Edmunds for an initial consultation when he will carry out a thorough examination and investigation of your cataract(s) and other eye health. For cataract assessments, it is very useful to bring your most recent refraction (optometrist report of your spectacle prescription).

If you have had previous eye surgery to correct short or long sightedness (for example, laser refractive surgery) then please bring details with you, particularly measurements and prescriptions before that operation.

Please note that Mr Edmunds will need to administer eye drops to dilate your pupils in order to evaluate the cataract(s). Your pupils will return to normal after a few hours but it does mean that you will not be able to drive for a few hours afterwards.

You will need to have biometry (your preoperative ocular measurements) performed. Measurements of your eyes need to be taken a few weeks prior to surgery so that Mr Edmunds can ascertain which new lens to insert.

Prior to biometry being done, you should cease any contact lens wear for 14 days in the case of hard or gas permeable lenses, or for 7 days if you wear soft contact lenses.