Manchester Royal Eye Hospital

Cataract information leafletWhat you need to knowabout cataract surgeryCataract CentreWithington Community Hospital

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What is a cataract?The normal function of an eye lens is to focus light so that you can see clear, sharp images. When acataract occurs, the lens inside your eye becomescloudy making it difficult to see well enough to carry out your daily activities.

One or both eyes may be affected and contrary towhat you might have heard, a cataract is not a skinthat grows over your eye.

As the cataract develops, it gradually restricts theamount of light that is able to enter your eye, and youmay experience some or all of the following symptoms:

• Blurred vision• Colours seem faded• Frequent changes required to your

spectacle prescription• Visual problems with light, for example glare

or dazzle

Lens becomes cloudy(a cataract)

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What causes cataracts?Most cataracts are a natural result of ageing, but they may occur in younger people due to a variety of reasons including:

• Trauma or injury to the eye• Following other surgery to the eye• Diseases such as diabetes or glaucoma• After prolonged inflammation of the eye

There is also a tendency for cataracts to run in families

What is the treatment for cataracts?

Cataracts can take many years to develop. If thesymptoms of your cataract affect your day-to-dayactivities, you may consider an operation to removethe cataract and replace it with an artificial lensimplant. This will allow the light to pass through to the back of your eye again.

A cataract does not need to be fully developed before surgery however; surgery is only consideredwhen the reduction in your vision interferes with everyday activities.

There are occasions when an intra-ocular lens implantis not possible. In this case, contact lens or glasses willbe prescribed in order to correct your vision.

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The pre-assessment clinic

At this clinic, you will undergo all the tests necessaryfor the staff to gather the information needed foryour surgery to go ahead. It will also give you thechance to ask any questions or raise any concerns youhave. A Doctor and Nurse will explain the operationand what will happen afterwards. They will requireinformation on your previous medical and surgicalhistory and current medication. You can obtain a copy of this information from your GP.

At the clinic, you may have eye drops instilled to make your pupils larger. This may cause your vision to become blurred and increase your sensitivity tobright lights. You are advised not to drive for several hours after your appointment. You may wish to arrange for someone to accompany you. You willfind bright light uncomfortable and we advise you tobring a pair of sunglasses to your appointment to helpwith this.

A Doctor will assess the cataract and the generalhealth of your eyes. They will discuss the benefits and risks of surgery and take you through the consent procedure including signing the consent form.

A Nurse or Optometrist will measure the strength ofyour spectacles and the length and curvature of youreye(s). This information will be used to calculate thestrength of the artificial lens implant to be placed inyour eye once the cataract has been removed.

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These tests are not painful and the Nurse/Optometristwill explain what is happening at each stage.

Most patients have cataract surgery as a day caseprocedure however; there are a few situations where the Doctor would want you to stay in hospital overnight. You will be advised of this before your admission.

Please feel free to ask questions at any time.

On the day of surgery

The Cataract Centre is situated on the first floor ofWithington Community Hospital and is a mixed sexunit attending to both male and female patients. This means that there may be patients of the oppositesex to yourself in the department at the same time. If you feel strongly that you would like to be treatedin a single sex environment, please phone us on thenumber at the end of this booklet to discuss theoptions available. Two to five days before surgery a clerical officer/Nurse will telephone you to confirmthat you are able to attend as planned.

On your arrival

You will be greeted by a member staff who will check your name, date of birth, address and generalpractitioner (GP) details. You will then be directed tothe day surgery room.

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A friend or relative is welcome to wait with you duringyour stay in the unit but, as waiting space is limited,they may be asked to wait in an alternative area.

Before your operation

You should eat and drink as normal and take allprescribed medication as normal unless you have been advised differently.

It is advisable that you wash your hands and face witha bactericidal soap for 3 – 4 weeks prior to youroperation to reduce the risk of infection.

We recommend that you wash your hair and take abath/shower the evening before surgery. Please payparticular attention to ensure that your face andfinger nails are clean on the day of surgery. Eye makeup if worn should be removed the day before youroperation and definitely must not be worn on the day of surgery.

Please ensure that clean clothes are worn on the dayof surgery and that your footwear is also clean. Pleasebring with you on the day of surgery a pair of new orfreshly washed house slippers. We recommend thatyou wear a front opening shirt, blouse or dress foryour comfort and convenience.

This advice is not meant to offend you. It is essentialthat attention is paid to strict personal hygiene inorder to prevent and to help reduce the risk ofinfection on your behalf.

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In order to reduce the risk of infection further pleaseDo Not bring reusable handkerchiefs. Disposabletissues only are advised and these will be provided.

In order to reduce the risk of your operation beingcancelled due to a condition called blepharitis, which is a chronic inflammation affecting the edges of theeyelids leading to a build up of deposits on the skinand the eyelash margins, we would like you toperform the following lid hygiene for 4 weeks prior to your operation.

How to clean your eyelids using shampoo solution

• Wash your hands thoroughly before and aftercleaning your eyelids.

• Mix one teaspoonful of mild baby shampoo (anybrand) into a mug full of warm tap water.

• Use a clean face cloth and dip in the solution. Putthe cloth over your finger and gently scrub theedges of your eyelids and between your eyelashesto remove any crusting or scaly deposits.

• You must be careful not to touch your eye.

• Rinse your eyelids thoroughly after cleaning usingwarm tap water on a clean face cloth.

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A Nurse will show you into the main preoperativeroom as soon as possible, where you will be seated in a chair. A locker will be available for you to lock yourpersonal belongings or clothes.

A Nurse will identify himself or herself to you as yournamed Nurse and he/she will be responsible for yourcare during your stay in the unit. The Nurse will place a name band on your wrist or an identification onlabel on your clothing and check whether there havebeen any changes in your general health.

Your operation

A member of the nursing team will accompany you into the anaesthetic room where you will beintroduced to the theatre nursing staff. The theatreNurse will check your name and hospital number withyour case notes and assist you to get comfortable onthe theatre trolley.

There will be a Nurse with you throughout theoperation to make sure you are comfortable.

The operation is performed in the operating theatreand takes up to 30 minutes. During the operation, the cataract is removed and replaced by an artificiallens (implant). Most patients having their cataractremoved have the operation under local anaesthetic,using eye drops only or eye drops and an injection inthe skin around the eye.

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The injection will make the area around your eye gonumb. It also stops the muscles working so that youcannot open or close your eyelids. The feeling hasbeen described as similar to when you have had a localanaesthetic at the dentists. Your eye may remain numbfor 2-6 hours, which may affect your vision.

The most common way to remove the cataract is by atechnique called Phacoemulsification. A small incisionis made in the front of the eye and a probe is passedthrough the incision. The probe breaks the cataractinto very small pieces, which are then sucked outleaving the clear lens capsule.

A plastic lens is then folded and passed through theincision into the lens capsule where it unfolds to itsnormal shape. The small incision usually heals itself,although occasionally a stitch is required. After theoperation a pad or clear shield will be placed over your eye.

Immediately after the operation your eye may lookred. This is due to the local anaesthetic given at thestart of the operation and the antibiotic injectiongiven at the end of the operation. This redness isnormal and settles down over 4 weeks. Most patientsexperience little or no pain following the operation,except for a mild gritty sensation, which may occur,but this usually settles within 4-6 weeks.

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Following your operation

You will be transferred back to day surgery in yourchair. Altogether, following your operation, you will be asked to stay for a minimum of 15 minutes. You will be given an information leaflet instructingyou on the ‘dos and don’ts’ following your operation.It is advisable that you continue to use a bactericidalsoap for 3-4 weeks after your operation to wash yourhands and face.

General Information

• On the day of surgery, you will be given anappointment for your postoperative review. This will usually be 4 weeks after surgery butoccasionally you may need to return to the hospital earlier and on more than one occasion.You will be advised of this prior to your discharge.

• Paracetamol or your usual painkillers will relieveany mild discomfort during the first 24 hours aftersurgery. If your eye becomes very red and painful or your sight worsens after the operation, you mustcontact the hospital immediately. The numbers aregiven in the information leaflet that you willreceive following surgery.

• Your sight should improve almost immediately.About 4-8 weeks after your operation, your eyeswill be tested for new glasses. Reading glasses orbifocals are usually needed.

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• Talk to your ophthalmologist about returning towork and driving following your operation.

Risks associated with cataract surgeryComplications that may occur during surgery

Cataract surgery is a very common operation that has a very good success rate. Like any operation, there aresome risks involved. The cataract management teamwill take great care to limit the chance of theseproblems occurring. The commonest problem thatoccurs during cataract surgery is the lens capsule bag breaking.

In a recent national survey of modern cataract surgerythis occurred in about 4 patients out of every 100operated on. At the Manchester Royal Eye Hospital,this occurs less often: 2 out of every 100 operated on.

If the lens capsule bag breaks during the operationsome of the cataract may float into the jelly at theback of the eye, and you may need to have a second operation.

The lens capsule bag supports the new lens implant. If the bag breaks, a different type of lens implant may be used, and stitches may be required. If this isthe case, the operation will take a few minutes longer and your eye will take a few weeks longer to recover.However, the final visual result is usually the same.

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The most serious sight-threatening problem that canhappen during cataract surgery is internal bleedinginside the eye. Less than 1 patient in 1000 patientsoperated on will have this problem.

Complications that may occur shortly after surgery

The signs and symptoms of potential complicationsand the action you need to take will be explained to you during your visits to the hospital and inadditional information leaflets that you will receive.

A serious problem that can occur after the operation isa severe infection inside the eye. In order to preventthis happening antibiotic drops are normally givenafter the operation. Serious infections are rare,affecting 1 patient out of every 1000 operated on. If this complication does occur, it can result in the lossof sight.

Other less serious problems that can occur after theoperation are:

• Inflammation inside the eye

• A rise in pressure inside the eye

• A temporary clouding of the cornea (thetransparent window at the front of the eye).

These problems usually last only a few days andhappen to less than 1 patient in every 10 operated on and do not affect the final vision.

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Long term complications

A more common problem that may occur months oryears following the cataract operation is a clouding of the lens capsule bag behind the lens implant. The design of the modern lens implants reduces therisk of this happening however; if clouding does occur,it can be treated using a laser beam to make a hole inthe capsule. This is carried out during an out-patientappointment visit. The capsule still supports theimplant but allows light to pass through to the back of the eye again.

The above outlines the most common complicationsassociated with cataract surgery; however, this is notan exhaustive list. During your pre-assessment clinic,the staff will discuss with you the risks and benefits of your treatment.

If you do not understand any of the informationcontained in this leaflet or require further information,please speak to a member of the nursing or medicalteam when you come for your appointment.

If you have any questions or are worried about any ofthe information provided in this leaflet please contacta member of the cataract services team on 0161 217 3008 Monday – Friday 7.30 am – 4.30 pm.

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Questions and answers

If you have any questions you would like to ask theDoctor or Nurse but may not remember whilst you arehere, this space is for you to write them down with the answers.

References

1. Royal college of Ophthalmologists Annual report.Cataract surgery guidelines. February 2001.

2. Nambiar A; mahmood S; Fernando B; Mills KB.Audit of Cataract Surgery. Regional PostgraduateAudit meeting June 2002.

3. Essence of care – Hygiene 2006: Indicators for bestpractice. NHS Modernisation agency, Departmentof health.

4. Biswas S. 2005. Endophthalmitis risk reductionstrategy for cataract surgery.

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REH 001/06/2W Produced September 2010 Review Date September 2012 (SF Taylor CM5148)

www.cmft.nhs.uk© Copyright to Central Manchester University Hospitals NHS Foundation Trust

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