A cataract is a misting or clouding of the lens of the eye, and is something that most people over the age of 60 develop as an age-related process. Other causes include the previous use of steroids, trauma (e.g. accidental damage to the eye) or a medical condition such as diabetes.

The eye functions rather like a camera. There is a front clear window (the cornea) and a short distance behind this and the pupil, lies a structure called the lens. The lens is usually clear and helps to focus light onto the retina at the back of the eye. The retina corresponds to the film in a conventional camera, and is responsible for transmitting visual information to the brain via the optic nerve.

As we age, the lens loses clarity and less light is able to pass through it. This results in the visual effect of looking through frosted glass. The lens also loses the ability to focus light accurately on the retina.

A cataract causes a gradual and progressive blurring of vision. It can alter the focussing properties of the eye (requiring more frequent changes of spectacle lenses). A cataract can also cause glare around bright lights (e.g. around car headlights or streetlights). Sometimes people become aware of a change in colour appreciation, or that things start to appear rather dull. Patients often comment that everything appears much brighter and sharper after cataract surgery and that colours appear much more vivid.

Your optician is qualified to detect signs of cataract. This may be discovered during your routine annual eye examination, or if you attend specifically because you have noticed the symptoms described above.

Opticians often refer patients directly to an ophthalmologist (ophthalmic surgeon or eye surgeon). It is not necessary to see your GP although your GP is kept fully informed.

The diagnosis of a cataract does not always mean that surgical treatment is required, but advice should be sought if you are experiencing any of the symptoms described above. If you wish to have cataract surgery or it is required e.g. because you are no longer meeting the legal visual standard required for driving, one of Face & Eye’sveryexperiencedConsultant Ophthalmic Surgeons will remove the cataract and replace it with a clear foldable plastic lens (an intraocular lens or IOL). This operation, when performed by an experienced surgeon, is relatively quick and usually very successful in restoring vision. This is one of the most frequently performed operations in the U.K. Most such operations are performed under local anaesthesia or with “twilight anaesthesia” (local anaesthesia with sedation provided by an anaesthetist).

How do I know if I have a cataract?

Cataracts cause a gradual and progressive blurring of vision. They can alter the focussing properties of the eye (requiring more frequent changes of spectacles) and also cause glare around bright lights (e.g. car headlights or the setting sun). Sometimes people notice a change in colour appreciation, or that things appear less bright. Your optician is usually best placed to detect signs of cataract. This may be during your routine annual eye examination, or if you attend specifically because you have noticed the symptoms described above.

Cataracts do not always require treatment, but advice should be sought if you are experiencing any of the symptoms described above.

When is a cataract treated?

If the cataract has progressed to the point where it is interfering with your vision, then surgical removal may be advised. Cataracts do not need to have progressed to a particular level of “maturity” before surgery is indicated. Modern techniques allow us to operate as soon as the cataract is impairing your vision to a level where it is affecting your lifestyle. Sometimes your vision may be reduced to the point that it no longer meets the legal standards for driving, and therefore surgery may be required.

Can cataracts be prevented?

There is no proven method for preventing cataract development and no proven treatment other than surgery. However, as cataracts frequently develop with age, it is important to have regular eye examinations, as we get older. This should be done preferably through a dilated pupil every 1 – 2 years.

Your optometrist or eye surgeon may also be able to detect signs of other conditions such as glaucoma and age-related macular degeneration.

How long will the surgery take?

The operation itself will take up to 10-30 minutes depending on the complexity of the case. However you may need to be in the clinic for up to 3-4 hours. You will need someone to collect you following the operation.

What happens after the operation?

After the operation you will rest for a while and have refreshments. You will be given a dressing pack to swab the eye clean the following day, and some antibiotic and anti-inflammatory eye drops to apply at home after the surgery, for a couple of weeks.

How quickly will my vision be restored?

Your vision will be blurred for a few days while your eye heals. It is usual to feel some discomfort until your eye settles but there should be no pain. Any discomfort can be relieved by taking paracetamol. After a couple of days you will start to notice a significant improvement in your vision. You will see the surgeon again after 1-2 weeks and will visit your optometrist for new glasses after 4-6 weeks. You can quickly return to many everyday activities, although heavy lifting or other strenuous activities should be avoided for at least a week. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your surgeon or optometrist when you can resume driving.

What will my vision be like after my eye has healed?

Once you have been given your new glasses, you may notice that everything seems a lot brighter than you remember. Colours may be sharper and may have a blue-ish tinge. Or, in bright sunlight you may feel you are looking through rose-coloured glasses. These colour tinges are normal and are because you are now looking at the world through a clear lens that is no longer cloudy. Within a few months your brain will get used to your new clear vision and these colours should go away.

Can I have both eyes done at once?

If you have cataracts in both eyes, the surgeon will not usually remove them both at the same time. You will usually need to have each done separately, although they can both generally be done within about 2-6 weeks of each other. You should discuss this with your surgeon.

What are the risks of cataract surgery?

Your Consultant has performed thousands of cataract operations. Face & Eye ensures that the technology and products used for the surgery are of the highest standards available.

Although the vast majority of patients achieve excellent results without complications, it should not be forgotten that cataract removal is a surgical procedure. As with all forms of eye surgery, cataract removal has risks and whilst we make every effort to minimise them they cannot be totally eliminated.

The most common and potentially serious risks associated with the cataract operation are:

• Retinal Detachment – this occurs when the retina detaches from its normal position and can result in severe loss of vision if surgical correction is not successful. The approximate risk of a retinal detachment in the general population is 0.01 % per year. Someone who is hyperopic has a smaller risk than this, whereas a myopic (short-sighted) patient has a slightly higher risk than this.

• Infection – every time there is an incision made in an eye for any reason it is possible to get an infection inside the eye which has the potential to cause severe visual loss. This problem is extremely rare and our rate of endophthalmitis is less than 0.1%. After the cataract operation, to help protect against infection, eye-drops are prescribed which must be used as directed.

• Bleeding – there is a small risk of a serious peri-operative bleed either in the orbit, or within the eye.

• Macular Oedema – is an accumulation of fluid at the central retina which can cause temporary or permanent reduction in vision after surgery. The postoperative eye-drops also help to reduce this risk.

• Floaters – are often noticeable immediately after surgery but usually become less noticeable with time.
• Posterior Capsule Opacification (PCO) – is thickening of the residual lens membrane which supports the lens implant. Approximately 25% of patients will, at some stage, notice a reduction in their vision due to PCO. It may occur months or even years after surgery and is easily and quickly dealt with by outpatient laser treatment using a YAG laser (this is known as a YAG laser capsulotomy).

Mr Ikram performing a YAG laser capsolotomy

• A refractive “surprise”. This refers to an unexpected optical/focussing error following the surgery. Prior to surgery you will undergo a test referred to as biometry. This uses a computerized optical device that takes several measurements of your eye to determine the correct power of intraocular lens required. These measurements are very accurate but occasionally the lens selected does not provide the desired visual outcome. This might require spectacles/contact lesnes to improve the focussing, further surgery to exchange the lens or corneal laser surgery to correct the error.

• Other possible complications include tearing of the lens capsule (<1%) which could mean that it is more difficult to implant an intraocular lens. There are other extremely rare complications which your surgeon can discuss with you prior to surgery.

How long does the implant last?

The lens implants we use are usually left in place for life.

Can a cataract come back?

Once you have a replacement lens implant (intra-ocular lens or IOL as it is called) you cannot develop another cataract in that eye. However, it is quite common for the membrane that holds the lens in place to develop some cell re-growth in the first 18 months after surgery. Should this occur, it is easily and painlessly removed in seconds using a small laser beam in the surgeons consulting rooms. This technique is called a YAG laser capsulotomy and is a simple outpatient procedure.

Will I need a referral from my GP or optometrist?

Your GP or Optometrist can refer you for treatment. Once you have been referred you can call us to schedule your initial assessment appointment with your surgeon.

What does cataract surgery cost?

This depends on the the how this is undertaken and what type of intraocular lens is used.