Consenting to a Cataract Operation
Date issued: June 2023
Review date: June 2025
Ref: A-577/KFA/Ophthalmology/Consenting to a Cataract Operation
PDF: Consenting to a Cataract Operation final June 2023.pdf[pdf] 171KB
Introduction
This leaflet gives you information that will help you decide whether to have cataract surgery. You might want to discuss it with a relative or carer. Before you have the operation you will be asked to sign a consent form. It is important that you understand the leaflet before you decide to have surgery. If you have any questions, write them down on the back of this leaflet to ask one of the hospital staff.
What is a cataract?
The lens in your eye has become cloudy causing your vision to become less clear. The cloudy lens is called a cataract. A cataract cannot be made clear again with tablets, drops or laser.
It can only be removed with an operation.
Your eye surgeon has recommended cataract surgery because it is difficult for you to see well enough to carry out your usual daily activities. If the cataract is not remove now, your vision will gradually worsen. You are free to choose whether or not to have the operation. Waiting until your vision gets worse is usually quite safe. Waiting does not make the operation significantly more difficult, unless your eyesight becomes so poor that all you can see is light and dark.
The cataract operation
The operation is done to replace the cataract with a plastic lens (implant) inside your eye. An experienced eye surgeon will carry out the operation or may supervise a doctor in training who also performs some operations. You will be given a local anaesthetic, which means that you will be awake during the operation, though in exceptional circumstances a general anaesthetic can be given. You will not be able to see what is happening but you will be aware of a bright light, colours and movement.
Just before the operation, you will be given eye drops to enlarge the pupil. You will be given a local anaesthetic to numb the eye either with eye drops or by injection of anaesthetic around the eye. The operation normally takes 10 - 20 minutes, but may take up to 45 minutes. During the operation you will be asked to keep your head still, and lie as flat as possible. You may be asked to look straight at the light to keep your eyes still. Do not worry about blinking as a special clip is used to keep your eye open during the operation. A nurse will hold your hand the whole time to make sure that you are all right. If there is a problem let the nurse know by squeezing their hand.
Most cataracts are removed by technique called phacoemulsification. The surgeon makes a very small cut into the eye, softens the lens with sound waves and removes it through a small tube. The bag that used to hold the lens (lens capsule) is left behind. An artificial lens (implant) is put into the bag to replace the cataract. The entry cut usually seals itself, but sometimes a small stitch is put in to close it.
At the end of the operation, a pad or shield may be put over your eye to protect it.
What is a lens implant and how long does it last?
Once your cataract has been removed, your eye must be helped to focus by a replacement plastic lens implanted into the eye at the time of the operation. Most patients now receive a lens implant. Rarely, complications at the time of the operation make it unsafe to put an implant in. Implants usually last a lifetime.
Very rarely an implant can become cloudy and need replacement. You will need to be retested for new glasses after the operation to get the clearest vision, especially for reading.
Will I stay in the hospital?
Most cataract operations are done as day cases meaning that you go home the same day. You will not usually be asked to return the following day to have the pad removed and the eye examined. You will be instructed on when to remove the eye pad and on post-operative eye care.
After the operation
If you have discomfort after the operation, take a pain reliever such as Paracetamol every 4-6 hours (not aspirin as this can cause bleeding). It is normal to feel itching or have slightly sticky eyelids and mild discomfort for a short while after cataract surgery. Some fluid discharge is also common. After 1-2 days mild discomfort should disappear. In most cases, healing will take 2-6 weeks after which your optician can prescribe new glasses.
You should protect your operated eye from any accidental pokes or rubs, which might open the cut, especially for the first few weeks. The eye takes months to heal strongly. You should use the eye drops prescribed according to the instructions given. The hospital staff will explain how and when to use them. They are normally used for about a month. The drops help to settle the eye more quickly and prevent infection. Strenuous exercise and sports should be avoided for two weeks. Use your operated eye as much as feels comfortable.
Certain symptoms could mean that you need prompt treatment. Please contact the hospital immediately if you have any of the following symptoms:
Excessive pain or sensitivity to light reduction or loss of vision
Increasing redness or stickiness of the eye
Likelihood of better vision
After the operation you may read or watch TV almost straight away, but your vision may be blurred. 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. You may not get the best vision until you get your new glasses.
The vast majority of patients have improved eyesight following cataract surgery.
If you have another condition such as diabetes, glaucoma or ageing of the retina (macular degeneration) your vision may still be limited even after successful cataract surgery.
Benefits and risks of cataract surgery
The most obvious benefits are clearer vision, reduction of glare and improved colour vision. Because lens implants are selected to compensate for existing focusing problems, most people find that their eyesight improves considerably after surgery. Most people will need to replace their glasses once the eye has settled. However, you should be aware that there is a small risk of complications, either during or after the operation.
Complications
Complications are unusual and in most cases can be treated effectively. In a small proportion of cases, further surgery may be needed. Very rarely some complications can result in blindness or loss of the eye.
Some possible complications during the operation
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Tearing of the back part of the lens capsule with disturbance of the gel (vitreous) inside the eye that may sometimes result in reduced vision. [1 in 100]
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Loss of all or part of the cataract into the back of the eye,
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needing a further operation to remove it. [3 in 1000]
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Bleeding inside the eye. [1 in 1000]
Some possible complications after the operation
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The most common complication is called “posterior capsular opacification”. It may come on gradually after months or years when this happens the back part of the lens capsule (bag), which was left in the eye to support the implant, becomes cloudy. This scatters light causing glare and misting. To treat this, the eye specialist uses a laser beam to make a small opening in the cloudy capsule to improve the eyesight. This is a painless outpatient procedure which takes only a few minutes.[≤ 1 in 20]
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Bruising of the eye or eyelids.
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Clouding of the cornea.
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Transient high pressure inside the eye. [≤ 1 in 20]
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Allergy to the medication used (redness and itching).
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Drooping of the upper eyelid (ptosis).
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Detached retina which can lead to loss of sight. [1 in 100]
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Incorrect strength or positioning of the lens implant.[<1 in 100]
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Late clouding of the lens implant. [<1 in 1000]
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Swelling of the retina (macular oedema). [1– 160 in 1000]
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Infection in the eye (endophthalmitis) [1 in 1000] which can
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lead to loss of sight or even loss of the eye [1 in 10,000].
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Inflammation which could affect vision in both eyes (sympathetic ophthalmia) [< 1 in 10,000]
What's next? How soon will I have my operation?
Your surgeon will tell you if you are on the waiting list. You will receive, or have now received a pre-admission clinic appointment. At this visit a nurse or doctor will again explain the details of the planned cataract operation to you. You will have the chance to ask any questions. It is helpful to write a short list of anything you wish to ask.
Your eye will be measured for a suitable implant. Like contact lenses and “prescription” eyeglasses, lens implants differ in terms of power. The length and curvature of your eye will be measured and the proper implant power for your eye will be worked out on a computer using these measurements. You are also checked to ensure that you are fit for the operation.
Will both eyes be done together?
No, it is safer to have one cataract operation at a time. The worst eye is usually done first, leaving you free to use your better eye while the operated eye is padded. After some weeks, when the first eye has fully recovered, you may choose to have the second eye done if it also has a cataract.
Where can I find more information about cataract surgery? You will be able to obtain further information about cataracts and cataract surgery at the following websites:
NHS.net: https://www.nhs.uk/conditions/cataract-surgery/
RNIB: https://www.rnib.org.uk/your-eyes/eye-conditions-az/ cataracts/
We hope this information is enough to help you decide whether to go ahead with surgery.
Please use the space below to write down any further questions to ask the doctor or nurse when you come to the hospital for your appointment. Don't worry about asking questions, our staff will be happy to answer them.
