What is a cataract?
A cataract is a clouding of the natural lens of the eye, which can cause your vision to get dimmer and more blurry, with washed out colours. Cataracts can also cause glare, for example from car headlights.
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Over time, cataracts tend to get worse, eventually blocking vision if left untreated.
What does cataract surgery involve?
Cataract surgery is a keyhole operation, using ultrasound to break up and remove the cataract before replacing it with a new lens.
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There is a light above you, which often becomes a kaleidoscope of colours during the surgery, which is typically painless, lasting around 10-15 minutes.
What is a cataract
A cataract is a clouding of the natural lens of the eye. This is very common as we grow older, and tends to get progressively worse with time. Some factors can cause cataracts to develop more quickly, such as diabetes, steroid medications, and previous injury to the eye.
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As the cataract progresses, it can cause the vision to get dimmer and more blurry, and can cause colours to become washed out. People often notice glare, for example from car headlights when driving at night. Cataracts can also cause your glasses prescription to change more quickly than normal.
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There is currently no medication that can reverse cataract formation, but cataracts can be effectively treated with surgery.
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What does cataract surgery involve?
Cataract surgery is a quick and typically painless procedure, generally lasting around 10-15 minutes.
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You would lie comfortably on an adjustable bed, and eye drops are used to numb your eye. Some antiseptic is used to sterilise the eye and lids, and a drape is placed over the area with a support to keep it away from your nose and mouth.
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There will be a light above you, and you will feel some cool water around the eye and cheek from time to time during the surgery. The light often takes on a kaleidoscope effect, which some patients find quite beautiful.
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Ultrasound is used to break up the cataract and remove it through a small opening in the clear part of the eye. The same small opening is used to insert the replacement lens, which then unfolds inside the eye.
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After the surgery, your eye will be covered with a protective shield, and our nursing team will explain the recovery process, including instilling eye drops (typically for around 4 weeks).
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You will need to lie relatively still during the procedure, and so we take time to ensure you are comfortable before we start. It is natural to feel slightly nervous before any procedure, and our friendly team will try to make you feel as relaxed as possible. If you are feeling particularly anxious it is possible to give you some sedation to help with this. It is also possible to undertake the surgery under a general anaesthetic (completely asleep), but this is rarely necessary.
Is cataract surgery safe?
Cataract surgery is the most commonly undertaken operation in the UK. The vast majority of patients get a good outcome following cataract surgery, but like any operation there are risks involved.
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Some patients have more inflammation than normal after cataract surgery, develop fluid at the back of the eye, or get high pressure inside the eye. These issues are usually treated with eye drops.
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Occasionally a hole or tear develops in the capsule that holds the lens (posterior capsule rupture), and this can lead to vitreous gel from the back of the eye coming forward, which can cause further problems. Across the UK, this occurs in around 1 in 100 cases, but occurs much less frequently in experienced hands (currently around 1 in 300 cases carried out by Robert Peden). If this occurs, your operation will take longer, the eye will take longer to recover, and in some cases you may need further surgery. Most patients who develop a posterior capsule rupture end up with a good final result.
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Rarely, more serious complications can develop, including retinal detachment, a bleed inside the eye, or infection inside the eye. Although rare, these can lead to a permanent reduction in or even loss of vision, and so every precaution is undertaken to reduce the chance of these occurring.
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Other possible complications include an unexpected glasses prescription (more common if you have had previous laser eye surgery), a droopy upper lid, a hazy cornea, change in the shape or size of the pupil, and double vision.
Lens implants
Monofocal lenses
Monofocal lenses have a single focal point for clear vision, usually set to be clear in the distance. This means that you will need glasses for closer activities such as reading, and may need glasses for intermediate vision such as computers work.
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These are the lenses typically used for cataract surgery in the NHS, and can be a good option for those who don't mind wearing glasses (for example those who are used to using varifocals).
Toric lenses
Toric lenses are designed for those who have astigmatism (where the eye is more rugby ball-shaped rather than football-shaped).
Toric lenses can significantly reduce your astigmatism, and can be monofocal, enhanced monofocal/extended depth of focus or trifocal.
Enhanced monofocal & extended depth of focus lenses
Enhanced monofocal/extended depth of focus lenses provide a greater range of clear vision after cataract surgery compared with monofocal lenses, without compromising the quality of your vision.
They are very effective at providing good distance and intermediate vision without glasses, and can be combined with monovision to reduce reliance on glasses for reading.
Trifocal/multifocal lenses
Trifocal/multifocal lenses have three distinct focal points for distance, intermediate and near vision. They give the highest chance of being completely independent of glasses for distance, intermediate and near vision. However, there are several compromises with trifocal lenses, including a significantly increased risk of glare and halos, reduced night vision and reduced contrast. Trifocal lenses also transmit less light to the back of the eye (around 89% of light transmitted). They are generally not suitable if there are other eye conditions present.
Monovision
Monovision is a surgical strategy where one eye (your dominant eye) is given a lens to aim to be clear in the distance, and your other eye is given a lens for nearer tasks.
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It is particularly effective with enhanced monofocal/extended depth of focus lenses, giving a smoother transition across the range of your vision as well as sharp intermediate vision.
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With this strategy many patients find they have little or no need to use glasses for most day to day tasks.
YAG laser capsulotomy
During cataract surgery, the new lens is placed inside the natural lens capsule, which helps to keep it stable and well-centred. Over time, in some patients the capsule can become hazy (called posterior capsular opacification, or PCO), which can lead to blurring of your vision. This is more common with older styles of lens implants, and can happen years after the original surgery.
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Thankfully, if this occurs it is possible to create an opening in the capsule using a laser to allow light to pass through, restoring clear vision. This procedure is called a YAG laser capsulotomy, and is typically quick, painless and effective. It can be carried out in a laser treatment room as an outpatient.
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Robert Peden is happy to provide this procedure regardless of where your original cataract surgery was undertaken.
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