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Frequent questions

Cataract surgery has the potential to greatly improve the quality of life so it is important not to delay having the operation for inappropriate reasons.

Modern cataract surgery has an overall success rate of around 98%. The wonderful improvements in the operation which have been made over the last 20 years have made it possible for far more people to undergo safe surgery. It is no longer necessary to spend long periods convalescing after the operation and the likelihood of complications is now lower than ever before

In some people it can take years before the cataract is bad enough to need an operation, whilst others can go almost completely blind in six months. In patients who are young or have diabetes, cataracts usually progress more quickly. It is difficult to predict how fast the progression will be in a particular person.

No, the cataract cannot regrow. However, occasionally the posterior capsule behind the new lens implant becomes opaque and needs to be divided with the YAG laser. This also only occurs once, so you will not need to have this done again.

There is no set interval between operations. Sometimes the second operation is done a few days later and in other cases it is several years. The only thing that is definite is that two eyes are not done at the same.

When your cataract is removed it is replaced with a small clear plastic lens , without which you would need extremely strong glasses to focus. So all patients receive this plastic lens implant known as an intraocular lens or IOL. Usually the IOL is in focus for distance. However if you want to use reading glasses less, you may have the IOL for close focus, have one eye each for far and near (monovision) or have trifocal lens implants in each eye.

The most common type of cataract surgery, known as “phacoemulsification”, or phaco for short, uses ultrasound to break up the cataract into a fine powder called “emulsificate”. This is flushed out of the eye with a special fluid (BSS). An intraocular lens (IOL) is then inserted to where the cataract previously existed within the eye. Almost all patients do think their surgery was performed using a laser. This was very popular perhaps 5 years ago. However the long terms studies now available have not found enough advantage to justify the significant additional cost of a laser procedure due to the high purchase, use and maintenance costs of the laser.

There are several ways to answer this. Essentially cataract surgery, in improving vision, will improve depth perception. It has been shown in published studies that having cataract increases the risk of falls whilst having cataract surgery decreases the risk of falls. So this is all good. If you wear very thick or strong prescription glasses however, cataract surgery in one eye only may increase the difference in prescription between the operated and non-operated eye, decreasing depth perception

Blurred vision can result from several factors depending on when you are experiencing blur:

  • In the first few days post cataract surgery is usually due to pupil dilation and some settling of the eye.
  • In the first week or so may be due to corneal swelling, usually after surgery on a denser cataract in an eye that had poorer vision prior to surgery. This almost always slowly resolves over weeks.
  • At 5-6 weeks post surgery may be due to retinal swelling, which is the most common problem after cataract surgery and can almost always be treated successfully with drops.
  • Long term blur - residual refractive error ie need for spectacle prescription. This may be expected, for example blurred vision for close work if you have opted for distance vision in that eye, or vice versa. Or it may be residual astigmatism. Rarely blur may be due to the predicted lens implant not being ideal strength for your eye.

Glare symptoms prior to cataract surgery is usually due to the cataract itself. Cataract surgery therefore usually decreases glare. Causes of postoperative glare include

  • A dilated pupil in the first few days following cataract surgery, glare can be significant and will decrease as the pupil comes back to its normal size.
  • Longer term glare can be present even after cataract surgery and tends to decrease over time.
  • Glare can be seen with multifocal lenses and even non-multifocal lenses. After cataract surgery with multifocal lenses some patients may even need a pair of glasses at night and/or for reading to achieve best vision. The duration of these symptoms can vary greatly depending on each patient’s unique circumstance.
  • Very rarely patients can have a long term increase in glare, as each eye is different, and whilst modern lens implants used for focus for clear vision after the cataract is removed are of a very high standard, none is good as the clear natural crystalline lens you were born with.

Routine blood tests, ECG and other tests are not needed prior to cataract surgery. You do not need to stop any medication except for diabetic tablets and insulin for which specific instructions are given. As we use topical (no eye injection) anaesthesia you do not need to stop blood thinning, anticoagulant, antiplatelet drops or aspirin.

Poor balance can be a result of many factors including muscles, joints, bones, cardiovascular and nervous systems, as well as just a lack of confidence. However the research does show that having cataracts increases the risk of falls and that having cataracts removed with cataract surgery does decrease the risk of falls again. This may be related to vision, depth perception and balance.

Firstly, we take many measurements of the dimensions of your eye, using a device called a “biometer”. Your spectacle or contact lens prescription is NOT used. The measurements taken are placed into mathematical formulae that estimate the correct lens implant power for your eye and your preferred pattern of spectacle use after cataract surgery. Note that this process is an estimation, and some patients will always end up with a need for a different spectacle prescription after cataract surgery than that intended as all eyes are built a little differently. This can be fixed with laser vision correction or a secondary lens implant.

Your cataract surgeon or eye doctor should be able to tell you what percentage of their outcomes are close (within +/- 0.5 D) of targeted outcome, and ideally can provide laser vision correction options as well as secondary lens implant options if you are not happy with the prescription outcome from your cataract surgery.

The main risk is decreasing vision with increasing cataract density. Reduction in vision has been proven to affect quality of life. Activities of daily living can become more difficult, driving at night or seeing road signs may become more difficult, and specific vision for specific sports such as bowls or golf more difficult. Socialisation and mental health can be affected through inability to recognise faces and to mobilise. There is a proven increase risk of falls.

Very rarely, if the cataract progresses far enough it may cause angle closure glaucoma or at end stage intraocular inflammation.

There are also increased risks of surgical complication if the cataract is left to the point where a severe reduction in vision due to cataract is present.

  • Number one is to not smoke.
  • Number two is to minimize ultraviolet light exposure to your eyes using UV blocking sunglasses.
  • Number three is a Mediterranean style diet that is also good to reduce the risk of macular degeneration.
  • Number four is preventing diabetes.

Many cataracts do just occur with time and age. Whilst there are many causes of cataract, advancing age is the most common.

There is no actual proof that antibiotic drops do reduce the risk of infection after cataract surgery. Some surgeons therefore do not use them, particularly if antibiotics have been placed in your eye (“intracameral”) at the end of your cataract surgery. Most cataract surgeons however do prescribe antibiotic drops for their patients after cataract surgery. If so they should usually be prescribed for two weeks, as the most common time for a postoperative infection to occur to the eye is at 10 days most operatively.

Yes, unless there are any other reasons you should have one not relating to your eyes. The lens implant placed in your eye after your cataract is removed is made of plastic and not affected by the magnetic field of an MRI.

There is no evidence this is the case.

There are no currently available drops that do this, though much research is underway. The confusion may arise because dogs have a condition called band keratopathy that looks like cataract. Band keratopathy can be fixed with eye drops. However band keratopathy is on the outside of the eye, and is not cataract which is inside the eye behind the pupil in humans and dogs!