What is a cataract?

A cataract is a clouding or opacity of the lens inside the eye. When a cataract develops, the lens becomes cloudy and prevents any light from passing through. There are different kinds of cataract: congenital (present at birth), drug induced (steroids) and traumatic (injury to the eye). There is a clear link between some diseases and cataracts—like diabetes for example.

Most cataracts are age related and develop in later life, and can occur any time after the age of 40. As the normal aging process develops, the lens gradually becomes cloudy. However, children can develop cataracts although this is rare.

Symptoms

Cataracts can develop slowly over several years, causing a gradual blurring of vision which glasses correction cannot correct. Sometimes though, vision can deteriorate quickly. They can also cause glare, night time driving difficulty and multiple images in one eye. They do not spread from eye to eye, but can develop at the same time.

At first, you might not be aware of a cataract developing as it may not have caused a problem with your vision. However, eyes with cataracts can look normal but if it is advanced, your pupil (the black part of the eye) can look cloudy or white.

Treatment

In most cases, cataracts are harmless and can be left alone. These are called ‘early’ cataracts. When the cataract gets to the point where is has progressed enough to interfere with vision, then surgery is the next step. There is no known method to stop cataracts developing, but modern surgery is highly successful for the majority of patients but as with all surgery there are risks. We do not operate on both eyes at the same time—this is usually done over a 4 week period where:

· Week 1—first eye procedure

· Week 2—post operative follow up

· Week 3—second eye procedure

· Week 4—second post operative follow up

Before surgery

The majority of patients have cataract surgery under local anaesthetic, where your eye is completely numb and you are awake. However, should you choose a general anaesthetic, you will need to be pre-assessed by the General Hospital to ensure that you are fit and well to undergo this. If you would like sedation, you do not need pre-assessing but will require to fast before your surgery. You will also need to have a biometry test (usually conducted during your initial appointment). If you wear contact lenses, you must leave them out for 2 weeks before this test as they give a false reading.

The operation

You will be lying flat, and a sheet draped over the area to be performed on. You will not see the operation at all, and try to keep as still as possible. This form of surgery is called phacoemulsification (shortened to ‘phaco’) which uses a technique of ultrasound to soften the lens which is then broken up and flushed out using special fluids. A clear artificial lens (intraocular implant or IOL) made to plastic-like material is then unfurled and inserted. The whole process is incredibly quick and the wound is very small. Occasionally very fine stitches are required to close the wound.

It is performed in Day Surgery which means you will be discharged from hospital a few hours after surgery.

The lenses

Standard monofocal—Your lens is removed during the operation and replaced with an artificial one. The choice of different strengths (powers) of lenses are decided before your procedure, and your consultant will clarify this on the day of surgery. You may well still need to wear spectacles for either reading or distance, but please discuss this at the time of your consultation.

Monovision lenses spread the focus between both eyes so they work together and there is not an unbalanced sensation.

Multifocal—These lenses aim to correct vision for both near and distance., and may result in not requiring glasses at all. However, not all patients are suitable for this type of lens.

Toric multifocal—These lenses also correct high astigmatism as well as distance and close up vision. Once the lens is inserted, it requires rotation into the exact correct position for each patient. Glasses may still be required.

The surgery is all the same for these types of lenses.

Aftercare

Your eye will be covered in a clear protective shield and we advise that you wear this to protect the eye at night, when sleeping.

Once the anaesthetic wears off, there can be a dull ache or sharp pain felt in/around the eye. It will also be red and watery, and your vision blurred. Please use over the counter pain relief when you get home. It can take a few weeks for the eye to settle, and it may feel ‘gritty’ for a few months.

You will have drops to take, and the nurses will show you how to administer these.

Avoid rubbing or touching your eye for 2 weeks post op. You may be sensitive to light, so please wear sunglasses in this instance.

Please avoid getting water in your eyes for 2 weeks after your procedures as it is not sterile, and avoid heavy lifting for a week or so. You can return to work after a few days. We will arrange for a post operative follow up appointment about a week after your procedure, just to make sure the eye is healing correctly.

You may see your optician for new glasses about 4-6 weeks after the operation.

You will be able to drive again once you have seen Mr Spiteri a week after your procedure, for your post operative check up.

Post operative medication

Before leaving hospital, you will be given post operative eye drops to be taken from the next morning after your procedure.

These will be:

Chloramphenicol and Dexamethasone, both of which are to be taken 4 times per day at regular intervals for 2 weeks, making sure they are taken 5 minutes apart from each other (no less).

This is then followed by a further 2 weeks taken twice per day in the same fashion.