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Cataract Surgery

A cataract is clouding and opacification of the naturally clear lens of the eye. Most forms of cataracts are age-related and we will all develop them if we live long enough.
Cataract surgery is the most commonly performed operation in the world but the procedure can be done in a number of different ways.
Mr Yadav has performed cataract surgery for thousands of patients. He is highly regarded in this field and has been responsible for teaching many other eye surgeons to help improve their cataract surgery techniques. He usually performs cataract surgery in a minimally invasive way using anaesthetic drops only (as opposed to anaesthetic injections to the eye socket or around the eye that most other eye surgeons use).
Using his expertly refined technique, surgery usually takes just 5 to 10 minutes and minimal ultrasound energy is used. Less energy and operating time is better for the health of the eye and improves final outcomes for patients. 

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What symptoms do cataracts cause?

Cataracts usually form slowly over years causing a gradual blurring of vision, which eventually is not correctable with glasses. In some people the vision can deteriorate relatively quickly. Developing a cataract can also cause glare, difficulty with night-time driving and multiple images in one eye which can affect the quality of the vision.

Are cataracts just a part of getting old?


Most forms of cataract develop in later adult life. This is called age-related cataract and can occur at any time after the age of 40. The lens continues to grow as we get older with new protein fibres being deposited. This normal process of ageing causes the lens to gradually become cloudy. Not all people who develop a cataract require treatment. The timing of treatment is guided by your vision. 

I didn’t know that I had a cataract until my optician told me – is that normal?


Yes. At first, you might not be aware that a cataract is developing and initially it may not cause problems with your vision. As the cataract develops over time, you start to experience blurring of vision. You may need to get a new glasses prescription more frequently. Eventually, when your cataract worsens, stronger glasses may no longer improve your sight and you might have difficulty seeing things even with your glasses on.

How do you assess a cataract?


You will be asked about your sight problems, any other eye conditions and your general health. Your vision will be tested and measurements will be taken with specialist equipment, which will help us to make recommendations about the best treatment for you. You will be given eye drops to make your pupil bigger so that we can examine your eyes fully. The drops will blur your vision and the effect of the drops will take a few hours to wear off. For this reason, you are advised not to drive after your hospital appointments. 

What do I need to do before my assessment?


If you wear contact lenses, you must leave them out for the following time unless told otherwise: 1 week for soft lenses, 2 weeks for any types of rigid lenses including gas permeable lenses. Ensure that you have someone to drop you off and collect you as your vision will be blurred for a few hours after the dilating drops used for assessment.

When should I have a cataract treated?


It is usually safe not to have surgery if you feel that you do not have a problem with your vision or do not wish to have an operation. When the cataract progresses to the point that it is interfering with daily activities or lifestyle, even when using up-to-date glasses, then cataract surgery may be the next step. Modern surgery is highly successful for the majority of patients but, as with all surgery, there are risks. Cataract surgery is performed when you have a problem with your vision and you want to do something about it.

Can anything be done to stop my cataract worsening?


No. There is no known method of preventing cataracts developing or slowing down their progression. Your cataract may worsen at a very slow rate or may rapidly start to affect your vision. 

I have a cataract developing in both eyes – are both operated at the same time?


Most people develop cataracts in both eyes. Your cataract surgery can be performed on different days, which may be inconvenient due to any imbalance in the glasses prescription and extra hospital visits. Some patients choose to have both cataracts operated on the same day with immediate sequential bilateral cataract surgery. Having both eyes operated on the same day means there is only one admission, one recovery period and one postoperative review. On the day of surgery, once the first eye cataract surgery is completed
satisfactorily, the surgeon will perform surgery on the second eye. You will remain in the operating theatre throughout, but the two procedures are independent, using separate surgical instrument sets and drapes. The surgical risks and refractive outcomes are equivalent to performing the cataract surgeries on different days. Mr Yadav will be able to advise on the suitability, as well as the risks and
benefits of having surgery on both eyes at the same time.

Do I need any special tests before the operation?


Yes. Special tests are required to determine the strength of the lens implant which is inserted into the eye at the operation. Each eye is different and the lens is selected specifically for your eye to achieve the best vision for you. These tests are done before the operation day, either at your first clinic attendance or during your booked pre-assessment appointment to ensure we have the correct lens for you. 

Does it matter if I have had previous laser treatment to my eyes?


Yes. Excimer lasers (e.g. LASIK and PRK) are used to reduce the need for glasses, most commonly in short-sighted younger people. If you have had laser treatment, it is very important that you tell us during your assessment. Excimer laser treatment affects the calculations that are used to determine the strength of lens implant that is inserted. Even though allowance is made for the laser treatment, it is more difficult to select the power of the lens implant and patients are at higher risk of being more or less long/short-sighted than planned following the cataract surgery. This may require glasses or contact lenses to be worn after surgery.

What do you do during the cataract operation?


Mr Yadav will place anaesthetic drops and clean your eye surface and skin with antiseptic. A sterile drape will be placed over the eye to keep the surgical field clean. A special clip will be placed to keep your eye open and you can blink as normal with the other eye. Your eye is never removed and replaced when operations are carried out. Mr Yadav will use the most modern and safest form of surgery called “phacoemulsification”. This technique uses ultrasound energy to soften the lens, which is then broken up and flushed out
using fine instruments and special fluids. A clear artificial lens (intraocular lens implant or IOL), made of a plastic-like material, is placed inside the eye. The back membrane of the lens (capsule) is left behind and this holds the artificial lens in place. The wound is very small and heals quickly without requiring stitches in almost all cases.  

What does it feel like during the operation?


The operation is performed while you are lying down on your back. Your face is partially covered by a sterile sheet. If you have difficulty lying flat or are claustrophobic, Mr Yadav will do his best to make sure that you are comfortable before the operation starts, but please inform us during your preoperative assessment. During the operation a microscope with a bright light is used. The covering sheet
means that you do not see the operation or the detail of the instruments but you may see moving shapes. You will be awake during the operation and will be aware of a bright light, and often coloured lights and shadows. You may feel Mr Yadav’s hands resting gently
on your cheek or forehead. A lot of fluid is used during the operation. Sometimes, excess fluid may escape under the sheet and run down
the side of your face, into your ear or on your neck. We will clean this up at the end of the procedure. You might hear conversations during the operation relating to equipment and checks. Please do not join in as it is important that you remain still during the procedure.

What kind of anaesthetic is used for surgery?


Most operations for cataract are performed under local anaesthetic, in which you are awake but your eye is numb. This is usually given by eyedrops or rarely by an injection around your eye. A very small number of patients require sedation or even a general anaesthetic, where you are asleep.

Will I have to stay in hospital?


No. Cataract surgery is a day-case procedure. You will usually arrive 30 minutes before your procedure is due to take place to allow the dilating drops enough time to work. Once your operation is completed (typically around 10 minutes) you can usually go home straight away. 

Will I still need my glasses after surgery?


Most people who have cataract surgery opt for good distance vision without glasses and using reading glasses when needed. There are options to have better focus for near vision and still require distance glasses. There are newer multifocal lenses that aim to correct near and distance vision but these are not suitable for all patients and can sometimes give unreliable results. Mr Yadav will discuss your options at your consultation to allow you to make an informed decision. 

What are the risks of surgery?


Cataract surgery is one of the most successful operations in the world and complications are very rare with 99% of patients achieving better vision. 


The risks during surgery include:

  • tearing of the lens capsule which may require additional procedures during the operation (vitrectomy)

  • inability to remove the cataract requiring additional surgery

  • bleeding

  • damage to other parts of the eye such as the cornea (the clear window at the front of the eye) and the iris


 Complications after the surgery include:

  • inflammation (swelling) in the eye which normally settles with anti-inflammatory eye drops

  • build-up of fluid in the retina (cystoid macular oedema) which normally settles after a few weeks on its own or with the help of eye drops

  • build-up of fluid in the cornea which is usually temporary and settles spontaneously 

  • retinal detachment (very rare)

  • infection (very rare)

  • thickening of the lens capsule which usually occurs months later and is easily treated with a quick laser procedure

All of these complications can be treated or resolve on their own but very rarely you may end up with vision that is worse than before surgery. 

What happens after the operation?


You will be given anti-inflammatory eye drops to use for 4 weeks after surgery to help the eye to settle down quickly. It is important to complete this course fully.

As the cataract removal allows light to enter your eye again you may perceive certain lighting to be too bright or things may appear more blue. This only last for a few days while your body adjusts to its new lens.

You can usually go back to most normal activities within days of surgery. Try to avoid the following activities for the first 2 weeks after surgery:

  • rubbing your eye (you will also be given a plastic shield to use at night for 2 weeks to avoid this)

  • swimming

  • contact sports or heavy lifting

  • wearing eye makeup 

After surgery you will need to see your optician around 4 weeks later to check your glasses prescription is as expected. You can wait to get your new glasses until you have had the other eye treated as well if this is planned. 

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