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Cataract Surgery

What is a cataract? A cataract is a clouding of the lens in your eye. It can occur naturally with ageing, secondary to injury or following use of certain medications such as steroids. The lens is normally used to focus light onto the retina (processing film) at the back of the eye. The cataract will reduce and disrupt any light reaching the retina. This can make your vision blurry, colours dull and you may experience glare from headlights at night. What is cataract surgery? Cataract surgery is the removal of the cloudy lens and replacement with a prosthetic one. Surgery is the only way to treat a cataract, and without it the cataract will worsen over time. How is the procedure performed? The procedure is a day case procedure. Most often it is safest to perform the operation with you awake, using drops or a small injection to numb the eye. However, if needed sedation or a general anaesthetic can be used. You will be asked to lie down and look at the light. A small drape will be placed over the eye to keep the area sterile. The operating surgeon will talk to you and explain things during the procedure. you may hear buzzing, talking and see some colourful lights. If you need the surgeon to stop for a minute you will need to press a call bell which will be given to you. Using a microscope, very small incisions are made to allow access into the eye. Following this a small circular hole is made in the capsular bag which surrounds the cataract. A phacoemulsification probe is then inserted. This uses ultrasound to break down the cataract and remove it from the eye. The capsular bag is then cleaned and the prosthetic intraocular lens is inserted, like a ship in a bottle! After a little more cleaning, a small amount of antibiotic is inserted into the eye to prevent infection. If needed a small stitch will be used to close the eye. However, the incisions are so small that this is not often needed. A patch will be placed over the eye to wear for 24 hours and then at night. Instructions for drops will be given to you by the nursing staff. It normally takes between 1 to 7 days for the vision in the eye to clear and 6 weeks for the eye to settle fully. You will normally be seen at around 2 to 4 weeks. Will I need glasses after the operation? When we insert the new prosthetic lens it give us an opportunity to change the prescription power of your eye. The type of lens available on the NHS is called a monofocal lens. This lens will give you the best vision for one distance. Most patients are comfortable with good vision for distance and retaining the need for reading glasses. However, if you are short sighted and wish to remain that way it can be achieved. If you have astigmatism you may continue to need glasses for all distances. If your eye is suitable a TORIC lens may be offered. This is a special lens which aims to treat the astigmatism as well as the cataract. It is best to discuss what you would like your glasses prescription to be with the operating surgeon before the procedure. Special cases: Narrow Angle Glaucoma - If you are having cataract surgery for prevention of glaucoma you may not experience improvement in your vision. The aim is to slow the progression of glaucoma not to improve vision. Diabetes - If you have diabetes you are more likely to develop a cataract. You are also more likely to develop a bit of swelling at the back of the eye, which can be treated with drops or injections. As diabetes damages the back of the eye it is important to remember that your visual outcome will depend on the health of the retina and rest of the eye also. Small pupil - If you have a small pupil or are taking tamsulosin, it may be necessary to take a bit longer during the operation as we will need to perform additional steps to open the pupil wider.
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