CATARACT SURGERY. Information Leaflet. Your Health. Our Priority.

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1 CATARACT SURGERY Information Leaflet Your Health. Our Priority.

2 Page 2 of 11 Introduction You are likely to have recently been told that you have a cataract and been referred to the Eye Department at Stockport NHS Foundation Trust. What is a Cataract? A cataract is a clouding of the lens of the eye. The lens of the eye is usually transparent to allow light into the back of the eye. A cataract means that you may experience some problems in your day to day life. What problems can I expect? Reduced eyesight Blurred eyesight Loss of brightness of colours Double vision Difficulty seeing to read, watching TV, crossing the road and driving the car, for example. What can be done about cataracts? This depends on how much of a problem your vision is to you. Your ophthalmic surgeon (eye doctor) will discuss this with you on an individual basis. Changing your spectacles (glasses) can sometimes help improve focussing. However, spectacles may have to be changed much more frequently.

3 Page 3 of 11 Surgery is the only option for getting rid of cataracts completely; there is no other way to remove them. You may choose to avoid having an operation and put up with your symptoms/problems. However cataracts do inevitably progress, although the rate of deterioration may vary between individuals. You and your surgeon will discuss the best way forward for you. If left untreated your vision may gradually deteriorate until you can see very little. What does a surgical cataract removal operation involve? Prior to any surgical operation a number of pre-operative tests are performed. A special test will be performed to determine the strength of the lens implant required for your eye. This involves measurements of the eye being taken. Whilst as accurate as possible, the calculation of the lens implant power cannot be done with 100% certainty. You may still have to wear glasses for distance and reading following a cataract operation, even if you did not do so previously. The operation involves having a small cut made in the eye. Using up to date surgical equipment/technology, the cataract is removed through this small cut and an artificial lens implant is inserted into the eye in the majority of patients. Is this operation likely to improve my eyesight? In most patients, it is likely to improve eyesight. However, if in addition to a cataract you have other eye problems your final visual result may not be as good as someone who does not have any other eye problems. This will be discussed with you.

4 Page 4 of 11 Are there any risks with the operation? As with all surgery, there are some risks and complications. Major complications are rare, occurring in less than one in 1000 operations. Possible complications may include: Common Bruising: bruising around the eyeball and/or eyelids is quite common. This will usually settle after a week or two. Posterior capsular opacification: clouding of the membrane behind the lens implant. Sometimes a Laser procedure is required to deal with this, months or years after the Cataract operation. Optical Aberrations: for example glare and star bursts in bright conditions. Whilst these often resolve, they can cause on going problems. Less Common Allergy: this maybe caused by any drugs used before, during or after the surgery. This can make the eye itchy and swollen. It usually settles within a few weeks. Postoperative pressure problems: raised pressure in the eye can occur which may require treatment to prevent damage to the Optic nerve. Cystoid Macular Oedema: may occur in the Macular area (central area of the Retina) This can cause a reduction in vision which may be mild or severe and may require prolonged treatment, such as tablets or anti inflammatory eye drops. Iris damage: this can be caused by a variety of different factors and may lead to pupil irregularities which may be permanent. Posterior capsule rupture and/or vitreous prolapse: this is a split in the thin back wall of the lens (behind the cataract). This requires longer than the average time to complete surgery. There is a higher risk of infection, inflammation, glaucoma and reduced vision after the surgery. Further surgical procedures may therefore be required. Refractive surprise: unexpectedly larger (or different from expected) refractive error, resulting in a greater need for spectacles (glasses)

5 Page 5 of 11 Uncommon Ptosis: droopy eyelid; this can be surgically corrected if it occurs. Dropped nucleus: the lens or part of the lens may fall to the back of the eye. Further and more complex surgery may then be required. Dislocation of lens implant: movement of new lens position which may require further surgery. Detached Retina: peeling off of the light sensitive layer at the back of the eye, this usually requires further surgery to repair. Endophthalmitis: an uncommon but severe (usually painful) infection inside the eye which may lead to blindness. This is treated with antibiotics into the eye, but the outcome is often poor and may lead to loss of the eye. Rare Suprachoroidal haemorrhage: bleeding inside the eye which may require further surgery. There is a risk of blindness/loss of eye if this occurs. Corneal Decompensation: clouding of the clear front window of the eye. The condition can be painful and may require a corneal graft operation to restore vision and comfort. More common in some individuals whose corneas may have an inherent weakness or tendency to decompensate. Sympathetic Ophthalmitis: inflammation occurring in the fellow eye in sympathy with the operated eye. It is possible, on rare occasions, that you may lose all sight in the eye if you get one of these complications. Death: this is incredibly rare with modern anaesthetic techniques. If you wish to discuss the possible complications in greater detail, please let us know. Please note: there is no guarantee that any particular surgeon will perform your operation.

6 Page 6 of 11 What happens next? You will be offered a date to attend the Stockport Eye Centre for a pre-operative assessment appointment. Please bring an up to date optician s report to this appointment (this must be no older than a year) At this appointment your nurse will need to know how you will get to and from hospital, and who will be putting your eye drops into the eye after your operation. You will be asked about your general health and what medication and eye drops you are taking. Once you have read this section of the booklet, please sign to say you have done so. I have read and understood this section of the booklet. Patient s signature: Patient s name (print): Date: Questions to be asked at pre-operative assessment clinic: Please bring this leaflet to the pre-operative assessment appointment. Thank you.

7 Page 7 of 11 Pre-Operative Assessment Your pre-operative assessment visit to the Stockport Eye Centre usually takes one to one and a half hours, where you will be examined by a nurse. Please bring your glasses with you and your most recent prescription from the optician. At the pre-operative assessment visit you will be advised of the date and time to arrive at Stockport Eye Centre for your operation. You may be given an eye drop at this visit to put into your eye for surgery on your operation date. Instructions will be given. **It is essential that you discuss any travel plans with the nurse as this will impact on your proposed surgery date.** You are advised not to travel within the first three weeks following your surgery. However local travel within the UK is alright as long as you are able to travel back for your follow up appointment. Can I eat before surgery? Most patients may have a light breakfast or lunch, such as toast or cereal & a hot or cold drink prior to their morning or afternoon operation. However, if you have been advised you are having a general anaesthetic or sedation you must not eat or drink for six hours prior to your operation. What should I bring with me on the day of surgery? Any eye drops and medication that you are taking, your glasses and some reading material. Please wear a front fastening shirt or blouse. You will be able to go into theatre in your own clothes. It is very important that your general health and the state of your eye are as good as possible, on the day of surgery. If this is not the case (e.g. if there are signs of infection), it may sometimes be necessary to postpone your surgery to another date. How long will I be in on the day of my operation? It is likely that you will be with us for the whole morning or the whole afternoon, i.e. about 4-5 hours. What happens during my operation? Your blood pressure and pulse will be monitored The oxygen in your blood will be measured by placing a finger-type peg on one of your fingers A cannula (a hollow plastic needle) will be placed into a vein A local anaesthetic will be given around or inside the eye to numb the eye The operation normally takes minutes during which a nurse holds your hand You will not be able to see out of the other as it will be covered with a drape There may be music playing whilst you are in theatre.

8 Page 8 of 11 What happens when I return from theatre? You will be offered refreshments following your operation. One of our nurses will contact your relative/friend/carer to collect you from the discharge lounge. Alternatively, a taxi can be called on your behalf. The cannula will be removed once you have had your refreshments, and before you go home. What happens when I go home? You will be allowed home approximately minutes after your operation. As you will not be able to drive yourself home, you will need to make arrangements for a partner, friend, carer or relative to collect you. You may go home by taxi. If you require help with transport home, please contact your GP. You will be wearing a protective eye shield when you leave the Eye Centre. This can be removed the next day. You will be given eye drops to take home. These are to reduce the inflammation after surgery and are started the day after your operation. You may also be given antibiotic eye drops. The drops you are given need to be instilled four or more times a day. It is important that you instil these drops as prescribed. You may have some discomfort when the local anaesthetic wears off. Take your usual pain relief tablets. You will be sent an outpatient appointment following your operation. The outpatient appointment can be up to 3 weeks after your surgery and it could be in either OPD B or The Stockport Eye Centre. If you don t receive this appointment within 4 days following your operation, please ring or Occasionally you may need to be seen the day after surgery. This will be arranged on the day of your operation. We will discuss with you about when to return to work and when you can resume driving. Generally you can carry on your normal lifestyle, but please follow the advice overleaf on the back page of this booklet. Please expect a courtesy telephone call the day following your operation. You will be asked to visit your optician for testing for new spectacles (glasses) following your operation. This will be discussed at your follow up outpatient appointment.

9 Page 9 of 11 Date of Operation:... Arrival Time:... Specific Instructions:... Information about your eye drops Please ensure you use the eye drops regularly until your first Outpatients Appointment when we will give you further instructions. Please remember to bring your drops with you each time you attend the Outpatients Department, or Stockport Eye Centre. The eye drops will be clearly labelled for you. Please wash your hands before putting the eye drops into the eye or bathing the eye. Is it necessary to bathe the eye? If you need to bathe the eye, please use cooled boiled water. Wipe from the inner to the outer corner using cotton wool pads. How do I use the eye drops? You will find it easier to put your drops in whilst sitting or lying down. With one hand pull the lower lid down and put the drop in with the other hand. One to two drops is sufficient. Look up when the drop is put into the eye to reduce any discomfort. If you have trouble doing this, you can use an Auto Dropper. Please ask about this. When do I use the eye drops? As long as you space the drops out evenly during the day, you can put them in at any time which suits you. If you are using more than one eye drop at a time, leave a few minutes between each instillation. How long do I use the eye drops? This varies from patient to patient. The nurse or doctor will tell you when to stop using your drops.

10 Page 10 of 11 Dangerous symptoms requiring an urgent telephone call to the Eye Centre Increasing pain which is not relieved by the pain relieving tablets recommended A sudden fall in vision from that achieved within hours of the operation Increase of redness and/or blurring of the eye after the first day Nausea / Vomiting Please telephone If outside the hours of 7.30am 6.00pm please contact the Accident and Emergency Dept telephone Useful telephone numbers Stockport Eye Centre Out-patients B (For concerns up to two weeks following your operation) Out Patient Appointments DO Wear your glasses all day. Wash your hands before putting drops in. Wear your eye cover at night. Take things easy Wash hair gently backwards. Watch television and read normally. DON T Rub your eye. Bend too quickly from the waist. Drive until advised by your doctor. Lift anything too heavy. This information booklet has been produced to help you plan your stay in hospital. If you have any questions during your stay, please ask the nursing or medical staff.

11 Page 11 of 11 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number OPT01 Publication date June 2014 Review date June 2015 Department Ophthalmology Location Stepping Hill Hospital

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