Understanding cataract. The Eye Service at Barts Health

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1 Understanding cataract The Eye Service at Barts Health

2 What is a cataract? If your doctor or optometrist/optician has told you that you have a cataract, do not be alarmed. Many people develop cataracts and most can be treated successfully. A cataract is a clouding of the lens of the eye, a clear structure found behind the pupil and iris. The iris is the coloured part of your eye and it has a hole in the middle, the pupil, which appears black. Light enters your eye through the pupil and is focused by the lens on to the back of your eye (the retina) to form an image. With a cataract your vision becomes blurred because the cataract in your lens acts like frosted glass, interfering with your sight. It is not a layer of skin that grows over your eye. Cross-section of the eye Iris Front of eye Light Pupil Lens (cataract develops here) Light focused on retina

3 How does a cataract affect sight? Blurry sight This is very common. You may notice that your sight has become blurred or misty as though your glasses are dirty or scratched. However, new glasses do not improve your vision. Dazzled by light You may be dazzled by light, such as car headlamps, and sunlight. Change of colour vision You may find colours look washed-out or faded. What causes cataracts? Cataracts can form at any age. Most develop in older people but we don t know why, although research is being done into a number of possible causes. In younger people cataracts are more likely to occur in diabetics, patients on certain medication, and as a result of other longstanding eye problems. Cataract treatment The only effective treatment for a cataract is an operation to remove the cloudy lens. This is replaced with an artificial lens. Diets and drugs do not reverse or stop the development of cataracts. The risks and benefits of cataract surgery Cataract surgery is usually very successful. Ninety-five out of every 100 patients (95%) have improved vision if no other eye problems are present. Difficulties during surgery occur in one in 20 operations (5%), but these are usually resolved at the time of surgery. Rarely, another operation may be necessary. The most serious complication is permanent loss of vision in the operated eye, usually because of bleeding or infection. This is extremely rare and only affects approximately one in a 1,000 people (0.1%). Within five years of surgery it is possible that the lens membrane, which is left behind to support the artificial lens, will thicken and reduce vision. This is a relatively common problem but it is easily correctable with painless outpatient laser treatment.

4 When can I be treated? In the past, eye specialists often waited until a cataract became 'ripe' (advanced) and vision was very poor before suggesting a cataract was removed. Nowadays, with modern surgery, the operation is usually done earlier. You will probably want to consider surgery as soon as your poor eyesight interferes with your daily life and your ability to read, work, or do the things that you enjoy. If you are a driver you must reach the visual standard required by the Drivers and Vehicle Licensing Authority (DVLA). Their contact details are in the back of this booklet. Please ask your eye surgeon for more information it may be necessary to have a cataract removed in order to keep your licence. Cataract surgery Your first appointment During your visit to the clinic an eye surgeon (ophthalmologist) will examine you to see whether cataract surgery would help. If it would, and you decide that you would like to have a cataract operation, a date for surgery will be arranged. You will be asked to sign a consent form for the operation. If you have cataracts in both eyes we will operate on different dates, usually a minimum of three weeks apart. Your pre-operative assessment Your pre-operative assessment will take place in the clinic, either as part of your first visit or on another date. If it is part of your first appointment, please be prepared for a long visit. You may be here for up to four hours. You will be given a general health check to make sure that you are fit enough for the operation. Your eye will also be measured (scanned) so that the surgeons can plan your surgery. You must let us know if you have had laser surgery to reduce your need to wear spectacles. If you have, you will need a separate scan of your cornea to reduce the chance of an error calculating the power of the lens implant you will need.

5 Preparing for the operation Please make sure that you arrange for someone to take you home after your operation (you must not drive home) and that somebody can stay with you overnight. Most people have a local anaesthetic to remove a cataract and can leave hospital soon afterwards. If you need a general anaesthetic, which is rare, you may have to stay in hospital for half a day to recover. On the day of the operation You will have your cataract operation in Daycare. There is a map at the back of this booklet. You will be asked to come to Daycare in the morning but we cannot give you an exact time for your surgery because this will depend on various clinical and technical factors. Please be patient and we will try to schedule your operation for as soon as possible. After you are admitted a member of staff will place some eye drops in your eye to enlarge your pupil in preparation for the operation. You will also be asked to confirm that you consent to the operation. Please ask a member of staff if you have any questions. Cataract removal During the operation we will make sure you are as comfortable and relaxed as possible. You will remain awake under a local anaesthetic but you will not feel anything as your eye will be numbed. You may be aware of some movement and lights but you will see very little. Usually the operation takes about minutes, although it can last longer. Using a microscope to magnify your eye, the surgeon will make very small cuts in the eye surface. The lens containing the cataract is broken up by ultrasound waves (not a laser), and removed through this incision. An artificial lens, called an intraocular lens implant, will then be placed in your eye where it will remain permanently. Stitches are not usually necessary as the cuts in the front of your eye are so small. After the operation an eye pad and eye shield will be put over your eye to protect it.

6 After the operation You will be offered a light snack and a nurse will check you are well enough to be discharged home. You will be given eye drops, a sachet of saline water and a dressing pack for cleaning your eyelids to take home with you. A nurse will show you how to use them. Please ask any questions you want. Before you leave hospital you will usually be given a clinic follow-up appointment for 2 4 weeks' time. An earlier appointment may be required following more complex surgery or if medical problems like diabetes are present. Back home The morning after surgery Remove the eye pad and shield the morning after surgery. Most people notice an instant improvement in sight when the pad is removed. Complete healing may take several weeks and your eye will be slightly red during this time. Throw away the eye pad but continue to use the shield over your eye at night for one week. The shield should be cleaned daily with soap and water. You now need to clean your eyelid and start using your eye drops. Cleaning your eyelid Wash your hands. Wet the lint swabs with the saline water that you were given, and gently clean your eyelid with your eye closed. Throw away the swabs after use. Eye drops You will have two types of eye drops to use, Maxidex and Chloramphenicol. Keep the Chloramphenicol drops in the fridge. The Maxidex drops can be kept at room temperature but make sure that you shake Maxidex before use. First wash your hands. Place one drop of Maxidex and one of Chloramphenicol in the eye that has been operated on four times a day, for example at meal times and before bedtime. It does not matter in which order you place the drops but leave a few minutes between each drop. Do not stop your drops until you come back for your follow-up appointment. If you run out ask your GP for a repeat prescription.

7 General eye care Do not rub your eye for at least a week. Continue to wear your glasses if they improve your vision or you may find inexpensive reading glasses, obtained from the chemist, are of help. Later on you are likely to need new glasses and you will be told at your follow-up visit whether you need an eye test for a new prescription. Getting back to normal Do not swim or submerge your head until you have checked you can do so at your follow-up appointment. Resume your normal activities gradually and avoid vigorous activity or heavy lifting for at least a week. You should be off work for at least one week but please see your GP if you need more time off. Please ask your eye surgeon about driving. If you have any problems such as excessive pain, deteriorating vision or your eye becomes red and inflamed please contact Clinic 2 immediately. Contact details Clinic 2 Ground floor The Royal London Hospital Whitechapel, London E1 1BB Tel: Opening hours Monday Friday, 9am 5pm Daycare 3rd floor (lift 8) The Royal London Hospital Whitechapel, London E1 1BB Tel: Opening hours Monday, 8am 2.30pm Tuesday, 8am 2.30pm Wednesday 11am 5pm Thursday, 8am 2.30pm

8 For further patient information leaflets contact: To Bethnal Green The Royal London Hospital The Royal College of Ophthalmologists 17 Cornwall Terrace London NW1 4QW Tel: Whitechapel Road To Aldgate East Whitechapel Main entrance East Mount St Raven Row A&E entrance For drivers medical information: Drivers Medical Group DVLA Swansea SA99 1TU Tel: Stepney Way entrance Stepney Way 8 Daycare 3rd floor (lift 8) Clinics 2 & 3 Ambulance entrance Milward St Newark St

9 General advice and support If you need support with any of our services, including help with any concerns you may have, please contact the Barts Health Patient Experience Team. Understanding cataract Tel: or The Eye Service at Barts Health Fax: For this leaflet in large print, please ring or For help in interpreting this leaflet in other languages, please ring Barts Health NHS Trust Switchboard: Publication date: January 2013 Reference: BH/PIN/110 (update of BLT/PTINFO/046) Produced by Medical Illustration

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