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1 Cataract Surgery Information for patients Ninewells Hospital Ward 25 Telephone: (available 24 hours) Eye Outpatient Clinic Telephone: (Monday Friday, 9am 4pm) Information for patients This leaflet gives you information that will help you decide whether to have cataract surgery. You might want to discuss it with a relative or carer. Before you have the operation we will ask you to sign a consent form so it is important that you understand the leaflet before you decide to have surgery. If you have any questions you may wish to write them down so that you can ask one of the hospital staff. The cataract Your eye surgeon has recommended cataract surgery because the lens in your eye has become cloudy, making it difficult for you to see well enough to carry out your usual daily activities. If the cataract is not removed your visions may stay the same, but it will probably gradually get worse. Waiting for a longer period of time is unlikely to make the operation more difficult unless your eyesight becomes so poor that all you can see is light and dark. The operation The purpose of the operation is to replace the cloudy lens with a plastic lens (implant) inside your eye. On the day of the surgery we will ask you to change the top half of your clothing and put on a gown. You will be given eye drops to enlarge the pupil. An experienced eye surgeon will carry out the operation or may supervise a doctor in training who also performs some operations. Page 1 of 8

2 We will give you a local anaesthetic which may feel uncomfortable for about a minute. You will not be able to see what is happening but you will be aware of a bright light. During the operation we ask you to keep your head still and lie as flat as possible. A nurse will hold your hand so that you can let him/her know if you have any problems by gently squeezing their hand. The operation normally takes minutes but may take up to 45 minutes. Most cataracts are removed by a technique called phacomulsification in which the surgeon makes a very small cut in the eye, softens the lens with sound waves and removed the cataract through a small tube. The membrane (capsule) of the lens is left behind and acts as a support for an artificial lens (implant) which is then inserted to replace the cataract. Sometimes a small stitch is put in the eye. At the end of the operation a shield will be put over your eye to protect it. Likelihood of better vision After the operation you may read or watch television almost straight away, but your vision may be blurred. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Benefits and risks of cataract surgery The most obvious benefits are greater clarity of vision and improved colour vision. Because lens implants are selected to compensate for existing focusing problems, most people find that their eyesight improves considerably after surgery but they need to replace their glasses. The lens that is placed into the eye is a single focus lens. This means that it cannot focus on distant and near objects at the same time. Therefore most patients will require reading glasses after cataract surgery. The vast majority of patients have improved eyesight following cataract surgery. However, you should be aware that there is a small risk of complications, either during or after the operation. Page 2 of 8

3 Some possible complications during the operation Complication Tearing of the back part of the lens capsule with disturbance of the gel inside the eye that may sometimes result in reduced vision Loss of all or part of the cataract into the back of the eye requiring a further operation which may require a general anaesthetic Risk 3 5% 1% Bleeding inside the eye 0.1% Some possible complications after the operation Complication Bruising of the eye or eyelids Allergy to the medication used Swelling of the retina macular oedema Clouding of the cornea Glare or visual disturbance High pressure inside the eye Incorrect strength or dislocation of the implant Detached retina which can lead to loss of sight Infection in the eye endophthalmitis which can lead to loss of sight or even loss of the eye Risk Common Common Uncommon Uncommon Uncommon Rare Rare Rare Very rare Complications are rare and in most cases can be treated effectively. In a small proportion of cases further surgery may be needed. Very rarely some complications can result in blindness. Page 3 of 8

4 Posterior Capsular Opacification Approximately 1 in 3 patients will develop a haziness of the lens capsule some months or years after the cataract operation. This is called posterior capsular opacification. This can be treated at on outpatient clinic using a laser beam to make a small opening in the cloudy membrane in order to improve the eyesight. Preparing for cataract surgery Pre-assessment visit Shortly before your operation we will send you an appointment for the preassessment clinic. This visit will take approximately 2 hours, during which time we may: Test your vision Examine your eyes Take measurements of the eyes to help plan the operation Contact lens wearers: Hard contact lenses please stop wearing 2 weeks prior to your preassessment appointment Soft contact lenses please stop wearing 1 week prior to your preassessment appointment Please bring: Your most up-to-date spectacles (for distance and reading) and your spectacle prescription A record of your medications If you take Warfarin, a record of your INR blood tests you will also need this checked 3 to 5 days before the operation bring your yellow book on the day of your operation if you are advised to change your Warfarin dose, please re-check your bloods the day before you are due to come in for your operation Page 4 of 8

5 The day of the operation Take your medications as usual bring any medication you might need during the day, including inhalers, insulin For operations under local anaesthetic you may eat and drink as normal Bring a dressing gown Leave valuables at home Remove make-up, nail varnish and artificial nails This is usually a day case procedure but you should plan to be on the ward for the most of the day Do not drive to or from your operation; please arrange to be collected from Ward 25. We do not have facilities for relatives to wait on the ward; drop off and collect only please. After the operation You will return to Ward 25 where tea/coffee and a sandwich will be available. You will be given eye drops to reduce inflammation. The hospital staff will explain how and when to use them. Please do not rub your eye. After an hour, if you are comfortable, you can be discharged home. Any discomfort can be treated with a pain reliever such as paracetamol every 4 6 hours. It is normal to have the following symptoms for a while after cataract surgery: Dry, gritty or itchy eye Sticky eyelids or watery discharge Mild discomfort Double vision After a few days even mild discomfort should disappear. Certain symptoms could mean that you need prompt treatment, including: Excessive pain Loss of vision Increasing redness of the eye If you experience any of these symptoms, please phone Ward 25 on Page 5 of 8

6 Post-operative care The evening after the operation we advise you to rest at home Do not remove the eye shield until the next day The following morning: o Remove the eye shield o Any crusting may be wiped away with cotton wool and cooled boiled water o Apply your eye drops you will be provided with an antibiotic eye drop and a steroid eye drop o Store antibiotic eye drops in the fridge o It does not matter which drop is applied first Apply your eye drops regularly as instructed by the nurse Use your eye drops for 4 weeks How to apply eye drops 1. Wash your hands 2. Tilt your head back 3. Gently pull down the lower eyelid with one hand 4. Look up 5. Allow one drop to fall inside the lower eyelid 6. If using 2 or more types of drops, allow 5 minutes between each drop 7. Do not share eye drops with another person due to the risk of infection 8. Try not to let the tip of the bottle touch the eye 9. To help you remember, put your drops in at set times each day, for example meal times Do not Drive until advised by the doctor ask your surgeon on the day of the operation when you can resume driving Over-exercise Return to work for 2 weeks or until advised by the doctor Rub your eye Swim for 4 weeks Page 6 of 8

7 Do Use your eye drops as prescribed Take things easy Use glasses/sunglasses if you find these helpful For reading, some patients purchase ready reading glasses, approximately dioptre strength If washing hair, ensure you back wash Most patients are reviewed in the eye clinic after 4 weeks and then advised whether to attend their optician for updated spectacles. A doctor or hospital optometrist will discuss your second eye cataract operation at your follow-up appointment. We hope this information is sufficient to help you decide whether to go ahead with surgery. Please use the space below to write down any further questions to ask the doctor or nurse when you come to the hospital for your appointment. Do not worry about asking questions, our staff will be happy to answer them. Questions/Comments.... Page 7 of 8

8 Eye drop reminder You can use the tick boxes below to keep track of your eye drop treatment. Week 1 Day Morning Lunch time Evening Bed time Week 2 Day Morning Lunch time Evening Bed time Week 3 Day Morning Lunch time Evening Bed time Week 4 Day Morning Lunch time Evening Bed time This information leaflet was prepared by the Ophthalmology Department, Ninewells Hospital and contains up to date information from medical and nursing literature, and has been reviewed by staff and patients. Revised: 03/2016 Review: 03/2018 LN0012 Page 8 of 8

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