525 - B. Cataract Surgery Information (Part 1)

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1 525 - B Cataract Surgery Information (Part 1) The written information on cataract surgery is in two parts. The first part is about what a cataract is and how the operation will proceed. The second part is about the instructions and check-ups after the operation. If, after reading the leaflets, you still have any questions, we recommend that you make a note of these, so that you can ask them at your next visit to the outpatient clinic. Cataracts Your eye surgeon has recommended that you have cataract surgery because the lens in your eye has become cloudy. This makes it difficult for you to see through it well enough to continue carrying out your normal daily activities. If the cataract is not removed, your eyesight may remain the same, but it will probably worsen progressively. It is unlikely that the operation will become more difficult if you wait longer, unless your eyesight is so bad that you can only differentiate between light and dark. What is a cataract? At the front of the eye, just behind the pupil, there is a clear and transparent lens. As we age, this lens becomes less clear. As a result, the things we see appear fuzzier and greyer in colour. This clouding of the eye lens is called a cataract. Everyone who ages gets them. This clouding causes your vision to deteriorate and even with glasses, it does not improve. What are the symptoms of cataracts? Age-related cataract is a normal ageing process. Some people notice even in their forties that their lens is becoming cloudy, but the first signs of cataracts usually only appear later on. Whether you notice it depends on the part of the eye in which the lens cloudiness develops, and the degree of cloudiness. If the cloudy spot is in the centre of the lens or close to it, you will soon get symptoms. You will, for example, experience blurred or double vision, colours will look duller or you will be troubled by light or glare. If, over a short period of time, you suddenly need much stronger or weaker glasses, that may also indicate cataracts. In the long term, different glasses may not help improve vision. Usually, the cataract increases in size over the course of time. This causes the eyesight to worsen increasingly. A visit to the ophthalmologist is then necessary. Anyone who can see well enough to carry out daily activities, hobbies and tasks such as driving without problems (and meets the requirements for a driving licence), does not yet need to be treated; an operation is not immediately necessary. However, it is realistic to bear in mind that future cataract surgery may be needed. After all, cataract problems never improve and the eyesight slowly deteriorates. Once early stage cataracts have been discovered, check-ups are necessary in case the symptoms get worse. When the cataract becomes too bothersome, your eyesight may be restored with cataract surgery. You can determine when the surgery will take place in consultation with your ophthalmologist

2 Treatment If the rest of the eye is healthy, cataract surgery can restore vision almost completely. The surgery is usually done as a day case under local anaesthetic and sometimes under general anaesthetic. The ophthalmologist almost always operates on only one eye in each operation. During the operation, the ophthalmologist will remove your cloudy lens from the eye and replace it with a clear plastic lens implant. In principle, this lens will last the rest of your life. The strength of the lens implant is calculated in advance based on measurements of the lens, so the type of prescription glasses you need after the treatment can be determined approximately. Cataract operations are perhaps the most commonly performed operations in the world. Even in very old age, the operation can still be undergone successfully. What is more, surgery is the only way to really treat senile cataracts. There is no medicine for cataracts. Prescription glasses after cataract surgery We generally try to decrease patients dependence on glasses after cataract surgery as much as possible. Lens measurement is therefore carried out prior to surgery. This measurement is necessary to calculate the strength of the lens implant to be used, and so that low-strength prescription glasses can be used for distance vision after the surgery.. It is important that you have not worn contact lenses prior to this measurement. You should not have worn lenses for: 6 weeks (hard contact lenses) 2 weeks (soft contact lenses) You are the responsible for this! However, even if the surgery is successful, the ophthalmologist can never fully guarantee that you will always be able to see sharply with the treated eye without glasses. Reading glasses will usually be needed in any case. In some situations, you may prefer to be able to read without glasses. Talk to your specialist about the options available. You will, however, still need glasses for distance vision. This choice depends partly on the prescription glasses required prior to surgery and on your reading habits. Special premium lens implants In recent years, special premium lens implants have been developed with the aim of having people be even less dependent on glasses following cataract surgery. These include synthetic toric' lenses, which aim to reduce the cylinder strength of any glasses required after surgery, or to eliminate them completely. There are also multifocal lens implants which, just as for glasses with multifocal lenses, aim to improve both distance vision and near vision. Multifocal lens implants therefore aim to make people less dependent on glasses not only for distance vision, but also for near vision. 2-6

3 These special lens implants cannot be used by everyone. They may have specific side effects (coloured rings around light sources, glare).furthermore, in some circumstances, reading glasses will still be required. Because these special lenses are not normally covered by insurance, an extra payment is often requested, usually several hundred euros or more for each eye. If you are interested in special lens implants and have no objection to a possible extra payment, please ask your own ophthalmologist about the possibilities in your own situation. Chance of better eyesight For the vast majority of patients, eyesight is better after cataract surgery. However, if you suffer from another condition, such as diabetes, glaucoma or age-related macular degeneration, the quality of your eyesight, may still be limited even after successful surgery. As is the case with all surgical procedures, the outcome cannot be predicted precisely. Emmetropia (i.e. no prescription glasses required) cannot be guaranteed. In some circumstances, you may still need distance and/or reading glasses. Depending on the type of lens, a correction for reading at some distances may still be necessary. Benefits and risks of the treatment The most obvious benefits are clearer vision and better colour vision. Most people discover that their eyesight has improved considerably after surgery, because the lens implants selected compensate for existing focussing problems. The lenses of their glasses will usually need to be replaced. Usually, reading glasses are also needed after cataract surgery. You should, however, be aware that there is a small risk of complications during or after surgery. Some possible complications during surgery Tearing of the posterior lens capsule with disturbance of the vitreous fluid in the eye which, in some cases, can lead to impaired vision. Loss of the old lens or fragments of the lens towards the back of the eye, which would necessitate a further operation. Bleeding in the eye. Some possible complications after the operation Bruising of the eye or eyelids. High pressure in the eye. Clouding of the cornea. Wrong strength or incorrect placement of the implant. Fluid accumulation in the centre of the retina in the macula. Retinal detachment, which may lead to a loss of vision. Infection in the eye - endophthalmitis - which can lead to loss of vision or even to the loss of the eye. Allergic reaction to the medicine used. 3-6

4 These complications occur only rarely and in most cases can be treated effectively. In a small number of cases, an additional operation is necessary. Very rarely, some complications may result in a serious deterioration of vision. Secondary cataracts The most common complication is called clouding of the posterior lens capsule (secondary cataracts). This may occur gradually, after months or years. In this case, the rear part of the lens capsule which has been left behind in the eye in order to support the implant becomes cloudy. As a result, light can no longer reach the retina. To treat this, the ophthalmologist uses a laser beam to make a small opening in the clouded membrane and so improve eyesight. This is a painless outpatient procedure. The operation The aim of the surgery is to replace the cloudy lens (cataract) with a synthetic lens (implant) in your eye. The operation will be performed by an experienced eye surgeon. One eye at a time is treated. You will start using drops one day beforehand and in line with the instructions you have received. With local anaesthesia, you will be awake during the operation. You cannot see what is happening, but you might be aware of a bright light. Just before the surgery, a pill will be placed in the eyelid which will cause your pupil to dilate. After this, your eye will be anaesthetised with an anaesthetic (narcotic). During the operation, you will be asked to keep your head still and to remain lying still for approximately 20 to 30 minutes. In most cases, the cataract is removed using a technique called phacoemulsification. This involves the surgeon making a tiny incision in the eye and the cataract being softened using ultrasound waves and removed through a narrow tube. The posterior layer of the lens (the posterior lens capsule) remains in its place. A synthetic lens (implant) is then introduced to replace your own lens. Very occasionally, a small suture (stitch) is applied to the eye. After the operation, a protective bandage and cap will be placed over your eye. 4-6

5 Transport We advise you not to travel alone. It is also not allowed to drive immediately after surgery, and if you are travelling by public transport, please bring someone along to accompany you. After the operation After cataract surgery, it is normal for your eyelids to itch and feel sticky for a short time, and that your eye fills with tears and you experience some discomfort. Do not rub your eye. In most cases, the healing takes about two to six weeks, after which a new pair of glasses can be prescribed. Certain symptoms may mean that you need immediate treatment. Symptoms include: Excessive pain Loss of vision Increasing redness of the eye You will receive an emergency phone number that you can call if you develop any of these symptoms, or if you need urgent advice about your eye. (036) (daytime) or (036) (evenings or weekends). Questions that you want to discuss with your doctor We hope this information has enabled you to decide whether you wish to undergo the operation. Use the space below to write down any questions you may still have so that you can ask your doctor when you come to the hospital for your appointment. Do not hesitate to ask questions. Our staff will be happy to answer them. My questions for my doctor: This leaflet was published the editorship of the Committee on Patient Information of the Dutch Ophthalmic Society (Nederlands Oogheelkundig Gezelschap or NOG)

6 Consent for cataract surgery Department of Ophthalmology Flevoziekenhuis Almere, date: Patient details: [Stick label] Anaesthesia The surgery is will be performed under local anaesthetic/general anaesthetic. Purpose The purpose of the cataract surgery is to improve my vision. Correcting my eyeglass prescription is not an end in itself. I will possibly still need distance and/or reading glasses. Risks and complications It is clear to me that complications may occur during or after the cataract surgery. These complications occur only rarely and in most cases can be treated effectively. After the operation For optimal aftercare, it is important that the rules and check-up appointments before and after treatment are strictly observed. The prescribed drops should be administered into the operated eye as per the instructions. The check-up will takes place 1 day after the surgery (by phone) and after 4-6 weeks at the clinic. I hereby give my consent for the above operation to be performed. I have been properly informed about the surgery and its risks. Signature of the patient Signature and name of ophthalmologist 6-6