Machen Eye Unit Cataract Pathway Important information please keep for future reference

Machen Eye Unit Cataract Pathway Important information please keep for future reference Page 1

This booklet is a guide for anyone who has a cataract and who would like to know more. We hope you find it helpful to understand the cataract pathway that is followed by the Machen Eye Unit team. We are committed to ensuring that you are able to make an informed decision regarding surgery. This information is relevant for up to six weeks following your cataract surgery. Machen Eye Unit South Warwickshire NHS Foundation Trust Warwick Hospital Lakin Road Warwick CV34 5BW Tel: 01926 495321 ext: 4501 office hours Page 2

CONTENTS PAGE Section 1 General information about cataracts What is a cataract? 5 Why do we get cataracts? 5 What are the symptoms? 6 What can be done? 6 Section 2 Cataract surgery explained What does a cataract operation involve? 7 Local anaesthetic used in eye surgery 8 Section 3 Benefits and risks Benefits and risks of cataract surgery 9 Some possible complications DURING the operation 9 Some possible complications AFTER the operation 9-10 Section 4 You have decided to have cataract surgery What happens now? Information for patients prior to surgery 11-12 12 What happens on the day of my surgery? 12-13 After the operation 13 Will I need any appointments? 13 The first 24 hours following surgery 13 What you should and should not do following surgery 13-14 Section 5 Frequently asked questions Will I have a pad on my eye? 15 How long will I be in the hospital? 15 What about my drops? 15 My eye feels gritty (like something is in it)- is this 15 normal? Can I bend down? 15 How long will I be off work? 15 When can I drive? 16 When can I fly? 16 When can I have my other eye done? 16 What about my glasses? 16 How can I tell if it is going wrong? 16 Where can I get more information, support and 17 advice? Page 3

Section 6 Your drops Drop regimen tick chart 18 How to use your eye drops 19 Section 7 Useful contact numbers 20 References, author and contributors 21 Page 4

SECTION 1 GENERAL INFORMATION ABOUT CATARACTS What is a Cataract? A Cataract is a clouding of part of your eye called the lens. The lens sits behind the iris (the coloured part of the eye). It bends light rays as they enter the eye to produce a clear image on the retina (at the back of the eye). The lens is normally clear like glass but becomes cloudier as we age. It is not a film or a skin over the eye although this is a commonly held belief. National Eye Institute, National Institute of Health. Ref: NEA09 Why do we get cataracts? Cataracts can form at any age although they are usually age related. In younger people certain medications such as steroids or conditions such as diabetes can result in cataracts forming at an earlier age. Cataracts can also be present at birth. Some studies have shown links between smoking, poor diet and excessive exposure to sunlight with the formation of cataracts. Page 5

What are the symptoms? You may notice that your vision becomes blurred or dim because light cannot pass through to the back of the eye It may seem like your glasses are dirty or scratched You may have problems with glare and lights may dazzle you Your colour vision may become faded or appear washed out You may become increasingly short-sighted or you may see double Your cataract may already be preventing you from doing things you need or want to do. This could involve looking after yourself or others, driving, reading or doing things you enjoy. If you are a driver you must reach the visual standard required by the Driver and Vehicle Licensing Agency (DVLA). What can be done? Don t be alarmed if you have been told you have a cataract. Anyone over 60 is likely to have some degree of cataract, with most people being treated successfully. Early cataracts may not affect your sight and so will require no treatment. The most effective treatment for cataract is an operation. This is known as a cataract extraction with intra- ocular lens implantation. Page 6

SECTION 2 CATARACT SURGERY What does a cataract operation involve? In the past a cataract was left until it was ripe. Nowadays the operation can be done at any stage of the cataract s development. Generally the operation is now done as soon as your affected vision interferes with your daily life. Current guidelines imposed by the Primary Care Trust (PCT) may need to be considered The operation removes the natural lens in your eye and replaces it with a clear plastic one. This helps the eye focus. The operation uses high frequency ultrasound. This breaks up and removes the cloudy lens (cataract) It is then replaced with a plastic intra-ocular lens. This new lens sits permanently within your eye and will work for the rest of your life. There is no risk of rejection The operation lasts approximately 15-30 minutes but may take longer depending on each individual patient. The surgeon makes microscopic openings to perform the operation, which are small enough to seal themselves so no stitches are needed Your eye is not removed from its socket during the operation. Page 7

LOCAL ANAESTHETICS USED IN EYE SURGERY What is a Local Anaesthetic (LA)? There are two types of LA used in eye surgery: LA injection This is given to freeze the eye and the area around it. A drop of LA will numb the surface of the eye before the injection is done so you won t feel anything sharp. You will feel a stinging sensation for a few seconds. Pressure will be applied to the eye for a few minutes after the injection to assist the LA effect. This is similar to an injection at the dentist, which makes your mouth and face feel numb. The numbness can last about four hours. Do not worry about moving your eye or keeping your eyelids open during the operation, as the anaesthetic will stop any movement. You may initially experience some double vision. This is due to the LA and should subside within 24 hours (please let us know if it has not improved within that time). There is no need to worry about this but do take extra care when moving around. Topical anaesthetic This consists of LA eye drops, which are instilled before the operation to numb the eye. You will still be able to move your eye but you won t be able to feel anything. You don t have to worry about blinking, as your eyelids will be held open for you during the operation. You will need to keep your head still and may be asked to look in a certain direction. Not everyone is suitable for topical anaesthetic. Your surgeon will discuss which anaesthetic suits your needs best. Page 8

SECTION 3 BENEFITS AND RISKS Benefits and risks of cataract surgery The most obvious benefits are greater clarity of vision and improved colour vision. Most people find that their eyesight improves considerably but you will still need to replace your glasses. You should be aware that there is a small risk of complications either during or after the operation. Fewer than 2 % of patients have serious, unforeseen complications and in most cases these can be treated effectively. In a small number of cases further surgery may be needed. Very rarely some complications can result in blindness. You can ask your surgeon at the time of signing your consent form about current complication rates Some possible complications DURING the operation Tearing of the back 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 Bleeding inside the eye Some possible complications AFTER the operation Bruising of the eye or eyelids High pressure inside the eye Clouding of the cornea Incorrect strength or dislocation of the lens implant Swelling of the retina (macular oedema) Detached retina, which can lead to loss of sight Page 9

Severe infection of the eye, which can lead to loss of sight, or even the eye Alteration of the shape of the eye called astigmatism Allergy to the medication used The most common complication is called posterior capsule opacification. It may come on gradually after months or years. When this happens the back part of the lens capsule, which was left in the eye to support the implant, becomes cloudy. To treat this you will need to have laser treatment to make a small opening in the cloudy membrane. This is a painless outpatient procedure which normally only takes a few minutes If you have any concerns please ask your surgeon. Page 10

SECTION 4 YOU HAVE DECIDED TO HAVE CATARACT SURGERY What happens now? After the doctor has seen you and cataracts have been confirmed you will need to have a pre-operative assessment. This involves the nurse explaining what will happen to you before, during and after your operation The nurse will check your vision so you will need to bring your near and distance glasses. She will also ask you about your medication and discuss your past medical history Your eyes will be measured to help the surgeon decide which implant to put in your eye when your natural lens is removed. Both eyes are measured even though we only do one eye at a time You will be asked about your transport plans for the day of your operation You will also be asked to give details of someone who can provide overnight care for the first 24 hours You will need eye drops for 20 days after your operation so you will be shown how to put them in correctly A date for your surgery will be sent to you This is also an opportunity for you to ask the nurse any questions about what will happen to you You will be asked to come back to the Machen Eye Unit for a final check within approximately 2 weeks of your operation. This will allow you time to read this information booklet and think about any questions you want to ask You may wish to discuss it with a relative or carer. You will be asked to sign a consent form at this appointment Page 11

It is important to understand that just because you have a cataract it doesn t mean you have to have a cataract operation The time to have surgery is when you feel your vision is causing enough problems to accept the small risk that is involved with surgery. Information for patients prior to surgery If you wear make up please do not wear it for 2 days prior to surgery. Thoroughly clean your eyelids the night before your operation to remove all residue of make up. If there are any signs of makeup your surgery will be cancelled If your eye is red your surgery will be cancelled If you have any symptoms of a cold or flu contact the Machen Eye Unit on 01926 495321 Ext. 4697 or 4502. You may be asked not to attend for surgery What happens on the day of my surgery? You will be asked to attend the day surgery centre at a specific time for either the morning or afternoon list. You will be asked to wait until it s your turn and given a gown to wear You will then be given eye drops to enlarge your pupil. Normally cataract surgery is performed with a LA. You will be awake but you will not be able to feel anything in your eye. LA s have been described in more detail on page 8 of this booklet The theatre staff will make you comfortable before the surgeon begins. It is important that you lie very still and do not talk during the operation. Your head will be on a firm pillow to keep it in position during your operation. A nurse in theatre will hold your hand during the operation in case you have any problems Page 12

Oxygen will be blown gently towards your face. You will have a sterile drape over you however this will be kept away from your face and mouth. You may see a bright light from the microscope but you won t be able to watch the operation. You may be able to hear background noises such as people talking or doors and cupboards being opened. You may feel water on your face or down your neck as it is used freely during the operation After the operation you will be sat in a comfortable chair and given a drink and a biscuit or sandwich. Your relative /friend can rejoin you if they are waiting After the operation This is not a painful operation. Your eye may feel sore for a few days so we suggest you take Paracetamol if needed as per packet instructions. Avoid using Aspirin as a painkiller as this can cause bleeding. This does not apply if you have been prescribed low dose aspirin, which you should continue taking as instructed by your doctor. Will I need any appointments? The surgeon decides on the day of your operation what further appointments you will need. Generally a nurse will phone you the day after your operation to see how you are and then 2 weeks later. You will be advised if any clinic appointments are needed. The first 24 hours following surgery You must rest at home Take extra care when moving around You may bathe your eyelids as instructed by the Nursing staff Should you need advice during the evening or night please telephone the switchboard (the number is on page 20) and ask to speak to the Eye Nurse on call (this only applies for the 1 st night after your operation). Page 13

You should: Use your eye drops as instructed Wear the eye shield (if given) at night for 3-5 nights after the operation if you so wish Carry on with your normal daily activities -use a common sense approach Light lifting -small bags of shopping is fine You can resume your sex life a week or two after the operation Take care washing your hair and face You should not: Rub or poke your eye Use eye baths, Optrex etc Do strenuous activity for at least 2 weeks Go swimming or do water sports until the eye drops have finished and the eye has settled down Wear eye makeup until the eye drops have finished Get soapy water in your eye Resume driving until you meet the legal visual requirements If you have any problems or concerns please phone the Machen Eye Unit: 01926 495321 ext.4697. All contact numbers are on page 20 of this booklet. Page 14

SECTION 5 FREQUENTLY ASKED QUESTIONS Will I have a pad on my eye? Not necessarily. Each patient is an individual with different needs. Generally you will have a protective shield over your eye and be asked to wear it for about 4 hours as the LA wears off. You can wear this at night after your operation if you wish. How long will I be in the hospital? You will only be in the day surgery centre for about 4 hours in total, sometimes less. What about my drops? You will be given the drops you need before you go home. It is important to put the drops in as instructed. They are an antibiotic and anti-inflammatory combination, which provide a safe environment for your eye to heal. A nurse will check you understand when to put them in. My eye feels gritty (like something is in it)- Is this normal? Yes. It is normal to feel itching and a gritty feeling for a while after cataract surgery. Some fluid discharge is common. Your eye may also look red for a few days. These symptoms should settle during the first 2 weeks. It takes about 6 weeks for your eye to settle down. Complete healing can take several months. Can I bend down? Yes. However you must take extra care to be aware of your surroundings i.e. table corners and kitchen cupboard doors. How long will I be off work? This will depend on the job you do. If your job is heavy and physical, refrain from work until the drops have finished. If your job is sedentary then you may return after one week. Your eye specialist will be able to advise you if you are unsure. Page 15

When can I drive? You can drive within 2-5 days if you feel confident and have no double vision. It is your responsibility to make sure you meet the legal visual requirement before you start driving. When can I fly? You may travel in an aircraft one week after the operation on a short or long haul flight. It is your responsibility to make sure that eye services are available in case of problems. You must continue using the eye drops as instructed. When can I have my other eye done? You can discuss this with the surgeon. This may depend on current guidelines. You may be asked if you want to be put on the list for your other eye at your 2-week telephone assessment or your next appointment. What about my glasses? It is usually necessary to change your glasses to get the full benefit from the operation. We recommend that your optician prescribe new glasses between 4 6 weeks after your operation. How can I tell if it is going wrong? Certain symptoms could mean that you need prompt attention. Please contact Machen Eye Unit (all contact numbers are on page 20) immediately if you have any of the following symptoms: Excessive pain Loss of vision Increasing redness Excessive stickiness Page 16

Where can I get more information, support and advice? Machen Eye Unit (01926) 495321 ext. 4697 RNIB Helpline 0845 766 9999 or www.rnib.org.uk Page 17

SECTION 6 DROP REGIMEN TICK CHART Operation date: To help you keep a track of your eye drops after your cataract surgery, please use the tick chart below. FOR THE FIRST 5 DAYS YOU MUST ADMINISTER 1 DROP 4 TIMES A DAY 1 st day 2 nd day 3 rd day 4 th day 5 th day 4 4 4 4 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Days 6 to 10 you must administer 1 drop 3 times a day 6 th day 7 th day 8 th day 9 th day 10 th day 3 3 3 3 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Days 11 to 15 you must administer 1 drop 2 times a day 11 th day 12 th day 13 th day 14 th day 15 th day 2 2 2 2 2 1 2 1 2 1 2 1 2 1 2 Days 16 to 20 you must administer 1 drop once a day 16 th day 17 th day 18 th day 19 th day 20 th day 1 1 1 1 1 Page 18

HOW TO USE YOUR EYEDROPS 1. After washing your hands, shake the bottle well, and twist off the cap. Hold between your thumb and middle finger (Fig. 1). 2. Tilt your head back, and gently pull down your lower eyelid with a clean finger to form a pocket between your eyelid and your eye. Bring the tip close to the eye, but without touching it (Fig. 2). Looking into a mirror may be helpful. 3. A gentle pressure of the index finger on the base of the upturned container will dispense one drop of medication at a time (Fig. 3). DO NOT TOUCH YOUR EYE OR EYELID WITH THE TIP OF THE CONTAINER, AND DO NOT TOUCH THE DROPPER TIP WITH YOUR FINGERS. If the drop misses your eye, try again. Blink your eyes to spread the eye drop on the surface of your eye; then close your eyes for a few seconds. 4. Screw on the cap after use. Keep the bottle tightly closed when not in use. Picture courtesy of Alcon Laboratories Page 19

SECTION 7 USEFUL CONTACT NUMBERS Main Hospital switchboard 01926 495321 Machen Eye Unit Reception: Ext. 4501 Nurses station: Ext. 4697 Call centre for appointment queries Direct line: 600036 Queries about your Operation or pre operative assessment Mr. Gary Misson/ Mrs. Shaila Pai/ Mr. Nabeel Almuktar: Call Yvonne Goode on Ext. 4728 Mr. Anthony O Driscoll and Mr. Don David: Call Marilyn Leech on Ext. 4502 If you experience any problems at the weekend/ overnight or on a Bank Holiday contact: Coventry University Hospital, Ward 32 for advice 024 76 964000 Page 20

This booklet is based on guidelines from the Royal College of Ophthalmologists and the RNIB and current Best Practice from various Ophthalmic Units. Lead Author: Staff Nurse Lynn Emerson Contributors Clinical Manager Ophthalmology Linda Collins Sister Alison Fell Consultants and Staff Machen Eye Unit As a key provider of acute healthcare and as an employer, the Trust has a statutory obligation to promote and respect equality and human rights. This is set out in various pieces of legislation including: Race Relations (Amendment) Act 2000, Disability Discrimination Act (2005), Sex Discrimination Act (1975) and the Age Discrimination Act (2006) Our information for patients can also be made available in other languages, Braille, audiotape, disc or in large print. PALS We offer a Patient Advice Liaison Service (PALS). This is a confidential service for families to help with any questions or concerns about local health services. You can contact the service by the direct telephone line on 01926 600 054 or using the phone links which are available in both hospitals or calling in at the office located in the main entrance at Warwick Hospital. Version 1/Catalogue Number: SWH-00255 Publication Date: July 2010 Review Date: July 2013 Page 21