Manchester Royal Eye Hospital Cataract information leaflet What you need to know about cataract surgery Cataract Centre Withington Community Hospital
What is a cataract? The normal function of an eye lens is to focus light so that you can see clear, sharp images. When a cataract occurs, the lens inside your eye becomes cloudy making it difficult to see well enough to carry out your daily activities. Lens becomes cloudy (a cataract) One or both eyes may be affected and contrary to what you might have heard, a cataract is not a skin that grows over your eye. As the cataract develops, it gradually restricts the amount of light that is able to enter your eye, and you may experience some or all of the following symptoms: Blurred vision Colours seem faded Frequent changes required to your spectacle prescription Visual problems with light, for example glare or dazzle 2
What causes cataracts? Most cataracts are a natural result of ageing, but they may occur in younger people due to a variety of reasons including: Trauma or injury to the eye Following other surgery to the eye Diseases such as diabetes or glaucoma After prolonged inflammation of the eye There is also a tendency for cataracts to run in families What is the treatment for cataracts? Cataracts can take many years to develop. If the symptoms of your cataract affect your day-to-day activities, you may consider an operation to remove the cataract and replace it with an artificial lens implant. This will allow the light to pass through to the back of your eye again. A cataract does not need to be fully developed before surgery however; surgery is only considered when the reduction in your vision interferes with everyday activities. There are occasions when an intra-ocular lens implant is not possible. In this case, contact lens or glasses will be prescribed in order to correct your vision. 3
The pre-assessment clinic At this clinic, you will undergo all the tests necessary for the staff to gather the information needed for your surgery to go ahead. It will also give you the chance to ask any questions or raise any concerns you have. A Doctor and Nurse will explain the operation and what will happen afterwards. They will require information on your previous medical and surgical history and current medication. You can obtain a copy of this information from your GP. At the clinic, you may have eye drops instilled to make your pupils larger. This may cause your vision to become blurred and increase your sensitivity to bright lights. You are advised not to drive for several hours after your appointment. You may wish to arrange for someone to accompany you. You will find bright light uncomfortable and we advise you to bring a pair of sunglasses to your appointment to help with this. A Doctor will assess the cataract and the general health of your eyes. They will discuss the benefits and risks of surgery and take you through the consent procedure including signing the consent form. A Nurse or Optometrist will measure the strength of your spectacles and the length and curvature of your eye(s). This information will be used to calculate the strength of the artificial lens implant to be placed in your eye once the cataract has been removed. 4
These tests are not painful and the Nurse/Optometrist will explain what is happening at each stage. Most patients have cataract surgery as a day case procedure however; there are a few situations where the Doctor would want you to stay in hospital overnight. You will be advised of this before your admission. Please feel free to ask questions at any time. On the day of surgery The Cataract Centre is situated on the first floor of Withington Community Hospital and is a mixed sex unit attending to both male and female patients. This means that there may be patients of the opposite sex to yourself in the department at the same time. If you feel strongly that you would like to be treated in a single sex environment, please phone us on the number at the end of this booklet to discuss the options available. Two to five days before surgery a clerical officer/nurse will telephone you to confirm that you are able to attend as planned. On your arrival You will be greeted by a member staff who will check your name, date of birth, address and general practitioner (GP) details. You will then be directed to the day surgery room. 5
A friend or relative is welcome to wait with you during your stay in the unit but, as waiting space is limited, they may be asked to wait in an alternative area. Before your operation You should eat and drink as normal and take all prescribed medication as normal unless you have been advised differently. It is advisable that you wash your hands and face with a bactericidal soap for 3 4 weeks prior to your operation to reduce the risk of infection. We recommend that you wash your hair and take a bath/shower the evening before surgery. Please pay particular attention to ensure that your face and finger nails are clean on the day of surgery. Eye make up if worn should be removed the day before your operation and definitely must not be worn on the day of surgery. Please ensure that clean clothes are worn on the day of surgery and that your footwear is also clean. Please bring with you on the day of surgery a pair of new or freshly washed house slippers. We recommend that you wear a front opening shirt, blouse or dress for your comfort and convenience. This advice is not meant to offend you. It is essential that attention is paid to strict personal hygiene in order to prevent and to help reduce the risk of infection on your behalf. 6
In order to reduce the risk of infection further please Do Not bring reusable handkerchiefs. Disposable tissues only are advised and these will be provided. In order to reduce the risk of your operation being cancelled due to a condition called blepharitis, which is a chronic inflammation affecting the edges of the eyelids leading to a build up of deposits on the skin and the eyelash margins, we would like you to perform the following lid hygiene for 4 weeks prior to your operation. How to clean your eyelids using shampoo solution Wash your hands thoroughly before and after cleaning your eyelids. Mix one teaspoonful of mild baby shampoo (any brand) into a mug full of warm tap water. Use a clean face cloth and dip in the solution. Put the cloth over your finger and gently scrub the edges of your eyelids and between your eyelashes to remove any crusting or scaly deposits. You must be careful not to touch your eye. Rinse your eyelids thoroughly after cleaning using warm tap water on a clean face cloth. 7
A Nurse will show you into the main preoperative room as soon as possible, where you will be seated in a chair. A locker will be available for you to lock your personal belongings or clothes. A Nurse will identify himself or herself to you as your named Nurse and he/she will be responsible for your care during your stay in the unit. The Nurse will place a name band on your wrist or an identification on label on your clothing and check whether there have been any changes in your general health. Your operation A member of the nursing team will accompany you into the anaesthetic room where you will be introduced to the theatre nursing staff. The theatre Nurse will check your name and hospital number with your case notes and assist you to get comfortable on the theatre trolley. There will be a Nurse with you throughout the operation to make sure you are comfortable. The operation is performed in the operating theatre and takes up to 30 minutes. During the operation, the cataract is removed and replaced by an artificial lens (implant). Most patients having their cataract removed have the operation under local anaesthetic, using eye drops only or eye drops and an injection in the skin around the eye. 8
The injection will make the area around your eye go numb. It also stops the muscles working so that you cannot open or close your eyelids. The feeling has been described as similar to when you have had a local anaesthetic at the dentists. Your eye may remain numb for 2-6 hours, which may affect your vision. The most common way to remove the cataract is by a technique called Phacoemulsification. A small incision is made in the front of the eye and a probe is passed through the incision. The probe breaks the cataract into very small pieces, which are then sucked out leaving the clear lens capsule. A plastic lens is then folded and passed through the incision into the lens capsule where it unfolds to its normal shape. The small incision usually heals itself, although occasionally a stitch is required. After the operation a pad or clear shield will be placed over your eye. Immediately after the operation your eye may look red. This is due to the local anaesthetic given at the start of the operation and the antibiotic injection given at the end of the operation. This redness is normal and settles down over 4 weeks. Most patients experience little or no pain following the operation, except for a mild gritty sensation, which may occur, but this usually settles within 4-6 weeks. 9
Following your operation You will be transferred back to day surgery in your chair. Altogether, following your operation, you will be asked to stay for a minimum of 15 minutes. You will be given an information leaflet instructing you on the dos and don ts following your operation. It is advisable that you continue to use a bactericidal soap for 3-4 weeks after your operation to wash your hands and face. General Information On the day of surgery, you will be given an appointment for your postoperative review. This will usually be 4 weeks after surgery but occasionally you may need to return to the hospital earlier and on more than one occasion. You will be advised of this prior to your discharge. Paracetamol or your usual painkillers will relieve any mild discomfort during the first 24 hours after surgery. If your eye becomes very red and painful or your sight worsens after the operation, you must contact the hospital immediately. The numbers are given in the information leaflet that you will receive following surgery. Your sight should improve almost immediately. About 4-8 weeks after your operation, your eyes will be tested for new glasses. Reading glasses or bifocals are usually needed. 10
Talk to your ophthalmologist about returning to work and driving following your operation. Risks associated with cataract surgery Complications that may occur during surgery Cataract surgery is a very common operation that has a very good success rate. Like any operation, there are some risks involved. The cataract management team will take great care to limit the chance of these problems occurring. The commonest problem that occurs during cataract surgery is the lens capsule bag breaking. In a recent national survey of modern cataract surgery this occurred in about 4 patients out of every 100 operated on. At the Manchester Royal Eye Hospital, this occurs less often: 2 out of every 100 operated on. If the lens capsule bag breaks during the operation some of the cataract may float into the jelly at the back of the eye, and you may need to have a second operation. The lens capsule bag supports the new lens implant. If the bag breaks, a different type of lens implant may be used, and stitches may be required. If this is the case, the operation will take a few minutes longer and your eye will take a few weeks longer to recover. However, the final visual result is usually the same. 11
The most serious sight-threatening problem that can happen during cataract surgery is internal bleeding inside the eye. Less than 1 patient in 1000 patients operated on will have this problem. Complications that may occur shortly after surgery The signs and symptoms of potential complications and the action you need to take will be explained to you during your visits to the hospital and in additional information leaflets that you will receive. A serious problem that can occur after the operation is a severe infection inside the eye. In order to prevent this happening antibiotic drops are normally given after the operation. Serious infections are rare, affecting 1 patient out of every 1000 operated on. If this complication does occur, it can result in the loss of sight. Other less serious problems that can occur after the operation are: Inflammation inside the eye A rise in pressure inside the eye A temporary clouding of the cornea (the transparent window at the front of the eye). These problems usually last only a few days and happen to less than 1 patient in every 10 operated on and do not affect the final vision. 12
Long term complications A more common problem that may occur months or years following the cataract operation is a clouding of the lens capsule bag behind the lens implant. The design of the modern lens implants reduces the risk of this happening however; if clouding does occur, it can be treated using a laser beam to make a hole in the capsule. This is carried out during an out-patient appointment visit. The capsule still supports the implant but allows light to pass through to the back of the eye again. The above outlines the most common complications associated with cataract surgery; however, this is not an exhaustive list. During your pre-assessment clinic, the staff will discuss with you the risks and benefits of your treatment. If you do not understand any of the information contained in this leaflet or require further information, please speak to a member of the nursing or medical team when you come for your appointment. If you have any questions or are worried about any of the information provided in this leaflet please contact a member of the cataract services team on 0161 217 3008 Monday Friday 7.30 am 4.30 pm. 13
Questions and answers If you have any questions you would like to ask the Doctor or Nurse but may not remember whilst you are here, this space is for you to write them down with the answers. References 1. Royal college of Ophthalmologists Annual report. Cataract surgery guidelines. February 2001. 2. Nambiar A; mahmood S; Fernando B; Mills KB. Audit of Cataract Surgery. Regional Postgraduate Audit meeting June 2002. 3. Essence of care Hygiene 2006: Indicators for best practice. NHS Modernisation agency, Department of health. 4. Biswas S. 2005. Endophthalmitis risk reduction strategy for cataract surgery. 14
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No smoking policy The NHS has a responsibility for the nation s health. Protect yourself, patients, visitors and staff by adhering to our no smoking policy. Smoking is not permitted within any of our hospital buildings or grounds. The Manchester Stop Smoking Service can be contacted on Tel: (0161) 205 5998 (www.stopsmokingmanchester.co.uk). Larger Print Please ask a member of the department staff if you require this information in large print or braille. Translation and Interpretation Service Do you have difficulty speaking or understanding English? 0161 276 6202/6342 www.cmft.nhs.uk Copyright to Central Manchester University Hospitals NHS Foundation Trust REH 001/06/2W Produced September 2010 Review Date September 2012 (SF Taylor CM5148)