Cataracts and their treatment Information for patients from Head and Neck Now that you have been told that you may have a cataract, you will be wondering what happens next. This leaflet explains what cataracts are and how we treat them. We hope it will help you reach a decision on whether you wish to have an operation. If you have any further questions after reading this please contact us before the date of your operation. What is a cataract? A cataract is a clouding of part of the eye known as the lens, which is normally clear. Your vision becomes blurred or dim because light cannot pass through to the back of the eye. It may develop over a number of years or very quickly and can interfere with your ability to lead your normal life. We care 1
What causes a cataract? Cataracts can form at any age, but they most often develop as we get older. In younger people they can result from injury, certain drugs, long-standing inflammation, or illnesses such as diabetes. What is the treatment? At present there is only one way to treat cataracts and that is an operation to remove the old lens and put an artificial lens in its place. Occasionally a doctor will decide that someone s eye is not suitable for a lens implant. In these cases contact lenses or glasses will be prescribed. An artificial lens viewed from front and side What are the benefits of the operation? Cataract surgery is one of the most successful operations performed today, with hundreds of thousands of people having excellent vision after surgery. You should enjoy improved vision for many years and once again be able to do the things that your cataract has prevented you from doing. If you have other eye problems, cataract surgery will not necessarily bring about an improvement in vision. Your consultant will discuss this with you. Are there any risks? Every operation no matter how big or small carries a risk, however the risks associated with cataract surgery are very small. Every care is taken to avoid complications but, even in the best of hands, complications do occur although rarely. We use all the means at our disposal to minimise the effects of any complications. There is a very small risk of developing a serious eye infection after surgery, but this is rare. If the bag that holds the lens tears, the lens may not be put in until a later date. Bleeding inside the eye is a possibility and can affect your vision temporarily or even permanently, especially if you have uncontrolled blood pressure. There is the possibility that some time after your operation your vision may become hazy due to debris forming behind the new lens. This is easy to remedy with laser treatment in the eye clinic as an outpatient. There is a small risk of a detached retina during the early weeks following surgery; there is a patient leaflet on this condition should you wish to know more. 2
What will happen before the treatment? Where possible we will arrange for you to attend a cataract clinic where you will be fully assessed. You will see a nurse and an ophthalmologist (eye doctor) and possibly an orthoptist as well. Please bring your current glasses and a list of any tablets you are taking. If you have been referred by your GP (rather than by your optometrist), then please also bring along a copy of an old spectacle prescription, say three to four years old. We advise you not to drive to this appointment as we will be putting drops into your eye that enlarge the pupils. This allows us to examine inside the back of your eye but can affect your vision for a few hours afterwards. What if I normally wear contact lenses? Soft contact lenses should be removed 24 hours before your appointment. Hard lenses should be removed at least one week before your appointment. This is because we may need to take some measurements from your eye, and the lenses may affect the measurements. What will happen at my appointment? Your vision will be tested and your eye and medical history will be discussed. Please advise the nurse or doctor at this appointment if you are on warfarin, aspirin, or are diabetic. Using a slit lamp, your eye will be examined by a nurse or an orthoptist, who will also measure the pressure of your eye. Using specialist equipment, the size of your eye will be measured to help the ophthalmologist to decide which lens to put into your eye once the cataract is removed. When the tests are finished the ophthalmologist will examine your eye in detail and discuss with you plans for giving you the best possible vision. You will be reminded about the risks and benefits, as you may then be asked to sign the consent form for the operation. Please note that this appointment can last two hours or more We will usually ring you a week or two before your surgery to ensure that we can meet all your needs both on the day of your operation and following your discharge. Will I have a pre-assessment appointment? We do not routinely see everyone for pre-assessment. Your doctor will decide whether we need to see you or whether this can be done over the telephone. You may be seen at the time of your clinic appointment or you will receive an appointment by post advising you of a further appointment. If we are assessing you by telephone, you will be notified by letter of the specific date and time that we will call you along with the date for your appointment. It is important that you take these calls; if you do not, your procedure will be cancelled. Who will carry out my operation? Whilst you will be in the care of a named consultant for your treatment, it does not mean that this is the person that will carry out your operation. All of our doctors work in teams and it may be another member of that team who carries out your surgery. 3
What will happen on the day of my operation? Unless you are having a general anaesthetic (you will have been advised) we do not usually ask you to change into a theatre gown. Please wear something that is comfortable and easily removed when you get home (button fronted garments are good) as you may be wearing an eye patch and do not want to be struggling to get clothing over your head. Please bring a book, magazine, or something to occupy you. Do not wear contact lenses on the day of surgery, hard or soft. Spectacles should be worn where necessary. Can I eat and drink before my operation? Unless we have advised you otherwise, you may eat and drink normally before your procedure. Should I take my normal medication before my operation? Do not stop any medications including painkillers or eye drops unless you have been asked to do so by your doctor or pre-assessment nurse. If you need to take medication during your stay, please bring them with you. If you are on insulin or any other diabetic medication, if you have a GTN spray or inhalers, please ensure that you bring these with you and inform the nurse when you arrive. What will happen when I arrive at hospital? On arrival, please report to the receptionist. A nurse will take your blood pressure and pulse and ask you a series of questions. Please bring the contact number of a relative / friend in case we need to contact somebody in an emergency. Your stay with us will be approximately four hours. Just before the operation, you will be given eye drops to enlarge your pupil. The doctor will also see you before your procedure and answer any further questions that you may have. 4
Cataract surgery using ultrasound Cataract surgery using Ultrasound Normally cataract surgery is carried out under local anaesthetic. This is given using either anaesthetic drops or an injection around the area of the eye. However, the ophthalmologist may decide that you need a general anaesthetic and will have discussed this with you already in the clinic. The operation is performed using a microscope and generally takes up to 35 minutes. Normally a small incision is made in the eye; this incision is designed to self seal and rarely needs stitches. Where a larger incision is necessary, you may need stitches. A pad or shield will be put over your eye to protect it from accidental rubbing and bumping. A nurse will be with you throughout and you will have some refreshments afterwards. Before you are discharged a nurse will give you all the instructions and advice that you need; this will be in the presence of any relative or friend you bring with you and who will accompany you home. Please ask any questions and share any concerns that you have. 5
What happens after the procedure? We do not routinely see everyone after their operation. In order to ensure that your follow-up is not compromised in any way you will still be seen post-operatively should your surgeon specify this. You must arrange for a responsible adult to collect you and take you home (in a car or a taxi not by public transport). Will I have a follow-up appointment? An ophthalmic nurse will telephone you approximately one week after your operation, to make sure everything is okay. A date and morning or afternoon time will be agreed with you on the day of your operation. If a problem is identified at this appointment the nurse will ask for you to be seen in clinic. This does not mean that anything has gone wrong and may just be a precaution. Will I need to visit my opticians for a follow-up? Following your operation you will be given a letter to take to your optician after four weeks. It is most important that you make an appointment and attend. At this appointment, the eye will be examined to ensure that everything is recovering as expected. If we are planning to operate on the other eye, you may wish to wait until you have had surgery on both eyes before changing your spectacles. However, it is still important that you visit your optician so that we can ensure that the two eyes are balanced together for the best vision. If you do not visit the optician as requested, we may not proceed with surgery to the second eye, if it is planned. If your distance vision is good, but you are having difficulty reading, you may wish to get a pair of ready readers to assist you until you see the optician. If you are happy with your frame, you may wish to change one lens and the other after the second eye surgery. Please remember that all eyes are different and your experience of cataracts surgery may not be the same as other peoples. If we are operating on both eyes it is possible that the experience will be different on the two occasions. What problems may I experience after my surgery? The majority of patients experience no problems after cataract surgery. What shall I do if my eye does not feel right after the operation? We ask you to contact us immediately if you experience any of the following: pain that is not resolved with your usual painkillers redness that is not resolving a loss of any part of your vision which is abnormal for you swelling to the eyelids a problem that appears to be worsening. 6
How long will it take for my vision to return? The amount of time that it will take for your vision to return to normal varies from person to person and is dependent on a number of factors such as the type and amount of anaesthetic that is used and how healthy the eye is. Most people have some useful vision within a few hours. However, it may take two or three days for the eye to settle down. Sometimes the vision will be very good and then become a little bit blurry before settling down again. Sometimes the vision starts blurry and then clears. The two eyes sometimes respond differently so do not worry if the second eye does not recover in the same way as the first. In the early days after the surgery it is sometimes possible to see from the edge of the lens to the edge of the vision; this can sometimes be accompanied by some twinkling lights. This will usually settle after a few days. Will my eye look different after the operation? Your eye should look exactly the same however it may be possible that you will have a small bruise in the eye. This is usually seen as a patch of solid red and may look like blood. Sometimes people worry that the eye is bleeding, but it looks more alarming than it usually is. The eye does not have the same pigment that the skin has and therefore the bruise looks red rather than the purple that you would get on the skin when it bruises. Like any bruise it will gradually get smaller and then disappear. Will my eye feel any different? Sometimes after cataract surgery the eye can feel dry or it can feel watery and sometimes feels as though there is something in the eye such as a stitch or an eyelash. This is not uncommon and usually settles with time. If you are finding this to be a particular problem, you may wish to use some Artificial Tears which can be purchased from your pharmacy. Please allow five minutes between these and the prescription eye drops that we have given you. It may seem strange to put tears into an eye that is watering, but the tears that you are producing sometimes get upset by the operation and are sometimes too watery to keep the eye lubricated properly. Will I still need my glasses? The best vision is often not achieved until both eyes have undergone surgery. In a very few cases, it may be necessary to cover one eye for certain activities until the second eye has been done. Your glasses may no longer be effective after cataract surgery. Unfortunately, there are no rules to say what will give you the best vision. Here are a few suggestions. If you can see better without your spectacles, then do not wear them. If your glasses still work well, then you can continue to use them. For most patients you will need glasses only for the eye that has not had surgery. If it is possible, you may ask somebody to remove the spectacle lens from the eye that has had the surgery. If you have some old spectacles at home you may wish to try them. 7
When can I drive again? You should not drive for 24 hours after your procedure and then only if you are able to read a car registration plate at a distance of 20.5 meters. We have tried to cover most of the more common problems that occur after cataract surgery. However, it is not possible to cover them all. Please remember that all eyes are different and your experience of cataract surgery may not be the same as other peoples. If we are operating on both eyes it is possible that the experience will be different on the two occasions. What if I have concerns or questions once I am home? Please remember that most patients have a very good result from their surgery. If you develop any problems following your operation please do not hesitate to call the on call nurse on 07887 804133 (mobile). Please be patient if your call is not answered straightaway. The nurse may be driving or dealing with another patient. Kent and Canterbury Hospital, Canterbury Waiting List Co-ordinator Telephone: 01227 866444 Ophthalmology Suite Telephone: 01227 866493 Queen Elizabeth the Queen Mother Hospital, Margate Waiting List Co-ordinator Telephone: 01843 234364 Day Surgery Unit Telephone: 01843 234458 William Harvey Hospital, Ashford Waiting List Co-ordinator Telephone: 01233 616757 Day Surgery Unit Telephone: 01233 616263 8
Any complaints, comments, concerns, or compliments If you have other concerns please talk to your doctor or nurse. Alternatively please contact our Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314, or email ekh-tr.pals@nhs.net Further patient information leaflets In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets covering conditions, services, and clinical procedures carried out by the Trust. For a full listing please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff. After reading this information, do you have any further questions or comments? If so, please list below and bring to the attention of your nurse or consultant. Would you like the information in this leaflet in another format or language? We value equality of access to our information and services and are therefore happy to provide the information in this leaflet in Braille, large print, or audio - upon request. If you would like a copy of this document in your language, please contact the ward or department responsible for your care. Pacjenci chcący uzyskać kopię tego dokumentu w swoim języku ojczystym powinni skontaktować się z oddziałem lub działem odpowiedzialnym za opiekę nad nimi. Ak by ste chceli kópiu tohto dokumentu vo vašom jazyku, prosím skontaktujte nemocničné pracovisko, alebo oddelenie zodpovedné za starostlivosť o vás. Pokud byste měli zájem o kopii tohoto dokumentu ve svém jazyce, kontaktujte prosím oddělení odpovídající za Vaši péči. Чтобы получить копию этого документа на вашем родном языке, пожалуйста обратитесь в отделение, ответственное за ваше лечение. We have allocated parking spaces for disabled people, automatic doors, induction loops, and can provide interpretation. For assistance, please contact a member of staff. This leaflet has been produced with and for patients Information produced by Head and Neck Date reviewed: April 2017 Next review date: August 2019 EKH079 9