Austin McCormick

                                                  Consultant Ophthalmic and Oculoplastic Surgeon MBChB, FRCOphth

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Tel: 01517098442                             Fax: 01517097509                                Email:  liverpool.eyesurgeons@virgin.net                               Address:  86 Rodney Street  L1 9AR UK

Cataracts

What is a cataract?


  1. The lens of the eye is responsible for focussing light that passes into the eye onto the retina.

  2. A normal lens is completely transparent and clear.

  3. A cataract is a lens which is no longer transparent or clear.

  4. This may cause blurring of vision and difficulty seeing detail.

  5. It may also cause glare around bright lights, especially at night.


What are the benefits of surgery?


  1. Cataract surgery aims to improve vision.

  2. This improvement is mainly the ability to read detail both close up and far away.

  3. It may also improve overall field of vision in some cases.

  4. Pre existing refractive error (short-sightedness or far-sightedness) may also be partly corrected at the same time.


What is cataract surgery?


  1. Cataract surgery is an operation in which your lens is removed and a clear plastic man-made lens is inserted in its place.

  2. It is carried out in an operating theatre with specialist equipment.

  3. The technical term for the procedure is: phacoemulsification and intraocular lens implantation.

  4. On the day of surgery drops will be put in the eye to numb it and to dilate the pupil.

  5. If you are having a general anaesthetic or subtenons local anaesthetic, you will next move into the anaesthetic room for the anaesthetic to be given.

  6. In the operating room iodine will be used to clean the skin around the eye.

  7. A sterile drape will be placed over your face. This has a hole in it to enable access to the eye to be operated on.

  8. A small retractor will hold the eyelids open so you don’t have to worry about keeping your eyelids open.

  9. A tiny 2 millimetre incision is made in the eye. Through this and another even smaller incision, the lens is removed by choping it into small pieces.

  10. The device which chops it is called the phacoemulsification probe. It is a needle that vibrates at ultra sonic frequencies.

  11. After the lens has been removed, a lens implant is inserted.

  12. This implant is a plastic man made lens, the power of which has been carefully selected according to your biometry measurements pre-operatively and your desired post operative refraction (focus point).

  13. The lens implant stays in the eye forever and never needs to be changed.

  14. Usually no stitches are needed as the wound is self sealing.

  15. A clear plastic eye shield is taped over the operated eye.

  16. The whole procedure routinely takes no more than 15 minutes.


What anaesthetic will I need?

  1. Most operations are carried out under local anaesthetic. There are two types of local: Topical anaesthesia; Subtenons anaesthesia.

  2. Topical anaesthesia: Anaesthetic drops are put in your eye, completely numbing the surface of the eye. After the first incision, an injection of local anaesthetic is given inside the eye which further numbs the eye. This is the simplest and safest method of anaesthesia. It does require you to keep your eye very still during the procedure.

  3. Subtenons anaesthetia: Anaesthetic drops are put in your eye, completely numbing the surface of the eye. Tiny sterile scissors are used to make a small cut behind the eyelid. A small injection of local anaesthetic is given behind the eyelid, through this small cut. No sharp needle is used reducing the risks of sharp needle anaesthesia. This anaesthetic not only numbs the eye but also stops it from moving and is a good choice if you are very anxious or don’t think you could keep your eye still during surgery.

  4. The last option is General Anaesthesia where you are completely asleep.



Are there alternatives to surgery?


  1. Cataract surgery is the most successful way of improving visual acuity in the presence of a cataract.

  2. If surgery is not wanted or not possible, vision can be optimised in other ways.

  3. A new pair of glasses may help.

  4. A low visual aid assessment can be carried out where you may try magnifying glasses and other devices aimed at improving reading.

  5. Using a light over your shoulder and directed onto your reading matter may help with reading



What will happen if I decide not to have surgery?


  1. The cataract and your vision may stay the same or gradually get worse.

  2. A cataract does not damage the eye. In other words, leaving it un-operated does not make surgery in the future more difficult.


When should I have the operation?


  1. The operation is carried out to improve vision. Therefore you as a patient should feel that there is a problem with your vision before having surgery.

  2. In other words, just because you have a cataract does not mean you have to have surgery.

  3. The risk of permanent loss of vision due to infection after cataract surgery is approximately 1 in 1000. A question you can ask yourself is : “Has my vision deteriorated to the point where I am happy to take a 1 in 1000 gamble with it?”

  4. It used to be the case that cataracts were best left until they were ‘ripe’. This is no longer the case - surgery can be carried out at any time.


What will happen before surgery?


  1. Before the operation you will be seen in the clinic by Mr. McCormick.

  2. He will ask you about your vision problems. He will also ask about other medical problems you have, medications you take and any allergies (bring a list or the tablets themselves with you).

  3. He will examine your eyes.

  4. If you are to proceed with surgery the operation will be discussed in detail. This will include any risks or possible complications of the operation and the method of anaesthesia.

  5. You will be asked to read and sign a consent form after having the opportunity to ask any questions.

  6. You will undergo biometry measurements of your eyes. These involve placing your chin on a rest in front of a special instrument. It is painless and quick. These measurements are used to calculate what power of lens implant to place in the eye at the time of surgery.

  7. You will also see a preoperative assessment nurse. She/He will carry out blood tests and an ECG (heart tracing) if required. She/He will also advise you if you need to starve before the operation.

  8. If simple local anaesthesia is used you will not need any of these investigations and you will not need to starve prior to surgery.



What should I do about my medication?


  1. Mr. McCormick will want to know all the medication that you take and about any allergies you have.

  2. In some cases you may be asked to stop or reduce the dose of blood thinning tablets like: warfarin, aspirin, clopidogrel (plavix), dipyridamole (persantin). This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery.

  3. Other medication should be taken as usual.



What are the risks and possible complications of surgery?


  1. Infection is a rare but serious complication. It occurs in approximately 1 in 1000 cases.

  2. If it occurs it can be treated with antibiotics. Some achieve god vision but others can loose all vision in the eye.

  3. If you have a painful eye with loss of vision after surgery, you should see an eye surgeon urgently.

  4. Bleeding

  5. You will have the opportunity to discuss the risks and benefits of surgery and anaesthesia with Mr McCormick and the anaesthetist prior to surgery.



What should I expect after surgery?


  1. A clear plastic shield will be placed over the eye, which will remain until the following day when you can remove it.

  2. The time when you can return to normal activities varies from person to person. Many are happy to do so after 2 – 3 days and the vast majority after a week.


Postoperative Instructions

  1. If an eye pad is placed it should remain until the next morning when you may remove it

  2.   For the first 10 days clean the wound using either sterile water sachets or boiled water that has cooled down and sterile cotton wool balls

•Follow up appointment 1 week later for suture removal (if required).