How cataract surgery is performed
Before having cataract surgery, you’ll be referred to a specialist eye doctor (an ophthalmologist or ophthalmic surgeon) for an assessment.
The specialist will assess your eyes and general health, and check for any other eye conditions that may be affecting your vision.
A member of the eye care team will take measurements of your eyes to assess the strength of the artificial lens that will replace your natural lens.
This is also a good time to discuss the procedure in detail and ask any questions you may have.
If you have cataracts that affect your vision in both eyes, you’ll need two separate operations, usually carried out 6 to 12 weeks apart.
This will give the first eye that’s been treated time to heal and your vision time to return. It also allows the surgeon to know your new glasses prescription in the first eye.
Cataract surgery is a common and relatively straightforward procedure that usually takes up to 30 to 45 minutes.
It’s usually carried out as day surgery under local anaesthetic, which means you’re conscious during the procedure and can go home on the same day.
The most common surgical technique used is known as phacoemulsification.
Before the operation, a nurse will put drops in your eye to widen (dilate) your pupil.
You’ll also be given a local anaesthetic, which can be applied as eye drops or given as an injection into the tissue around your eye.
The surgeon will make a tiny cut in your cornea, the transparent layer of tissue at the front of your eye.
A small probe that emits ultrasound waves is inserted through your cornea into the eye to break the affected lens into pieces. The pieces are then liquified and sucked out. A second probe sucks out the remaining soft pieces of outer lens.
After the affected lens has been removed, the surgeon will insert a small plastic lens in its place.
The replacement lens is usually curled up in an injector and injected through the cut in the cornea. When it’s in place, it unfolds itself and adopts the natural position of the old lens.
In a few cases, it may be necessary to make a slightly larger incision in the eye to replace the affected lens, which may need to be closed with tiny stitches that are removed a few weeks later.
After the cloudy lens has been removed, it will be replaced with an artificial clear plastic lens. The replacement lens is called an intraocular implant, or intraocular lens (IOL).
There are three types of IOL available. They are:
- fixed strength (monofocal) lenses –which are set for one level of vision, usually distance vision; this type of lens is used in the majority of cataract operations
- multifocal lenses – which can be set at two or more different strengths, such as near and distance vision
- accommodating lenses – which allow the eye to focus on both near and distant objects in a similar way to a natural lens
Using multifocal or accommodating lenses can potentially reduce the chances of needing reading glasses after surgery, although most people will need to wear glasses in some situations after surgery regardless of the type of lenses they had fitted.
Multifocal and accommodating lenses aren’t usually available on the NHS. If you would like multifocal or accommodating lenses, you may be able to have them by paying for cataract surgery privately.
Most people are able to go home a few hours after having cataract surgery, although you’ll need to arrange for someone to collect you and take you home. You’ll usually have a pad over your eye when you go home.
It’s also a good idea to arrange for someone to help look after you when you get home as you may feel out of sorts for 24 hours.
If the vision in your other eye is poor, you may struggle with your vision for the first few days as it settles down.
It’s likely you’ll experience some discomfort in and around your eye after the procedure, but this should improve within a few days.
Complications in the days and weeks after surgery are rare, but you should contact the hospital as soon as possible if you experience increasing pain or vision loss at any point.
The ophthalmic team
If you have cataracts, a number of different healthcare professionals may be involved in your care:
- optometrist – examines eyes, tests sight, and prescribes and dispenses glasses and contact lenses. They’re trained to recognise eye conditions and sight defects. Most optometrists work in high-street opticians, while some work in hospitals.
- ophthalmologist – a medical doctor who specialises in eye conditions and their treatment. They mainly work in hospitals and hospital eye departments.
- dispensing optician – make up glasses from prescriptions provided by optometrists or ophthalmologists. They may also fit contact lenses, but don’t carry out eye examinations.
- orthoptist – specialises in problems relating to eye movement and the eyes working together, including squint, lazy eye, and double vision.
- ophthalmic nurse – a nurse who has developed skills in eye care. They work in hospital eye departments.