Cataract Surgery

The eye has a natural lens which bends light rays to focus on the retina. As we get older, the lens gradually becomes more dense and cloudy. The light then cannot focus clearly on the retina and vision becomes cloudy. It is like looking through a frosted window.

The eye has a natural lens which bends light rays to focus on the retina. As we get older, the lens gradually becomes more dense and cloudy. The light then cannot focus clearly on the retina and vision becomes cloudy. It is like looking through a frosted window.

source – American Academy Ophthalmology

If you are getting cataract, you will start to notice gradual changes in your vision such as:

• Difficulty seeing in dim light such as at dusk or at night
• Intolerance to strong light (glare)
• Haloes around light or an edge to images (double vision)
• Faded colours
• Continuous need to upgrade your glasses

• Age: as we get older, there is a natural change in the colour and density of our natural lens. This is the main cause of cataract.
• Family history: you may have a strong family history of getting cataract especially at a younger age.
• Medical conditions: some medical problems can lead to cataract development such in diabetes when it is not well controlled.
• Medications: steroid use can lead to a certain type of cataract which develops rather quickly (over a few months) and causes considerable glare and haloes.
• UV rays: cataract seem to occur more to people who have spent a lot of their lifetime outdoors with strong ultraviolet (UV) light exposure and not wearing protective sunglasses.
• Smoking is a key risk for cataract

Wearing sunglasses or having anti- UV coating in your medical glasses is the best way to reduce the risk of getting cataract by reducing the exposure to ultraviolet light rays. It does not need to be a sunny hot day to have a high UV index. A cloudy day may also have a high UV radiation. It is advised to wear protective sunglasses:

• During summer when UV radiation is high.
• At beach or near water
• When at high altitude such when skiing
• If you are taking medications which increase sensitivity to light

There are no medications such as tablets or drops that can prevent or reverse cataract. It can only be cured by surgery.

It is always best to discuss the timing of cataract surgery with your experienced cataract surgeon at the Northern Eye Centre. This will depend on your individual needs and lifestyle circumstances.

You can wait for a while if the cataract is not giving you trouble, so long as you are safe and can achieve your life demands with no visual handicap, in particular if you are safe to drive.

If you start to have problems, then it is reasonable to consider surgery. The operations for cataract have improved tremendously over the last 20 years and are now considered to be one of the safest and most satisfying surgeries anyone can go through. It is by far a gratifying experience. You always need to discuss the benefits and risks of the surgery with your eye specialist before going ahead.

Your age is not a deterrent to going ahead with surgery as it is done under regional anaesthesia as a day surgery case.

You will be required to attend the Northern Eye Centre to undergo some measurements and tests before you proceed with surgery. These include;

• Ocular Biometry: measurements of the cornea powers and length of the eye are taken, then calculation is done on multiple equations to decide the power of the Intraocular Lens Implant (IOL); that is the synthetic lens implant which replaces the original crystal lens of the eye.
• Corneal Topography: a detailed cornea power and surface analysis. This test helps to detect unknown corneal problems prior to surgery.
• OCT of the Retina:  is a scan of the macula (centre of the retina) which may be necessary to exclude other disease that needs treatment prior to cataract surgery.

• Food: We advise that you fast for 6 hours before surgery.
• Medicine: Regardless of the timing of surgery please be sure you take all your medications in the morning as usual. The exception would be if you are on anticoagulant or diabetic medications, please read the following paragraphs:
• Diabetic patients:
  • Tablets: If you usually take tablets for diabetes in the morning, do not take them on the morning of surgery, but please bring them with you to the hospital.
  • Insulin: If your surgery is planned for the morning, please take only a third of your usual dose of insulin and do not have breakfast. Take your other medications with a sip of water in the morning as usual. It is advised that you check your blood glucose level and take sweets such as sugar if you are hypo (low glucose level below 5).
  • If your surgery is planned in the afternoon, have breakfast as normal then fast for 6 hours before admission. Take a third of your normal morning Insulin dose.
• Anticoagulants
  • Aspirin: you can continue taking Aspirin as usual.
  • Warfarin: if you are on Warfarin, we advise that you consult with your blood lab to adjust your INR to be below 3.0. Please do a blood test on the Friday before surgery and fax the results to the day surgery.
  • Plavix (Iscover), Xarelto: It is preferable if you can stop those tablets for a week before surgery. You need to get permission to stop from your family doctor or treating heart specialist.
• Smoking: Please stop smoking because the longer you stop smoking prior to surgery, the greater the benefit. Please inform your anaesthetist if you have frequent coughing, emphysema or chronic bronchitis.

• Admission: We recommend you bring a companion with you. The operation is performed in a modern up to date day centre. You will be admitted an hour or so prior to the allocated time of surgery. Nurses will perform the routine admission and perform general checks prior to you been reviewed by our anaesthetist.

• Anaesthesia: The operation is done under regional anaesthesia. In the majority of cases this is done by installing anaesthetic eye drops. You will receive mild sedation to make you relaxed and calm but you will be still awake during surgery and hear our instructions. You will not feel pain. The actual surgery usually takes 10 to 15 minutes.

• Small incision cataract surgery:
  • A Small 2.4mm self-sealing incision at the cornea edge is done.
  • A circular opening is made in the lens front capsule
  • Cataract is fragmented by ultrasound and aspirated.
  • A foldable Intraocular Lens Implant (IOL) is inserted inside the original lens capsule. It opens gradually and is positioned in the correct location.
  • The corneal wound is structured to be self-sealing with no sutures required in the majority of cases.
  • A small dose of antibiotic is given locally.
  • Laser may be used in certain steps of the surgery.

• Day Surgery Recovery
  • You will be taken to recovery from the operating theatre. Nurses will assess you and give you tea/coffee and sandwiches.
  • You will be discharged to home. We recommend that you have someone with you that night at home as you may be still drowsy for a few hours after surgery.

• You will be using eye drops for 3 weeks.
• In many patients vision will be quite good immediately on the first day after surgery. In others, it may take a week or so before it improves.
• You need to report if you develop any problems after surgery, especially if you get pain, ache in the eye or your vision gets worse again.
• You may need to take a week off work after surgery
• Driving is possible the day following surgery if you feel confident and your vision is good.
• You may resume normal activities but avoid rubbing or pressing on the eye.
• You can shower and wash your hair normally but avoid getting water directly into the eye.
• You are advised to avoid swimming for 2 weeks after surgery.

• The aim of cataract surgery is to improve your vision. For many patients there is also the added benefit of reducing or eliminating the need to wear their distance glasses or contact lenses. You may still need to wear glasses for certain functions such as reading but there are alternative for the planned after surgery outcome that you may wish.
• You need to discuss your needs with your cataract surgeon at Northern Eye Centre, Melbourne, prior to surgery so we ensure that we can fulfil your visual needs.
• It is important to have realistic expectations. While we will ensure to do our best, the final level of vision will depend on the overall health of your eye. If your eye is already affected by other conditions such as macular degeneration, glaucoma or diabetes, this may limit the final outcome of the cataract surgery.

• The standard IOL is measured to allow you to see well for far (more than 6 meters away). This is called Monofocal IOL. You will still need to wear glasses for mid and near vision such as for computer work and reading a book.
• Some patients may prefer to have one eye operated upon to achieve good far vision and the other eye is to have an IOL for mid or near vision. This is called Monovision.
• Multifocal IOLs: these implants are manufactured to allow for both far and near vision. These lenses are suitable for a small percentage of patients and may not be suitable for you. They are also more expensive but are covered by most private health insurers. If you are interested in multifocal IOLs, please discuss your needs with our specialist.
• Toric IOLs: a normal cornea has a perfectly spherical surface with equal curvatures. In some eyes, the cornea is not spherical but rather like an Australian AFL ball with different curvatures. This is called astigmatism. A toric IOL is designed with a surface to compensate for the astigmatic cornea. If you have astigmatism, you may be suitable to have this type of implant which reduces the need to wear glasses after surgery to correct for this pre-existing condition. This type of IOL is more expensive than the standard monofocal IOL but is covered by most private health insurers. We will determine if you need this type of implant when you undergo pre-operative testing.

Cataract surgery is one of the most commonly performed and most successful procedure worldwide. By far the majority of patients are very satisfied with the outcome of surgery. However, as with any surgery, complications can still occur during or after cataract surgery. This may affect your final vision. Complications may include:

• • Eye infection
  • Inflammation to same or other eye (sympathetic)
  • Swelling of the macula ( centre of the retina)
  • Changes of pupil size and shape
  • Dry eyes
  • Haemorrhage
  • Late complications of lens implant such as dislocation (moving out of position)
  • Droopy lid
  • Pain
  • Retinal detachment
  • Vision loss

  At Northern Eye Centre, we treat every patient with the highest standard of care. Our surgeons have operated for many years on thousands of cataract cases. We promise the highest level of surgical expertise and post-operative care to every patient.

Your vision may become cloudy again some months or years after a successful cataract surgery and initial excellent vision. This is often due to opacification of the posterior (back) capsule of the original lens. This problem occurs in a small percentage of cases and can be easily treated by laser. The procedure is painless and performed at the centre over a few minutes. It regains your vision to the level immediately enjoyed after your original cataract surgery.

• Royal Australian and New Zealand College of Ophthalmologists
• American Academy of Ophthalmologists