Advice after your nerve block for surgery
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Introduction
A cataract is a clouding of the lens of the eye causing hazy or blurred vision and is most usually due to advancing age. Genetic factors or family history may make you more prone to cataract. Cataract surgery is usually successful at restoring vision.
When will I have my surgery?
Our waiting list is typically 5 months long for routine cataract operations. Once you have been booked for surgery by the doctor in the clinic, you may not hear anything for 3 or 4 months, as the final operating list running orders are not decided until 4 to 6 weeks before surgery. You will be telephoned by our booking team a few weeks before your operation to give you a suitable date, and you will then receive confirmation in the post.
Pre-operative assessment
You will be asked to visit the eye clinic at Frimley Park or the Aldershot Centre for Health about 2 weeks before the operation to attend a pre-assessment clinic. At this clinic you will see either an orthoptist or a specialist nurse. You will have the opportunity to ask them questions about the operation.
The purpose of this visit is to have your eyes measured and ensure you are fit and prepared for the surgery. Both your eyes are measured to calculate the power of the lens implant to be inserted for first eye surgery and second eye surgery if that is also planned. This measurement is called biometry. Biometry is carried out by shining a light on the eye to measure the curvature of the cornea, the depth of the anterior chamber, the lens thickness and the exact length of the eye.
A computer uses these measurements to calculate the power of the lens implant required. We will normally aim to put a lens inside your eye that is calculated to give you distance vision without glasses. Occasionally short-sighted patients who can read without glasses choose to remain like this. In this case we would put a lens for reading vision inside the eye, and glasses would then be needed for distance vision. The measuring procedure is not painful and your eye will feel normal afterwards. Dilating drops are not usually required at this visit.
If your biometry has revealed astigmatism, we may try to correct this at the time of surgery. We can do this by corneal incision placement, extra incisions in the laser room called arcuate keratotomies, or by using a toric intraocular lens. If you need a toric lens, which we use for higher levels of astigmatism, this is ordered after biometry, 2 weeks before your operation.
Contact lens wearers
Contact lenses temporarily change the shape of your cornea and need to be removed before measurements to ensure accuracy. If you wear contact lenses you should not wear them at all for ideally 2 weeks and minimum 1 week (soft lenses) or ideally 4 weeks and minimum 2 weeks (gas permeable) before biometry. You may wear them again after biometry.
Previous laser refractive surgery
This affects the biometry measurements. If you have had laser surgery (LASIK , LASEK, PRK) it is imperative that you make every effort to supply us with the pre and post- operative eye and optician readings that were taken at the time of the surgery. Please bring printed copies on the day of your biometry. Without these we cannot predict your cataract surgery lens power accurately.
Blood pressure will be checked and if you have diabetes, a blood sample will be needed to check your sugar levels. If either of these are found to be too high, surgery may have to be postponed.
At the pre-op assessment
Please remember to bring a list of all your usual tablets and eye drops with you. Please also bring your current reading and distance spectacles, and your most recent spectacle prescription.
Usually you will be awake for your operation. If you require a general anaesthetic for your surgery (i.e. you need to be put to sleep by an anaesthetist), you will need a separate assessment on the same day after your eye measurements, in a separate part of the hospital, for a more detailed general health examination (e.g. a tracing of the heart rhythm called an ECG).
Eyelash cleaning at home before surgery
Eyelashes tend to accumulate bacteria. We ask that you clean your eyelashes once a day with a cotton bud or a cotton pad for a week before surgery. You can use hot tap water, to which you can add a pinch of bicarbonate or a few drops of baby shampoo if you prefer. Try to clean the roots of the eyelashes quite firmly - this is where most debris can accumulate. This reduces the risk of infection, and the risk of us cancelling your operation on the day.
The day of your operation
- You may have your normal meals.
- You should take any medications as usual, including any eye drops for glaucoma. If you have been given drops to dilate your pupil at your pre-assessment, put these in before you leave home.
- If you are having a local anaesthetic (most patients) you will go into the operating theatre in your own clothes. Wear something comfortable that is not tight around your neck.
- The collar of the shirt you wear sometimes gets wet from the infusion of saline used during cataract surgery, bring a spare if you wish.
- Please do not wear any make-up on the day of surgery. It is important for the eye and surrounding skin to be completely clean.
- Don’t wear any jewelry.
The eye ward
The time you are given to come in is not the time of your operation. Your operation will start at least an hour after your arrival, and sometimes much longer, as your pupil needs to dilate fully. We have two operating theatres with separate operating lists, so don't worry if someone who arrives after you is called for surgery before you.
When you arrive on the eye ward, eye drops and sometimes a little pellet are tucked inside your lower lid to dilate your pupil. The pellet does not dissolve and is removed later.
The operation
Most patients have the operation under local anaesthetic and are only at the hospital for 4-6 hours. Sometimes we use a femtosecond laser to perform the first part of your cataract surgery. This will depend on your eye, your surgeon, and the type of operating list. The laser cuts a precise opening in the capsule of the cataract and fragments the cataract into pieces. This all takes only a few minutes in the laser room. This is performed with you lying on the laser bed, after your details have been checked in the room by a nurse. Drops are instilled to numb the eye. A plastic clip holds your eye in contact with the laser. Weak suction is used, which often creates a harmless red ring on the white of your eye, which will fade over 2 weeks. You will be aware of lights during the laser procedure.
After the laser is completed there is a variable pause before the cataract pieces are taken out in a second room, the operating theatre itself, with a phacoemulsification ultrasound probe, and the new plastic acrylic intraocular lens is inserted. This is all through a tiny incision (about 2mm). This means the eye is very secure afterwards.
In the (good) old days we used much larger incisions, which was why we used to give advice about not lifting and bending down. These precautions after surgery no longer apply.
Some patients only require a one-stage procedure in the operating theatre, without laser. We can’t do laser with you asleep, so if you are having a general anaesthetic, that will also be a one-stage procedure.
In the operating theatre
The local anaesthetic in the operating theatre consists simply of eye drops and an infusion of local anaesthetic solution inside the eye. We don’t use a needle. Your eye and face will be underneath a sterile drape, which is held off your nose and mouth by a pipe supplying air.
During the operation you will not be able to see exactly what is happening, but you will be aware of the bright operating microscope light and shapes, and you will be able to sense touch and pressure but not pain. You do not need to worry about blinking as we use a little clip to keep the eye open.
You will be in the operating theatre for about 30 minutes. The operation itself usually takes 10 - 25 minutes, but it may take up to 45 minutes.
We are an ophthalmic teaching hospital so you may hear the senior surgeon advising another surgeon on technical aspects of the operation during your surgery. A nurse will hold your hand if you wish, for reassurance and as a means of communication during the operation.
Post-op eye drops
You may go home about half an hour after the operation. You will be given 3 bottles of eye drops to take 3 times daily. The drop called “Acular” stings for a minute. The one called “Maxidex” can also sting a little.
One or two of the drops will need to be used for 4 weeks after surgery. If you have diabetes, you will be asked to use one of the eye drops for 2 to 3 months. The bottle looks tiny but usually will last for the full 4 weeks. Running out a day or two early is not a problem, especially if the eye feels comfortable. If you do run out before then, please come to the eye ward where the staff will be happy to give you a fresh bottle.
If you use glaucoma drops please continue to use them unless otherwise instructed.
Going Home
You will not be able to drive yourself home; it is best if somebody accompanies you. If you have any initial pain take a pain reliever such as paracetamol every 4 - 6 hours. It is normal to feel mild discomfort and grittiness for a few days after cataract surgery. Clear watery discharge from the eye is common in the first 24 hours.
In most cases healing will take about 4 weeks, after which time you can go to your optician for new glasses if necessary.
If this is your first cataract operation, we may ask you back for a 2-week check by a nurse.
If it is your second cataract operation, and you have no other eye problems, we won’t need to look at your eye in the clinic at a later date if all has gone well.
It is quite normal for the eye to feel improved but still not quite right for about 3 months after surgery. In this time the edge of the new lens can sometimes be seen as a bright or dark curved shadow at the edge of your vision - lens dysphotopsia. This tends to diminish in the first 3 months. It often disappears altogether, but sometimes a subtle dark shadow remains that most patients hardly notice.
If the eye becomes painful, sticky and red, and especially if the vision gets worse please call to the eye treatment centre.
What am I allowed to do?
Take it easy on the first 2 days after surgery and don’t get water in the eye or rub it. If the eye waters, dab the corner with a clean tissue.
After 2 days you may resume all normal activities including hair washing, bathing, showering, bending down, lifting, walking and travelling by car, bus, train or plane. Tinted spectacles or sunglasses may help in bright light but are not essential.
When washing your hair take care not to let the water run over your eyes for the first week.
Avoid swimming and strenuous exercise for 2 weeks.
What about glasses?
- You may wear your usual glasses, although the lens on the side of the operated eye is unlikely to be correct. Your old lens won’t harm your new eye.
- If you prefer not to wear your glasses, that is also fine.
- Most patients will need reading glasses following surgery.
- After a month you can visit your optician if you wish. If you do, please take the audit form with you that you are given on discharge and hand it to the optician.
- If you have prisms in your glasses, your prescription will be less, but you will most likely still need prism glasses after surgery.
When can I drive?
You may drive provided your vision is comfortable and clear with or without spectacles as appropriate, provided you have no double vision, and can read a number plate with both eyes open at 20 metres. This means that some patients will still be unable to drive until their spectacles are updated, because their vision may not meet the legal standard with or without spectacles.
Patients who need to drive at an earlier stage may decide to update their spectacles sooner and accept that these may need to be revised perhaps within a few weeks as the eye continues to heal. There are separate regulations for HGV drivers.
What will my vision be like?
Immediately after the surgery the vision will be blurred. The day after surgery the vision will be clearer but may not clear completely for a few days.
Most patients have improved eyesight following cataract surgery. If you have another condition such as diabetes, glaucoma or age-related macular degeneration, your quality of vision may still be limited even after successful surgery.
Benefits and risks of cataract surgery
The most obvious benefits are greater clarity of vision and improved colour vision. Because lens implants are selected to compensate for existing focusing problems, such as short and long sight, most people find that their eyesight improves considerably after surgery without glasses, although glasses may still be necessary for best distance vision, and are often needed for reading.
Some lens implants are available which try to provide clear vision for reading as well as distance. These are multifocal lenses, implanted the same way, but at the moment are only available privately. Unfortunately the NHS does not allow you to “top up” by paying extra for a different lens.
Some possible complications during the operation
- Tearing of the back part of the lens capsule with disturbance of the vitreous gel inside the eye that may sometimes result in reduced vision - approximately once every 100 operations.
- Loss of all or part of the cataract into the back of the eye requiring further operation which may require a general anaesthetic - less than one case every 500 operations.
- Bleeding inside the eye - rare.
Some possible complications after the operation
- Bruising of the eye.
- High pressure inside the eye.
- Clouding of the cornea.
- Incorrect strength or dislocation of the implant.
- Swelling of the retina - macular oedema - this almost always resolves. If it persists there is treatment available.
- Retinal detachment - this may need a further operation - 1 case in every 500 operations.
- Infection in the eye - endophthalmitis - which can lead to loss of sight - 1 case every 1000 operations.
- Allergy to the medication used.
Complications after a year or two
In up to 20% of patients the remaining lens capsule becomes cloudy, causing a gradual loss in clarity of vision. We call this posterior capsule opacity or PCO. This is easily treated as an outpatient by a 10 minute laser procedure. After laser, this clouding does not come back.
How to use your eye drops
Tilt your head back and pull down your lower lid to make a pocket. Look up and squeeze one drop into the pocket of the lower lid. Then close your eye.
Leave a minimum of 5 minutes between drops.
If you run out of drops, please come back to the eye ward where the staff will be happy to give you a fresh bottle.
If you have any concerns in the first six weeks after your operation, please contact the staff in the Eye Treatment Centre on the following
| From 9am to 5pm Monday to Friday: | 0300 373 5884 |
| From 5pm to 9am and at weekends: | 0300 614 5000 and ask for the Eye Doctor on call |
Contact us
If you have any queries relating to this information, please contact the Ophthalmology service.
About this information
Service:
Ophthalmology
Reference:
QQ/005
Approval date:
2 August 2024
Review date:
1 July 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.