Frequently Asked Questions

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Is Surgery The Only Treatment For Cataract?
What Anaesthetic Is Used for Cataract Surgery?
When Can I Return To Work?
Can Cataract Surgery Be Done On Both Eyes At The Same Time?
Will I Need Glasses After Cataract Surgery?
What Are The Risks Of Cataract Surgery?
What If There Are Other Eye Problems As Well As Cataract?
What Is Secondary Cataract?

Is Surgery The Only Treatment For Cataract?
Surgery is the only treatment for cataract. Cataract cannot be cured or prevented from advancing in any other way. Surgery for cataract is more commonly performed than any other operation on any part of the body. Fortunately it is also one of the most successful operations available to modern medicine. Once it has been removed, a cataract will not recur.

What Anaesthetic Is Used for Cataract Surgery?
There are two types of anaesthetic. If you have a general anaesthetic you will be asleep during the operation or alternatively you may prefer a local anaesthetic in which case you will be awake. In fact there are two ways of giving the local anaesthetic. A numbing injection may be given gently into the tissues around the eye, but not into the eye itself. This is similar to the injection given by a dentist before a filling. Alternatively powerful anaesthetic eye drops are used instead of the injection. Either way there will be no pain during the operation and you will not ‘see’ the operation, although there is slightly more ‘awareness’ if the anaesthetic eye drops are used. I invite most patients to choose whether they prefer a general or local anaesthetic as both are equally safe for the surgery. However I sometimes suggest a particular method, for example a local anaesthetic may be preferable for patients with heart problems. I will also advise you which type of local anaesthetic (injection or drops) will work best for you.

When Can I Return To Work?
Modern phacoemulsification cataract surgery makes it possible for you to return to work as soon as you wish, even the day after surgery.

Can Cataract Surgery Be Done On Both Eyes At The Same Time?
Normally one eye is done at a time with an interval of a few weeks between the two.

Will I Need Glasses After Cataract Surgery?
Cataract surgery and distance glasses Modern cataract surgery is designed to minimise your dependence on distance glasses after the operation for activities such as driving or watching TV. In fact you may not need them at all even if you have worn distance glasses for many years. Please understand however that it is not possible to guarantee freedom from distance glasses and that you may need to wear weak glasses after the operation even if you have not needed them previously. If they are necessary, new distance glasses may be obtained from an optician one month after cataract surgery.

Cataract surgery and reading glasses You will need reading glasses after the operation even if you do not need distance glasses. This is true even if you have not worn reading glasses before. However there are two ways around this which work for some patients -

(a) You can be given a new type of lens implant called a multifocal lens. This focuses light from close as well as distant objects, reducing and sometimes abolishing dependence on reading glasses. Multifocal lenses are an important technological advance. However they do have drawbacks. Firstly they do not guarantee freedom from reading glasses. Secondly they are not appropriate for patients who have a high degree of astigmatism, which is caused by an uneven curvature of the cornea of the eye. Thirdly they sometimes cause haloes around car lights when driving at night, although this is not normally a severe problem and the haloes often disappear after a while. If haloes occur after the first eye is implanted with a multifocal lens, they are paradoxically often cured by implanting a multifocal lens in the second eye when its cataract is removed. Fourthly the vision provided by a multifocal lens may be slightly less sharp than by an ordinary lens implant. However the difference is usually too small to be noticeable. In summary patients are usually delighted by the independence from glasses provided by multifocal lenses but they are not appropriate for everyone.

(b) There is another way of reducing your need for reading glasses after the operation which does not depend on a multifocal lens implant. This method is to use an ordinary lens implant and to intentionally focus your eye for near vision. The aim is to provide good near vision with minimum dependence on reading glasses. The drawback is that you will need glasses for all distance tasks such as watching TV or driving. Note that this is the opposite of the usual way of using an ordinary lens implant when the eye is focused for clear distance vision but needs reading glasses for all near tasks. I only recommend this method to those who prefer wearing distance rather than reading glasses. These are usually patients who have never needed reading glasses but who are accustomed to distance glasses.

What Are The Risks Of Cataract Surgery?
I believe it is important that this subject is discussed even though you may find it unsettling. You should be reassured by the knowledge that in experienced hands the risk of modern cataract surgery is very low. As with any operation performed on any part of the body a complication may occur but this is uncommon. It is always the case in medicine that some risk must be accepted in order to achieve a cure, but fortunately in cataract surgery the balance is heavily weighted in favour of a happy outcome.

Possible serious complications include infection, retinal detachment, macular oedema (swelling of the retina), clouding of the cornea and inability to remove all of the cataract during the first operation in which case a second operation is necessary. Possible less serious problems include prolonged inflammation after the operation necessitating the use of steroid eye drops for longer than normal, haloes when driving at night, dependence on distance and/or reading glasses post-operatively even if they were not needed pre-operatively and a slight drooping of the eyelid post-operatively. This is not an all-inclusive list.

What If There Are Other Eye Problems As Well As Cataract?
Sometimes there are other eye problems in addition to the cataract such as macular degeneration or glaucoma. In this case cataract surgery may not restore perfect vision. However if there is significant cataract it is usually worthwhile removing it in order to give the eye the best chance of good vision.

What Is Secondary Cataract?
This is a common phenomenon and should not be confused with a recurrence of the original cataract which never happens. Secondary cataract is caused by a thickening of the lens capsule that is used to hold the lens implant in place. Vision becomes blurred, a change that can begin at any time from a few months to many years after the operation. It is not regarded as a complication because it is caused by a natural change in the condition of the eye rather than an untoward event during the operation. Fortunately secondary cataract can be easily removed using a special laser. This is a minor outpatients procedure that takes only a minute or so and causes no discomfort.

This lens implant has developed a rough and
uneven surface from secondary cataract
(The small, bright circle is the camera light)

The white discoloration is secondary
cataract located behind the lens implant
Secondary cataract is not normally visible to the naked eye