Buchanan Optometrists

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Cataracts

What are cataracts?

Cataracts are a very common eye condition which affects most people at some point in their lives. Contrary to popular belief cataracts are not a film or skin growing over the eye. Cataracts occur when the lens inside the eye gradually gets more cloudy with age. Cataracts usually slowly get worse so your eyesight gets less clear over time but they can often be removed with surgery and replaced with an artificial lens to enable you to see normally again.

Most cataracts are age-related and occur after 50 years old however some children develop cataracts before or just after these are called congenital cataracts. Some people also develop cataracts more quickly because of an injury or medical conditions such as diabetes or steroid use.

The eyes natural lens helps us focus on objects from near to far by changing shape. It gradually thickens throughout life making near focus more difficult- this is why after 40 most people need a different spectacle prescription to help them read- a condition called presbyopia.

The lens gradually gets more cloudy as cataracts form and your vision gradually becomes less clear. Initially, cataracts may develop slowly causing subtle changes in your vision such as difficulty reading in a bad light or driving at night. As less light passes through your lens, you may find that you are affected more by dim lights. You may also experience more glare on bright days due to the cataract scattering light that enters your eyes.

It is not uncommon to be told you have "early cataracts or lens opacities" for many years before you notice any effect from them.

While we can improve your vision with spectacle lenses, there is no clinical need to take cataracts out (the NHS will not operate until your vision declines to a certain standard, some people opt to have a private operation at an earlier date to improve their vision). When cataracts start to affect you vision in a way that cannot be improved by changing your spectacles, you will be given the option to have cataracts removed. Occasionally cataracts appear to change your vision more quickly over a couple of months. If you notice your vision becoming more difficult, please book an appointment to see us as soon as possible by calling 01634 240645.

How can I prevent against cataracts?

Age is the largest influence on cataracts which we cannot prevent. Other factors involved in cataract development include life-long exposure to sunlight, smoking and having a poor diet lacking antioxidant vitamins. Therefore, it is important not to smoke, eat a healthy diet including plenty of fruit and vegetables and protect your eyes with quality sunglass lenses from childhood. Regular eye examinations will help to monitor the effects of cataracts on your vision and keep you seeing well until you are ready for a cataract operation.

What symptoms do cataracts cause?

When your cataract starts to develop, you may feel your sight is changing or not as good as it once was. Some people described it as looking through dirty spectacles lenses. Gradually, you may find your sight becomes cloudier, making it harder to see. You may also notice that colours appear less bright.

Driving at night can be difficult due to glare - a problem which can be helped with a special blue control coating on your spectacle lenses.

Reading can be more difficult- This can often be helped with specialist varifocal or reading lenses.

You may be prone to more frequent prescription changes. Keep your spectacles up to date for the best possible vision in all lighting conditions. Sometimes a small change to your prescription can make the difference in being able to see something or not.

How are cataracts treated?

The only effective treatment for cataracts is surgery to remove your cloudy lens and replace it with an artificial lens implant. One eye is done at a time. Usually, the eye with the more developed cataract is done first followed a few months later by the other eye if it is ready.

When should I have my cataracts removed?

There is no longer a reason to wait until the cataract is "ripe" before removing it. However, because any surgery involves some risk, it is usually worth waiting until we can no longer make significant improvements with spectacles before removing the cataract. Kathryn and Alisdair can help you decide when you are at the right stage to have your cataracts removed.

Can I drive if I have cataracts?

Many people with cataracts are still legally able to drive. Ask your optometrist for advice as although you may pass the DVLA number plate test you may find driving in certain lighting conditions more difficult. You may be helped by specialist spectacle lenses or tints- Ask Gill or Sean to show you some samples. If spectacles do not help it is a good time to consider having your cataracts removed.

Cataract Surgery

The Royal College of Ophthalmologists advises that cataract surgery usually takes about 30 -45 minutes and most people go home from the hospital a few hours later. It is usually done with a local anaesthetic, which means that you will be awake during the operation but you won't feel any pain. You will be able to talk to the operating team and ask for any assurance you need. The local anaesthetic may involve drops and an injection or just drops.

During the process, a small incision is made into the eye to enable removal of your lens so you don’t need any stitches.

To remove the cataract, the ophthalmologist needs to remove the natural lens in your eye and replace it with a plastic lens implant. The ophthalmologist introduces the small instruments they need to remove the cataract through the tiny incisions.  The cataract is broken up and removed. A new artificial lens is then introduced to sit in the eyes natural lens holder called the lens capsule.

As you are awake during the operation, you will be able to hear what is happening in the operating room. You can also communicate with the ophthalmologist and the nurses who are on hand to reassure you. Because the eye is anaesthetised and your pupil is dilated, you may be able to see some lights and movement but not the details of the instruments used. You should not feel any pain in your eye.

A short time after your operation, your eye will be examined, to make sure the operation has been successful. Your eye will be covered with a dressing which stays in place when you go home, normally a few hours later.

Your eye may begin to feel slightly sore once the local anaesthetic starts to wear off. The dressing, which is put on in the hospital, usually needs to stay on your eye overnight, but you should be able to take it off the following morning. Your eye may look red and you might develop some bruises but these will improve over the next few days. 

How quickly will I notice an improvement?

Some people can tell that their sight has improved straight away. Your sight may not be as good as you expect for the first week after the operation, as the eye is still recovering from the surgery and will probably be a little swollen. Rarely visual improvement may be limited by other eye conditions such as macular degeneration or glaucoma. Rarely some side effects from the operation can cause the vision to be poorer than expected.

If your eye is very painful or your vision suddenly gets a lot worse, then you should let the hospital know as soon as possible as this may mean they need to see you again.

You may still need spectacles after the operation but your prescription is likely to change dramatically compared to before the operation meaning that you may not be able to see very well through your usual spectacles until they have been updated. You should book your eye examination here six weeks after the cataract operation so as we can measure you for new spectacles. It is only at that point that you will truly be able to see the improvement the operation has made.

While you are waiting for the six weeks for the eye to settle, we can sometimes remove or change your usual spectacle lens temporarily to help you with adaptation.

Following surgery you will notice that colours are brighter – sunglasses can help alleviate any glare you may be experiencing.

What to expect after a cataract operation

Most people have no problems after the surgery and they are up and about as normal the next day.

After surgery, you can usually go back to your everyday activities straightaway as soon as you feel up to it. The hospital will give you eye drops to use for up to two months. There are usually two drops you can take: one is an antibiotic which stops infection and the other are steroid drops to help reduce the swelling. If you think you may have problems using the drops, you should let your GP know as they may be able to arrange some help for you.

Other than the drops you can usually carry on as normal, although you might need to avoid the following for the first week to ten days:

Usually, you will see the ophthalmologist about six weeks after the operation and at this appointment you can ask them about returning to all your usual activities.

What are the risks?

Cataract surgery is very successful. Complications only affect about three percent of people who have cataracts. The most common complications can be dealt with and usually don't affect sight in the long term. Your surgeon will discuss the risks with you before you decide to have the surgery.

More serious complications are much rarer and include retinal detachment, macula swelling, a break in the lens capsule, infection or problems with the lens implant. If your eye is very painful or your vision suddenly gets a lot worse, then you should let the hospital know as soon as possible as this may mean they need to see you again.

What is posterior capsule opacification?

One of the most common complications is a thickening of the lens capsule which holds the lens in place. This may occur a couple of months or even years after the original operation. If this happens, your sight will become cloudy again, as though the cataract has come back. This complication is known as posterior capsule opacification and it is usually quickly dealt with by a small laser procedure.

What happens if I don’t want my cataract removed?

You are not obliged to have a cataract operation until you are ready. Try not to be put off by the thought of the operation. It is quick and painless and a lot of people are nervous about their first cataract operation but are happy to go back for the second one.

If a cataract isn't removed, your sight will become increasingly cloudy. Eventually, it will be like trying to see through a fog. Even if your cataract gets to this stage, it can still be removed and your sight improved.

What are Multifocal lens implants?

Some lens implants are available which try to provide clear vision in the distance and up close. These are called multi-focal lenses. There are different types available but usually implanted in the same way as the more common lenses. At the moment, multi-focal lenses are usually only available privately because as opinion is divided as to whether they work as well as the traditional single vision lenses. In our experience patients experience better vision with single vision lens implants and still wear spectacles, compared to the multifocal implant lenses which often need a top up spectacle correction.