Cataract operation at the Eye Hospital Welcome to the Oxford Eye Hospital. The following video has been developed to help inform you about your impending cataract operation. You will have an opportunity to discuss this with a member of the nursing and medical staff before your operation. Cataract surgery was first performed, in a very primitive form, 100s of years ago. Even up until the last 20 to 30 years patients were admitted to hospital for several days; they were unable to return to their normal lifestyle for several weeks following surgery. Today, cataract surgery has been developed into a quick and sophisticated form of restoring sight. Generally, the operation is performed on a day case basis, with a hospital stay of about four hours. Return to normal lifestyle is almost immediate. In Oxford, we perform cataract surgery on approximately 3,500 patients per year. This figure is set to rise, with the increase in growth of individuals over the age of 65. This diagram shows a side view of the eye. The lens is normally transparent, and is situated behind the iris and pupil. A cataract is simply a clouding of the lens, caused mainly by the ageing process. There are other conditions that can cause cataract formation, such as diabetes. Various drugs can also bring about early cataracts, steroids for instance. For some individuals, cataracts can develop because of other eye problems, or previous eye surgery. The operation is designed to remove your lens, and to replace it with a clear plastic implant lens, which is done by making a small cut, about 3‐4 millimetres, into the top of the eyeball. An ultrasonic probe is inserted through this cut, and breaks down the lens into fragments. These are then removed from the eye. The outer shell, or capsule of the lens, is left intact, to protect the delicate tissues at the back of the eye, and also to provide support for the implant. Once this process has been completed, the implant is inserted. It may or may not be necessary to place a stitch in the eye, to seal the initial cut. All of this takes about 15‐30 minutes. “If I could ask you to hold this instrument against your glasses, just put the centre part on your nose, and read what you can from the chart up ahead there, just take your time…” Andre has a cataract, and is here for his first assessment two weeks before his operation. The assessment process involves measuring and checking your eyes, and general health. “So it’s checking your blood pressure and your pulse at the same time and the reading will come up here. If I could have your glasses, I’ll check them on the machine here. Put your chin on this rest here, and your forehead against the bar, OK? I’m going to have to adjust it a little bit to get you level…” “So you’ve come in to have your right eye operated on, and this is normally done under a local anaesthetic, on a day case basis, that suits you OK does it? And you’re coming in from Didcot. How are you going to get into hospital and home again?” We also like to make certain that you are aware of what will happen to you before, during and after your operation. “And is there any family history of any eye problems at all?” “No, none at all really.” Any special care needs can be planned at this stage. “Just rest your head back there, look right up at the ceiling.” These drops will numb your eye, to allow us to measure for the power of the implant to be inserted into your eye during the operation. It only takes a matter of minutes to perform. Generally, our measurements are calculated to restore a level of vision that is good for middle and long distance, but that will require you to have reading glasses. “What I need you to do is just look straight ahead at Mickey Mouse there, and try and keep your eyes as still as possible. I’m going to do both eyes, I’m going to do your right eye first and then straight on with the left. You won’t feel anything, but you will hear a lot of beeps, but that’s just me. Just concentrate on looking straight ahead for me.” For those of you who are short sighted, which means you need glasses to help you see in the distance, there is an opportunity to insert an implant to correct this: again, reading glasses will be needed after surgery. Some surgeons are using implants which are very sophisticated, and can give good near and distant sight. These are called multifocal implants. These options will be discussed with you if appropriate. Having completed the assessment, Andre will return in about two weeks’ time for his operation. Normally, you are asked to arrive on the ward an hour or so before the predicted time of your operation, and we ask that you do not eat for six hours, and also not drink for two hours before this time. “Lovely to meet you, sit down there, that’s it, right, we’re just going to get your ready for your surgery today…” All patients have a checklist completed. This is mainly so we are certain that we haven’t forgotten anything. “OK, now, do you understand what’s happening to you today?” “I think so: they remove the affected lens and replace it with a perspex one.” “That’s right, that’s a really good understanding of the whole procedure, yes”. Your blood pressure and pulse rate are taken. Drops to enlarge your pupil will be put into your eye. Sometimes these are given by placing a small sponge soaked in fluid just inside your eyelid. “There you go, that’s it, and that will stay there for 15 minutes, OK?” At this stage there can be a wait before transferring you to the operating theatre, to allow the drops time to work. You are normally taken to theatre in a wheelchair, as this is a tortuous five minute walk from the ward. If you wish, you can walk, but we do like to wheel you back. “Right, it’s Andre? My name’s Trudy. I am just going to hold your hand and look after you while we’re up here. So you’ve got no allergies at all? You’re feeling fit and well today? Good. And you’ve signed your consent form. And which eye are we going to do today?” “The right one.” “Correct.” At this point in time, you will be lying flat on the operating trolley. Your head is supported in a special rest. If need be, we can raise your head slightly. The trolley will be bent slightly under your knees, to increase your comfort during the operation. Occasionally we place a small plastic needle into the vein in the back of your hand. This is in case you should need any medication during surgery. It is normal for a local anaesthetic to be given prior to the surgery. This means you will stay awake during the operation, but you do not feel anything. The eye is numbed by either an injection into the skin in the bottom of your lid, or by drops applied directly to your eye. The skin around your eye is cleaned, after which you will be covered with a plastic drape. Cool air will be piped under the drape. You will need to remain quiet and still during surgery. A nurse will hold your hand during the operation, which you are asked to squeeze if you need to speak with your surgeon. Some people are anxious that they might see the operation being performed, but this is not the case. At the most, you may see brightly coloured lights. The equipment in the operating theatre is quite noisy, so we generally aim to play background music to you during your operation. Once completed, your eye is covered with an eye pad and plastic shield. You will be helped to sit upright and then transferred back to rest on the ward. “Get your bearings; don’t go anywhere just yet. You’ve still got that in your hand, they’ll take that out once you’ve had a cup of tea – and a sandwich. There we go sir, nice and gently, you might feel a bit dizzy.” On the ward, we offer you something to eat and drink, and ask that you rest for about an hour. After this time we will check your eye and discuss your aftercare with you. “Right, your eye looks good at the moment, Andre, just have a seat back there in your chair. Now, we just need to clean your eye, OK? And then I’ll give you the instructions that you need to take home with you. You have this leaflet here called ‘Dos and don’ts following eye surgery’, and this basically tells you everything that you must do when you get home, OK? It explains it very clearly and concisely, as you can see. This whole page explains the eye drops that you are going to take home with you, and I’m just going to explain those to you now.” Generally you are given two types of drops, one to prevent infection, and the other to help reduce inflammation. Aim to start these the next morning. “When you came back from surgery you were wearing this clear eye shield. Now, I’m going to stick this back over your eye, and you need to wear it for the rest of the day and through the night, and then you need to take it off tomorrow morning and start putting your eye drops in. Then you can leave the eye shield off for the rest of the day, but when you go to bed tomorrow night you need to wear it again, and then you need to wear it thereafter for the next two weeks, every night, just to protect the eye from the sheets and pillowcase corners, all right? It goes on like this, OK? This thin part at the top gets placed over the bridge of your nose, and then you put a couple of pieces of tape over it. So, on the back of this instruction leaflet are a number of dos and don’ts after surgery. The first one is, never rub or touch your eye if possible. Please remember to wear your eye shield as I’ve just explained. When washing your face it’s important that you try and avoid the eye area. Avoid strenuous activities such as sports and swimming for one month, and heavy lifting and gardening for the next two weeks. It’s OK to look and bend down, and you can watch TV and read without any problems. As I explained already, you might get some hazy vision and some double vision, but that should hopefully clear within the next few days as the eye settles down…” 90 percent of patients achieve a very good result following cataract surgery. Most will notice an improvement in their vision within a few days. Up to ten percent can suffer a delay in the return of their sight: this may be either due to an existing eye condition, or because of a complication during the operation. One patient out of every thousand can lose the sight in their eye as a direct result of surgery, but you do have to remember that this is one of the safest operations commonly performed today. “If you notice any sudden redness, swelling, or intense pain, or drop in vision, then it’s important that you contact the hospital immediately, because it could mean that there is a problem with your eye. There is a 24 hour number, which is staffed by an ophthalmic nurse, which you can ring to get some advice or reassurance if you do find that you have any problems.” For those individuals who are short‐sighted, there is a very small increased risk of developing a retinal detachment following cataract surgery. Should this occur, further surgical treatment is generally required. It is normal for most people to be ready for new glasses 4‐6 weeks following their operation. If the fellow eye needs surgery, new glasses can be delayed until after the operation on the second eye. Or alternatively, a new lens can be supplied for just the eye that has been operated on. If the fellow eye does need surgery, we will generally aim to undertake this 3‐6 months after the first operation. Andre will return to the outpatients’ clinic within the next three weeks for a routine check‐up. If however he has any problems or questions before this time we do operate a 24 hour helpline for any problems or concerns he may have. “My overriding impression of my stay up here was the friendliness of the staff, their considerable knowledge, the dedication to duty and the way I was looked after. There was no great pain at any stage of the proceedings. No‐one need have anything to fear. It’s not an unpleasant experience, because you can have complete confidence in all those that take part in this procedure.”