Patient information sheet
Cataract surgery and/or implantation of an intraocular lens
This information is given to you so that you can prepare for the discussion with your eye surgeon.
This document will help you understand the risks of cataract surgery. It mainly addresses the risks and
benefits of the cataract operation. Eyeglasses or contact lenses are usually required for best vision
after cataract surgery.
If, after reading this form, you have any questions or concerns, please discuss these with Dr Françoise
Belloir Furet.
Introduction
What is cataract?
Cataracts are cloudy patches in the lens of the eye that can make your vision blurry. They may
eventually lead to blindness if they are left untreated.
Cataracts can develop in one or both eyes, and over time, the size of the cataract can get bigger until
the whole lens is covered.
The lens of each eye should be clear in order for your eyes to work properly. The clear lens allows
light to reach the retina at the back of the eye, so it’s important to keep up to date with eye
examinations. Ideally, you should have your sight checked by an ophtalmist every two years, although
people over 60 years old may be required to have eye tests every year.
If you have a cataract, it will continue to develop. The only way to restore your vision is by having the
cataract removed by surgery.
Cataract surgery is one of the most common and quickest surgeries performed nowadays, and many
people are able to return to their daily routine after 24 hours.
If the cataract is getting in the way of your daily business and affects your ability to drive or read, you
may need cataract surgery. Typical signs are blurred vision or dazzles from lights (such as oncoming
car headlights).
Surgery to remove a cataract can now be done at any stage of development. In the past, people with
cataracts were encouraged you wait until the condition was so bad they could hardly see. Now,
cataract operation can be performed from an early stage to prevent further eye conditions developing,
such as macular degeneration or diabetic retinopathy. If you are at risk of developing an eye condition
caused by cataracts, your GP may recommend having cataract surgery.
Are there alternative to surgery?
New glasses, brighter lightning, anti-glare sunglasses or magnifying lenses can help with the first
signs of a cataract (slight blur at the edge of an image), but they won’t stop the cataract growing and
blurring your vision. However, if your cataract isn’t interfering with your daily life, you may decide
not to have the operation straight away. It’s safe to leave a cataract. It doesn’t become harder to
remove if you decide to wait a while before having surgery.
What will happen if I don’t have the operation?
Without surgery, your lens will gradually become so cloudy you won’t be able to see any detail at all,
although some light will always be distinguishable. There is no medication that can clear a cloudy
lens.
Surgery will be needed to remove any cataract you may have. If you have cataracts in both eyes, they
will be operated on at separate occasions so the first eye has time to heal and to allow your vision to
return. A majority of cataract operations are performed with keyhole surgery and are usually
performed as day surgery, meaning you can go home afterwards. You will need someone to look after
you for the first 24 hours.
Before the operation, your optician or GP will refer you to a specialist eye doctor (ophthalmologist or
ophthalmic surgeon) who will assess your eyes and general health. This is called pre-operative
assessment.
During this assessment, measurements of your eye wil be taken, to prepare for the artificial lens that
will replace the natural blurring one.
An appointment will probably be made for your operation to take place in a separate visit.
There are three types of cataract surgery.
They are :
Phacoemulsification
Extracapsular cataract surgery
Intracapsular cataract surgery.
Since cataract surgery is so common these days, these operations can often be completed within 45
minutes.
Phacoemulsification usually takes 15-30 minutes, although extracapsular or intracapsular operations
can take longer.
Phacoemulsification
Phacoemulsification is the most common cataract procedure.
The surgeon puts drops into your eye to dilate (widen) your pupil. You will also be given a local
anesthetic, which can be applied as drops or given as an injection into the issue around the eye.
The surgeon then makes a tiny cut incision (2.4/2.8 mm) on the front surface of the eye (the cornea).
A small probe is inserted into the cornea, which releases ultrasounds that help to break up the cataract
into tiny pieces. The ultrasound probe is removed and a new probe is inserted, which sucks out the
cataract.
Once the entire cataract has gone, the surgeon inserts a small plastic lens through the incision in the
cornea. The lens sits in the lens capsule, behind the pupil. The replacement lens is folded in half when
it is inserted so it can fit through the incision in the cornea. When it is in place, it unfolds itself and
adopts the natural position of the old lens.
Extracapsular cataract surgery
If your doctors think your lens is too awkward to be removed by phacoemulsification, they may
suggest extracapsular surgery.
The surgeon will need to make a larger incision in the cornea and through to the lens capsule, in order
to remove the whole lens in one piece. Once the lens is removed, an artificial lens (such as those used
in phacoemulsification) is inserted into the lens capsule.
Intraocular cataract surgery
This form of surgery is very rarely carried out, but is sometimes needed if the zonules (which support
the lens) are too weak.
Intraocular cataract surgery involves the removal of the entire lens, including the lens capsule. An
artificial plastic lens is then inserted through the incision, where it sits over the pupil.
The replacement lens
There are several types of replacement lens available. Your doctor will decide which one will be the
best for you.
For any lens replacement, the quality of your vision after having cataract surgery depends on the
correct measurements of your eye being taken BEFORE your operation. This pre-operative
assessment ensures that the most appropriate lens replacement is chosen to fit with your eye and
reduces the chance of poor vision afterwards.
Risks :
Cataract surgery is very common and the risks are very low. It’s estimated that the complication
occurs in 2% of cases. Ask your surgeon to go through the possible risks with you before your
operation.
The most common risk is developing a condition called posterior capsule opacification. This occurs
when a part of the lens capsule thickens and becomes cloudy. It can be treated, usually with laser
surgery.
Other possible complications after cataract surgery include:
Infection in the eye
Bleeding in the eye
Inflammation in the eye
Tearing of the lens capsule
A bit of the cataract drooping into the back of the eye
Damage to other parts of the eye, such as cornea.
It is usually possible to treat any complications. However, occasionally, your vision may be worse
than before or there may be permanent damage to the eye, causing loss of sight – but this is very rare.
If a severe cataract is not treated, there is the possibility that loss of sight may be permanent.
Childhood cataract surgery
There are slightly more risks involved with childhood cataract surgery. They include :
Increased pressure inside the eye (glaucoma)
Squint(strabismus)
Abnormalities affecting the eye pupil
Vision becoming cloudy again (visual axis opacification or posterior capsule opacification)
Separation of the retina from the inner wall of the eye (retina detachment)
Infection –for example a rare bacterial infection (endophtalmitis)
If childhood cataract is left untreated, the child may become blind. Even if cataract is removed, visual
impairment or blindness can remain.
After the operation :
Your eye may be covered with a pad or piece of tape, which you can take off after a few hours.
Your doctor or nurse will give you eye drops to help prevent infection and promote healing
You can go home once you’ve made a full recovery from the anesthetic. Arrange for someone to
collect you and take you home as you will not be allowed to drive yourself. Also arrange for someone
to take care of you for the first 24 hours after surgery. You will need someone to look after you for the
first 24 hours.
Sensation usually returns to the eye within a few hours, and improved vision after a few days.
Complete healing may take several months.
You’ll be given a 24-hour contact telephone number and a date for a follow-up appointment – most
surgeon see their patients one to three weeks from the operation
It may be helpful to wear sunglasses or a hat when you leave hospital, as your eye could be sensitive
to the sun.
What should I do when I get home ?
Take it easy for the first two or three days after the operation.
Try not to touch or rub your eye.
Keep soap and shampoo out of your eyes.
In the past, the advice was not to bend after surgery, but this is no longer the case. You can bend,
carry shopping, wash your face and hair and generally carry on your life as normal.
It’s best not to swim for one week and you should avoid sports, such as tennis, where there is a risk
you may get knocked in the eye.
You should be able to read and watch tv almost immediately if you have reading glasses, but your
vision may be blurry as your healing eye gets used to its new lens. You may have to get new reading
glasses.
If you suffer more than mild pain, experience loss of vision or if part of your eye starts to get red, you
should immediately contact your hospital for advice. Painkillers like paracetamol should help mild
pain.
You can drive again when you can read a number plate at 20.5 meters. You may have to get new
glasses to be able to do this again.
After the operation, if you don’t have any other eye diseases, you should be able to :
See things in focus, although you may still need glasses.
Look into bright light without as much glare.
Tell the difference between colors.
Start to enjoy your usual activities, such as reading, knitting, working, watching tv, sports, driving.
Results
Most people (95 %) see an improvement with their sight almost immediately after surgery, although
cataract surgery does not always completely restore your vision.
Treatment usually involves surgery to replace the clouded natural lens with an artificial monofocal
one, which has just one strength of focus. A monofocal lens will usually restore good distance vision,
but you may still need to wear reading glasses for close work.
Sometimes, the natural lens is replaced with either a monofocal or an accommodating lens, which
allows you to focus on both near and distant objects.
Some patients who have a multifocal lens fitted may not need to wear glasses at all after surgery. A
review of studies by NICE showed that just 68 % of patients who had multifocal lenses implanted
needed glasses after their operation, compared with 95 % of patients who were given monofocal
lenses.
It will take several weeks after the operation for your vision to settle down before your optician can
give you a new glasses prescription, if necessary.
Approximately 1 patient out of 100 will need a second operation. One patient out of 1000 will
experience a complication that results in them having permanently worse vision, even when wearing
glasses.
Your ophtalmologist, Dr Françoise BELLOIR-FURET will be with you at your surgery to assist
the surgeon, the fee for assistance is 50€ and the social security will rembourse you
approximately 6€. If you have any questions do not hesitate to ask to the doctor.
VERY IMPORTANT RECOMMENDATIONS
After surgery please : take clean bed clothes, bedsheet and pillowcases, at home;
Please see that the person who administers the eye drops wash their hands very carefully with
soap and a hydroalcoholic solution before each eye drop.
Do not let your pets sleep in your bed room.
Avoid rubbing your eyes
Carefully wash your hands each time you go to the toilets
On the eve of the surgery day, take a shower and a shampoo so that your hair are clean
NO RETURN HOME WILL BE ALLOWED THE DAY OF THE SURGERY IF YOU
LIVE ALONE OR IF NO ARRANGEMENT TO HAVE SOMEONE LOOK AFTER
YOU HAS BEEN MADE.
Arrange for someone to take care of you for the first 24 hours after surgery.
Insurance law forbids you from driving any vehicule for 48 hours after the operation.
You must be accompanied when attending the required visit the following day.
AVOID ANY STRONG PHYSICAL EFFORTS
----------------------------------------------------------------------------------------------------------------------------INFORMED CONSENT FORM
Your doctor is obliged by law to prove that information has been supplied to the patient. So
as it is asked you to sign this document, the copy of which will be kept by your doctor.
The undersigned
First name ...................................................................................................................................................
Surname .....................................................................................................................................................
have read and plainly understood the explanation provided to me by Dr BELLOIR-FURET.
The nature of the examination or the intervention, as well as its profits and its risks, were
explained to me in words I understood. I have had all my questions answered to my
satisfaction.
I have been given enough time to think about it, and
I agree
I do not agree
To the procedure which is proposed to be done.
I also understand that if anything untoward occurs the surgeon will do as he/she thinks best
for me at that time.
Date
Patient signature