Frequently asked questions about Cataract

No. However, people often develop them simultaneously in both eyes or after a variable period.

Yes, but it is rare. They are known as congenital cataracts.

Patients are initially unaware a cataract is developing, and they do not experience any vision problems. As the cataract develops, you will start to notice a decline in your vision or that you must change your glasses prescription more often than usual.

There is a group of professionals at the hospital who look after patients with cataracts, including nurses, nursing assistants, optometrists and ophthalmologists. During the appointment they will ask you about your vision problems, your general state of health and which medications you take regularly. They will check your visual acuity and carry out other examinations with special equipment to help them make recommendations regarding the best line of treatment for your vision problem. During these tests they will place drops in your eyes to dilate the pupils, so they can perform a complete examination and check inside your eye. These drops will give you blurred vision for a few hours. Therefore, you are advised not to drive after the hospital appointment. Whilst your vision is blurred you must also take care not to trip over while walking.

Since it involves intraocular surgery, most ophthalmologists recommend operating on each eye individually with a few days separation between operations as it is considered safer. This minimises the risk of getting an infection in both eyes. The eye with poorer vision is generally operated on first. It is sometimes advisable to operate after the other one, although it does not cause discomfort, in an attempt to correct the graduation so you can see better with both eyes at the same time.

Excimer laser surgery (e.g., LASIK, PRK, etc.) has been used in recent years to reduce the need to wear glasses, especially in young patients with myopia. If you have received treatment with this type of laser it is very important that you tell the doctors, optometrists and nurses you meet during your appointments. Excimer laser treatments on the cornea alter the calculations required to determine the power of the intraocular lens implanted in your eye during cataract surgery and this can imply a greater risk of developing residual postoperative myopia or hyperopia.

No. However, in the months or years following surgery you may develop thickening or opacity of the posterior lens capsule, which is the membrane behind the intraocular lens. This is called posterior capsule opacification and it causes a progressive loss of vision in 10–15% of patients within 2 years of undergoing a cataract operation. It can be treated on an outpatient basis using a laser in a very effective, rapid and painless intervention known as a YAG laser posterior capsulotomy; however, very occasionally, this procedure can cause retinal detachment or intraocular inflammation.

You should continue applying all your normal eye drops until the day before the intervention. On the day of the operation, do not place any drops in the eye which will be treated. Nevertheless, you can still apply drops as usual to the other eye.

Yes, unless you have been told differently. Take them with a little water. There may be exceptions with certain anticoagulant (Sintrom®) or antiplatelet agents (acetylsalicylic acid) and some alpha blockers taken to treat the prostate (e.g., tamsulosin).

Depending on the type of contact lens you wear, you will need to remove them before taking measurements for the intraocular lens to be implanted. Contact lenses distort the cornea and can produce a “surprise” or unexpected result in the intraocular lens calculation. You will receive specific instructions regarding this point.

Eye make-up may contain particles and bacteria (particularly eyeliner pencils and eyelash mascara) and therefore you must stop wearing eye make-up three days before and for two weeks after surgery.

The surgical intervention is generally carried out in under 20 minutes. However, you will be in the operating theatre for roughly 2 hours, as the preparation and postoperative observation usually involve more time.

You will be lying on your back throughout the intervention. Part of your face will be covered with a sterile paper drape. If you have trouble lying down or claustrophobia, the surgical team will do everything possible to ensure you are relaxed and comfortable before and during the operation. It is a good idea to explain your fears or worries to the nurses and doctors before the intervention. During surgery, the surgeon will use a microscope with a bright light, which, together with the drape, will ensure that you do not see any details of the operation, just shades, lights and colours. You may also notice the surgeon’s or assistant’s hands resting on your forehead or cheeks. A lot of fluid is used throughout the operation. Some fluid may occasionally run beneath the drape and wet the side of your face down to your ear or neck, which could cause some slight discomfort. You may also hear conversations during the intervention. They may be related to the operation, for educational purposes or regarding another matter. Do not try to take part in any discussions unless the surgical team ask you something, as it is important that you remain still throughout the procedure.

Patients do not usually feel any pain. Most patients are surprised when told the operation has finished. Thanks to the sedation used for the operation, you will normally feel relaxed and may even sleep during surgery. Some patients may notice slight discomfort during the intervention because of the instruments used to prevent the eye from moving or blinking.

Most patients are awake and relaxed throughout surgery, but do not usually remember very much about the operation. You are advised to bring somebody with you, so they can take you home after the operation because of the effects of the anaesthetics and sedatives.

This will depend on the type of anaesthesia used for the cataract surgery. If your eye needs to be covered, an eye pad, dressing or a plastic protector will be used. The medical staff will tell you when you can remove the cover, usually the day after the operation. If surgery is performed with topical anaesthesia, you may leave with your eye uncovered, but your vision will probably be blurred for the first few hours after the operation.

The most typical anaesthesia is the application of drops (topical anaesthesia) or an injection around the eye (retrobulbar, peribulbar or sub-Tenon’s anaesthesia) with or without intravenous sedation. Several studies have shown that the results of cataract surgery, assessed in terms of visual acuity, visual function, complications and patient satisfaction, are similar for each anaesthetic technique.

Very occasionally, if there is a medical, psychological or surgical indication, the operation may be performed under general anaesthetic.

As the eye stabilises, you may notice fluctuations, cloudiness or a bright glare in your vision; this is normal. You may also be very sensitive to intense light. You can wear sunglasses if you find they help, but they are not necessary. It is very likely that your old glasses are unsuitable, and you may even see better without them. However, there is no harm in wearing them until you have your definitive optical correction, which will be after approximately 1 month.

Many patients who undergo surgery with topical or regional anaesthesia (particularly in the case of topical anaesthesia), and who are sufficiently awake to realise, notice variable visual sensations such as lights, colours, the movement of instruments or the surgeon’s hands and fingers.

The eye needs some time to recover from the trauma associated with any intervention, no matter how small it is. The most common symptoms following cataract surgery are mild redness, irritation or tearing. Some patients can notice the microscopic wounds healing and have a sensation there is a foreign body or some sand in their eye. These symptoms are normal and tend to diminish after applying the eye drops prescribed for postoperative care.

You will not normally need stitches. Most cataract operations are carried out through an incision of little more than 2 mm, and so stitches are not usually required. Nevertheless, if your ophthalmologist thinks stitches are necessary to ensure wound closure, then this is the best means of finishing the operation.

The indications for cataract surgery in patients with a potential for good vision in just one eye are the same as those for patients with two good eyes, but you must be made aware that there is a small possibility of irreversible vision loss in this eye. The operation must be performed by an ophthalmologist who specialises in cataract surgery.

Cataract surgery is currently one of the safest eye operations and the risk of postoperative blindness is very low. There is a chance of developing a very dangerous intraocular infection, but the incidence is less than 0.1%.

No. No eye drops have proven to be effective in eliminating or “dissolving” cataracts. It can only be resolved surgically. Some researchers are working on a cure involving eye drops and maybe in the future we will have “anti-cataract drops”, but at the present time the only treatment is surgery.