Dr Gerry Kervick, consultant ophthalmologist with the Mater Hospital, explains what is involved with cataract surgery.
Q. My father is 80 years old and has been told he would benefit from surgery to remove his cataracts. He is worried about the procedure. Could you explain what’s involved?
A. Mr Gerry Kervick, consultant ophthalmologist says cataract surgery is one of the most commonly performed surgical procedures in the world today.
Despite this, there are still many misconceptions amongst the public about the surgery and what it entails.
For a start, many people still believe that the cataract must be ‘ripe’ before the surgery is performed.
This idea is a legacy from many years ago before the advent of modern cataract surgery with lens implants and quicker recovery time.
In fact, in cases of advanced or ‘ripe’ cataracts, the surgery is more likely to be complicated and the recovery prolonged. It is safer to have the surgery earlier rather than later.
The eye is like a camera with a lens in the centre allowing us to focus on the world around us.
When that lens becomes cloudy and prevents or reduces clear vision then that can be a sign of a cataract developing.
Typically, one of the first signs of the aging of the lens is the need for reading glasses as we get older, usually in our late 40s or early 50s.
This then progresses over time requiring stronger glasses to see clearly at all distances.
Often the tipping point for the patient requesting a referral for treatment is when they find they have to change their spectacle prescription more frequently than was previously the case.
Even after getting new glasses, the patient can still be unhappy with the quality of their vision, experiencing symptoms such as glare when driving at night and having difficulty seeing in poor light conditions.
In most cases, cataracts develop very slowly over many years, but sometimes they can be quite rapid and really affect the vision quite rapidly preventing activities such as driving.
Naturally, this is very distressing for the patient. The correct time to have cataract surgery is when the symptoms are bothering the patient and that can vary depending on how active the person is, whether they are driving or working, or, indeed, on their age.
Modern cataract surgery is typically performed as a day case procedure under topical anaesthesia (i.e drops only, no injections around the eye).
It is a relatively quick procedure taking less than 10 minutes to complete. The cataract is removed and replaced with a new lens inside the eye.
The patient goes home the same day. There should be limited downtime after successful surgery. There are misconceptions about not being able to bend or stoop for many weeks after.
With today’s surgery that is not the case and most patients can be back at work within a few days, resuming most normal activities (for example, driving or golf) within a few days.
Another common misconception is that cataracts can ‘come back’ and reduce the vision again. This is not the case. Once the cataract is removed it cannot come back.
In 10-15% of cataract patients after a year or more a film can develop at the back of the new lens and cause the vision to blur once more. In this case, however, the treatment is a once-off laser treatment that is painless and takes about 30 seconds.
Increasingly many patients are opting to have their cataracts removed at an earlier stage rather than waiting for the vision to deteriorate significantly.
When the surgery is combined with the appropriate lens implantation, it can mean that the patient may not need any glasses after the surgery or at least a greatly reduced dependence on glasses.
As with all medical procedures, however, nothing can be guaranteed in terms of outcome.
All surgery has some degree of risk associated with it. Your surgeon will explain all this at consultation.
Cataract surgery, thankfully, in most cases, is a very successful procedure.
* If you are experiencing reduced quality of vision despite glasses, discuss the possibility of cataracts with your optometrist.
* Modern cataract surgery has a quick recovery timeand can be used as a means to reduce your dependence on glasses for near and distance.
* Once removed, cataracts can’t ‘come back’ after a few years. If there is some return of blurred vision, it is usually treated with laser.
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