A cataract is a clouding of the lens in your eye.

Your lens sits just behind your iris, the coloured part of your eye. Normally your lens is clear and helps to focus the light entering your eye. Developing cataracts will cause your sight to become cloudy and misty.

Cataracts can affect one or both eyes.

Cataracts are treated by surgery, during which the cloudy lens is removed and replaced by an artificial lens.

How your eye works

When you look at something, light passes through the front of your eye, and is focused by the cornea and then the lens onto the retina. The lens is normally clear so that light can pass directly through to focus on your retina (the lens is clear because of the way the cells in the lens are arranged). When the lens focuses light onto the retina, the light is converted to electrical signals. A network of nerves delivers these signals from the different parts of the retina to the optic nerve and onto the brain. The brain interprets these signals to “see” the world around us.

The lens can change shape, allowing us to focus on objects at different distances – this is called “accommodation of vision”. As we get older, the lens isn’t able to change shape as well as it used to – even people who can see clearly in the distance without glasses will need reading glasses to see things up close. This process is not caused by a cataract.

Cataracts result from changes in the way the cells of the lens are arranged and their water content, which causes the lens to become cloudy instead of clear. When this happens, light cannot pass directly through the lens and you may notice problems with your vision. A cataract is not a growth or a film growing over the eye; it is simply the lens becoming cloudy.

Do I have cataracts?

Cataracts normally develop very slowly. At first, the changes they make to your sight may be difficult to notice, but as they get worse you’ll start to notice symptoms such as:

You feel like your glasses are dirty and need cleaning, even when they don’t.

Your sight is misty and cloudy.

You’re more sensitive to light – bright sunlight or car headlamps may glare more.

Everything looks a little more washed out than it should be.

Eventually, almost all people with cataracts will find that their sight has turned misty or cloudy, and things have become difficult to see all of the time.

Cataracts sometimes develop so slowly that you might not notice the changes in your vision, but when you have your regular eye test, your optometrist (also known as an optician) may detect them and refer you to a hospital.

What can be done about cataracts?

Cataracts can be removed by surgery. Cataract surgery removes your cloudy lens and replaces it with an artificial lens. This lens is known as an intra ocular lens – often shortened to IOL. The artificial lens is made of plastic or silicone, and will not need to be changed for the rest of your life.

There isn’t any medicine or drops that can remove cataracts – surgery is the only way to treat them.

Normally, if you have cataracts in both eyes, they will be removed separately. You’ll have one eye operated on and then once this eye is healed, you’ll have the cataract in your other eye removed.

Why have I developed cataracts?

Developing cataracts is a normal part of growing older. Most people start to develop cataracts after the age of 65, but some people in their forties and fifties can also develop cataracts.

Certain things make it more likely that you will develop cataracts:

Diabetes – people who have diabetes often develop cataracts earlier.

Trauma – having an eye injury can cause the injured eye to develop a cataract.

Medications – some prescription drugs can cause cataracts, for example steroids.

Eye surgery – surgery for a retinal problem will likely lead to cataracts in the affected eye at some point in the future.

Eye conditions – other eye conditions, such as retinitis pigmentosa, glaucoma or uveitis, may also cause cataracts.

Having high myopia (being very short sighted) may cause cataracts.

Cataracts caused by aging, medications and other eye conditions usually develop in both eyes. Cataracts caused by an eye injury or eye surgery only develop in the affected eye.

Despite the different causes, most cataracts are dealt with using the same type of surgery.

Some children have cataracts, which are dealt with in a different way. Read mora about childhood cataracts.

When should I have my cataract surgery?

Cataracts can be removed at any stage. You don’t have to wait for them to “ripen” before having surgery.

Making the decision to have your cataracts removed depends on a number of things:

how badly your sight is affected

whether you have any other eye conditions

if you only have sight in one eye

how you use your sight from day to day.

The decision to have your cataracts removed comes down to whether the benefit of having the operation outweighs the small risk attached to the surgery.

If you have no other eye conditions or health concerns, then the benefit of having your cataracts removed usually outweighs the risk of surgery. For example, if you’re finding it difficult to read, use a computer or drive, then removing your cataracts may be necessary.

The timing of surgery is different for everyone. If you make your living by driving, for example, you may need your cataracts removed earlier than someone who doesn’t drive.

If you have another eye condition, it may be possible to have your cataracts removed, but there may be more concerns about complications. Your ophthalmologist (also known as a hospital eye doctor) may want to delay the operation for as long as possible to put off the slight risk of the surgery, but this needs to be balanced with how much of your sight is being affected by cataracts.

If you have sight in only one eye, your ophthalmologist may recommend putting off surgery for as long as possible. Having sight in only one eye doesn’t make the cataract surgery more difficult, but any serious complication which affects your sight would mean the outcome is worse when compared to someone with sight in both eyes. By delaying the operation for as long as possible, this risk is avoided until the operation is really necessary.

Cataracts only affect the lens and no other part of your eye. If you decide to put off surgery, your sight will become increasingly cloudy, but the results of your surgery, no matter how delayed, will be the same as if you had it done earlier. You don’t have to worry that you’re permanently damaging your vision by delaying surgery.

What will happen before surgery?

Before your surgery, you’ll have a pre-assessment appointment. At this appointment, your eye will be examined and measured. Measurements of the shape of the front of your eye and the length of your eye will help the ophthalmologist decide which lens to implant into your eye.

If you have had any previous surgery to your eye, including laser surgery to reduce your need for glasses, you should tell your ophthalmologist or nurse at this appointment.

This assessment will also check if your general health is good enough for surgery.

What happens during cataract surgery?

Cataract surgery removes your natural lens and replaces it with an artificial lens implant. Replacing your lens removes your cataract and makes your sight clear again.

Practically all cataract surgery in the UK is performed by phacoemulsification. This is a way of removing your cataracts with an instrument which uses sound waves to break up the lens in your eye.

Most people have the operation under a local anaesthetic. This means that you’ll be awake during the operation but you won’t feel any pain. Your local anaesthetic may be just eye drops, an injection, or a combination of both.

Most cataract operations are performed as day-case procedures, meaning that you won’t stay in a hospital overnight. You should probably plan to be at the hospital for all or most of the day of your surgery. Your hospital will tell you how the cataract surgery is organised, including when to arrive, how to get to the hospital and when you can expect to leave.

If you think that having the operation with a local anaesthetic may be difficult, speak to your ophthalmologist as soon as you can.

It’s possible to have the cataract surgery under general anaesthetic. However, because a general anaesthetic has more risks, it’s usually only offered to people who would have real difficulty with a local anaesthetic – such as someone with uncontrolled movement problems, or someone who may struggle to follow instructions because of dementia or learning difficulties. If you have your surgery under general anaesthetic, you may need to stay in the hospital overnight; your ophthalmologist will let you know if that is the case.

How are cataracts removed?

Cataract surgery is carried out in a hospital operating theatre. Before the surgery, you’ll be given local anaesthetic drops and or an anaesthetic injection to numb your eye. You’ll also be given drops to dilate your pupil, that is to make your pupil larger.

Usually, the nurse or ophthalmologist will clean your eye and the area around it to help prevent infection. Your face will then be covered with a sterile sheet so that only the eye being operated on is exposed (this also protects you from infection). Once your eye is numb and your pupil is dilated, your ophthalmologist will continue with the operation.

During the surgery you may be able to see movement and a change in lights or shadows, but it’s unlikely that you will be able to see any detail of what’s happening.

Your ophthalmologist will make some very small cuts through the cornea, which is the clear front of your eye. This allows them to introduce instruments through your dilated pupil to reach your lens.

The lens in your eye is made up of different layers, and the outside layer is called the lens capsule. During the operation, the ophthalmologist cuts through the front of the lens capsule so they can reach the lens inside. Using the same instrument, the ophthalmologist can break up your lens and the cataract inside your eye, and remove it using suction. Your lens capsule is kept in place so that the artificial lens implant can be placed inside it. The tiny implant is folded so that it can be put into your eye through the same instrument that has been used to remove your cataract. The lens unfolds within the eye and is held in place by the lens capsule.

At the end of the operation your eye may be covered with a dressing to keep it clean. Your eye will be checked on shortly after the surgery. Then, once your ophthalmology team is happy with your eye, you’ll be able to go home.

Recovering from cataract surgery

Your eye may feel sore once the local anaesthetic begins to wear off. The hospital will tell you how to deal with this pain, but usually, it can be helped by taking over-the-counter painkillers such as paracetamol. If you have a dressing on your eye from when you left the hospital, you should keep it in place overnight, as this will help protect the eye. Normally, you can remove the dressing the next day, and after this, you can leave your eye uncovered during the day. At night you may be given a plastic eye shield to wear, which will prevent you from accidentally rubbing your eye while you’re sleeping.

Your eye may look red when you remove the dressing and you may notice some bruising around your eye. This is normal and should improve after a couple of days.

Most people recover very quickly following cataract surgery and you may feel back to normal the day after your operation. Some people might feel more tired than usual after the surgery, but after a few days you’ll start to feel back to normal.

After surgery, you’ll have a course of two drops – an antibiotic, which helps to prevent any infection, and a steroid or non-steroidal anti-inflammatory drop to help control any swelling and to promote healing. It is important to finish this course of treatment. For most people, this means taking the drops for at least two weeks. Your ophthalmology team will let you know what you need to do.

What will my sight be like after the operation?

When you take the dressing off your eye, you may notice your vision is brighter and maybe clearer than it was before the operation. You might notice this change straight away as soon as you remove the dressing, but it may also take a couple of days for your sight to improve. Within two to five days, your eye should be feeling normal and the cloudiness caused by your cataract should be improved.

The lens that is implanted in your eye is usually designed to give you clear distance vision without needing glasses. Sometimes this is not quite achieved and you’ll need a pair of distance glasses to fine-tune the focus and to get the best possible distance vision. Because the lens implant isn’t able to provide in-focus near vision, almost everyone needs to wear reading glasses after the operation, and this will usually be a different pair from the one you had before the operation.

As you may need cataract surgery in both eyes, your ophthalmologist may recommend waiting about six weeks after your second operation before trying to get a new pair of reading glasses.

Although all the calculations and measurements done before the surgery may have been correct, you may still find that you need both distance and up-close glasses afterwards, to give you the best possible vision. This is because the aim of cataract surgery is to give you clear vision, rather than to remove your need for glasses.

Some lenses, which aim to correct both your distance and up-close vision so that you no longer need to wear any glasses, are available privately. However, some people who choose these lens implants may still require glasses, either for reading, for distance or sometimes for both. Because of this, they aren’t available on the NHS at present, as there is not enough evidence on how well they work.

Talk to your ophthalmologist if you want to discuss how your eyes will be corrected following your operation.

You can only have cataract surgery on one eye at a time. If you need surgery on both your eyes (most people do), your ophthalmologist will schedule your operations six weeks to three months apart.

Most people will not have too much trouble in between the two surgeries. However, you may face temporary challenges such as unbalanced or double vision if your eyes have high levels of refractive error, that is, if you’re very short or long-sighted. This is because your first surgery will correct the refractive error in one eye only, and not the other.

If you think you may have a high level of refractive error, check with your optometrist or ophthalmologist. They will be able to tell you if they think you may find it difficult to manage in between your operations, and help to put a plan in place to make things easier.

What are the complications of cataract surgery?

Cataract surgery is a safe and successful operation. The chances of having a complication are very low. The risk of having complications that could affect your sight in the long term is even lower.

Generally speaking, you have a 97 per cent chance of your cataract operation being successful, meaning you’ll have a good level of clear vision following the operation.

The most likely complication following the surgery is called posterior capsule opacification. This is where your lens capsule, which holds the lens implant in place, becomes cloudy. This can occur weeks, months or years after surgery. This cloudiness will affect your vision. If this happens, you will usually be offered a simple laser procedure to make your sight clear again.

Other rarer complications of cataract surgery include:

retinal detachment

macular oedema, a condition where fluid collects in the central part of your retina

problems with the position of the lens implant

a break in the lens capsule

infection.

If you do have any of these rare complications, you will be offered treatment to help maintain good vision.

If you’re concerned about the risks of your cataract operation, then you should discuss this with your ophthalmologist before the surgery.

Most people who have cataract surgery have no problems at all.

Do I need to avoid any activities after my surgery?

You’ll probably feel back to normal within two to three days. If you’re working, you may feel fit enough to go back soon after the operation, depending on the nature of your job. However, there are some things that you should probably try to avoid for the first seven to 10 days:

rubbing your eye

strenuous activity and heavy lifting – lifting up light shopping is fine, but you will want to avoid activities such as moving heavy furniture

wearing eye make-up – until your ophthalmology team is happy that your eye has fully recovered.

You may also need to be careful in these situations:

when it’s windy outdoors, in case something blows into your eye, though it’s OK to get out and about

in dusty environments – very dusty places may irritate your eye

when washing your hair and face – be careful not to get soapy, dirty water into your eye when you’re washing.

You may also find that lights seem brighter than normal immediately after your operation, but this should get better with time.

Until your eye is fully healed, you should not:

go swimming even with goggles – as it may cause an infection

take part in contact sports, such as boxing, karate, rugby or other sports which risk a blow to the eye.

Your ophthalmologist will tell you at your follow up appointment if your eye is healed and whether you can go back to your normal activities, including the ones listed here.

It’s difficult to find any evidence about whether or not a particular activity is safe after a cataract operation. If you’re concerned about a particular activity, it may be worth avoiding it until you’ve had your follow up appointment, where you can ask your ophthalmologist about its safety.

Most people are able to drive soon after their cataract operation. However, if you have a strong glasses prescription, you may have an imbalance in your vision between your operations. You should ask your ophthalmologist for advice about driving if you have an imbalance or if you have any other eye condition.

Sources

https://www.rnib.org.uk/sites/default/files/APDF_Understanding_Cataracts.pdf

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