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Benefits of cataract surgery
The purpose of the operation is to replace your cloudy lens with a plastic lens (implant) inside your eye. The vast majority of patients will have improved eyesight with greater clarity of vision, improved colour vision, reduction in dazzle and glare.
The first step is to book a consultation with Mr McMullan. Please note that you will need a driver as Mr McMullan will need to dilate your pupils with eyedrops and the drops can take four hours to wear off, during which time you should not drive or operate machinery etc. The second step is to have your biometry done; then surgery; and finally a follow up consultation.
Biometry is a non-invasive test to show the power of the new replacement lens to be fitted to your eye during your cataract operation.
The measurements do not involve any flashing lights or puffs of air, and are completely non-invasive. You will just need to sit still and stare at a target for a few seconds at a time.
You would not normally need drops to dilate your pupils for this appointment, so you may drive to and from it, providing that it is legal for you to do so.
NB. If you have had laser refractive surgery in the past please make sure that Mr McMullan knows this. If you are a contact lens wearer please do not wear any soft lenses for one week prior to biometry or hard lenses for two weeks prior to biometry.
As the Three Shires Hospital does not have an in-house optometrist, Mr McMullan refers patients who want to have their surgery at the Three Shires, to the orthoptic department at Northampton General Hospital to carry out the biometry. The Three Shires Hospital will cover the fee for this.
If you have your consultation with Mr McMullan at Woodland Hospital, you will have your biometry carried out by a nurse immediately before, or directly after your consultation with Mr McMullan.
You may choose not to have surgery in which case your vision may stay the same or worsen. Putting off surgery does not usually make the operation in the future any more difficult but it may do so if the lens becomes very hard/thick.
There is nothing currently you can do to stop getting cataracts although you may reduce the risk by stopping smoking, and protecting your eyes from bright sunlight with sunglasses and hats.
You should decide and discuss your post operative visual requirements; most people opt for the eye to be focussed on distance and wear readers after cataract surgery, but some people, particularly those who have been short sighted for a long time, may prefer a near vision focus and continue to wear distance glasses.
Lens choice/refractive planning
Most patients have a lens inserted in the eye that is designed to give good distance vision. As such, reading or varifocal glasses may be required for close or intermediate (eg computer) work. Some patients opt for their near vision to be good and need glasses for distance.
There is also the option for a multifocal or trifocal lens that can try to reduce the need for glasses for intermediate or near work. Mr McMullan doesn’t use these as he feels if a multifocal lens is placed there are increased risks. However, this is not to say that you can’t choose these lenses as other surgeons do use them.
Mr McMullan uses monofocal lenses or EDoF (extended depth of focus) lenses.
Toric lenses are available to correct excess astigmatism and this is an option in patients with more than 2D of astigmatism. These lenses cost more and may need adjusting (5% of cases).
On the day of surgery
Most patients cataract surgery is performed under local anaesthetic (LA). However, if you feel strongly that you want a general anaesthetic (GA) or sedation, this is a possibility. If you do have a GA, it is imperative that the hospital knows as you’d need a preoperative assessment and you would need to adhere to very important ‘starving instructions’in the six hours prior to surgery.
If you have a LA, there are no onerous pre-operative instructions apart from a request that you avoid wearing moisturiser or eye make-up on the day of surgery and that you ensure you have a driver to take you home as you won’t be able to drive. Please also do not wear contact lenses on the day of surgery.
You may eat and drink as usual and some people prefer to wear loose clothing.
You may wish to wash your hair on the morning of surgery so that you don’t have to wash it too soon after surgery (you are urged to keep your head raised post operatively –see post-op instructions).
When in theatre you will have a drape over your face with a hole cut out so that your eye is exposed. The local anaesthetic consists of drops and or an injection of local anaesthetic solution. You will be awake during the operation but you will not be able to see what is happening though you will be aware of light and colours. You will need to lie flat and keep your head and eyes as still as possible. This all sounds more difficult than it is.
Your cataract will be removed by a technique called phacoemulsification in which the surgeon makes small cuts in the eye and uses instruments to make a round opening in front of the lens. An instrument which vibrates at high frequency liquifies the cataract which is removed through a tube. The capsule, which is the membrane surrounding the cataract, remains and is used to support the artificial lens. Sometimes a small stitch is put in the eye (this may be permanent, self dissolving or removable in clinic).
Transport & care at home
Please make arrangements for someone to drive you home after surgery. Please have someone at home to help you during the first evening/night as you will have a pad placed over your eye. This will make you temporarily monocular which can affect your judgement of distances. (You will be able to take the pad off the next morning). Needless to say it is important that you take all precautions to keep away from people with Covid /flu etc during the post operative period (and of course the preoperative period).
Please arrange for a driver to take you home after surgery. (It is advisable not drive for the first week and only then if you can read a number plate 20m away. The length of time this takes varies from person to person).
You will be allowed home fairly soon after the surgery, once the nurses have discharged you.
After your surgery, the dressing over your affected eye will be left until the morning. At this stage it can be removed. You can clean sticky eyelids with boiled cooled water but only from day 2.
You will be given eye drops to help the healing process as well as to prevent infection. Unless exceptional circumstances you will be given Tobradex to use 4 x day for 3 weeks, and Acular to use 3 x day for 2 weeks. Please start the drops four hours after surgery, unless told otherwise. Please use the Tobradex and Acular at different times, rather than together.
Please arrange for someone to be at home for the first evening following surgery. Your eye is likely to be padded which, in effect, makes you monocular. Distances can be difficult to judge in this instance and you may need help with stairs/pouring the kettle etc.
You may find that initially your eye is more sensitive to sunlight than usual. It will be red and the whites of your eye may be bruised.
Sensation usually returns to the eye within a few hours and it will probably feel a little uncomfortable or mildly painful. You will probably have blurred vision and a feeling of grittiness in your eye. You may have a slight headache. These side effects are completely normal and should improve within a few days. Taking an over-the-counter painkiller, such as paracetamol or ibuprofen, will help reduce any pain. Wearing sunglasses may also help avoid any short-term discomfort caused by bright lights.
However, if the eye becomes more painful and more red or the vision worsens please contact the hospital immediately. Otherwise, your post operative review is normally 3-6 weeks after the operation.
Please try to avoid touching or rubbing the eye. Keep soap and shampoo out of it. Please avoid wearing eye makeup for four to six weeks.
You should be able to read and watch television almost immediately. Your vision may be blurry as your eye gets used to its new lens.
Please avoid anything strenuous for the first two or three days after surgery. However, you can still bend, wash your face and hair (but avoid washing your hair face down), carry bags etc – in other words, carry on as usual but avoid anything too hectic.
It is advisable to take a week off work after cataract surgery.
It is advisable to avoid swimming for six weeks after surgery.
Please avoid any sports in which you are at any risk of being hit in the eye for around six weeks.
If you are intending to fly within 3 or 4 weeks of cataract surgery, please let Mr McMullan know.
You will have to get an updated lens in your glasses which can usually be prescribed after about six weeks by your own optician.
In the meantime, in your current glasses, the lens will be wrong for the operated eye. You can remove / get the lens removed so that the ‘other eye’ only has a prescription lens. You can also buy ready-readers from supermarkets/pharmacies/opticians to read, until you see your optometrist to update your glasses. The hospital/surgeon fee for cataract surgery does not include any costs of new glasses/prescription lens. Do not put contact lenses in the eye which has had surgery.
The Driver and Vehicle Licensing Agency (DVLA) states you can start driving again if you can read a number plate 20 metres (about 65.5 feet) away with both eyes open. Many people who have cataract surgery will need glasses to be able to do this, in which case you'll need to wait until your new glasses are fitted a few weeks after surgery. If your vision is good in the other eye, you may be able to do this sooner, but in either case you also need to be confident doing an emergency stop.
Mr McMullan will tell you when he’d like to see you for your follow up appointment (usually around 3-6 weeks after surgery). Mr McMullan may need to dilate your pupils at the follow up so please ensure you have someone drive you home afterwards.
Risk factors of surgery
Cataract surgery is usually safe and predictable with a 99% success rate.
The most serious risks are infection or haemorrhage which can result in permanent loss of vision. The risk is less than one in a thousand, with a 1 in 10,000 risk of loss of the eye.
There is about a two in a hundred chance of running in to problems during the operation which might require prolonged surgery or even another operation on another occasion and/or hospital. Eg a tear in the bag which holds the lens in place. This may result in some of the jelly part of the back of the eye (vitreous) coming forward, which is then removed at the front of the eye during the operation by vitrectomy.
Sometimes the eye can remain inflamed after surgery and require extra anti-inflammatory treatment (steroid drops are given as a matter of routine for a month).
There is also a risk of fluid accumulation in the retina (cystoid macula oedema) which tends to be self-limiting or treatable but may persist and reduce the visual outcome.
There is a small risk of inducing a retinal detachment after surgery and this risk is likely higher in short-sighted (myopic) eyes. This can be repaired surgically but would of course require another operation with the consequent risks etc
About one in five patients require a YAG capsulotomy a few weeks/months/couple of years after surgery due to a clouding of the bag which holds the artificial lens in place. A YAG capsulotomy is a very simple laser procedure and takes a few minutes.
The risks attached to surgery are increased in difficult cases with poor pupillary dilation or co-existing disease such as Fuch’s endothelial dystrophy or Pseudoexfoliation Syndrome. Mr McMullan will have taken care to examine your eyes carefully to appraise you of any increased risks which can be discussed and addressed.
If you have other conditions such as diabetes, glaucoma or age related macular degeneration your quality of vision may still be limited even after successful surgery.
You can compare independent information about the quality of private treatment offered at the hospital and other private healthcare providers from the Private Healthcare Information Network (PHIN) website: www.phin.org.uk.
Currently the fees for cataract surgery at the Three Shires Hospital, Northampton and at Woodland Hospital, Rothwell near Kettering, are around £2,850.
We are legally obliged to inform you that, even if someone else is paying the fee for surgery, you are responsible for paying any charges which they do not pay.
All treatment carries risks and it is possible you experience or develop an unforeseen complication that may, for example, require you to return to theatre, be cared for in an intensive care or high dependency unit, stay in hospital longer than anticipated, have any further tests or be transferred to another hospital. Any quote will not include the costs associated with each of those unanticipated outcomes.
You may need to have a Covid test prior to surgery. The hospital will contact you to advise whether you need a lateral flow test 1-3 days prior to surgery (which they would arrange).
There is no pre or post op isolation period but it is strongly recommended that you keep as very safe as possible in any pre and post operative period.
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