Pre-operative Assessment
Biometry
Anaesthetic Choices
Some patients do not like the idea of any type of injection near their eyes, but are not so nervous that they would require a full general anaesthetic. For these patients topical anaesthesia is ideal. The surface of the eye is first made numb with drops and once the operation begins additional anaesthetic is infused in front of the iris. A potential disadvantage is that the patient can find the microscope light very bright, and can find it difficult to keep their eye still. An advantage is the speed of recovery and there should be less risk of a red eye after the operation.
Subtenons:
Subtenons anaesthetic is a very popular technique in the UK. There are no sharp needles, the technique is very effective and very comfortable for the patient. The only disadvantage is that the technique usually gives a red eye post operatively.
Sedation:
Both subtenons and topical anaesthesia can be made even more comfortable and relaxing by the addition of intravenous sedation.
General Anaesthetic:
A full GA is only very rarely required for cataract surgery. Some patients have difficulty in lying still, and some are simply so nervous that they request sedation to the level that is effectively a general anaesthetic. So long as you have a healthy throat, heart and lungs a modern anaesthetic is very safe.
Surgery
You will normally be admitted to the eye ward and your nurse will put dilating drops into your eye. Your surgeon will visit you to answer any last minute questions and ask you to sign your consent form to give your permission to proceed with the operation. In order to give valid consent it is important that you have had opportunity to discuss any concerns with your surgeon, are aware of the significance of the potential complications of cataract surgery and are happy to go ahead with the operation. While the actual surgical time is quite quick, you will normally be in the Hospital for 3 hours.
The video below shows in real time exactly what happens during your surgery.
Post-Operative
When you return to the ward after your surgery you will be offered a drink and something to eat. After an hour a nurse will examine your eye to check everything is satisfactory before you go home. They will explain how to use your eye drops. We recommend that someone takes you home from the hospital but it is not necessary for a friend or relative to stay with you overnight.
You will usually go home with a plastic shield covering your operated eye. You should be comfortable but a gritty sensation from the eye is common. You do not need to start any eye drops until the next day. If you develop a headache take some paracetamol.
The next day you can take the shield off. Normally you will be immediately aware of how much more clearly you can see and you may be somewhat dazzled by how bright everything seems. For the majority of patients the improvement in their vision is quite remarkable.
Sometimes it takes a little longer for the vision to improve. If your cornea has become swollen your vision can be a little misty initially. Crucially any such mistiness should improve during the day.
Your eye may feel gritty, you may have some eye ache, you may have some headache and your vision may not always be immediately perfect but these symptoms should all rapidly improve. No symptoms should deteriorate.
When you look in the mirror your eye may be red and you can sometimes have bruising around the eye depending on the anaesthetic technique used. So long as you are comfortable and your vision is good it does not matter at all if your eye is red. The redness will fade away over the next few days.
Contact your surgeon urgently if you notice:
Increased pain
Rapid loss of vision
Increased redness or discharge
Flashes of light, floaters or a curtain across your vision.
We recommend that you wear your shield at night for the first week.
You should start using your post op drops from day 1. A typical treatment regime is 4 times a day for the first week, 3 times a day for the second week, 2 times a day for the third week and then just once a day for the last week. I like my patients to use more drops for the first day and recommend putting a drop in every hour for the first day only, and then changing to 4 times a day from the second day onwards.
After 4 weeks you can go to see your optician or the hospital optometrist to have your eyes and your need for spectacles measured.
Using Eye Drops
After your cataract surgery you will need to put some drops into your eye for 4 weeks. By the end of the 4 weeks you will have mastered the art, but it can be difficult at first. The best techniques are described below.
Assistant:
If you are lucky enough to have someone else able to put your drops in for you this is the easiest technique of all. Sit in a chair with a high back so you can rest your head against a support. Your assistant then holds the dropper upside down, pulls your lower lid down and away from your eye to create a trough, and drops a single drip from the bottle into the trough. If they find this difficult you can also lie flat on a bed or sofa and they can apply the drops to your eye from just above.
Self application:
Putting in your own drops is a skill. Each individual tends to develop their own technique but the broad principles are the same - it is very difficult at first and then easier and easier. If you can try the mirror and trough technique first. In this technique you avoid tipping your head backwards, instead you look closely into a mirror, hold the drop bottle in one hand and pull your lower lid down with your other hand to create a trough, then gently tip the bottle to allow a single drop to drip into the trough. On releasing your eyelid the drop will wash over your eye.
The head back technique is very similar but done without a mirror, positioning the bottle to be directly above your eye and lower lid trough. An alternative is to lie flat on your back and position the bottle directly above your eye and lower lid trough.
It is very important to use your drops regularly to prevent infection and inflammation, so whichever technique you use, persevere until you are sure the drops are reaching your eye.
FAQ:
Can I shower and bath?
You can most certainly shower and bath, but be careful not to rub or press on your eye, and do not go underwater in the bath.
Can I swim?
Not for 2 weeks, and ideally do not go underwater for a full month.
Can I exercise?
Yes, but try to avoid strenuous activity such as heavy lifting. You can bend down however, for example to tie shoe laces.
Can I drive?
The legal limits for driving are the ability to read a number plate at 25 yards, with good health and an unimpaired visual field. As soon as you reach these limits you can drive. For some patients this may be day 1, but for others it may not be until you pick up your new glasses at 4 weeks.
Do I need time off work?
Under most circumstances you would be able to return to work almost immediately, but it would be safe to book a week off in case it took your vision longer to recover.
Can I wear my old glasses?
Under most circumstances your old glasses will now have the wrong prescription for the operated eye, but still the correct prescription for the other eye. You can wear them if they are comfortable, but may find you are more comfortable without your old glasses.
When can I see my optician for new glasses?
You need to wait for 4 weeks to allow your eye to settle fully before measuring for new glasses. In the meantime if you are having difficulty reading you may choose to use a pair of the cheap "ready readers" for the first few weeks.
If my eye drops run out do I need to get more?
Yes please. You can contact your GP, your surgeon or the hospital to pick up some more drops. If you stop the drops too soon you can have a rebound inflammation and the eye can become red and sore.