Cataract Surgery - All your questions are answered

Cataract surgery is one of the most common operations performed today. It is very safe and recovery is quick. The aim of surgery is to restore your vision (particularly distance vision) as much as possible. Your surgeon removes the cloudy natural lens of your eye (cataract) and replaces it with a new intraocular lens (IOL).

Cataract surgery is one of the most common operations performed today. It is very safe and recovery is quick.

A cataract is the clouding of the eye’s natural lens caused by proteins in the eye forming clumps which prevent the lens from sending clear images to the retina. Cataracts are the most common cause of vision loss in people aged over 40 years. Without treatment (normally surgery) cataracts will eventually lead to blindness. If you are not able to or do not wish to have surgery, your cataracts may be temporarily managed with stronger glasses, magnifying lenses or sunglasses with an anti-glare coating. Cataract surgery is recommended when your cataracts interfere with you doing your normal day to day activities, such as reading or driving.

How do I know if I have a cataract?

Cataracts start off small and at first you may notice that your eye sight is a little blurred or cloudy. Driving your car at night can become difficult as oncoming headlights cause more glare. Colours don’t appear as bright as they used to be and you find that you need to change your prescription glasses more frequently. Cataracts can affect one eye at a time or both eyes at the same time. Your GP or optometrist can make an initial diagnosis after a basic eye examination and if a cataract is suspected, an assessment by an eye specialist (ophthalmologist) is recommended.

What are the risks of developing a cataract?

Apart from ageing, other risk factors include: too much exposure to sunlight, diabetes, hypertension, obesity, smoking, prolonged steroid medications, statin medications to reduce cholesterol, previous eye injury or surgery, hormone replacement therapy, high alcohol intake, high myopia and a strong family history. Cataracts can exist at birth (congenital) although this is very rare.

What are the different types of cataract?

Cataracts are classified according to which part of the lens they affect. There are three main areas in the eye’s lens where a cataract can develop and each has its own symptoms. Some people have a mix of all three types.

Nuclear cataract forms in the central zone (nucleus) of the lens. This is the most common cataract usually associated with ageing and exposure to UV light over the years. It is normally slow to develop.

Subcapsular cataract occurs at the back of the lens. People who have diabetes or take steroid medication are most at risk of developing a subcapcular cataract. Symptoms are normally fast developing and include difficulty reading, halo effects and glare around lights.

Cortical cataract has white, wedge-like opacities that start from the outside of the lens and work their way into the centre (the lens cortex). The opacities cause the light that enters the eye to scatter, giving blurred vision, glare, contrast and depth perceptions. It is normally slow to develop.

Preparing for cataract surgery and choosing an intraocular lens (IOL)

At your initial consultation your eye specialist (Ophthalmologist) will do a number of eye tests and discuss with you what your preferred focus after cataract surgery is, whether it be for near vision or distance vision, or both. Additional measurements of your eyes will be taken to determine the curvature of your cornea and the length of your eye. These measurements are essential in order to select the proper power of the intraocular lens to give you the best vision possible after surgery. The clear artificial lens is made from an acrylic material and is designed to last forever. You will not feel it in your eye.

Due to advancements in both ophthalmic surgery techniques and the lens technology, you can now have your cataract removed and replaced with an intraocular lens that improves your eye sight.

A standard monofocal lens will provide you with vision at one set distance - long, middle or short - and you will then require glasses for the other distances. Most people who choose monofocal lens choose a distance vision lens and then have a pair of reading glasses for near vision.

Some people wish to be glasses free after their cataract surgery and choose monovision where the dominant eye is focussed for distance (driving or watching a movie) and the non-dominant eye for near vision (reading). The brain blends the information from both eyes to provide overall vision giving you the ability to see both near and far without having to use glasses. Monovision corrects presbyopia providing a greater range of vision after cataract surgery than the standard monofocal lens.

Other people choose a multifocal lens which splits the light in each eye to give a near and distance focus. Multifocal lenses are usually used if they can be implanted into both eyes and give the result similar to wearing bifocal glasses.

If you have astigmatism a toric intraocular lens can be inserted to correct both the astigmatism as well as the near or far sightedness.

What will my vision be after my cataract surgery?

95% of people who choose a monofocal IOL will have their vision returned to how it was before they developed the cataract. The majority of people who have no other eye problems with their vision after cataract surgery will meet the standard for driving without glasses. If you choose a monofocal IOL you will need to wear glasses for reading. After 4 weeks from your surgery is normally the time to upgrade your glasses with your optometrist. Glasses will normally provide an extra 5-10% vision improvement.

At Bowen Eye Clinic we also offer Laser Eye Surgery post cataract surgery for those who wish to have perfect vision without glasses.

Can I have both my cataracts done on the same day?

Most people have cataracts in both eyes. Your surgeon will usually wait at least a week for your first eye to recover and you have good vision in that eye before performing cataract surgery on your second eye.

What to expect on the day of cataract surgery

Cataract surgery is most often completed as a day procedure with only a short hospital visit. It is done under local anaesthetic which means that you are only in hospital for 2-3 hours. You will need to arrive 1 hour before your surgery time to have your pupil dilated with eyedrops. You will be given a local anaesthetic to fully numb the eye. The skin surrounding your eyes will be cleaned with iodine and a sterile drape is placed around your head and face. The actual cataract procedure only takes 10-15minutes to complete. After your surgery you will stay in the hospital recovery area for observation for an hour. You will be given information on how to care for your eye after the surgery and how to use your eye drops. Antibiotic eye drops prevent infection and steroid eye drops will help reduce any inflammation. An eye pad will be placed over your eye to keep it safe in the early stages of recovery and your surgeon will advise you on when you can remove it, either later that night or the next morning. You will need someone to drive you home after the surgery.  Pack a pair of sunglasses to wear to protect your eye from the bright light and glare after the surgery.

What does the cataract surgery involve?

The aim of surgery is to restore your vision (particularly distance vision) as much as possible. Your surgeon removes the cloudy natural lens of your eye (cataract) and replaces it with the intraocular lens (IOL). The lens capsule that surrounds the natural lens is kept intact during the surgery and the surgeon places the IOL within this capsular pocket. The most common technique to remove a cataract is Phacoemulsification. The surgeon makes a micro incision in the side of your eye called the cornea, and inserts a pencil thin probe into the lens substance where the cataract has formed. This probe transmits ultrasound waves to break up the cataract and remove the broken fragments. The back of the lens capsule is left intact to hold in place your new intraocular lens.

The other less common type of surgery is Extracapsular cataract  (ECCE) surgery where a larger incision is made in the front of the eye and the cataract is removed as one piece. The posterior capsule is left in place to support the new lens. Once the lens has been fitted the incision in the eye is closed with tiny stitches.

What to expect on the days after cataract surgery

When you first take off your eye pad you may experience a “wow” moment with your vision already sharper and colours more vibrant. But not everyone does and other people may experience cloudy, blurry or even wavy vision. This will ease as it can take some time for your vision to adjust and the local anaesthetic in your eye to wear off. Your eye may be red or bloodshot but this will also go in a few days as your eye heals. It may take a day or two for your eyes to synchronise and most people are able to do all day to day activities within a couple of days to weeks.

Take it easy and avoid any bending forward or lifting activities. Keep your eye closed while showering and bathing and avoid swimming or hot tubs or dusty environments for at least two weeks. This is to reduce any chance of infection. Follow your surgeon’s instructions on how to use the eye drops. Your surgeon will check your eyes in the first few days after your surgery to make sure there are no complications and everything is healing as it should be.

What are the risks of having cataract surgery?

Cataract surgery is one of the most common and most successful surgical procedures performed. Complications from the surgery are very rare and most are treatable with no long-term impact on your vision.

Some complications include:

Posterior Capsule Opacification (PCO) approximately 10% of people who have had cataract surgery develop PCO. This is when the lens epithelial cells that were not removed grow back over the back of the artificial lens onto the capsule causing cloudy vision and this is often referred to as a secondary cataract. This is not your cataract returning. PCO can be treated safely and effectively with an eye laser procedure called YAG laser capsulotomy which takes a couple of minutes and is preformed in the doctor’s clinic. The procedure is painless  and you can go about your normal day activities straight afterwards.

Cystoid Macular Oedema (1-2%) the macula part of the retina can become swollen in the first 1-4 weeks. This is treated with additional anti-inflammatory eyedrops over 2-3 months.

Lens Capsule Tear (0.5-1%) as the lens capsule is extremely thin it can sometimes tear or break. This will make your cataract surgery longer and the IOL may need to be repositioned, exchanged or removed. Most people who experience a capsule tear get the same visual result but it just takes longer to heal and recover.

Endophthalmitis (0.1%) is an internal eye infection which although very rare can result in a loss of vision. It is treated with intensive antibiotics but unfortunately the vision loss can be permanent.

If you do experience any loss of vision, increasing pain or increasing redness, light flashes or several new spots known as floaters in front of your eye you should contact your surgeon immediately.

How much does cataract surgery cost?

Insurance companies and health providers arrange to have a fixed amount for the fee for standard cataract surgery. Any upgrades in intraocular lens or surgical techniques will need to be met by you. Check that your eye surgeon is affiliated with your insurance company and that the hospital where you are planning to have your surgery is a preferred provider.

Additional costs that you may incur include:

initial eye examination and scans

anaesthetic charges

intraocular lens upgrade (usually only the standard monofocal lens cost is covered)

follow up procedures or medical care due to complications arising from the surgery (this is very rare <0.1%)

If you don’t have health insurance then you are responsible for the full cost of the cataract surgery.

In Wellington New Zealand the average cost of cataract surgery with a standard IOL is in the range of $4150 to $4650.

If you unable to pay privately for cataract surgery and do not have health insurance, you may wish to have your cataract surgery in a public hospital. The public health system has a scoring system to determine who is most in need to qualify for fully funded public health care. If your vision is not severe enough your score may be too low and you will referred back to your GP or optometrist.

At Bowen Eye Clinic, Dr Reece Hall is an affiliated surgical provider with Southern Cross Healthcare and works with all other health insurance companies including Sovereign, Unimed, NIB, Partners Life, Accuro and ACC. He has been doing cataract surgery for over 14 years and operates at Bowen Hospital, Southern Cross Hospital (Wellington) and Crest Hospital (Palmerston North). All three hospitals are affiliated providers for Southern Cross insurance. Dr Hall is also a consultant at Capital Coast DHB where he does cataract surgery for the public health system.

Phone 0800 69 2020 or email to make an appointment for an assessment for cataract surgery.