What To Expect After Cataract Surgery

Cataract Surgery can give you a great improvement in your vision. It is completed as a day procedure with only a short hospital visit. The modern technique Phacoemulsification uses ultrasound to remove the cataract. Regular eye drops are used for 4 weeks after surgery to help the healing and reduce any infection risk. Normally glasses can be prescribed 4 weeks after surgery.

Cataracts cause blurry vision and can increase the glare from lights. Cataract surgery treats the clouding lens (cataract) and replaces it with a new clear intraocular lens.

Here’s a list of questions to ask yourself if considering cataract surgery.

- Can you see well enough to perform your job or drive a car?

- Are regular tasks such as cooking, shopping or doing work challenged by poor vision?

- Are you having problems reading or watching television?

- Do you have difficulty seeing faces clearly?

- Do bright lights make it more difficult to see?

Cataracts can be treated with modern Cataract Surgery. The procedure involves removing the damaged lens of your eye and replacing it with a new clear intraocular lens.

Dr Reece Hall can perform your cataract surgery on an outpatient basis, meaning you don’t have to stay in the hospital after surgery. The procedure normally takes less than 10 minutes to perform.

Preparation before cataract surgery 

An initial consultation with Dr Reece Hall can be done at Bowen Eye Clinic either in Wellington, Kapiti or Palmerston North.  This is a comprehensive eye examination and includes an eye scan to measure the size and shape of your eye. Dr Reece Hall will discuss what the best treatment and intraocular lens is best for you, along with the benefits and risks of the different types of lens available.

There are a variety of intraocular lens to chose from. Some block ultraviolet light, and some work like bifocals providing both near and distant vision. Others target only distant or near vision and intraocular lens can be used to provide distant vision for one eye and near vision for the other. Toric intraocular lenses are very successful at treating astigmatism.

Laser eye surgery is also available for those who want to be fully independent from wearing glasses after their cataract surgery.

What happens on the day

You will visit your chosen hospital at least one hour before your surgery time. Cataract surgery is done at Bowen Hospital or Southern Cross Hospital in Wellington and at Crest Hospital in Palmerston North. Eyedrops are used in your eye to dilate your pupil and you will be given a local anaesthetic to fully numb the eye.

There are a couple of methods surgeons use to remove cataracts. The most common modern technique is Phacoemulsification. This uses an ultrasound probe to break up the cataract for removal during the procedure. Dr Reece Hall will make a micro incision in the side of your eye - called the cornea and he will insert a pencil thin probe into the lens substance where the cataract has formed. He will then use the probe which transmits ultrasound waves to break up the cataract and remove the broken fragments. The back of your cataract is the lens capsule and this is left intact to hold in place your new intraocular lens. The clear artificial lens is made from an acrylic material and essentially lasts for ever.

Small stitches are only very rarely used to close the small incision in your cornea, on completion of your cataract operation.

The second method, although less frequently used is called Extracapsular Cataract Extraction (ECCE). This requires a larger incision than the more common and more modern phacoemulsification technique. This method may be performed if a person has other eye complications and stitches are required to close the incision.

Over 99% of people will have the modern Phacoemulsification technique.

What happens after cataract surgery

Once the cataract has been removed, an eye pad is worn. This can be removed later that night or the next morning. Being a short operation of less than 15 minutes and being in the hospital around 2 hours means you will go home on the same day of your surgery. You will need someone to drive you to and from the hospital. You may also need to make plans for some help around home as you may be advised to limit bending and lifting activities.

Removing the eye pad can be a “wow” moment, with a significant improvement in vision noticed. Vision is sharper, colours are more vibrant especially in the blue end of the visual spectrum. You will see things again you may have missed for a long time. 

Two types of eye drops are used after your cataract surgery. A steroid eye drop (Predforte) is normally used 4 x a day for 4 weeks following your surgery date. The second drop is an antibiotic eye drop (Chloramphenicol) used also 4x a day but for only one week after your surgery date. Sometimes the frequency and duration of the eye drops is adjusted to your healing response after surgery. If you are on eye drop treatment for glaucoma it is important not to stop these. Starting a new bottle of your glaucoma eye drops is recommended in the eye that has just had the cataract operation. 

The new lens requires no care and you won’t be able to see or feel it, making it seem as if it had always been there.

Sometimes your new vision may take a few days to improve. It can sometimes be blurry until your eye has fully healed and adjusted to the new lens.

Dr Reece Hall will follow up your progress with clinic visits in the first month after surgery. These can be arranged in Wellington, Waikanae or Palmerston North.

Following cataract surgery, most people can see well enough to drive a car without the need for glasses. Glasses will normally improve the vision another 5-10% but are not recommended until 4 weeks after the procedure.

If you have cataracts in both eyes, the second cataract procedure can be done the next week or at a later date if preferred.

Things to watch out for

Detailed instructions will be given to you from the hospital outlining when and how to use your eyedrops and things to watch out for.

It’s important to remember that itching and mild discomfort following surgery is normal and you should avoid irritating it by rubbing or touching your eye.

To prevent infection and reduce inflammation it is important to take your eye drops as prescribed. Sometimes to control eye pressure Dr Reece Hall may prescribe additional eye drops or other medication.

You should contact Bowen Eye Clinic in the first instance if you experience vision loss, persistent pain, severe eye redness, light flashes or several new spots known as floaters in front of your eye.

You should also contact Bowen Eye Clinic if you suffer nausea, vomiting or persistent coughing.

Cataract Surgery Risk

Like all surgical procedures, there is an associated small risk. With cataract surgery, the main risk is infection. Other side effects include inflammation, bleeding, swelling, retinal detachment, glaucoma, or a secondary cataract. These can sometimes result in loss of vision but fortunately are rare.

The risk of complications can be greater if a person has another eye disease or other medical condition. In some situations, cataract surgery will not improve a person’s vision because of underlying eye damage from other eye problems such as glaucoma, diabetic eye disease or age related macular degeneration.

Dr Reece Hall will assess you fully for any individual risk and discuss this with you at your cataract assessment appointment.

Secondary Cataract

Some people after successful cataract surgery can develop a secondary cataract called posterior capsule opacification (PCO). This can occur in the first 12 months following cataract surgery or even after 10 years.

This can happen when the back of the lens capsule - the part not removed that now supports the new intraocular lens implant, becomes foggy impairing a person’s vision.  

Posterior capsule opacification can be treated with a five minute painless eye laser procedure known as Yttrium-Aluminium-Garnet (YAG) laser capsulotomy. This can be done during a clinic visit. The laser beam is used to make a small opening in the clouded capsule so that light can again pass through.

If you think you have cataracts and are considering cataract surgery then give us a call at Bowen Eye Clinic 0800 69 20 20 and make an appointment with Dr Reece Hall to have your eyes assessed.


Glossary :

Astigmatism irregular defocus, or an eye that is ‘more rugby ball shaped than an equal spherical football shape.’ The first number in your prescription for glasses describes the amount of long or short sight (-2.00/-1.00x180). The second number describes the amount of astigmatism and the angle (-2.00/-1.00x180). Most of us have at least some astigmatism, and a small amount can even help extend the range of activities you can do without reading glasses when you get older.

Cataract when the natural lens gets cloudy enough to make vision hazy it is called a cataract.

Cataract surgery is the surgery to replace the natural lens with a new intraocular lens (IOL). It is performed in patients who cannot see clearly despite using glasses or contact lenses with the main aim of restoring clear vision.

Cornea the clear part of the eye wall at the front of the eye. Two thirds of the focusing power of the eye is from the cornea.

Glaucoma this is a condition in which the optic nerve is gradually damaged causing the visual field to contract. Left untreated, patients with glaucoma may develop ‘tunnel vision.’ Glaucoma is often associated with a higher than normal intraocular pressure, and treatment is centred on medication or surgery to lower the intracocular pressure.

Intraocular Lens (IOL) IOLs are small synthetic lens implants that are used to replace the natural lens in cataract surgery and refractive lens exchange. They can also reduce astigmatism.

Laser eye surgery correction of sight using excimer and/or femtosecond lasers to alter the curvature and focusing power of the cornea.

Lens is made of transparent, flexible tissue and is located directly behind the iris and the pupil. It is the second part of your eye, after the cornea, that helps to focus light and images on your retina. When young the lens is flexible and elastic, it can change its curved shape to focus on objects and people that are either nearby or at a distance.

Natural lens the natural lens sits just behind the pupil and is suspended by a trampoline like array of microligaments from the ciliary muscle, which contracts during accommodation. The natural lens accounts for one third of the focusing power of the eye and is the flexible element of focus. The natural lens gets less flexible with age. It also becomes less clear as we get older. If the natural lens gets misty enough to make vision hazy, it is called a cataract.

Phacoemulsification this is the standard technique for liquefying the natural lens in cataract surgery and refractive lens exchange. Ultrasound energy delivered from the tip of a fine, hollow probe liquefies the lens. Fluid is washed continuously into the eye around the probe, and the liquefied lens material is sucked away. Where previously the natural lens had to be shelled out like a pea, phacoemulsification allows it to be removed through a tiny, key-hole entry into the eye.

Posterior capsule opacification (PCO) in cataract surgery, the IOL is implanted within the capsule of the natural lens. This thin, clear membrane then shrink-wraps the IOL and stabilises it in the natural position in the eye. As part of the healing up process, the membrane often goes misty, causing gradual loss of vision after surgery. This is posterior capsule opacification (PCO). It can be treated successfully with a one-off minor laser procedure called YAG capsulotomy.