What happens on the day of your cataract surgery?
Choosing the correct lens for the patient
Jane: How do you decide with your patient which lens will be best for them?
Jaheed Khan: Well, that is a fairly detailed conversation about what their needs are, and I get some patients who just want normal vision for distance and are quite happy to wear reading glasses. I also get certain patients who will say “I want to have glasses only for certain tasks or even indeed have no glasses at all” and patients who do not require or would like to be glasses-free can be offered multifocal lenses. But, they need to be counselled as to the benefits and the small risks of multifocal intraocular lenses because they are not suitable for everyone.
Jane: Why are they not suitable for everybody?
Jaheed Khan: For the majority of our patients they are suitable, but if you have other pathology, let us say you have glaucoma or you have macular degeneration, those lenses do not tend to work so well with people who have already got problems with their vision from other conditions. It does need to be put in both eyes to get the best effect, so if you have one cataract and your other eye is good, then sometimes you have to have two operations to get the best benefit out of multifocals. Some patients do not want to have that.
Jane: What proportion of patients have a normal lens and what portion have a multifocal lens?
Jaheed Khan: Multifocals. Yes the analogy is varifocal glasses, and some people get on with varifocals, and some people don’t.
Jane: Varifocal glasses can certainly take a while to get used to.
Jaheed Khan: There is a little bit of adaption with varifocal glasses, and similarly there is with multifocal, and then your question is at what percentage? So, I would say that 10-15% of people will request multifocal lenses, but the large majority of people are very happy with monofocal lenses.
What happens on the day of cataract surgery
Jane: What happens on the day of cataract surgery?
Jaheed Khan: So, on the day, you come into the hospital, and you will meet the nurses who will admit you. They will do some screening tests for things like blood pressure to make sure that is not too high, make sure that you have not got any infections, you have not had any recent falls, make sure that you are safe for surgery on the day.
Then you will have your eyes dilated, and that means you will have lots of drops in the eye to make the pupil big. We enlarge the iris so we can see the cataract.
Then you will go up to the operating theatre, and we will do the operation, and that involves lying flat on a bed…
Jane: And I would have been measured for a special lens by then?
Jaheed Khan: Yes, we don’t do all of the measurements on the day of surgery, we always do those in advance. We are entirely prepared for what power lens we put in the eye, but on the day of surgery that is all pre-prepared and the lens is ordered, so we have no surprises on the day.
Then you will lie flat on the bed, and we will make sure that you are comfortable and we ask you to look up at a light, and that is a microscope light and keep your head very still.
We have a little cup that your head sits in.
We clean the eye and make sure that the infection risk is very low, so we do not get any inadvertent skin bacteria anywhere near or inside the eye.
We would put a little clip on the eye to keep your eyelid open, which feels like a little stretch.
Then, we will ask you to look at the bright lights, and you will hear everything in the operating theatre, you will hear the surgeon talking, you will hear the anaesthetist talking, and you will hear us talking about the instrumentations needed in cataract surgery.
There is nothing to worry about.
If you lie still, look at the light for about 10 minutes, you will feel the surgeon touching the face, and you will hear a few buzzing sounds. But after that, once all of that is done, we will put a pad on the eye and make sure that everything is comfortable and you will not have any pain afterwards, but we have anaesthetised the eye.
Jane: It sounds very reassuring… I almost feel I want to come have my cataract surgery done, but I am not quite ready for it yet. What will happen after my cataract surgery?
Jaheed Khan: So, you will get discharged after your operation. I usually come and say hello and make sure that you are happy and that everything has gone fine.
Then we ask you to use drops after the operation. We use two sets of drops, one to prevent infection, which is an antibiotic drop that you use in the eye, and one is an anti-inflammatory, which prevents inflammation as any operation incites inflammation, so we dampen that inflammation response with topical drops on the eye such as steroid drops. We ask you to use that for at least four weeks and we ask you to use it four times a day for a couple of weeks and then reduce that to twice a day for a couple of weeks.
I arrange to see you in about a week just to make sure that you are happy, to make sure the eye is settling down in the outpatient clinic. So, you then you do not need to come back to the hospital, you come back to the outpatient clinic, and we just check that the eye is healing well.
There are three things that we would like to check:
- We check that the little openings that we make at the operation are closed and are healing nicely.
- We make sure that there is no risk of infection.
- We make sure the lens is in place and is nicely centred.