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Cataract Videos

Please watch one of the video’s below to get a better understanding of what a cataract is and how it effects your vision.

Cataract Surgery at Eyescan

 

 

The Eyescan Eyecare Organisation is one of the largest specialist eye care centres in Holland. They perform thousands of cataract and retinal surgical procedures every year.

They are registered with the Dutch surgical regulatory bodies and are fully licensed.

What is a cataract?

A cataract is a clouding of the eye’s natural clear lens. When the lens becomes cloudy, light rays cannot pass through it easily and vision becomes blurred. Cataract development is a normal process of aging. A cataract can also be present at birth, develop from injuries, certain diseases, medications or long-term exposure to sunlight. Symptoms of cataract include cloudy or blurred vision, fading of colours and the need for frequent prescription changes to your glasses or contact lenses. Glare, halos around lights, double or multiple vision in one eye or poor night vision may also be a problem.

A cataract may not need to be treated if your vision is only slightly blurred. Simply changing your prescription may help improve your vision for a while. There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear or prevent them from developing. Surgery is the only way to remove a cataract. When you are no longer able to see well enough to perform your daily activities including hobbies and safely driving a car, cataract surgery should be considered.

Preparing for your cataract surgery

Cataract surgery involves removing the cataract together with your natural lens and replacing it with an artificial lens. Before the operation can go ahead, lens-measurements are performed to calculate the correct strength of the lens implant required for your eye.

Lens-measurements (biometry)

This involves a painless procedure in which a ray of light is used to measure the length of the eye. This is needed to calculate the strength of the lens implant. The presciption for your glasses after the operation will depend on the strength of the artificial lens placed into your eye during surgery.

Patients wearing contact lenses are required to leave them out before these measurements are taken enabling the best possible accuracy. However there are no guaranties as to the exact strength of your glasses after surgery.

The amount of time you need to leave them out for biometry varies depending on the type of lenses you wear: soft contact lenses for two weeks and hard contact lenses for four weeks.

Scheduling the surgery

You will receive a proposal for a date and time for the operation. Follow-up examinations will be scheduled for one day at our clinic in the Netherlands and approximately one month after surgery at the local optometrist back in Ireland. If you need surgery on both eyes, separate appointments can be made for you. Normally speaking an operation on the second eye may be planned a few weeks after surgery on the first eye.

Eye drops

You will be provided with a prescription for eye drops and a roll plaster. We advise you to collect these at your local chemist on time, preferably at least one week prior to surgery.

General health

You will be requested to fill in a questionnaire regarding your general health. Please notify us any medication you are currently taking. This information is assessed by the nurse anaesthetist to avoid any complications. Contact may be made with your general practitioner or a medical specialist. In case of local anaesthesia, however, this is seldom necessary.

Preparation at home

One day before the operation you should start using the drops in the eye that will be operated on. If you are not able to put in the eye drops yourself, make arrangements for someone else to help you or contact your G.P. and/or Home Care.

Personal hygiene is an important factor to reduce the risk of infection. Therefore you are advised to have a bath or shower and wash your hair the evening or morning before surgery. Please do not wear any make-up, nail polish or jewellery, other than a wedding ring. Please wear clean, loose fitting comfortable clothing. Maybe with a front fastening.

The fluid used to keep the equipment cool during the operation, occasionally leaks near your face and you may notice that your hair or ear are damp. This is why a hearing aid should be left out on the same side of the eye that will be operated on. As the surgery is usually performed with a local anaesthetic fasting before surgery is not necessary. It is recommended however to have a light breakfast prior to your operation.

You may feel less fit than usual after the operation. Also your eye will be covered up with an eye shield.

Medication

You can continue to take all your usual medication. Unless you have been advised otherwise. This includes Warfarin®, Plavix® and Aspirin®. Please bring with you any medication you need to take whilst you are here. If you forget your medication please inform us when you arrive. Also inform your surgeon if you have ever taken the drug Flomax®/Omnic® (Tamsulosin®).

Diabetes mellitus

If you have diabetes it is important to bring your diabetic medication or insulin with you and use them as prescribed. It is also advisable to bring along a packed lunch on the day of surgery.

Falling ill before the operation

Please get in touch if you should have a fever, flu or illness during the days prior to your surgery. It may sometimes be necessary to postpone your surgery to another date.

Refreshments

It is a good idea to have a snack or drink after the procedure. The clinic offers coffee, tea and water free of charge, there is no food provided whilst you are in theatre and recovery complex but you can arrange with housekeeping to provide a snack.

What should you leave at home?

It is advisable not to bring valuables or money to the clinic. The clinic can not accept any responsibility for loss, theft or damage.

Day of surgery
Scheduled time

When you arrive for your appointment please check in with the nurse at the reception of the ZHA Eyescan Clinic. We ask patients to arrive at specific times to allow plenty of time for all the necessary preparations, for the surgery and postoperative care. You can expect to be under the direct care of the surgical team for between one and a half and two hours. During this time, several checks are made to ensure the correct patient receives the correct procedure on the correct eye. These may seem tedious, but are in the interest of your safety.

Accompanying person/contact

On the day of surgery you may be accompanied by your partner, a relative or friend. During the operation the person who is with you may remain in the waiting room. Any exceptions will need to be made with the staff present and/or operating team. The name and telephone number of the same person should be written on the back of your health questionnaire.

Dilation of the pupil

Upon arrival, the nurse looking after you, will insert a tiny “pellet” (Mydriasert®) into the appropriate eye. This is to dilate the pupil. Your blood pressure will be measured. To reduce anxiety, some people may be offered a sedative drug to help them relax during the procedure. If you think you may need sedation, please talk to the nurse.

Anaesthetic

When everything is ready you will be taken to the operating theatre via a preparation room where extra clothing will be provided that is suitable for the operating department. This clothing can be worn over your own clothes. A small needle will be placed into a vein in your hand/arm. This is in case it should be necessary to administer any medication during the procedure.

The operation will be done with a local anaesthetic.

These are the methods used:

  • Drop anaesthesia: anaesthetic eye drops are administered to the eye that will be operated on. During the surgery the eye will be held open with an eyelid speculum. Sometimes the surgeon will instruct you to look into the light of the operating microscope.
  • Sub-Tenon anaesthesia: in addition to the anaesthetic drops, a local anaesthetic will be gently injected with a blunt cannula into the tissues around the eye. You will feel some pressure behind your eye for a few seconds. With this type of anaesthesia you won’t have to worry about unintentional eye movements.
In the operating theatre

The operation is carried out while you are lying on your back, in a chair that in some ways resembles a dentist chair. The eye and eyelids will be disinfected with an iodine-solution and a drape will be placed over part of your face to keep the operation area sterile. You can still breathe normally. Please let us know if you have difficulty lying flat, are short of breath or if you are claustrophobic. We will try to make you as comfortable as is possible.

Operation

The usual procedure to remove cataract is called “phacoemulsification”, often shortened to “phaco”. This technique uses ultrasound to soften the lens, which is then broken up and flushed out using fine instruments and special fluids. (figure 1) A folded artificial lens, made of a perspex material is inserted inside the eye. (figure 2) The back membrane of the lens (capsule) is left behind and holds the artificial lens in place. (figure 3) The incision (wound) is very small and most patients do not require any stitches. At the end of the operation a pad and clear shield are put over the eye to protect it.

Duration of the operation

The operation will be done by an experienced eye surgeon and usually takes 10-20 minutes. During the operation you will be attached to a monitor with which we can check your vital signs. It’s important that you will try to keep still and not talk during the surgery.

The theatre staff will advise you on how to communicate if you become anxious during the operation, need to cough or move. The theatre can be a little noisy with the equipment used to remove the cataract. You will hear talking between the surgeon and other members of the theatre team.

A lot of fluid is used during the operation. Sometimes, excess fluid may escape under the sheet and run down the side of your face, into your ear or on your neck. This could be uncomfortable, but is nothing to worry about.

Risks of cataract-surgery

Modern cataract surgery is generally very safe and successful. Complications (unintended consequences) affect less than one percent of people who undergo this procedure. These include:

  • Acute or chronic inflammation.
  • Posterior capsule tear, which could lead to part or all of the cataract falling into the back part of the eye, needing another operation to remove it.
  • Wound leakage, needing repair and additional stitches.
  • Dislocation of the lens implant into the wrong position.
  • A haemorrhage inside the eye.
  • Serious infection in the eye, which could lead to severe loss of vision, or even the eye. (endophthalmitis)
  • Loss of clarity of the cornea, resulting in the need of a corneal graft.
  • Swelling of the central part of the retina (macular oedema), which may require prolonged treatment with antiinflammatory drugs.
  • Detachment of the retina. Timely retinal detachment surgery is usually successful in restoring vision. • A weakened or “droopy” upper eyelid.

Most of these unintended complications are manageable and can be treated well. In a small proportion of cases, however, additional surgery is required. Severe loss of eyesight is a very rare event.

Posterior capsule opacification

Although the artificial lens lasts a lifetime, the back of the capsule around the lens may lose clarity months or years after the operation due to the formation of a membrane. This will lead to a decline of sight. This clouding of the lens-capsule, which occurs on average 2 years after the operation in approximately 20 percent of the patients, can be treated with a YAG-laser. With this brief laser procedure a clear opening is made in the posterior capsule.

After the surgery

As your eye is covered by a protective shield after surgery, please be careful when moving about. It may be difficult to judge distances e.g. steps, shelves etc. Therefore you will be accompanied to a post-operative area by the nurse. After the operation, you will have a chance to drink and eat something. The anaesthetic nurse will ensure that you are fit to leave the surgical area and be moved to recovery.

Pain

When the local anaesthetic wears off you may have some discomfort. Unless your doctor has advised otherwise, this can be helped by taking pain killers preferably a 500 mg Paracetamol tablet. Please make us aware in case the pain is not relieved after an hour, especially if associated with nausea or vomiting.

The morning after the surgery

The morning after surgery you will have a check up with a member of our ophthalmic team. The protective eye shield will be removed and the eye will be gently cleaned. Once discharged and back home in Ireland you must start using your eye drops as prescribed.

Protective eye shield

For the first two weeks after your operation you must use the shield provided at night to protect your eye. Use the tape to keep it in place. This is the tape you picked up together with your eyedrops at the chemist.

Recovery at home
Spectacles (glasses)

During your initial assessment your doctor will discuss with you whether you want to have better vision for closeup or in the distance. Most people choose to aim for good distance vision after the operation. If you choose this option, you will usually need reading glasses. You may also need glasses for fine focussing in the distance.

Some people may choose to aim for good close vision, especially if they like to read without glasses or do a lot of detailed close work. If you choose this option, you will need glasses for distance including driving. For these options monofocal lens implants are used.

(Multifocal intraocular lenses for more freedom from glasses both for distance and closeup and toric lens implants to correct a high astigmatism or cylinder cannot be offered to you for two reasons: with your three day stay there is not enough time to order such a customized lens at the supplier and the extra costs of multifocal and toric lenses are not covered by the HSE, your health insurance).

Guidance and instructions after cataract surgery

As your eye is more vulnerable the first weeks after surgery you should avoid rubbing or touching the eye. To stop rubbing your eye while asleep wear the protective shield at night. We advise this for two weeks.

Strenuous activities should also be avoided, such as lifting heavy weights or high impact exercise. Refrain from all activities where there is a risk of your eye being knocked for three to four weeks. Normal household activities and office duties are generally safe. If you work how soon you can return depends on what your work involves. Most people can return within a few days, but you may require more time if your work is physically strenuous. Being at risk of exposure to liquid or dust in your workplace is also of importance.

There are no restrictions with bending or lifting most household objects, but avoid bending with your head below waist level for extended periods of time.

You can read and watch television almost immediately without doing any harm. It is possible that your vision may be blurred until your eye gets used to its new lens or your new glasses are fitted. You may bathe and shower after your surgery. Keep your eyes closed while you shower and avoid getting water and soap directly into the eye.

You should not swim or bathe with your face under water for the first two weeks after the procedure. Avoid wearing make-up for one week.

You may wear your old glasses, this has no effect on the result.

Driving standard after cataract surgery varies from person to person and the recovery of the eye. Sometimes driving standard can be regained within days of surgery but cannot be guaranteed. Consult your doctor after the operation if you have any doubts about driving. If driving with impaired vision, it could cause problems with your insurance in the event of being involved in an accident.

Your eye usually settles over two to four weeks after the operation, although some patients take slightly longer. Some blurriness or fluctuations of vision during healing is normal. A mild pain in and around the eye, a slight feeling of grittiness, an itchy or sticky eye, discomfort looking at bright light and some bruising of the skin around the eye are also common. This should improve within a few days.

Concerns

You should seek medical advice as soon as possible if you experience:

  • a throbbing or severe pain in or around the eye
  • a severe frontal headache with or without nausea and vomiting
  • a sudden deterioration or loss of vision
  • increasing redness in your eye
  • the sudden appearance of black dots or streaks (floaters) or a shadow in the field of your eye with or without flashes of light

These problems may be a sign of a complication of cataract surgery.

Eye drop instructions after cataract surgery

Use your prescribed eye medication as directed for the duration advised by your doctor, which is usually for one month. As long as you space the drops out evenly during the day, you can put them in at any time which suits you. If you are using more than one drop at a time, leave a few minutes in between.

How to put in the eye drops:
  • Wash your hands with soap and water, before using your drops or ointment.
  • Open both your eyes and look up to the ceiling with your head tilted back. Alternatively, lie down on your back in case of neck complaints.
  • With one finger gently pull down the lower eyelid of the eye to form a “cup” (figure 1).
  • Squeeze the eye drop into this cup (figure 2). One drop is sufficient. If in doubt whether the drop has reached your eye, put another drop in to be safe.
  • Try not to touch the eye or eyelid with the bottle.
  • Close the eye gently for one full minute (figure 3). With a tissue, gently remove excess liquid from the eyelash/cheek.
  • Close the bottle well and store it according to prescription.

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