Cataract Surgery - a Cataract is a cloudiness or opacity of the lens of the eye

The information below will give you a better understanding of the nature of "cataract". It should help you decide whether and when you would like to have a cataract removed, and also provide you with information about the operation and what you can expect afterwards.

		Place cursor over image Shown is a normal, clear field of view as seen through the clear lens of the eye. When a cataract is present, vision becomes darkened, cloudy, yellow and blurred.

What is a cataract?
The human eye has a lens to focus light on the retina. This lens must be clear so that light can pass to the retina, which is at the back of the eye and is rather like the film of a camera. The retina interprets different shapes and colours, and passes this information to the brain.

A cataract is a cloudiness or opacity of the lens of the eye. It can obstruct normal vision, may dull contrast and colours and may cause excessive glare.

		Place cursor over image Before surgery, the lens is cloudy, causing images to be blurred & yellowed. Vision is hazy & colors are faded. After surgery, Vision is clear.

When should a cataract be removed?
This will vary from person to person. A very active person may want a cataract removed early, when there is minimal visual disability; others may choose to wait.
Prior to the introduction of intraocular lenses, patients waited for a cataract to be "ripe" or "mature" before surgery.
With modern surgery, as long as the retina and all other parts of the eye are healthy, the cataract can be removed as soon as it causes any symptoms such as glare, blurred or dimmed vision,.
The decision about when to remove the cataract is yours, but be aware that a very advanced cataract will increase surgical risk.

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What is an "implant" or "intraocular lens"?


		During cataract surgery, the lens itself must be removed, and an artificial intraocular lens is then implanted to replace the natural lens. This implant is permanent and unlike a contact lens, it does not have to be removed. As far as is known, the implant can stay in the eye indefinitely.

While the implanted lens cannot change focus for different distances, some patients may be suitable for a multifocal lens, which assists with vision at different distances. However, after surgery, glasses are often still necessary for intensive reading and sometimes also for distance.

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Determining the power of the implant for your eye
Each eye is different, and a scan will be performed to determine as accurately as possible the power of the implant required for your eye to provide good focus.
Our state-of-the-art equipment includes the Zeiss IOLMaster, the most advanced and accurate machine in the world for this measurement. We also have the conventional ultrasound to use in some cases.

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What is involved in the surgery?
1. Hospital arrival
You will need to arrive at the hospital (Linley Clinic) about two hours prior to surgery, so that medical records can be made up and more importantly, so that drops can be given to dilate the pupil. Please ensure that you have no food for four hours, and nothing to drink for 2 hours, prior to surgery, except enough fluid to take any normal medications.

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2. The anesthetic
Cataract surgery is normally performed with local anesthetic. The aim of anesthesia is to provide comfort and safety during surgery.

Our preferred technique, which we use in over 99% of cases, is topical anesthesia in which the eye is anesthetized with drops alone.
This technique appeals to many patients because there is no injection, no chance of bruising, no pad required and the eye recovers very rapidly.

The alternative and more common form of anesthesia for cataract surgery is injection of local anesthetic near the eye. For local anesthetic injection, the anesthetist will put you to sleep for a few minutes while the injection near the eye is given, so you will neither feel any pain nor be aware of the injection. The risks of this are minimal, although some bruising around the eye can occur.

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Our anesthetists:
Our anesthetists, Dr Karl Alexander or Dr Nick Balis, are always present to look after your well-being and comfort at all times. The anesthetist plays a critical role in ensuring that you are not anxious, that your vital signs such as blood pressure, heart rate and oxygen levels are all correctly monitored and that you feel little if any discomfort during the procedure Our Patient Satisfaction surveys show an extremely high level of patient satisfaction with Dr Alexander and Dr Balis.
Learn more about our anesthetists by clicking here Our anesthetists

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The procedure
Despite what you may have heard, cataracts are not removed with laser, but YAG laser is often performed months or years after cataract surgery to treat thickening of the membrane (the posterior capsule) deliberately left behind at surgery to support the implant.

We use the most advanced method of cataract surgery presently available.

This is phacoemulsification under topical anesthesia, in which a tiny, self-sealing incision (3mm) is made into the tissue of the eye, and the tip of a very sophisticated ultrasound machine is used to break up the cataract. When the cataract has been cleared away, the intraocular lens is implanted, normally in the same position as the original lens and the self-sealing incision normally requires no sutures.

The procedure normally takes less than ten minutes.

During the operation, you will be covered with protective, sterile drapes, with plenty of oxygen to breathe. Only the anesthetized eye will be left uncovered. You will however be awake and alert, and you may like to bring a Walkman and your favourite music to listen to during the procedure.

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What happens after the operation?
After the operation, your eye will not be covered if you had topical anesthesia (drops alone). However, you will be provided with a protective shield to wear while sleeping. Although there may be some redness for a few days, there is little if any pain involved with recovery from normal cataract surgery. You may need two Panadol four hourly for discomfort, but if this does not provide relief, you should call Dr Collie.

Normally, you can return to all your normal activities within a day or two of surgery, but avoid any direct danger to the eye (eg wear protective glasses for tennis).

Eye drops to control inflammation and prevent infection will be used for a few weeks after the surgery. After three to four weeks, the eye is stable and a measurement for any glasses necessary can be made.

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Do I go home immediately?
Cataract surgery can now be performed safely as a day procedure and you will usually feel fine to go home immediately after some refreshments. As you may have some sedation during the procedure, it is preferable if you have a responsible adult to accompany you home from the hospital and to stay with you for the first night after surgery. You need to be able to telephone Dr Collie or the hospital should the need arise after the operation, and to come to see me the day after surgery.

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Follow-up
Follow-up after cataract surgery is usually very straight-forward.
Your vision may be blurred for a day or two especially while the pupil is still dilated after surgery, and you may notice some irritation in the eye which may persist while you are using the drops. Artificial tear drops usually help and these will be provided for you.
You will be seen in the rooms the day after surgery and again about one week after surgery.
Post-op visits are usually very brief examinations to make sure you are happy with the progress and to examine the eye particularly to ensure that there is no inflammation and no infection.

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How successful is the operation and are there any complications?
Dr Collie has performed thousands of cataract operations. He utilises the latest techniques, the most advanced equipment and a range of state-of-the-art lens implants to best suit your needs.
The operation is performed at Linley Clinic (click here to go to Linley) a boutique private hospital in Canterbury. In most cases, you will be on your way home less than 2 hours after arrival, in complete comfort, with no patch over the eye and with very few restrictions on your activities.

In the vast majority of cases, you can expect to have your sight returned to normal and you will only need glasses for reading. If there are other co-existent eye problems, surgery may still improve your vision within the limitations of those co-existent problems.

Click here to see our Cataract Patient Satisfaction Survey»

While the operation is very successful, there is, however, a small number of cases that are complicated by unforeseen problems either during surgery or in the post-operative period.

Complications that may permanently affect sight occur in less than 1% of all cases. These may include vitreous loss, post-operative wound leak or rupture, retinal swelling or detachment, glaucoma and displacement of the natural lens or implant. The most serious complications are severe haemorrhage or infection, but these occur in less than one in a thousand cases.
Our surgical team will do everything we can to minimize the chances of complications. In spite of these precautions, problems may occur, but to improve your vision, some minimal risk must be taken.

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Costs
We will provide you with a written estimate of your surgical costs and your out-of-pocket expenses. Medicare will cover a proportion of the surgical and anesthetic costs, and if you are insured privately, your health insurance will make a further contribution to both the medical and other costs. However, patients are responsible for ensuring prompt settlement of their accounts, including the difference between the fee charged and benefits received.

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