Eye Care Blog

There is a popular misconception that cataract surgery cannot be undertaken until the cataract has reached a particular ripeness. This was the case many years ago, when the only method of removing the cataract was by the extracapsular method, which involved opening the capsular bag and washing away its contents. If the cataract was very ‘immature’, it was technically rather difficult to do this.

Today a cataract is removed when the level of vision is not sufficient for the patient’s everyday needs. Since the success rate of surgery is very high, the decision to operate may be taken much earlier than formerly, when the outcome was less certain. It is, however, difficult to attain the ideal of restoring visual performance to what it was before cataract developed in the eye.

Individual visual requirements vary enormously. It may be reasonable to perform the operation because driving is becoming difficult due to dazzle, although the eye’s level of acuity is still fairly good in ordinary lighting conditions. Conversely, some short-sighted people with cataract may be perfectly happy with very poor distance vision provided that they can continue to read small print with ease.

Absolute visual levels and degrees of cataract maturity are therefore immaterial in the timing of the operation. It is the personal needs of the individual that matter.

Most surgeons prefer to remove one cataract at a time, operating on the worse eye first and then dealing with its fellow a few weeks or months later. Very occasionally the operation is complicated by infection or haemorrhage, or the patient may have a fall or other mishap which results in a less than satisfactory surgical result. If both eyes have been rendered vulnerable by simultaneous surgery, the outcome may be disastrous; great caution is therefore usually exercised.

Preparation for Operation

The exact details of preparation vary considerably from hospital to hospital and also from surgeon to surgeon. Generally speaking, the patient is admitted a day or so before the operation is to take place. This allows the patient to become familiar with the ward, its staff and its routine, and to permit any tests which may be necessary to be carried out, particularly if the operation is to be performed under a general anaesthetic. These tests may include a blood examination to rule out the presence of anaemia; an electrocardiogram (ECG) to check heart function; and urine tests to make sure that the cataract is not caused by diabetes or, in the case of a diabetic, to assess the stability of the diabetes. A general medical examination is carried out, particular attention being paid to any possible chest trouble as coughing and sneezing are to be discouraged during and immediately after the operation.

Many surgeons like to have the eyelashes cut short before the surgery because this helps to lessen any possible contamination. To exclude the presence of any infections swabs may be taken from the conjunctival sac for bacteriological examination. Sometimes the tear sac itself will be washed through, again to eliminate any possible source of infection.

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