Treatment for age-related cataracts may not be needed if:
- you have no symptoms
- your sight is only mildly affected
In the early stages of a cataract, your vision may be improved with stronger glasses, or by using a brighter light when you read, for example. However, the improvement may not last long.
Surgery is the only way to treat cataracts that become more severe.
When cataracts are treated
Your optometrist (a specialist who examines eyes and tests sight) or GP will probably recommend treatment if your loss of vision affects your usual daily activities. For example, if cataracts affect:
- your ability to look after yourself or someone else
- your driving
- going out
- seeing people's faces
- your work
- reading
- watching television
Surgery
Cataracts are treated by having surgery to remove the cloudy lens in your eye. In most cases, the natural lens is replaced with an artificial, clear plastic lens. This is called an intraocular implant or intraocular lens (IOL).
Most cataract operations in the UK are carried out under local anaesthetic, as keyhole surgery, where a very small incision (cut) is made. You will probably be admitted as a day patient (day case), which means that you will not need to stay in hospital overnight.
The most common cataract operation is called phacoemulsification, and is sometimes referred to as phaco extracapsular extraction. Cataracts cannot be treated with laser surgery (when beams of energy are used).
Before the operation
Before having cataract surgery, your GP or optician will refer you to an ophthalmologist or an ophthalmic surgeon (medical doctors who specialise in eye conditions and their treatment). They will assess your eyes and your general health. This is called a pre-operative assessment.
During the assessment, your eyes will be measured. The artificial lens that will replace your natural lens can then be prepared. An appointment will probably be made for your operation to take place during a separate visit.
Just before the operation, drops to dilate (widen) your pupil (the black circle in the middle of your eye) will be put into your eye. You will also be given a local anaesthetic that will prevent you feeling any pain during the procedure. This may be applied to your eye as drops, although sometimes an injection in the tissue around the eye may be used.
Once the anaesthetic takes effect, you will not be able to feel anything. While the operation is taking place, all you will be able to see is a bright light. You will not be able to see what is happening.
The replacement lens
Different types of replacement lens are available. These include:
- fixed strength lenses (monofocal), which are set for one level of vision, usually distance vision
- multifocal lenses, which allow two or more different strengths, such as near and distance vision
- accommodating lenses, which allow the eye to focus on both near and distant objects, in a similar way to the natural human lens
Your ophthalmologist will discuss with you which type of lens will suit you. Not all of the lenses described above will be available on the NHS.
Multifocal and accommodating lenses are not usually available through the NHS. NHS funding for these types of lens will depend on your local primary care trust (PCT).
Ask your GP or ophthalmologist about the types of lenses that are available in your area. If NHS funding is not available for these types of lenses, you may be able to pay to have them fitted on a private basis.
The operation
During the operation, your ophthalmologist will make a very small incision (cut) in the surface (cornea) at the front of your eye. Your ophthalmologist will then insert a tiny probe through this cut. The probe breaks up the cloudy lens into tiny pieces using ultrasound (high frequency sound waves). The tiny pieces will then be sucked out of your eye.
Once this is done, your ophthalmologist will insert an artificial, clear plastic lens through the incision. The lens sits in a little 'pocket' called the lens capsule to keep it in place. The lens is folded when it is inserted, and once it is in position it is allowed to unfold.
The operation usually takes 15 to 30 minutes, although sometimes it can take slightly longer.
Other operations
Two other operations may be performed to remove age-related cataracts, although these are much less common. They are:
- manual extracapsular extraction
- intracapsular extraction
In manual extracapsular extraction, the ophthalmologist makes a slightly larger cut in the eye. The lens is removed in one piece, rather than being broken up by ultrasound.
During intracapsular extraction, the lens capsule is removed, as well as the lens. A replacement plastic lens is then sewn into the eye. In some cases, special (aphakic) glasses or contact lenses may need to be worn instead. Intracapsular extraction is rare in the UK.
See the Health A-Z topic about Cataract surgery for more information about this procedure.
After your operation
The vision of most people who have cataract surgery improves almost immediately. However, it may take a little time to settle down completely. The incision (cut) in the eye's surface is so small that it usually heals by itself, although sometimes a small stitch may be needed.
Your ophthalmologist will probably advise you to take it easy, for example, by:
- avoiding sports and any vigorous activities
- not rubbing your eye
- not getting soapy water in your eye, for example, while taking a shower
- wearing a pad over your eye to protect it
When the operation has been completed, your plastic lens will be set up for a certain level of vision. After the operation, you may need to wear glasses in order to see objects that are:
- far away (distance vision)
- close to you (near vision)
If you wore glasses previously, your prescription will probably change. It will take several weeks after the operation for your vision to settle down before your optometrist can give you a new prescription.
