Cataracts: should I have surgery?

What are cataracts?

If you have a cataract, the lens in your eye turns cloudy. This makes your vision blurry. It's just the same as if a camera lens got scratched. The marks would show up on the pictures. Cataracts usually affect both eyes, although you can get them in just one eye.

Lots of people think that a cataract grows on the surface of your eye. But cataracts actually affect the lens, which is inside your eye, just behind the coloured part.

Cataracts are common, especially in older people. A third of people over 65 have cataracts.

What treatments work?

Surgery is the only way to get rid of a cataract. During cataract surgery, your surgeon removes the cloudy lens in your eye and replaces it with an artificial one. It’s a simple operation and only takes 10 or 20 minutes. You'll probably be able to go home the same day.

Cataract surgery is done in hospital. You'll be taken to an operating theatre and lie on a bed that has a pillow to hold your head still. A doctor or nurse will numb your eye with anaesthetic drops or an injection near your eye. You may also have a sedative to help you relax. Very occasionally, people have a general anaesthetic to make them sleep.

You'll have to lie still and not speak. A nurse will tell you how to signal if you feel uncomfortable. During surgery, you may see flashes or catch a glimpse of the surgical instruments. People don't usually find these things unpleasant.

There are two ways to do the operation. The lens can be taken out in one piece through a small cut in your eye. Or sound waves can be used to break up the lens. The pieces are then sucked out through a tiny cut in your eye, using a hollow needle. Surgery that breaks up the lens works better and it's the type that's almost always used in the UK.

Once your old lens has been removed, your surgeon will put a clear, plastic lens into your eye. It shouldn't feel any different from your natural lens.

After your operation, you'll need to put drops in your eye every day for several days or weeks. If you have cataracts in both eyes, it's normal to treat them in separate operations, one or two months apart.

How can cataract surgery help me?

After your operation, you should be able to see better. More than 9 in 10 people who have a cataract operation can see well enough to drive. Seeing better may help you to enjoy life more. And there's research that shows you're less likely to hurt yourself in an accident or fall after having cataract surgery.

It may be a few days before you get the full benefit of cataract surgery. Even then, you're unlikely to have perfect eyesight. Many people still need to wear glasses. You may only get the full benefit of your operation when you get new glasses.

Most artificial lenses can't change focus. That means you'll need to have different glasses for either reading or for seeing long distances. Newer artificial lenses that can change focus are being tested. They're called accommodating lenses. There's research to show that they work well in the short term. They can change focus better and give you clearer vision than the older types of artificial lens. But, because accommodating lenses are new, there haven't been any long-term studies yet. If your doctor suggests accommodating lenses, he or she will explain all the risks and benefits. You'll have some longer-term check-ups to see how well your operation worked.

If you have another eye problem as well as cataracts, it may affect how well your operation works. Your doctor can advise you about what the benefits are likely to be for you.

What are the risks?

Less than 1 in 10 people have any complications during surgery. And you're unlikely to get serious problems that make your sight much worse. Serious problems only happen to 1 in 1,000 people.

About 1 in 4 people have mild problems a couple of days of their operation. These include bruising, pain, inflammation or an infection. These are all easy to treat.

Some problems can happen months or even years after your operation. Cataracts can't grow back, but sometimes the tissue around the new lens turns cloudy. This happens to about 1 in 5 people. It can be treated with laser surgery.

It's possible to get a detached retina after cataract surgery, although it happens to less than 1 in 100 people. A detached retina can damage your eyesight badly, and needs emergency surgery. If you start to get problems with your vision, get help urgently.

What will happen if I choose not to have surgery?

If you don't have an operation, your sight will gradually get poorer. But cataracts usually get worse very slowly, so there’s no need to rush into a decision about treatment. You may find your symptoms don't bother you. If your cataract isn't interfering with your life, you may choose not to have an operation straight away.

How do I decide?

An eye test can give you an idea of how good your vision is. But doctors don't tend to recommend surgery just based on your eye test. They usually suggest you think about the way you live your life. For example, if you enjoy playing golf or reading, or you need to drive a car, you may want to have cataract surgery sooner. If your main hobby is listening to music, you may prefer to put off having treatment.

If you choose not to have treatment now, you can always change your mind in the future if your cataracts start to bother you. There's no need to wait till cataracts get very bad before you have surgery. It's up to you to decide when they're bad enough for you to want treatment.

Although your sight is likely to be better after you've had a cataract removed, you'll probably still need to wear glasses or contact lenses. So if you can still see well enough with glasses to do the things you want to do, you may want to put off having surgery.

Sometimes, people have another eye problem that needs treating, and the cataract is in the way. For example, some people get damage to the blood vessels in their eye because of diabetes or a condition called macular degeneration. If you need surgery for one of these conditions, it makes sense to have your cataract treated too.

Occasionally, another eye condition can mean you won't get much benefit out of cataract surgery. And if your health is generally poor, surgery may have more risks. If this is the case, you may think it's better to avoid having the operation.

If you decide to put off having surgery, there are things you can try to make your life easier. Get new glasses if you need them, as this can make the most of the sight you have. Brighter lighting in your home may help. Anti-glare sunglasses or a hat with a brim can stop glare from lights or the sun bothering you so much. Magnifying lenses can make reading easier.

Where to get more help or support

The National Institute for Health and Clinical Excellence (NICE) has produced some information on the newer artificial lenses that can change focus. You can read it at their website (http://www.nice.org.uk/guidance/IPG209).