CATARACT SURGERY

A cataract is an opacification or clouding of the lens inside the eye. Note that it is not a growth on the outside of the eye, therefore you cannot see it when looking in a mirror. The cause is not usually known but it is associated with people older than 50. Sometimes younger people can get cataracts especially if they suffer from diabetes or smoke. The treatment is removal by surgery followed by implantation of a new lens.

When should surgery be done?

With modern surgical techniques, smaller cataracts are easier to remove through a smaller cut. Therefore one should not wait for the cataract to become “ripe”, as in the old days. The sooner the operation is done the more likely that there will be minimal pain and redness and the better the eye will heal. This is especially true for people who are short or far-sighted. Old, large cataracts can often not be removed through small incisions and the old technique with a large cut plus many sutures may need to be done.

How long does the operation take?

The operation takes about 20 to 30 minutes but the whole procedure including administration and preparation takes several hours. Be prepared to spend several hours at the hospital (no nights). Someone should drive you home from the hospital.

Is it done under general anaesthetic?

It can be done under general or local anaesthetic but most cases are done under local. Do not eat anything for at least 8 hours before the operation except that if you are taking any prescribed medication then this must be taken with water. Diabetics, however, should not take their insulin or tablets as these must be taken with food. Clear fluids in small quantity (eg water or a small cup of black tea or coffee with sugar) may be taken at home that morning before you leave for the hospital. Bring your medications, drops, pumps, etc with you.

Will it be painful?

The operation itself is painless as your eye will be anaethetized. When the anaesthetic wears off, mild pain or discomfort may occur for the first few days. Sometimes the anaesthetic causes nausea and muscle pain. Severe eye pain after the first day is abnormal and should be reported to your eye-specialist.

When will the sight improve?

The eye is usually blurry for a few days after the surgery. Vision will improve when you receive your new spectacles several weeks after the surgery. In most cases your eye specialist will refer you to your optometrist 2 weeks after the surgery. Your optometrist will then test your eyes for new glasses. If you have retinal problems (at the back of the eye behind the cataract) the vision may not be as good as expected. Retinal problems are common in older patients and may not be diagnosed until after the surgery as the cataract blocks the view of the retina.
Remember that no two eyes (and no two operations) are exactly the same and the two eyes may not feel or see exactly equally after cataract surgery.

What are the risks?

Cataract surgery is one of the safest and most successful operations. However, as with any medical treatment, there are risks and possible complications and results can never be guaranteed. Serious complications are rare, occurring in less than 2% of cases. These are: anaesthetic problems, infection, retinal detachment, haemorrhage, corneal clouding and perforation. Less serious complications are: retinal swelling, pressure elevations, lens implant displacement, spectacle intolerance, glare, haloes, light sensitivity, uncomfortable eyes. Membrane formation behind the artificial lens implant is common but easily treated with laser. “Floaters” (dots or threads seen floating around your visual field) are also commonly seen after cataract surgery.

New spectacles may be needed after the operation (even if spectacles have never been worn). Occasionally some of the cataract falls into the back of the eye during surgery. In such cases the eye surgeon will close the eye and send you to a retinal surgeon. Occasionally (especially if the cataract is large and deep) the entire cataract can not be removed. In such a case the remaining part of the cataract must be removed by a different operation from behind the lens. This will need to be done as a separate operation by a retinal surgeon. Occasionally the lens implant is rejected by the eye. If this happens drops may be needed for many months or the lens may need to be removed. The lens may also need to be exchanged for one of different design or power if it is causing problems.

Where will the surgery be done?

At Lakefield Surgical Centre, 23 Lakefield Ave, Lakefield, Benoni. Tel: 011 894 8008. All the staff are highly trained in ophthalmic procedures and it has all the necessary modern equipment.

Please note that some medical aids do not cover the entire bill in which case you will have to pay in the difference. For example, some schemes do not cover the cost of the lens implant (approx R2000), some refuse to pay for the medication (approx R600), and some refuse to cover the viscoelastic material used during the operation (approx R1650).
If you receive any accounts from the hospital, anaethetist, or surgeon asking you to pay in an excess over what medical aid paid, please phone the Springs rooms before paying.

What to do after the operation.

If you feel comfortable you may do any light activities eg reading, sewing, watching TV, bending over, washing your face and hair, cooking, etc. Any spectacles that feel comfortable can be worn. Sunglasses may be worn outdoors. You must return to your surgeon for a check-up in 1 or 2 days. You can drive and return to work after 2 or 3 days.

How much does one cataract operation cost?

The total fee for one eye including VAT, hospital, medications, lens implant, surgeon, and anaesthetist is approximately R31 000. This is medical aid rates and is fully covered by most medical aids. Note that this is for routine surgery with no complications. This does not cover further costs (such as additional surgery) that may be incurred in the unlikely event that complications arise. These extra costs will also be covered by medical aid.