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Specific Questions Related to Cataract Surgery

One of the objectives of The Royal College of Ophthalmologists is the education of the general public in all matters relating to vision and the health of the human eye. Towards the end of 2004, the College agreed to collaborate with Dr Foster, one of the leading publishers of healthcare information in the UK, on a range of articles. These articles were to be published in The Times ‘Body Beautiful’ Supplement but in the event, lack of space meant that not all the copy was featured. We believe that the work deserves an audience and we are able to post in full the articles on cataract surgery, glaucoma, laser refractive surgery and corneal disease on the College website.

We hope that the readers find the pieces interesting and informative although they are not a substitute for a detailed medical consultation. The Royal College of Ophthalmologists has collaborated with Right Care on a Shared Decision Making Aid to help inform patients about cataracts and treatment options.The new online  tool is accessible on the Shared Decision Making website. The Patient Decision Aids have associated Apps, with versions for Android and Apple devices. Patients can download them from the Google Play Store or iTunes from your device (search for “patient decision aid”).

How long will I have to wait for treatment?

According to Dr Foster’s hospital data the average wait for cataract surgery in 2003/4 was 190 days, but was as much as 313 days or as little as 13 days. The government has invested £52m in the cataract care pathway programme – it hopes to reduce waiting times to below three months and significant progress has been made in many NHS trusts over the last six months.

Can I be treated as a day case?

Best practice is to perform this operation as a day case. You get to go home straight after the operation, which patients often find more convenient. However, some hospitals are better than others at managing to do this. Dr Foster statistics show that the best hospitals treat all patients as day cases while the worst treat only 22 per cent in this way. The average is 92 per cent, so ask what the day case rate is for your surgeon’s hospital.

How many operations have you done?

A number of studies have made an association between the volume of procedures carried out by surgeon or hospital and the outcome, suggesting that practice makes perfect. Cataract surgery is one of the most commonly performed operations in NHS hospitals. Some non-specialist hospital trusts conduct up to 6515 operations a year, while others carry out as few as 18. Find out how experienced your surgeon and hospital is in this procedure.

Do you specialise in cataract surgery?

More than 40 per cent of the 1101 ophthalmologists in the Dr Foster database specified a special interest in cataracts surgery. For complex cases, make sure you see someone that specialises in the surgery you are undergoing. In some cases a junior surgeon may assist, but less experienced surgeons should not be performing the operation on their own so find out what kind of supervision there will be. Full details of consultant’s special interests can be found by going to http://www.drfoster.co.uk/Guides/ConsultantGuide/

What is your complication rate?

Cataract surgery has one of the highest success rates and according to the Royal College of Ophthalmologists fewer than 2 per cent of patients have serious, unforeseen complications. One of the most common is a thickening of the lens casing, but this can easily be corrected with laser treatment. Check how the surgeons carrying out your operation compare – there could be three or four members in the surgical team. If some operations they carried out had complications, ask them to explain what they were and why they occurred.

What kind of anaesthetic will be used?

A local anaesthetic is usually used, but a general anaesthetic might be appropriate depending on your circumstances. You should tell your consultant if you don’t want a sharp-needle anaesthetic. A sub-Tenon’s local anaesthetic is highly effective at pain relief and is much safer. Topical anaesthetic is good in skilled hands, but is associated with more perception of what is going on. If undergoing a general anaesthetic, your life is in the anaesthetist’s hands even in what is otherwise a routine surgical procedure, so try to find out what qualifications and experience they have and try to meet them before the operation.

What is your accuracy of biometry?

Biometry is the process that uses either laser or ultrasound to predict the correct lens implant power and getting it right is a key part of a successful operation. Consultants should adhere to the guidelines from the Royal College of Ophthalmologists. Ask whether your hospital audits the accuracy of biometry and find out what kind of results your surgeon has had.

Are you going to try anything on me that is new to you?

New lens technology is being developed that neutralises various aberrations, but you need to consider the possible long-term dangers of something that hasn’t got a long track record of success. Although new implants might be shown to be both safe and advantageous over time, some ophthalmologists are still wary about new types of lens and lens materials.

Will you be providing a multifocal lens?

While it’s possible that multifocal lenses can improve your vision for distance and for reading so that no further correction is required, in practice this is not always achieved. Contrast is reduced by certain types of multifocals and biometry has to be very accurate to get good results. There is also a period of adjustment required on the part of the patient to a diffraction type of multifocal lens. In a recent survey by the United Kingdom and Ireland Society of Cataract and Refractive Surgeons, only 5% of its members had used multifocal lenses.

What is your attitude to complementary therapies?

One Spanish study shows that Lutein – available as a supplement or found in spinach or kale – may improve sight for people with age-related cataracts. If you are interested in complementary treatments, you should assess your consultant’s attitude towards them and ask what they suggest in your case.

And finally – is surgery really necessary?

Unnecessary cataract operations could result in a worsening of vision. The first question to ask the surgeon is whether you definitely need surgery. In general, surgery should be considered if your eyesight interferes with your daily life and affects your ability to read or work. If you drive, you must reach the required standard set by the DVLA, so you might need the cataract removed if you want to keep your licence.

More information is available in the RCOphth RNIB Understanding Cataracts 2013.