Cataract Surgery FAQs

Preparation for cataract surgery

1. Your regular medications

The only medications that may need to be ceased prior to cataract surgery are any anticoagulation (“blood-thinning”) medications. These include Aspirin, Plavix (Clopidrogel), Warfarin and Pradaxa. Dr Then will ask you to consult with your GP, cardiologist or other relevant specialist to assess if it is safe for you to cease these medications 3-7 days prior to your cataract surgery.
Your anaesthetist will also discuss your anticoagulation medication with you prior to surgery.

If you have had recent heart surgery or a stroke, then it may not be safe for you to cease your anticoagulation medication completely. You may require cover with injections of Clexane (Heparin) prior to the surgery. Your GP and anaesthetist will discuss this with you and organise this prior to surgery.

All other medications should generally be taken up until the night of cataract surgery. Again, your anaesthetist will discuss this with you in detail.

2. Diabetic Patients

Patients on insulin or other oral diabetic medications may need specific advice on when to take their medication prior to surgery. Your anaesthetist will discuss this with you prior to surgery.

3. Patients who wear contact lenses

Contact lens wear needs to be ceased 3 days prior to cataract surgery.

4. Fasting before surgery

You will need to fast a minimum of 6 hours prior to cataract surgery. For patients having their surgery in the morning, this means no food or drink from midnight the night before. For patients having their surgery in the afternoon, you may have a light breakfast at 7am on the morning of surgery, and no food or drink after this.
Diabetic patients will be given specific instructions regarding this.

5.Dressing for the surgery

Please wear comfortable clothes on the day of surgery.
Please do not wear any make-up, lotions or nail polish on the day of surgery.

6. Transport on the day of cataract surgery

You will need to have a driver to bring you to and from the hospital on the day of surgery.

7. Support at home on the first night of surgery

We require all patients to have support at home on the first night after surgery, whether it is your partner, family or a friend. This is because you may be groggy after the sedation from your surgery, particularly if you have had a general anaesthetic. Also, you will have a patch over the operated eye, and will therefore only be navigating with one eye for that night, which may make certain activities difficult.

What to expect on the day of cataract surgery

Before the operation:

You will be admitted into hospital at least 2 hours before your surgery is scheduled. This time is required to relax and prepare you for the surgery. In particular, intensive eye drops will need to be instilled in the eye prior to the surgery. These eye drops will dilate the pupil of the eye, and also include antibiotic and anti-inflammatory eye drops.

As the order in which patients are operated on may change at short notice on the day, you will not be given a specific time at which your operation will occur.

Dr Then would have already discussed the type of anaesthetic that you will be receiving during the operation. Most patients will have a local anaesthetic consisting of eye drops and an injection in the eyelid tissue, along with a light sedative (“twilight sedation”) to relax them. A small proportion of patients will require a general anaesthetic.

During the operation:

During the operation, you will be lying on a comfortable flat bed. Your face will be washed by Dr Then, and will then be draped with a light paper-cover. This drape sits above the face and does not cover the nose or mouth. There will be an oxygen tube under the drape which keeps fresh air on your face at all times. If you suffer with claustrophobia, let Dr Then know and she will arrange to make the draping as comfortable as possible for you.

During the operation, your eye will be kept open with a comfortable speculum, so that you do not have to worry about keeping your eye open yourself. All that you will see during the operation are lights and colours. All that you need to do during the operation is keep your face and body still.

After the operation:

The operation itself generally takes about 15 minutes. After the operation, Dr Then will place an eye pad and shield on your eye. You will then be sent back to the ward to recover and rest, and you will be offered something to eat and drink.

Overall, you should expect to be in the hospital for the half-day. For morning surgery patients, you should be home before midday. For afternoon surgery patients, you should be home by 5pm.

The eye pad and shield is to be kept on overnight. You will be asked to remove the eye pad and shield yourself when you wake up the following morning. You can then begin instilling your eye drops prior to seeing Dr Then for your review appointment that day.

The clear shield should be kept. If you sleep on your side, or feel that you may accidentally rub your eye whilst sleeping, then you should tape this shield over your eye at night for the first week after surgery.

Treatment after cataract surgery

You will be given a prescription for 3 different eye drops to be used after your cataract surgery. These eye drops prevent infection and reduce surgical inflammation in the eye. You will also be given a written timetable telling you when to start and stop each of these eye drops.

These eye drops are:

1. Chlorsig (Chloromycetin) – this is an antibiotic medication
2. Maxidex –this is an anti-inflammatory medication
3. Acular–this is an anti-inflammatory medication

Follow-up appointments after cataract surgery

You will be reviewed by Dr Then (or her ophthalmic assistant) the next day after surgery.

If you are having cataract surgery to both eyes, your first eye that has been operated on will also be reviewed by Dr Then 2-3 days before the second cataract surgery is due.

Your final review will be 4 weeks after cataract surgery. At this visit, Dr Then will ensure that your eye has completely healed, that your eye is comfortable and that you are satisfied with your vision. She will also measure your vision and advise if any specific prescription spectacles are required.

Will I need glasses/spectacles after my cataract surgery?

If you have received a single-vision Intraocular lens (IOL) implant, then you will require reading spectacles after your cataract surgery.

If you have received a multifocal Intraocular lens (IOL) implant, you will most likely be independent of spectacles for most distances. Dr Then will guide you through the 6 months following surgery.

If you require prescription spectacles after cataract surgery, you will be asked to make an appointment to see your local optometrist to measure and make these up for you. This should be done 4-6 weeks after your final cataract surgery.

What to expect after your cataract surgery

1. Recovery of vision

As the eye will be mildly inflamed and swollen after surgery, your vision will take a few days to recover and improve. This means that it will be blurry for at least the first few days after surgery. As everyone is different, some patients may notice rapid improvement in their vision in the first few days, whilst others may take a bit longer. Overall, the vision usually takes about 4 weeks to stabilise.

If you are having cataract surgery to both eyes, your vision may not be optimal or entirely comfortable in the 2-4 weeks between the surgeries. Dr Then will advise you on what to do with your current glasses or contact lenses between the surgeries. If you have single-vision glasses, your optometrist may “pop-out” the lens in the glasses in front of the first operated eye between surgeries. If you have bifocal/trifocal/multifocal glasses, it is usually best to keep both lenses in between surgeries. If you wear contact lenses, you may wear the contact lens in the eye awaiting surgery.

2. Eye discomfort after surgery

Most patients are quite comfortable after cataract surgery, and any discomfort is usually minimal and easily treated. However, here are 2 things that almost all patients will experience to some degree after cataract surgery:

Gritty eye:
Most patients will experience a gritty/itchy/foreign body sensation in the eye for the first few weeks after surgery. This is entirely normal and is due to multiple factors. Initially the small incisions made on the eye will cause this sensation until they heal, usually within 48 hours. After this, the tear film is slightly unstable and leads to a more rapid drying-out of the eye for the first few weeks. This is especially if you already have dry eyes prior to surgery. Dr Then will usually advise you to treat these symptoms with an artificial tear eye drop (eg. Optive, Refresh, Systane, Bion tears or other) for the first 4 weeks or longer if required.

Glare / light sensitivity:
This will vary between patients. It is generally due to your eye (and brain) adapting to the increased light entering the eye through your new intraocular lens implant. It can usually be relieved significantly with a good pair of dark sunglasses or tinted spectacles. Your eyes will generally adapt to the glare within the first few weeks, although some patients may take longer.

What you CAN do after cataract surgery

1. When can I drive?

As your vision will take at least a few days to settle after cataract surgery, it is not advisable to drive until your vision is clear and comfortable. This will usually take a few days at least. When you do recommence driving, limit it to daytime driving along familiar routes initially, until you feel more confident.

If you are having cataract surgery to both eyes, your vision and visual judgement in the period between surgeries will not be optimal. And any driving glasses you have will not be optimal either. Again, never drive if your vision is blurred or if you feel that your visual judgement is compromised.

2. When can I resume exercise?

• Light exercise can be resumed when your eye is comfortable, usually within a few days.
• Weight lifting may be resumed 1 week after surgery.
• Yoga/Pilates may be resumed 1 week after surgery.
• Contact sports or sports where injury is possible (tennis, golf, football, cricket) should not be resumed for at least 2 weeks after surgery.
• Swimming may be resumed 4 weeks after surgery.

3. When can I return to work?

This will depend on the type of work that you do and how quickly your vision recovers after surgery. Dr Then will generally advise 3 days off work after cataract surgery. If your job is likely to expose you to significant dirt or dust, then you may want to take longer off work. If your job requires you to drive or operate heavy machinery, then you may also require longer off work. Dr Then will discuss this with you as required.

What you CAN’T do after cataract surgery

1. Bending over

It is very unlikely that your eye will come to any harm if you bend over in the immediate period after surgery. However, you will be advised to keep you “head above your heart” for the first 3 days after surgery, to reduce any sudden pressure rises within your eye.

2. NO swimming in the first 4 weeks after surgery (pools or beach)

3. Any activity that will put your eye at risk of infection or injury

Common sense prevails!