Cataracts

Things that may increase your risk of cataracts include:

• Increasing age
• Smoking
• Diabetes
• Hypertension
• Obesity
• Previous Eye Injury
• High myopia (Near-sightedness)
• Alcohol
• Sunlight exposure

Managing my condition

Mild cataracts can be managed with stronger glasses and brighter reading lights.

You can choose to put off having surgery for a while and have regular check-ups to monitor the situation.

There are no medicines or eye drops that have been proven to improve cataracts or stop them getting worse.

If you have cataracts, they may affect your ability to drive. You must tell the Driver and Vehicle Licensing Agency (DVLA) if you have cataracts in both eyes. You will not need to tell the DVLA if you only have cataracts in one eye unless you have a medical condition in the other eye or have a valid Group 2 licence. If you drive a bus, coach or lorry (Group 2 licence) you must inform the DVLA if you have cataracts in one or both eyes.

Please click here for more information from the DVLA.

Making a decision about surgery

Surgery is usually offered on the NHS if your cataracts are affecting your eyesight and quality of life.

The decision to have surgery should not be based solely on your eye test (visual acuity) results.

You may have other personal reasons for deciding to have surgery, such as your daily activities, hobbies and interests.

If both eyes have cataracts that meet the criteria for surgery, your Provider will usually operate on your worst cataract first and when you have recovered from that surgery will operate on your second eye. Some providers offer to operate on both eyes at the same time, this is called bilateral surgery.

NHS England have produced a Shared Decision Tool that you can work through with your Ophthalmologist (if you have an existing long term eye condition) or your optometrist (optician). This tool is a key part of the referral process in Devon.

Risks of Surgery

Surgery is not risk free and results are not guaranteed:

The risk of serious complications developing as a result of cataract surgery is estimated at around 1 in 50 cases.

These can include:

• blurred vision
• some loss of vision
• detached retina – where the the thin layer at the back of your eye (retina) becomes loose

Most of these serious complications can be treated with medicines or further surgery.

There is a very small risk – around 1 in 1,000 – of permanent sight loss in the treated eye as a direct result of the operation.

Benefits of surgery

After cataract surgery you should be able to:

• see things in focus
• look into bright lights and not see as much glare
• tell the difference between colours

If you have another condition affecting your eyes, such as diabetes or glaucoma, you may still have limited vision, even after successful surgery.

Patient Information Leaflet

Local hospitals have produced a leaflet for patients to explain what to expect when having cataract surgery.

Video about My Cataracts

How cataract surgery is carried out
Bupa Health UK| Published: 8 August 2013

You should be able to go home on the same day as your cataract surgery.

Feeling should start to return to your eye within a few hours of surgery, but it may take a few days for your vision to fully return.

It’s normal to have:

• grittiness
• watering
• blurred vision
• double vision
• a red or bloodshot eye

These side effects usually improve within a few days, but it can take 4 to 6 weeks to recover fully.

If you need new glasses, you will not be able to order them until your eye has completely healed, usually after 6 weeks.

When to seek help

Contact your eye surgery department as soon as possible if you experience:

• increased pain and/or redness
• decreased vision

All providers have 24/7 helplines, contact details are on the leaflet given to you on the day of your surgery.

There are two types of cataract services in Devon –

‘High flow’ services which are suitable for the majority of patients who require a straightforward cataract operation.

Your outpatient appointment will usually be with an optometrist.

And

‘Complex’ services which are geared towards patients with potentially more complex needs, such as those with other ocular or health conditions, or patients who may have cataracts which are not age-related. Specific requirements will be discussed and agreed during the outpatient appointment with an Ophthalmologist.

How will I know if I need to be seen in a ‘complex’ service?

• Patients must be 18 years old and over
• Patients who require communication support
  This would include patients with severe dementia or severe learning difficulties.
• Patients who would struggle to lie flat and be still for half an hour
  Patient must be able to lie still during the procedure, those who aren’t able to are likely to require a general anaesthetic
• Patients with mobility issues, such as needing more than 1 stick to get about
  There is often lots of walking to get to pre-op room and theatres. High flow services tend to have less physical space and can’t support wheelchair users or hoists to get on/off couches
• No BMI limits – can support patients with BMI>40
  High flow services often don’t have hoists available and possible weight limitations on couches, so BMI must be ≤40
• Patients with complex health needs who may require additional support such as:
  • Require continuous oxygen
  • Have had a cardiac arrest, heart attack or stroke in the last 6 months
  • Have an implantable defibrillator
  • Have other long term eye conditions (such as glaucoma) and the patient’s ophthalmology consultant has suggested cataract surgery should be done in the eye hospital where all eye conditions can be monitored, not just the cataract surgery in isolation

• Quality outcomes information is published annually and is available on the National Ophthalmology Database (NOD) for many providers and consultants.

• Press release – Unique partnership pilot cutting Devon’s waiting lists

• NHS England publish average waiting times for all specialties (including Ophthalmology) on the MyPlannedCare (MPC) web site (https://www.myplannedcare.nhs.uk/).

  The waiting times shown are the (mean) average of all patients waiting within the specialty at the trust. Some patients will wait less time than the average and some patients will wait longer than the average waiting time. Patients are managed based on clinical urgency and therefore waiting times can vary depending on each patient’s clinical condition. The waiting times include all services within that specialty.

  Below are the current indicative waiting times specifically for cataract surgery in Devon. These are updated fortnightly with data supplied by each provider.

Providers in Devon who offer High Flow cataract surgery

You are free to choose to be seen at a provider outside of Devon where they are contracted to provide suitable NHS services, Devon Referral Support Service (DRSS) will be able to discuss these options with you as part of the choice conversation.

* For more information about what it means to be GIRFT accredited please visit the Getting It Right First Time (GIRFT) web site.

Providers who offer Complex cataract surgery

You are free to choose to be seen at a provider outside of Devon where they are contracted to provide suitable NHS services, Devon Referral Support Service (DRSS) will be able to discuss these options with you as part of the choice conversation.

Further information on providers can be found on their web sites:

• Centre of Excellence for Eyes, Nightingale Hospital
• Royal Devon University Hospital (Exeter | Barnstaple)
• Royal Eye Infirmary (Plymouth Hospitals NHS Trust)
• Torbay & South Devon Hospital
• ACES Exeter
• Mount Stuart Hospital (Ramsay Healthcare)
• Newmedica (Exeter | Plymouth)
• Optimax (Newton Abbot)
• Practice Plus Group (Plymouth)
• Spa Medica (Exeter)