Cataract Surgery

There is considerable variation on how people describe their cataract but more importantly there is significant variability in how severe cataracts are before they impact on any individual. This can depend on your personality, occupation, age and visual expectations. Most people report 1 or more of the following:

•  Blurred vision
•  Fading of colour vision
•  Loss of low light vision
•  Difficulty reading
• Glare particularly with oncoming headlights when driving at night
• Blurring of distance vision but no longer needing to wear reading glasses- ‘Second Sight’
• The need to change glasses every 6 months to maintain clear vision
• Double vision coming from 1 eye.

Pain is not a feature of cataracts.

Generally, your optometrist will identify cataracts during a routine visit or when you present for glasses. Occasionally, your GP may diagnose a cataract, however, you should have an optometrist review this with a microscope prior to referral to an ophthalmologist.

Once referred to an ophthalmologist a complete eye examination including investigations such as:

• Retinal photography
• Retinal laser scan (OCT)
• Intraocular pressure measurement
• Corneal topography
• Laser ocular Biometry

The eye will be examined in detail with a microscope including a careful examination of the lens to assess for cataract. Your pupils will need to be dilated and the whole process normally takes about
two hours.

At Melbourne Comprehensive Eye Surgeons, we can offer cataract surgery  starting from $1600* per eye.

At Melbourne Comprehensive Eye Surgeons, we have a set fee for cataract surgery. All health funds pay a different amount to the surgeon. If your fund pays less than our fee then you will have to pay the difference as a gap. For some funds there is no gap, for most funds there the gap may range from $200-$500 per eye. Unfortunately, some of the budget health funds pay low fees and most of the surgeon fee ends up being paid by the patient. There may be an excess payable depending on your health fund.

Yes. Cataract surgery is available to everyone. If you do not have a Medicare card you will not receive subsidies from Medicare to assist with the cost of surgery and you will have to pay an increased day surgery fee. Please give the clinic a call for an accurate quote if you would like to consider cataract surgery.

We perform cataract surgery at:

1. PANCH Day Surgery
   Corporate One Business Centre
   Level 4
   84 Hotham Street
   Preston VIC 3072

The most common type of cataract is called senile nuclear sclerotic cataract and is associated with a generalised yellowing and hardening of the lens. In the late stage the lens will become brown and can turn white completely blocking vision. This type of cataract is generally slow growing and symptoms will evolve over many years to a decade.

The next most common type of cataract is a cortical cataract. This type involves the softer material outside the central ‘nuclear’ core of the lens. It can occur in younger patients and if the soft material at the back of the lens is involved can cause vision loss quite rapidly over a number of months. Cortical cataract is also more likely to be associated with medication use or other medical conditions such as diabetes.

The only choice is between having cataract surgery and delaying cataract surgery. There are no drops, medications, supplements or other treatments that have been shown to reverse or slow the progression of cataract. With modern cataract surgery cataract extraction is now very safe and most people with advanced cataract will elect to have cataract surgery. However, for some patients who present with early cataract vision changes may be able to be managed with glasses for a number of years while the cataract slowly progresses.

Cataract surgery is generally required for 4 reasons:

1. Most commonly cataract surgery is undertaken when you are not able to do the things you want to do because your vision has reduced due to cataract.
2. Some patients who have strong glasses and have cataract in one eye will need to have cataract surgery on the fellow eye, even if no cataract is present, to balance the eyes.
3. Many patients with glaucoma, particularly the angle closure form, are having early cataract surgery, often with a stent inserted, to help control their glaucoma and reduce the need for drops or more invasive cataract surgery.
4. For some patients who need very strong glasses, refractive lens exchange is a good option to decrease their need for glasses, particularly if they cannot tolerate contact lenses. This type of cataract surgery is entirely self-funded with no access to Medicare or private health fund re-bates.

In the past before the advent of modern minimally invasive sutureless cataract surgery, the risk of cataract surgery was significant enough that the patient was told to wait until their cataract was mature, and their vision reduced to a point where the benefits of cataract surgery would outweigh the risks. This old-fashioned concept is generally no longer advised because modern micro-surgery is minimally invasive and associated with much quicker recovery of vision and far fewer complications. It is one of the most common cataract operations in Australia. Better outcomes and lower risk meant that the cataract operation can safely be performed on earlier cataract with more mild symptoms without unnecessary risk.

It is possible to perform cataract surgery on both eyes at once but not recommended. At Melbourne Comprehensive Eye Surgeons, we generally prefer to operate on the second eye 2- 4 weeks after the first is done. Waiting this short period of time ensures that the risks of serious complication in the first eye has passed. In certain patients, particularly those with strong glasses, it can be useful to see how the first eye has gone to try and refine the accuracy of the refractive outcome in the second eye.

There is a common misconception that lasers are used in cataract surgery. This may have evolved because lasers are used in so many different aspects of eye care. However, cataract surgery is best performed with ultrasound and micro-surgery.

Laser assisted cataract surgery has been trialled in the last 5- 10 years. However, a recent extensive review of the scientific research around this technique have demonstrated that it is no better than modern micro-surgery with ultrasound. Given that it is substantially more expensive and takes longer to perform few surgeons are routinely using this technique.

Lasers may be needed after cataract surgery to treat a condition called posterior capsule opacification that occurs when scar tissue grows over the thin membrane that holds the artificial lens in place. This is sometimes called secondary cataract.

Modern small incision cataract surgery is essentially painless. Most surgeons now perform the cataract operation with anaesthetic drops and twilight anaesthetic. In some cases, a needle or injection behind the eye may be considered the best option to anaesthetise your eye. This decision will be made in conjunction with your surgeon and anaesthetist and will take into account your personal preference.

It is generally not necessary or advisable to have a general anaesthetic for cataract surgery. Most patients have their cataract operation with drops and twilight anaesthesia. Many people have little or no recollection of the experience and there is no pain associated with modern cataract surgery. A general anaesthetic may be required in rare circumstances.

An experienced cataract surgeon using modern microsurgical techniques would generally take less than 10 minutes to perform cataract surgery. Cataract surgery is not a race and the most important thing is to perform high quality and safe cataract surgery.

You should generally expect to spend about 3 hours at the day surgery or hospital for your cataract operation. This allows time for you to be: checked in, have your eye prepared for cataract surgery, have your anaesthetic, have cataract surgery, and for you to recover from the anaesthetic.

Many patients who need cataract surgery are take some specific medical tablets or aspirin to thin the blood. In most cases you should continue to take all your medications on the day of cataract surgery. Because most cataract surgery is undertaken with topical anaesthesia there is no bleeding and stopping blood thinners is not necessary.

Most patients can see reasonably well within a few hours of cataract surgery. With routine cataract surgery, your vision should be quite good the following day and should be very sharp within a week or two of cataract surgery. If you have an anaesthetic injection behind the eye you will have no vision that day and you may experience slightly more blurring on the first morning. In certain circumstances, particularly in patients with dense cataracts or very shallow eyes, such as in angle closure glaucoma, you may expect to have blurry vision for a week or two following cataract surgery.

In most cases, for routine uncomplicated cataract surgery, it is not necessary for you to come to the clinic the day after your cataract operation. At Melbourne Comprehensive Eye Surgeons, we generally will call you the morning after your cataract surgery to make sure that you are recovering as expected. If your cataract operation is complex or there are any concerns about how you may recover from cataract surgery we will ask you to attend the clinic within a day or two of cataract surgery for a review appointment.

It is important to avoid strenuous physical activity for up to 1 month following cataract surgery. In the first week, you need to be quite careful and should avoid swimming or getting anything in the eye. After the first week, you can return to essentially normal activities but avoid very strenuous tasks or contact sports.

Do not rub your eye. You may bend over and you are allowed to shower and wash your hair but avoid getting soap in your eye.

Your ability to drive will depend on the vision in your other eye, how quickly your vision returns and if there is a large difference in the need for glasses between your eyes after cataract surgery. You are the best judge of when you can drive, but should not drive if you don’t feel your vision allows you to be safe behind the wheel.

The decision about when to drive after cataract surgery is different for each individual. Your ability to drive will depend on the vision in your other eye, how quickly your vision returns and if there is a large difference in the need for glasses between your eyes after cataract surgery. You are the best judge of when you can drive, but should not drive if you don’t feel your vision allows you to be safe behind the wheel.

It is important not to wear any make-up on the day of cataract surgery. After your cataract operation avoid any make-up around the eye for at least 1 week. You can apply make-up to other areas the day after surgery.

The aim of modern cataract surgery is to leave you with good distance vision without glasses. Most patients achieve this; however, some patients will choose to wear glasses to sharpen their vision for certain activities such as watching a movie or driving at night. Most patients will require glasses for reading, using a computer or other tasks undertaken at near distances. If you would prefer to be glasses free for near tasks and use your glasses for distance discuss this with our surgeons before your operation. You should see your optometrist for consideration of glasses four to 6 weeks after your cataract surgery.

Multifocal implants have been around for over a decade and various technological advances have made it possible for some patients to become glasses free. Multifocal implants do not suit every patient and the decision to use a multifocal implant with your cataract surgery can be made after consultation with our surgeons.

Cataract cannot return once it has been removed. However, one of the most common complications of cataract surgery is posterior capsule opacification (secondary cataract). Scar tissue can grow over the clear membrane that holds the lens in place making it become cloudy. Posterior capsule opacification can cause symptoms that seem as if your cataract has returned, it is easily treated with a laser procedure performed in the clinic.

Your implant will last a lifetime. There are very rare instances of implants developing problems where they have to be replaced, however, this is exceptionally rare with modern artificial lenses.