What are the disadvantages of cataract surgery? Risks and wins

What to expect with cataract surgery?

Cataracts are a common eye condition which often requires surgery. As you get older, the lens inside your eye gradually becomes less transparent, affecting your ability to see.

Cataract surgery involves replacing the cloudy natural lens inside the eye with an artificial one. The old cloudy lens is removed with an ultrasonic probe and replaced with an artificial lens (Intraocular Lens Implant IOL), which restores vision. Cataract surgery is considered a safe procedure with a high success rate.

Cataract surgery usually only takes around 30 minutes and you can go home on the same day.

Hear from our expert:
“Cataract surgery is a straightforward procedure with a very high success rate. It usually only takes around 30 minutes.“

Teresa Anthony
Consultant ophthalmology surgeon

Is cataract surgery safe?

In the vast majority of cases, the operation is successful and vision improves immediately. In fact, it’s a 98% complication-free operation.

Advancements in surgical techniques, technology, and anaesthesia have significantly improved the safety of cataract surgery.

In a small number of cases, complications occur but these are all uncommon and can usually be treated. However, on rare occasions they are serious enough to cause permanent visual problems.

Ongoing problems after cataract surgery may be related to pre-existing eye problems like glaucoma and macular degeneration.

Patient testimonial

“I had my 2nd cataract operation at Practice Plus Group Ilford and I must report how pleased I have been with every aspect – efficient, friendly, and skilled. Information, both verbal and printed, was spot on. I am a very satisfied patient!

Barry Cohen, cataract surgery patient at Practice Plus Group Hospital, Ilford

Cataract surgery risk factors

Certain risk factors can increase the likelihood of complications. Older patients may have increased risks due to age-related changes in ocular tissues and overall health. Those with pre-existing conditions such as glaucoma, macular degeneration or diabetes may have a higher risk of certain complications.

Other risk factors include; poor overall health, the use of certain medications and previous eye surgery.

The pros and cons of cataract surgery

Pros:

• it’s a quick procedure that takes around 15 minutes
• there’s minimal discomfort
• it has a high success rate in restoring vision
• there is < 1% risk of complications
• it has a short recovery time
• most people experience better vision straight away
• it enhances quality of life by restoring independence
• it has long term benefits
• it improves night vision.

Cons:

• you need to follow post-operative care instructions carefully
• there is a small risk of complication (around 1%)
• there is a cost involved if cataract surgery performed privately.

Post-cataract eye surgery complications

The risk from cataract surgery is very low (< 1%) and complications are very rare.

As with any eye surgery, there is a small risk of infection, blurred vision and detached retina. There is a very small risk, around one in 1,000, of permanent sight loss in the treated eye.

Cataract operation complications

Potential complications during the operation itself include:

• Damaged iris – The iris could be damaged by the ultrasound probe (risk 1 in 50 patients)
• Corneal abrasion – or accidental scratching of the eye during the operation. The eye can feel gritty, post-surgery but generally heals rapidly (risk 1:100)
• Posterior capsule rupture – Tearing of the lens capsule, leading to vitreous loss (the vitreous is a jelly-like substance located between the lens and the retina). This may cause vision problems or loss of a lens fragment into the back of the eye. This may require further surgery (risk 1:100)
• The lens could move from its intended position (risk 1:400)
• Severe bleeding inside the eye during surgery (risk 1:1,000).

Post-cataract surgery complications

The following potential complications could occur after surgery:

• Blurred vision – due to swelling of the retina. This can be treated with drops (risk 1 in 20 patients)
• Pain – this is usually mild and can often be treated with a pain killer such as paracetamol. If you experience severe pain, this may indicate an infection or inflammation. We advise you to urgently contact your eye-care team (risk 1:50)
• Allergic reaction – to the prescribed eye drops (risk 1:100)
• Drooping of your eyelid(s) (risk 1:100)
• High pressure in the eye (risk 1:100)
• Clouding of the cornea (risk 1:100)
• Retinal detachment – this can occur over the subsequent five years. If the retina detaches you may notice a series of flashes followed by a shadow that creeps across the vision. Action is needed to save your vision and you should seek urgent advice (risk 1:250)
• Infection of the eye – Despite the care we take in theatre and the antibiotics given to you following surgery, infection is still a risk. If your eye becomes painful and blurred, you should contact the hospital straight away (risk 1:1,000).
• Posterior capsule opacification (PCO) – PCO is one of the most common complications of cataract surgery. It is reported to occur in 20%–40% of patients between two and five years after surgery. This is a common long-term complication where the lens capsule becomes cloudy. This can be treated with a quick and painless laser procedure (YAG laser capsulotomy).

Cataract surgery side effects

Common side effects include:

• Blurry vision – Blurriness is common in the immediate aftermath of surgery and usually improves within a few days
• Eyes feeling dry and gritty – Patients often experience dry eyes or a gritty feeling. This can be relieved with lubricating eye drops bought at any pharmacy
• Light sensitivity – Increased sensitivity to light typically improves over time
• Itching and discomfort – Mild itching, discomfort, or a sensation of a foreign object in the eye is normal as the eye heals
• Redness – The eye may appear red or bloodshot temporarily due to minor blood vessel breakage during surgery

Less common cataract removal surgery complications include:

• Swelling – Swelling of the cornea or retina can occur, usually resolving with anti-inflammatory medications
• Infection (Endophthalmitis) – Though rare (about 0.1%), infection can occur and requires prompt treatment with antibiotics. This can occur inside the eye and is a serious infection. The treatment involves further operations to administer antibiotics into the eye. Around half of endophthalmitis patients unfortunately do not recover their sight
• Dislocated Intraocular Lens (IOL) – The artificial lens implanted during surgery can become misaligned, sometimes necessitating repositioning surgery
• Damage to the back part of the lens capsule – this can lead to a disturbance of the gel (Vitreous) that is inside. In turn, this can cause reduced vision. All or part of the cataract may be lost into the back of the eye, which may require further surgery

Very rare post cataract operation problems include:

• Cystoid Macular Edema – Swelling in the central part of the retina can affect vision and is usually treatable. It can occur in 1- 5% of patients within the first few weeks of the operation and is treated with anti- inflammatory eye drops or steroid injection.1
• Glaucoma – Rarely, cataract surgery can contribute to the development of glaucoma, especially in patients with pre-existing conditions
• Loss of vision – Very rarely, severe complications can lead to significant vision loss or blindness.
• Corneal Edema – Persistent corneal swelling can cause blurred vision and may require additional treatments or surgery

Visual problems after cataract surgery

Some people experience some visual disturbances after surgery such as double vision or light sensitivity. In most cases, these improve over time.

Blurriness is common immediately after surgery and typically improves within days to weeks after surgery. Certain types of IOLs can cause halos or glare, especially in low light conditions.

Cataract surgery complications in the elderly

The most common reason for the risk of cataracts is growing older when natural changes within the lens occur. Most people over the age of 65 have some changes in their lens and the majority will develop a cataract in time.

Older patients may experience delayed healing and increased risk of infection. This is dependent on many factors including overall health and pre-existing conditions.

What are the most common problems after cataract surgery?

Most problems after cataract surgery are manageable and temporary. The most common include discomfort, dry eyes and blurred vision.

Regular follow-up care, proper medication use, and attention to any changes in vision or discomfort can help ensure a successful recovery after cataract surgery.

What percentage of cataract surgeries have complications?

Cataract surgery is a common procedure carried with a complication rate of roughly 2%².

When to seek medical attention

Seek immediate medical attention if you experience:

• sudden loss of vision
• severe pain in the eye
• persistent redness or swelling
• flashes of light or a significant increase in floaters

Always speak to your doctor or healthcare professional for personalised healthcare advice.

What are the benefits of cataract surgery?

Some of the advantages of cataract surgery include:

• Clarity of vision – A cataract forms when the protein in your eye accumulates on the lens. These deposits cloud the lens and cause foggy and blurry vision. Cataract surgery fixes this, replacing the old lens with a new artificial one. The new lens provides clearer, crisper vision.
• Colour – Cataracts can cause the lens in your eye to become yellow or brownish. This can cause everything to look faded. Cataract surgery can help fix this, with many patients reporting seeing much brighter colours than before.
• Fewer injuries – Eye problems contribute to falls which are a common cause of injury and death among older adults. Recovery can potentially last a long time which can lead to social isolation and depression. After cataract surgery, patients are less likely to need varifocal glasses. In turn, this means they’re much less likely to suffer falls.

If you have the signs you may need cataract surgery, please don’t hesitate to get in touch.

The benefits of early cataract surgery

If the surgery is delayed the cataracts harden and the surgery can become more difficult.

Leaving cataracts to develop can lead to increased risks and complications during and after surgery which can impact negatively on your quality of life. The longer you put off cataract surgery, the worse your vision will become.

One of the benefits of private cataract surgery is the reduced waiting list. At Practice Plus Group, you can get treated within 4-6 weeks.

Is cataract surgery worth it?

NICE guidance states that any symptom generated by a cataract is sufficient for cataract surgery. Your surgeon will listen to your symptoms and discuss the risks and benefits of cataract surgery with you. One of the benefits of private cataract surgery is the reduced waiting list.

If left untreated cataracts can interfere with everyday life including driving, work and hobbies. Cataract surgery is a safe procedure with a low complication rate that can improve vision and quality of life.

How can I reduce the chance of risks and complications?

To further reduce the risk following cataract surgery you should:

• Select a cataract surgeon with experience in cataract surgery, especially if you have additional risk factors
• Take it easy at home for a few days following surgery
• Avoid strenuous effort for about one month, including lifting heavy things
• Use prescribed eye drops (antibiotics and anti-inflammatories) exactly as directed to prevent infection and control inflammation
• Avoid rubbing the eye. A scratchy or gritty eye is normal after cataract surgery
• Wear dark glasses for a few days as your eye(s) will be more sensitive to light
• Avoid getting the eye wet
• Take paracetamol or your usual painkillers if experiencing any discomfort such as a headache or mild pain
• Wear sunglasses outdoors to reduce glare and protect your eyes from UV rays
• Attend all scheduled follow-up appointments to monitor healing and detect any issues early
• Promptly report any unusual symptoms such as severe pain, vision changes, increased redness, or discharge.

When selecting a healthcare provider, check their quality rating from the Care Quality Commission (CQC). Our ‘Good’ or ‘Outstanding’ CQC ratings demonstrate that we provide safe and effective treatment. For advice pre or post surgery, discuss with your eye doctor.

Ready to improve your vision and get back to doing the things you love with ease? Speak to our team today to learn more about our experienced consultants, excellent facilities and fast access to treatment.

Sources and references

¹ https://www.hey.nhs.uk/patient-leaflet/risks-benefits-cataract-surgery/

² clevelandclinic.org

Acknowledgements