What are the risks of cataract surgery and how can patients reduce risks of cataract surgery?

What Are the Risks of Cataract Surgery?

Cataract surgery is one of the most commonly performed operations in the NHS and private sector and is generally very safe. More than 95% of patients experience improved vision after surgery. However, as with any procedure, there are risks.

Common and Usually Treatable Risks

• Dry eye. The most common complication of cataract surgery, tends to be most noticeable in the first 3 months after surgery. This manifests itself as watering, grittiness or intermittent blurring of vision especially when reading, driving or watching TV for any length of time. Treated with preservative free lubricant eye drops at least 4 times a day.

• Posterior capsule opacification (clouding behind the lens implant) — affects up to 1 in 5 people over time (normally 2-3 years after surgery) and is easily treated with a quick laser procedure.

• Temporary inflammation, discomfort, or raised eye pressure, usually settling with eye drops.

• Cystoid macular oedema (CMO) — swelling at the centre of the retina that can blur vision.

  • This is more common in people with diabetes, even when diabetic eye disease is mild.

  • Most cases respond well to anti-inflammatory drop treatment.

• Refractive surprise - up to 10% of patients can end up either more short or long sighted than anticipated by their eye measurements. This means they will still require glasses for the best vision at near and/or distance after surgery. Most patients cope well with this, but rarely intraocular lens exchange or top up laser can be required though both of these come with some additional risks. Glasses will generally restore good vision and no additional risk.

  
  

Less Common Risks

• Infection or bleeding inside the eye (around 1 in 1,000 cases).

• Surgical complications, such as a tear of the capsule supporting the lens, which may slow recovery or require a second operation to improve vision (<1:100 cases with Mr Benson).

  
  

Rare but Serious Risks

• Retinal detachment, where the retina separates from the back of the eye.

  • This is rare overall, but risk is higher in younger patients, those who are very short-sighted, or people with previous eye injury or surgery.

  • Warning symptoms include flashing lights, a sudden increase in floaters, or a curtain-like shadow in vision.

• Permanent loss of vision — very rare, most commonly due to infection (called endophthalmitis) can happen in approximately 1:3000 people.

  
  

What Can Patients Do to Reduce the Risks?

While not all risks can be eliminated, patients can play an important role in making surgery as safe as possible:

Before Surgery

• Control diabetes, blood pressure, retinal disease and dry eye carefully — good blood sugar control reduces the risk of CMO and infection.

• Tell your surgeon about all medical conditions and medications, especially blood thinners or previous eye problems especially laser treatments.

• Attend all pre-operative appointments, so measurements and risk factors are identified accurately.

• Patients with blepharitis or dry eye should ensure that they are managing this as well as possible prior to eye surface measurements to reduce risk of post op dryness and risk of refractive surprise.

After Surgery

• Use your eye drops exactly as prescribed — this is one of the most important steps in preventing inflammation, infection, and CMO.

• Avoid rubbing your eye, heavy lifting, and swimming until advised it is safe.

• Keep follow-up appointments, even if your vision feels good.

Know When to Seek Help

Contact your eye unit urgently if you notice:

• Worsening pain, light sensitivity or redness

• Sudden drop in vision

• Flashes of light, new floaters, distorted vision or a dark shadow in your peripheral vision

Prompt treatment greatly reduces the risk of long-term problems.

Author - Aidan Benson FRCOphth is an expert cataract surgeon having performed thousands of cataract surgeries for NHS and Private patients in the UK who prides himself on being up to date with the most innovative yet safe techniques and approaches to get patients their best possible vision.