Does cataract surgery hurt?

Interview transcription:

In an interview, Alex Shortt discusses whether cataract surgery hurts and explains the whole procedure from the patients perspective.

Interviewer: So, does cataract surgery hurt?

Alex Shortt: There are all sorts of myths out there. And it’s amazing; some people believe we actually take out the eye, do the work and put it back. Let’s be clear on this. We do not do that.

Interviewer: Okay, good. That’s good news.

Before surgery

Alex Shortt: From the patient’s perspective, cataract surgery involves coming into the hospital, and the first thing we do is give you some mild sedation. We give you a tablet, usually, which relaxes you, and it just helps you relieve the anxiety and the stress.

The next thing, you come to the operating theatre, we lie you flat on the bed, and we put some eyedrops in. Those eyedrops are, firstly, anaesthetic; very, very powerful anaesthetic drops which numb the entire surface of the eye and also the edges of the eyelids. We do several rounds of that, and then we bring you into the operating theatre.

We clean the eye, place a sheet over the face but lift it up, so it’s almost like being in an oxygen tent. The only thing exposed is the one eye we’re going to do the surgery on.

The next step is more anaesthetic drops, so by this stage, you are well and truly marinated in anaesthetic, and also some antiseptic drops.

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During surgery

Alex Shortt: They are critically important in preventing infection because obviously everything we do we want to minimise the risk of infection. Antiseptic drops to sterilise the eye, and then we make our tiny, 2 mm keyhole incisions, which you absolutely will not feel.

Interviewer: But you’re awake the whole time?

Alex Shortt: Yes, you’re awake through all of this. It’s as if you’re looking at a bright light in the ceiling – like one of these spotlights. You’re aware of movement in the periphery of the vision. But at no stage should you see anything coming directly at you, that shouldn’t happen. You’d be aware of things moving in the edge, but you can’t see what I’m doing because I’m out here.

Interviewer: But what if I’m moving my eye, and what if I’m moving it involuntarily?

Alex Shortt: Small eye movements are not a problem at all. In the microscope, there are three little lights, and we give you your choice, you can look at whichever of the lights you want. That keeps the eye in the correct position.

Interviewer: And everybody just manages to do it?

Alex Shortt: Absolutely. Occasionally we have patients who are hard of hearing, English may not be their first language, or they may have dementia. In those situations, it’s my responsibility to have picked that up beforehand. I can then put measures in place so that those people are very clear that they do need to look in the general direction of the light. You don’t have to look exactly spot on, but in the general direction of the light is fine.

And then that’s it. A lot of the operation is as if you are underwater in a swimming pool looking at the sun. You’re aware of someone at the edge of the swimming pool, but you’re not really sure what they’re doing.

Interviewer: So at no time during the operation, are you feeling any pain?

Alex Shortt: You should not feel anything throughout the operation.

After surgery

Interviewer: And what about after, when it’s done? Is it something that aches?

Alex Shortt: Most patients turn around and voluntarily say, “I would much rather have my cataract done than go to the dentist.” I have heard this hundred of times from patients. Now, no disrespect to dentists, but the experience and the level of discomfort for the patient make it far, far nicer to have a cataract operation than to have your teeth cleaned.

Afterwards, it’s very common for people, about an hour after the operation, to notice that their vision is starting to sharpen, but it’s a foggy and misty vision. There’s enough to see you’re here and to move around, but there should be no pain, no discomfort. Occasionally, people say they’re aware of a gritty sensation – as if they’ve got a hair or an eyelash in the eye. Buty it’s temporary and usually goes away within 24 or 48 hours.

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About the author

Mr Alex J. Shortt | Consultant Ophthalmic Surgeon

MB BCh MSc PhD FRCOphth PGDipCatRef

I’m Alex Shortt, a highly trained academic researcher and Consultant Ophthalmic Surgeon based in London’s famous Harley Street medical district. I trained and worked as a consultant for 14 years at London’s Moorfields Eye Hospital. I specialise in advanced technologies for correcting vision, including cataract surgery, implantable contact lenses and laser vision correction.

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