Download Information for Patients Undergoing Cataract Surgery

Information for Patients
Undergoing Cataract
Surgery
Ophthalmic Directorate
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01253 955588
Our Four Values:
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index
Information for patients
3
The cataract
3
The operation
3
After the operation
4
Likelihood of better vision
5
Benefits and risks of cataract surgery
5
Some possible complications during the operation
5
Some possible complications after the operation
6
2.
Checklist: One week before cataract surgery
7
3.
Checklist: The day before surgery
7
4.
Instructions for the day of surgery
7
5.
Post-operative care
8
6.
Consent Form for Cataract Surgery (for reading purposes only)
7.
Directions to the Ophthalmic Surgical Unit
1.
Page 2
9-10
11
This leaflet gives you information that will help you decide whether to have cataract
surgery. You might want to discuss it with a relative or carer. Before you have the
operation, you will be asked to sign a consent form and so it is important that you
understand the leaflet before you decide to have surgery. A copy of the consent
form you will be asked to sign can be found on page 9 and 10. Please read this
before you arrive at the hospital.
If you have any questions, you may wish to write them down in the box on page 6,
so that you can ask one of the hospital staff.
The cataract
Your eye surgeon has recommended
cataract surgery because the lens in
your eye has become cloudy making
it difficult for you to see well enough
to carry out your usual daily activities.
If the cataract is not removed, your
vision may stay the same, but it will
probably gradually get worse. Waiting
for a longer period of time is unlikely
to make the operation more difficult,
unless your eyesight becomes so poor
that all you can see is light and dark.
The operation
The purpose of the operation is to replace the cloudy lens (cataract) with a plastic lens
(implant) inside your eye.
• An experienced eye surgeon will carry out the operation or may supervise a doctor
in training who also performs some operations.
• Please do not wear any face or eye makeup on the day of surgery
• You will be able to go into theatre wearing your own clothes
• Dentures (if you wear them) need not be removed
• You will come to the Ophthalmic Surgical Unit (OSU) to be prepared for your operation
• In the hour before the operation you will have a series of eye drops instilled to
enlarge the pupil. This is in fact a hole in the coloured part of the eye, the iris.
• After this you will be escorted to the anaesthetic room in the theatre where you will
be given an anaesthetic to numb the eye. This may consist simply of eye drops or
injecting local anaesthetic solution into the tissue surrounding the eye. After the
anaesthetic you will not feel any discomfort or pain.
Page 3
With a local anaesthetic you will be awake during the operation. You will not be able to
see what is happening, but you will be aware of a bright light.
You will be escorted to theatre where your operation will take place. A peg will be
clipped onto one of your fingers to monitor your pulse. The area around your eye is
cleaned and then a light sterile drape will cover your face and chest. A tube underneath
the drape gently blows out some fresh air therefore you will be able to breathe normally.
During the operation you will be asked to keep your head still, and lie as flat as possible.
A member of the nursing staff is usually available to hold your hand during the
operation, should you want them to.
The lids of the eye,
to be operated
on, will be held
open with a small
instrument.
You will be asked
to refrain from
talking during the
operation but you
can be assured
that a nurse will
be present to
ensure that you are
comfortable.
The operation
normally takes
15-20 minutes, but
may take up to
45 minutes. Most cataracts are removed by a technique called phacoemulsification, in
which the surgeon makes a very small cut in the eye, softens the lens with sound waves
and removes the cataract through a small tube. The back layer of the lens is left behind.
An artificial lens (implant) is then inserted to replace the cataract. Sometimes a small
stitch is put in the eye. At the end of the operation, a pad or shield may be put over your
eye to protect it.
After the operation
If you have discomfort, we suggest that you take a pain reliever such as paracetamol
every 4-6 hours (but not aspirin - this can cause bleeding). It is normal to feel itching,
sticky eyelids and mild discomfort for a while after cataract surgery. Some fluid
discharge is common. After a few days even mild discomfort should disappear. In most
cases, healing will take upto 6 weeks, after which new glasses can be prescribed by your
optician. You will be given eye drops to reduce inflammation. The hospital staff will
Page 4
explain how and when to use them. Please don’t rub your eye. Certain symptoms could
mean that you need prompt treatment, including:
• Excessive pain
• Loss of vision
• Increasing redness of the eye
You will be given an emergency telephone number to ring in case you develop any of
the above, or should you need urgent advice about your eye.
Monday-Friday, 9am-5pm 01253 957420
Out of hours and weekends - Ward 15A Tel. 01253 953415.
For all ophthalmic queries, help and advice.
Likelihood of better vision
After the operation you may read or watch TV almost straight away, but your vision may
be blurred. The healing eye needs time to adjust so that it can focus properly with the
other eye, especially if the other eye has a cataract.
The vast majority of patients have improved eyesight following cataract surgery
Please note that if you have another condition such as diabetes, glaucoma or agerelated macular degeneration your quality of vision may still be limited even after
successful surgery.
Benefits and risks of cataract surgery
The most obvious benefits are greater clarity of vision and improved colour vision.
Because lens implants are selected to compensate for existing focusing problems,
most people find that their eyesight improves considerably after surgery but you
will need to replace your glasses. Reading glasses are usually needed after cataract
surgery.
However, you should be aware that there is a small risk of complications, either during
or after the operation.
Some possible complications during the operation
• Tearing of the back part of the lens capsule with disturbance of the gel inside the eye
that may sometimes result in reduced vision.
• Loss of all or part of the cataract into the back of the eye requiring a further
operation which may require a general anaesthetic.
• Bleeding inside the eye.
Page 5
Some possible complications after the operation
• Bruising of the eye or eyelids.
• High pressure inside the eye.
• Clouding of the cornea.
• Incorrect strength or dislocation of the implant.
• Swelling of the retina - macular oedema.
• Detached retina which can lead to loss of sight.
• Infection in the eye - endophthalmitis - which can lead to loss of sight, or even loss
of the eye.
• Allergy to the medication used.
• Several complications listed above may result in permanent sight loss.
Complications are rare and in most cases can be treated effectively. In a small proportion
of cases, further surgery may be needed. Very rarely some complications can result in
blindness.
The most common complication is called ‘posterior capsular opacification’. It may come
on gradually after months or years after cataract surgery. When this happens, the back
part of the lens capsule, which was left in the eye to support the implant, becomes
cloudy. This prevents light from reaching the retina. To treat this, the eye specialist uses
a laser beam to make a small opening in the cloudy membrane in order to improve
the eyesight. This is a painless outpatient procedure which normally takes only a few
minutes.
We hope this information is sufficient to help you decide whether to go ahead with
surgery.
Please use the space below to write down any further questions to ask the doctor or
nurse when you come to the hospital for your appointment. Don’t worry about asking
questions. Our staff will be happy to answer them.
Page 6
Checklist: One week before cataract surgery
1.Ensure that your blood glucose levels are stable if you are diabetic (below 21mmol/l).
2.Ensure your blood pressure is below 200/110 if you suffer from high blood pressure.
3.Check your warfarin blood levels and ensure these are within the therapeutic range.
4.Take all medications as normal upto and including the day of surgery.
5.Arrange transport to arrive in time for your appointment.
6.If you develop any illnesses, coughs, colds or any medical or eye conditions please let
us know by phoning 01253 957420. This will prevent you being cancelled on the
day and the operation slot can be offered to someone else.
7.You will not be able to drive home yourself so please ensure you have someone with
you and a means of transport home.
Checklist: The day before surgery
1.Ensure the above are completed.
2.You can eat or drink as normal.
3.Bring with you a list of your medication. It maybe that the doctor will wish to see
this.
4.Take your normal medication. If you take warfarin, and you know your levels are
abnormal you must ring the department as soon as you can.
5.Have the telephone number with you of the person taking you home.
Instructions for the day of surgery
1.Report to the reception desk upon arrival to the hospital
2. If you are having a local anaesthetic you can have a light meal prior to the surgery.
3. You should continue to take all medications for blood pressure, heart problems,
asthma and epilepsy with sips of water up to 2 hours prior to surgery. Please bring
your daily medications with you (in their original containers) on the day of your
operation.
4.Leave all jewellery and large sums of money at home. Bring just enough money for a
taxi ride home. The hospital assumes no responsibility in the case of loss.
5.You will be asked to remove all make-up and hair ornaments. Rings that cannot be
removed will be secured with tape. Please remember to bring your contact lens
container.
6. If you are to have a general anaesthetic, an intravenous drip may be started before
your procedure.
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7.You are NOT TO DRIVE after receiving a general anaesthetic or sedation. You must
arrange for a responsible adult to drive you to and from the hospital. You must not
operate hazardous machinery, drive a car or sign important documents for 48 hours.
8.Wear loose, comfortable clothing.
After your surgery, you may return to the hospital recovery area for a short time, where
you will be given something to eat and drink.
Post-operative care
After your surgery we would like you to go home and take it easy.
You are NOT to use any eye drops that evening.
Please do not rub or touch the eye.
It is normal for your eye to feel some itching and mild discomfort after surgery.
Some discharge is also common and your eye may be sensitive to lights.
If there is slight discomfort you can use a mild pain reliever (paracetamol).
If you experience a lot of pain or a decrease in your vision, you should contact the
hospital. This is not normal.
1. Avoid lifting anything over 20 lbs. or 9 kilos in weight for two weeks (Children,
groceries etc.).
2. Avoid water sports or swimming for two weeks.
3. You can have a shower but avoid getting water or soap into the operated eye.
4. You can wash your hair by tilting your head backward as at the hairdressers.
i. Certain sport activities need to be avoided (i.e. bowling, swimming) for a time,
usually 2 weeks.
ii. If you still work, it will depend upon your job when it would be safe to go back to
work. Please discuss with your doctor.
iii. You may drive if you are legally able to do so. Some patients may need to wait 3-4
weeks until they have new glasses prescribed.
Please discuss any activities you would like to participate in with the doctor.
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Patient agreement to investigation or treatment
(Designed in compliance with the Department of Health consent form 1)
CONSENT FORM 1
Responsible health professional ....................................................
Job title ............................................................................................
C
la
Special requirements: ........................................
(eg other language/other communication method)
FO
RI
NF
OR
MA
TIO
NP
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PO
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NL
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All patients about to undergo any elective or emergency surgical or endoscopic procedure likely to involve contact with tissues
of medium or low level infectivity should be asked the question:‘’Have you ever been notified that you are at increased risk of Creutzfeldt-Jakob disease (CJD) or variant Creutzfeldt-Jakob
disease (vCJD) for public health purposes?’’
If the patient’s response is No, proceed using normal infection prevention measures.
If the answer is Yes, please ask the patient to explain further and consult the Infection Prevention Team for advice.
If the procedure is likely to involve contact with tissues of potentially high level infectivity (Brain, spinal cord, implanted dura
mater grafts prior to 1992, cranial nerves and ganglia, pituitary gland and posterior eye (specifically: posterior hyaloid face,
retina, retinal pigment epithelium, choroid, sub retinal fluid and optic nerve) the following questions should be asked:1. Have you a history of CJD or other prion disease in your family?
2. Have you ever received growth hormone or gonadotrophin treatment?
3. Have you ever had surgery on your brain or spinal cord?
If the answer to any of these questions is Yes, please discuss with the consultant in charge of the case and consult the Infection
Prevention Team for advice.
Name of proposed procedure or course of treatment:
Right eye / left eye
Cataract extraction and intraocular lens insertion including photography/video for teaching
and publication
Statement of health professional (to be filled in by health professional with appropriate knowledge of
proposed procedure, as specified in consent policy)
I have explained the procedure to the patient. In particular, I have explained:
The aim of the cataract operation is to improve the quality of your vision. Surgery may also improve the doctors'
view of the back of the eye. We will try to reduce your dependence on spectacles as much as possible, but you
may require distance glasses for best vision and will probably need reading glasses. Your glasses prescription will
change after the operation.
Serious or frequently occurring risks
It is possible for cataract surgery to leave you worse off than you are now. One person in every 1000 will go blind
in that eye as a direct result of the operation. One in 10,000 will lose the eye. There is virtually no risk to the
other eye. Details on the most common specific complications are given below.
Ecchymosis - Bruising of eye or eyelids (quite common).
Posterior capsule rupture and / or vitreous loss - a split in the thin back wall of the cataract which can allow
communication between front and back compartments of the eye.
Post operative glaucoma - raised pressure in the eye for the first day or so (common). This may require treatment.
Posterior capsular opacification - clouding of the membrane behind the implant causing blurred vision.
Cystoid macular oedema - inflammatory fluid in the centre of the retina. This is commonly mild and needs no
treatment. It can be severe and require prolonged treatment.
Refractive surprise - unexpectedly large (or different from expected) need for glasses.
Allergy - to drops given after the operation, causing an itchy swollen eye until the drops are stopped or changed.
Dropped nucleus - part or all of the cataract falls into the back part of the eye, needing another operation to
remove it.
Corneal decompensation - clouding of the normally clear front window of the eye.
Detached retina - peeling off of the seeing layer of cells within the eye.
Endophthalmitis - severe (usually painful) infection inside the eye.
Dislocation of the implant - movement out of position of the lens implant.
Complications are rare and in most cases can be treated effectively. In a small proportion of cases, a further
operation may be required. If you decide against a cataract operation, your vision will probably slowly worsen.
Individual additional risks - (e.g. deterioration of diabetic retinopathy, corneal oedema, unexpected refractive
outcome particularly post laser patients)
Extra procedures that may be necessary during the procedure - Vitrectomy
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The following leaflet/tape has been provided: Cataract Surgery information leaflet
local anaesthesia sedation
This procedure will involve: general and/or regional anaesthesia
Signed .......................................................................................... Date ..........................................................................
Name (PRINT................................................................................Job title ......................................................................
B
File in Section 3
1)
g
f
s'
u
ll
d
e
Use black biro to complete form.
Write patient details or affix
Identification label
Statement of interpreter (where appropriate)
I have interpreted the information above to the patient to
the best of my ability and in a way in which I believe s/he
can understand.
Signed ....................................................................................
Hospital Number:
Name:
Address:
FO
RI
NF
OR
MA
TIO
NP
UR
PO
SE
SO
NL
Y
..
)
Contact Details (if patient wishes to discuss options
later)
Date........................................................................................
Name (PRINT) ........................................................................
Statement of patient
Date of Birth:
NHS Number:
Please read this form carefully. If your treatment has been planned in advance, you should already have
your own copy of page 1 which describes the benefits and risks of the proposed treatment. If not, you will
be offered a copy now. If you have any further questions, do ask - we are here to help you. You have the
right to change your mind at any time, including after you have signed this form.
I agree to the procedure or course of treatment described on this form.
I understand that you cannot give me a guarantee that a particular person will perform the procedure.
The person will, however, have appropriate experience.
I understand that I will have the opportunity to discuss the details of anaesthesia with an anaesthetist
before the procedure, unless the urgency of my situation prevents this. (This only applies to patients
having general or regional anaesthesia).
I understand that any procedure in addition to those described on this form will only be carried out if it is
necessary to save my life or to prevent serious harm to my health.
I have been told about additional procedures which may become necessary during my treatment. I have
listed below any procedures which I do not wish to be carried out without further discussion.
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
Patient’s signature ...................................................................... Date ..................................................................
w
Name (PRINT) ..........................................................................................................................................................
t.
A witness should sign below if the patient is unable to sign but has indicated his or her consent.
Young people/children may also like a parent to sign here (see notes).
o
d.
o
r
.
e
Signed .......................................................................................... Date ..................................................................
Name (PRINT) ..........................................................................................................................................................
Confirmation of consent (to be completed by a health professional when the patient is admitted for
the procedure, if the patient has signed the form in advance).
On behalf of the team treating the patient, I have confirmed with the patient that s/he has no further
questions and wishes the procedure to go ahead.
Right eye
Name/signature................................................................
date ................................................
Left eye
Name/signature................................................................
date ................................................
Important notes: (tick if applicable)
See also advance directive/living will (eg Jehovah’s Witness form)
Patient has withdrawn consent (ask patient to sign/date here ....................................................................
Bottom copy accepted by patient: yes / no (please ring)
Approved by the Health Records Committee 00/00/2014
Patients Notes
VS335 (R2)
Directions to the Ophthalmic Surgical Unit (OSU)
How to get here
The hospital
is adjacent to
Blackpool Zoo.
From the A583
Preston New
Road turn onto
South Park Drive,
which becomes
East Park Drive.
Department
Area Floor
A&E Entrance
3
G
Accident & Emergency
(A&E)
3
G
Accounts Office
1
G
Acute Medical Unit
3
1st
Adolescent Ward
8
1st
Ambulance Liaison Office
1
G
Bereavement Office
2
G
Birth Centre
8
G
Blue Skies Shop
1
G
Breast Care Centre
2
G
12
G
Caféteria
1
G
Caféteria
Cardiac Reception
12
G
Cardiac ITU
12 2nd
Cardiac Investigation Unit 12
G
Cardiology Day Ward
12
G
Car Parking Office
16
G
Chapel
3
G
Children’s Assessment
8
1st
Children’s Wards
8
1st
Combined Assessment
and Treatment Unit (CAT)
3
1st
Coronary Care Unit
12 1st
Diabetic Resource Centre
4
G
Dietetics & Nutrition
4
G
Education Centre
14
G
Entrance East Park Drive
2
G
Gastroenterology
6
G
Haematology & Oncology
Day Unit
5
G
Home
15
Intensive Therapy Unit
3
G
Information Desk
5
G
Lancashire suite
12 1st
Main Entrance
16
G
Main Entrance Outpatients 1
G
McMillan Windmill Unit
8
1st
Medical Retina Unit
5
G
Medical Photography
5
G
Mortuary
2
G
Neonatal Unit
8
1st
Occupational Health
13
G
Occupational Therapy
1
G
Ophthalmic Surgical Unit
5
G
Orthotic Department
1
G
Pathology
2
G
5
G
Pharmacy
Physiotherapy
1
G
Primary Care Dept
3
G
Department
Area Floor
Reception A
1
G
Reception B
1
G
Reception - Blue
4
1st
Reception - Cardiac
12
G
Reception Women & Children’s
8
G
Research & Development
5 2nd
Restaurant
5
1st
Retail Units
16
G
Security Office
1
G
Simulation & Skills Centre
2 2nd
Speech Therapy
14
G
Surgical Appliances
1
G
Surgical Centre
7
G
Surgical Rapid Access Unit
(SRAC)
3
1st
Trust Headquarters
16 2nd
Urgent Care Centre
3
G
Urology
7
G
Victoria Centre
8
G
Ward C
8 2nd
Ward D
8 3rd
Ward E (Haem Ward)
8 4th
Ward 1 (HDU)
4
G
Ward 2
4
1st
Ward 3
4 2nd
Wards 5 & 7
5
1st
Ward 6
5
1st
Ward 8
5 2nd
Ward 10
5
G
Ward 11
5
1st
Ward 12
5 2nd
Ward 14 (Surgical Centre)
7
1st
Ward 15 (Surgical Centre)
7
1st
Ward 16 (Surgical Centre)
7
1st
Ward 18
3
1st
Ward 19
3
1st
Ward 23
3 2nd
Ward 24
3 2nd
Ward 25
3 2nd
Ward 26
3 2nd
Ward 32 (Stroke)
11
G
Ward 33 (Stroke)
11
G
Ward 34 (Orthopaedic)
11 1st
Ward 35 (Orthopaedic)
11 1st
Ward 37
12 1st
Ward 38
12 1st
Ward 39
12 1st
X-Ray Central
4
G
X-Ray North
3
G
For the Southern
entrance to the
Hospital, turn
right at the set of
traffic lights after
the entrance to
the Zoo.
Suggested Car Park
for Main Outpatients
appointments subject to
availability – alternative
Main Entrance Car Park
Speech
Therapy
Staff Parking Only
ROAD
RING
Whinpark 2
Car Park
Occupational
Health
Drop Off Point 4
Disabled Parking
Home
Entrance
Whinpark 1
Car Park
MAIN ENTRANCE
CAR PARK
Urgent Care
Centre Entrance
Exit
Education
Centre
Drop Off Point 1
Restaurant
(1st Floor)
Women and
Children’s Unit
Main
Entrance
Breast Care
Centre
Drop Off
Point 5
Disabled &
Staff Parking
Only
Staff Parking,
Car Sharers
and On Call Only
7
Surgical Centre
Drop Off Point 3
Disabled &
Staff Parking
Only
Drop Off Point 3
Disabled &
Staff Parking Only
Drop Off Point 2
Disabled Parking
For the Northern
entrance, carry
on to Four
Lane Ends
roundabout. Take the fourth exit and turn right into Whinney Heys Road.
DROP OFF & SHORT STAY
POINT
CYCLE
PARKING
Information correct at the time of printing
Hospital policy
Smoking- the Trust operates a no smoking policy and your cooperation with this is
appreciated
Health and Safety- our patients may have poor vision, please consider their safety by
cooperating with the following:• Try not to obstruct the corridor.
• To reduce the risk of injury to you and other patients, please avoid assisting others.
Facilities available on the unit
• Music via CD player or radio in the postoperative area.
• Telephone for making out going calls.
• Chilled water fountain.
Page 11
Useful contact details
Monday-Friday, 9am-5pm 01253 957420
Out of hours and weekends - Ward 15A Tel. 01253 953415.
For all ophthalmic queries, help and advice.
Hospital Switchboard: 01253 300000
Patient Relations Department
The Patient Relations Department offer impartial advice and deal with any
concerns or complaints the Trust receives. You can contact them via:
Tel: 01253 955589
email: [email protected]
You can also write to us at:
Patient Relations Department, Blackpool Victoria Hospital,
Whinney Heys Road, Blackpool FY3 8NR
Further information is available on our website: www.bfwh.nhs.uk
References
This leaflet is evidence based wherever the appropriate evidence
is available, and represents an accumulation of expert opinion and
professional interpretation.
Details of the references used in writing this leaflet are available on request from:
Procedural Document and Leaflet Coordinator 01253 953397
Approved by:
Date of Publication:
Reference No:
Author:
Review Date:
Opthalmic Directorate
26/08/2016
BFWH143 - PL/502 v3
Mr Rahman
01/08/2019