Cataracts

What is a cataract?

A cataract is formed by clouding or opacity of the natural lens of the eye. As cataract progresses, it blocks and scatters light, causing progressive deterioration of vision, that cannot be corrected with spectacles or contact lenses. Symptoms begin due to a gradual reduction in the amount of light entering the eye. With time, there is increasing blur and poor vision, as the lens becomes more opaque. People with cataracts will often complain of increasing difficulty reading in low light, or more trouble making out street signs, especially in dim conditions. They may notice increasing glare, particularly when driving at night. Often, the development of cataract will change the glasses prescription. The ability to perceive colour, especially blue, is affected, but this is not obvious to a lot of people until after the surgery. In people over 80, cataracts significantly increase the risk of having falls and accidents. Cataract will often lead to reduced confidence in getting around, and it may not be recognised as the cause. Progression of cataract can also make dementia appear worse; it is important to address early in people with dementia.



Cataract surgery is recommended when your decreased eyesight interferes with normal daily activities and work. The goal is to restore your vision so you can see and do the things you enjoy.



Cataract is much more common above the age of 60, but can occur at any age, including being born with cataracts. Risk factors for developing cataracts include previous injury to the eye, previous retinal surgery, systemic conditions including diabetes, medications including steroids (oral, inhaled or creams), and exposure to high levels of UV light.


Cataract Surgery

There are two 2 key components of cataract surgery:



1. Removal of the cataract – to remove the opacity that is blocking your view of the outside world.



2. Insertion of the new intraocular lens – when the natural lens (cataract) is removed, the refractive power of the eye is significantly reduced. The new intraocular lens is required to focus light onto the retina. The design and the power of the lens is important in determining the visual outcome of surgery. One of the most critical jobs that Dr Daya Sharma and Dr Shanel Sharma do prior to surgery is determine which type of intraocular lens is most appropriate for you, and to determine the appropriate power of the intraocular lens. The accuracy of lens calculations depends on the technology used to make these measurements, as well as the interpretation of this data. At Eye & Laser Surgeons, we have invested highly in the most cutting edge and state-of-the-art equipment to do this (optical biometry and corneal topography/tomography). We also have an ultrasound machine, which allows measurements to be able to be taken in patients with very dense cataracts in whom optical biometry is not suitable. Modern cataract surgery is essentially another type of refractive surgery, where the aim is to provide the best possible visual outcome according to the individual requirement.



Dr Daya Sharma is a cataract, refractive and corneal subspecialist. He has undergone fellowship training in anterior segment surgery (corneal, cataract and refractive surgery) at Moorfields Eye Hospital in London (one of the world’s most prestigious training institutions). He has an interest in looking after patients whose vision is critical for their quality of life and work. He is particularly interested in cataract surgery in patients with corneal disease, high or irregular astigmatism, and after previous refractive surgery. If you would like to make an appointment to see Dr Daya Sharma, please contact our offices in Bondi Junction (02) 9387 5300 or Miranda (02) 9531 5300.



Dr Shanel Sharma is an experienced cataract surgeon, who is particularly interested in dealing with patients who have a combination of age-related macular degeneration and cataract; diabetes and cataract, strabismus (squint) and cataract, and glaucoma and cataract. If you would like to make an appointment to see Dr Shanel Sharma, please contact our offices in Bondi Junction (02) 9387 5300 or Miranda (02) 9531 5300.

Cataract Surgery Experience

Cataract surgery is recommended when your decreased eyesight interferes with normal daily activities and work. The goal is to restore your vision so you can see and do the things you enjoy.

What is a cataract?

A cataract is a cloudiness of the eyes natural lens. Cataracts usually start very small and gradually grow, causing blurry vision and discolouration.

Cataracts are generally a sign of aging, but can occur as birth defects, eye injuries and exposure to high levels of UV light.

If your cataract is interfering with your vision to the point where it is unsafe to drive, or doing everyday tasks, then it may be time to discuss surgery with your ophthalmologist

What can I expect before surgery?

You need to have a thorough eye examination. Your pupils will be dilated and Dr Sharma will perform testing to:


– Assess if you have any other ocular problems which may affect your surgery or vision after surgery.


– Take a series of measurements of your eye to calculate the power of the lens implant needed.

Am I awake for the surgery?

Yes. Cataract surgery is done with a local anaesthetic to numb the eye. It is safer for you than using a full general anaesthetic, and the recovery process is quicker. Often, a sedative is given to relax you, and make sure you are comfortable. During surgery, you will be able to hear the machines working, and theatre staff talking. You will also have a sterile drape covering the eyes, which blocks the vision, but there will be plenty of oxygen underneath to breathe. Occasionally, you may be asked to move your head slightly during the surgery.

What if I move during surgery?

Sudden, unexpected movements can cause problems during the surgery, so patients who are very prone to sudden, uncontrollable movements may be advised to have a general anaesthetic. If you need to cough, sneeze or move, let Dr Sharma know so the instruments can be removed from the eye. Surgery can then proceed safely when you are ready.

What do I see during surgery?

The anaesthetic often makes the vision quite blurry, however, some patients still retain vision in the eye that is having surgery and are able to see the microscope light. It is not a concern, and some even comment on colourful effects from the lens implant unfolding in the eye.

How long will surgery take?

Cataract surgery usually takes 20-30 minutes. However, the more dense and hard the cataract, the longer it takes to remove.

Do I need to stop regular medications before surgery?

Not usually, however please ensure all medications are listed on your admitting form, so the anaesthetist can plan the best anaesthetic for your surgery. Dr Sharma will advise you if you should discontinue any medications. If you are diabetic, be aware that we usually ask patients to stop food 6 hours before surgery. In some cases, a lower dose of medication will be recommended. If you are on glaucoma drops, please continue using as usual. Blood thinners are usually continued as usual, however, if you are on warfarin, we will usually check the level a few days prior to surgery to make sure the blood is not too thin.

Can I eat and drink before surgery?

Normally you will not be able to eat for 6 hours and drink for 4 hours prior to cataract surgery. Please confirm with the day surgery centre the day before surgery. Having an empty stomach means that sedation can be given more safely, so that you are relaxed for the procedure.

Can surgery be done on both eyes at the same time?

If you require surgery on both eyes, treatment will usually be scheduled at least 1 week apart. Although it is technically possible to operate on both eyes on the same day, most eye surgeons, including Dr Sharma, recommend performing cataract surgery on only one eye at a time.

How safe is surgery?

Cataract surgery is considered one of the safest surgeries today. Techniques have significantly improved, particularly over the last 20 years, to make the surgery safer, and the recovery process faster. As with any procedure, there are risks involved, and these will be explained to you prior to booking the surgery.

Can I wear make-up and hairspray?

We ask you not to wear make-up, perfume or hairspray on the day of treatment, as the area around your eye needs to be carefully cleaned with a sterile solution.

Does everyone get the same lens implant?

No, definitely not. There are many lens implant options available for private patients; the right option for you will be tailored according to your needs. Some lenses are custom manufactured only for your eye. In general, there are single focus lens implants (which have one set focus) and multifocal lens implants (which correct for distance and near). Both of these types of lenses are available with astigmatism correction. You will be involved in the process of planning your visual outcome from surgery, in terms of explaining what your needs and concerns are. Our clinic has advanced equipment for performing detailed measurements of the eye prior to cataract surgery. These measurements are used to choose the best lens implant power to get the outcome you desire.

After surgery

Will I wear an eye patch?

Normally, your eye is padded and protected with a plastic shield for the first night after surgery. It will be removed the following day at your post-op appointment by Dr Sharma. However, you will need to use an eye shield at night to protect the eye for the first week after surgery.

When can I resume normal activities?

You will want to take things a little easy for a day or two, but you may resume normal activities. Some patients experience double vision the day after the surgery, which is due to the anaesthetic. This wears off quite quickly, but driving is not advised on the first day.

Is there anything I shouldn’t do after surgery?

You should not rub your eye. This is very important as there are no stitches in the incision site – rubbing can cause the fluid within the eye to leak. This is why you should not use shampoo or hairspray for one week, due to irritating chemicals you will feel the need to rub your eyes. You should wear protective eyewear when outside. We recommend that you not swim for two weeks.

How soon can I drive?

When you are able to see clearly, Dr Sharma will advise you when you can drive. It is best to assume about a week. Although most patients meet the driving standard on the first day, it is generally best to adapt to the new vision by being a passenger first. Also, if the unoperated eye has a strong spectacle prescription, there may be some imbalance issues that would affect driving.

When will I need to see Dr Sharma?

Post-op appointments are usually scheduled at:
The next day
One week after surgery
Four to six weeks after surgery

How soon can I get new glasses?

Dr Sharma will advise you to see your optometrist for new glasses, generally from two to four weeks after your cataract surgery.

Intraocular Lens (IOL) Options
Single-focus implants (monofocal implants)

Until recently, only single focus lenses were available. These lenses can be chosen to provide a single sharp focus, usually distance or near, sometimes intermediate. Monofocal implants provide the best quality of vision, but will usually require spectacles for some activities after surgery (to change the focus).



Some patients choose to have both eyes corrected for distance after cataract surgery, and wear reading glasses for close vision. Others who want to be less dependent on glasses, can choose to have monovision (“blended vision”) where one eye is corrected for distance focus and the other eye corrected so it is focused for close work. This gives a better range of focus with both eyes working together, and the brain usually learns to adapt to this by enhancing the clear image, and suppressing the blurred image. Many cataract patients would have been using monovision in contact lenses already, and sometimes we will recommend trying it first with contact lenses.

Multifocal Implants

Multifocal lens implants are designed to maximise independence from spectacles after surgery. Multifocal implants are best used in individuals who want the best chance of not needing spectacle correction after their cataract surgery, and who have no other significant ocular health problems. Multifocal implants have the ability to focus distance, intermediate and near simultaneously. There are several different lens options available, which can be tailored according to the visual requirements.



Mutlifocal implants are not recommended if there is irregularity or disease of the cornea or macula, or if there are very high visual quality requirements. Multifocal lenses will produce more scattering of light than a monofocal implant, resulting in increased glare and haloes, which usually diminish with time as the brain adapts to the vision. Dr Sharma is selective about using multifocal implants in the right candidates, and about choosing the best option for your visual requirements.

Astigmatism-correcting Intraocular Lenses (Toric Intraocular Lenses)

Also known as toric implants, these lenses compensate for blurred or distorted vision caused by astigmatism. Toric lenses are available in both monofocal (single-focus) and multifocal intraocular lenses, and can be customised to treat very high levels of astigmatism as seen in cases after corneal transplantation or keratoconus. Dr Sharma will usually recommend that astigmatism is corrected at the time of cataract surgery if this is possible. Part of the diagnostic workup for cataract surgery involves detailed measurements of your cornea in order to get the best measurements to plan correction of the astigmatism.