Cataract Surgery - An Owner's Guide

What is a cataract?

A cataract is an opacity within lens. The lens is situated behind the pupil and helps focus images onto the retina. Early cataracts may not cause any visual problems but as they progress vision will eventually be lost. Cataracts may occur as a result of genetic disease, old age, inflammation, trauma and other problems.

What can be done about it?

Cataracts can only be removed by surgery. This is done using a process called phacoemulsification. This process breaks the lens into tiny fragments using ultrasonic energy. These fragments can then be removed from the eye. Once this has been done a synthetic lens is placed into the eye in the majority of patients to establish normal vision. Where this cannot be done the eye is still visual but long-sighted. The technique and instrumentation is the same as used on human patients.

How successful is the operation?

Phacoemulsification success rates (defined as normal vision at 6 months) are around 90-95% per eye. This does mean that 5-10% of eyes have complications which range from imperfect but improved vision, or inflammation that requires long-term medication through to glaucoma and/or retinal detachment. Complications can lead to loss of the eye in about 1% of cases. Without surgery the eye will remain blind and may also develop serious and painful problems such as inflammation and glaucoma anyway.

Is it better to have both eyes done at the same time?

If both eyes are equally affected then it is better to do them together as this reduces the overall anaesthetic time and financial cost compared to having one eye done at a time. It also means just one set of re-examinations. If the cataracts are at different stages in each eye then we will discuss the pros and cons of having both done together with you.

Will the cataract grow back?

The cataract itself cannot reform as the lens has been removed. However, a type of scarring can develop within the lens capsule which may cause reduced vision. This is known as capsular opacification. This is a common problem in younger dogs and precautions are taken to minimise the risk of this happening. Despite this a small number of animals will require further surgery to remove the opacities.

If I want to go ahead, what is the timescale for the surgery?

We try to perform surgery within 1 week of assessment as this prevents further problems developing. If the cataracts are not ready for surgery we will advise a re-assessment at a later date with a view to performing the surgery then.

Describe the routine for my pet

We ask for all non-diabetic patients to be starved overnight prior to surgery but to have water available. For diabetic patients we will give you an alternative routine. We like our patients to arrive at the surgery at 9.00am the day of the surgery or if this is not possible the afternoon before. We will then run through any further questions you may have before admitting them to the ward. We then spend the next 2 hours giving eye drops every 20 minutes to prepare the eyes for surgery. At this point they will have a premedication and then be put under general anaesthesia about 30 minutes later. The surgery can take between 45 minutes to an hour and a half depending on the number of eyes treated and the difficulty of the surgery. We anticipate that most animals are visual as soon as they are awake. Afterwards we need to monitor the eyes closely but we are happy for your pet to go home the same day and come back the next day for re-examination. We then assess the eyes 1 week later, 1 month later and 4 months later. After this we will perform reviews every 6-12 months for life. A course of tablets (antibiotics and/or anti-inflammatory/pain-relievers) for 5 days and eye drops for several weeks are prescribed following the cataract surgery. A typical post-operative treatment plan would be a long course of eye drops (e.g. 4 x daily for 4 weeks, then 2 x daily for 4 weeks, then once daily for 4 weeks). If treatment is stopped early, irreversible damage to the eye may develop. Your pet will need to be handled quietly and carefully for the first week. Exercise off the lead and vigorous play are not encouraged until we are happy that everything has settled down. If you have any concerns about the eyes after surgery we encourage you to phone for advice straight away. We would much rather see you for a minor problem than miss a major one before it is too late to deal with.

What is the Cost?

The cost will vary from case to case, but is usually around £1700-2300 inc VAT for one eye, or £2300-2900 inc VAT for both eyes. The reason for the variation in prices is because we do not always know which equipment will be required during the surgery until we are removing the cataract. This cost includes the general anaesthetic, operation, hospitalisation, medication dispensed on the day of the surgery and lifetime follow-up examinations. It does not include any extra medication or surgery required after the initial cataract removal.