Did you know that a cataract operation is performed using local anaesthetic in the vast majority of patients? This means that you are awake throughout the procedure with your eyes open. How does that make you feel?
This often comes as somewhat of a surprise to my patients, some of whom are expecting to be asleep under a general anaesthetic for their operation. The thought of being aware of surgical instruments in the eye, or the possibility of experiencing pain is something I am commonly asked about, and I am only too happy to reassure and address these concerns with you here in this blog post. It is really important to me that my patient is fully informed of all options, so that we can decide on the best operation plan together.
Anaesthetic Options
There are three main types of anaesthesia available to you. These options should always be discussed with you prior to cataract surgery. Information about the different modes of anaesthesia is also included in any useful patient information leaflet.
The first, and most common approach for cataract surgery in the UK and in my practice, is the use of topical anaesthesia. This is administered as local anaesthetic drops, immediately before the procedure, by one of the theatre practitioners. This numbs the eye initially, and then I inject some additional local anaesthetic inside of the eye to ensure that it is completely numb throughout the operation. When this type of anaesthetic is used, you are able to look at the microscope light throughout the procedure. It is a remarkably effective technique and means that your vision, which may initially be a little blurry, improves quickly over the first 24 hours following surgery.
It is very important that the eye is as still as possible throughout the procedure. Whilst the local anaesthetic successfully numbs the eye, resulting in a pain free procedure, it does not stop the eye from moving. As you will be awake during your cataract operation, I will use my voice to reassure and calmly instruct you to look at the microscope light throughout, the majority of my patients are able to do this with ease. This is known in the trade as “vocal local” and usually results in a calm, effective and mutually beneficial surgical experience.
In certain cases (less than 2%) my patients may need a little bit of extra help to keep their eye still, in which case a second type of local anaesthetic approach may be used. This is called a Sub Tenon block and simply means the administration of anaesthetic under the outer layers of the eye. The Tenons layer is a layer of tissue directly underneath your conjunctiva. After the administration of the aforementioned numbing eye drops, I use a blunt cannula (small plastic tube) to place some local anaesthetic under these layers of tissue, in the corner of the eye closest to your nose. This type of anaesthetic not only numbs the eye, but also prevents you from being able to see or move the eye. As this type of anaesthetic takes approximately 8 hours to wear off, you will be advised to wear an eye pad. This is because you will likely experience double vison post operatively as your eye recovers movement.
With both topical anaesthesia and sub tenon block techniques, you will be aware of the small clip we use to keep the eye open, gently keeping the eye lids apart. Patients are always aware of a gentle stretching of their eye lids but quickly become acclimatised to this sensation.
Some of my patients do not wish to be awake for their surgery. In this instance the third option offered is a General Anaesthesia (GA). Although modern day GA is very safe, it involves the administration of anaesthetic directly into the body, and therefore you will need to have a pre-assessment with an anaesthetist to check that you are a suitable candidate to be put to sleep safely.
On occasion I have been asked by patients whether it is possible to have sedation in addition to a local anaesthetic option. Sedation is sometimes given in the form of a tablet or an infusion of a sedative agent during the procedure. I personally prefer not to offer this option. Sometimes, the effects of sedation can be unpredictable leading to reduced patient cooperation. This is obviously not ideal in the middle of a cataract operation as it is more likely to lead to a complication.
I hope this blog has been helpful to you. I am very happy to discuss all of the above with you directly in a consultation. Please do contact me via the contact details on my website to book an appointment.
With best wishes
Steve Naylor