Is it painful doctor?
A common question our consultants are asked is “how painful will my cataract surgery be doctor?”. We are aware of the Yorkshire grit demonstrated all too frequently by our patients, however, tolerating pain during a cataract operation is not a challenge we would expect you to rise to!
It is really important to understand the options for anaesthesia available to you. These options should always be discussed with you in any consultation about cataract surgery. Information about the different modes of anaesthesia is also included in any useful patient information leaflet.
Anaesthetic options
The three main types of anaesthesia for cataract surgery include topical (i.e., eye drops), a sub-Tenon block or a general anaesthesia. Topical and sub-Tenon anaesthesia are both local anaesthetic (LA) options.
The most frequently employed technique for cataract surgery in the UK is topical anaesthesia. Eye drops are administered to numb the eye immediately before the procedure. The surgeon may also choose to use some additional anaesthetic inside the eye at the beginning of the operation (intracameral anaesthetic). When this type of anaesthetic is used, you are awake throughout the procedure with your eyes open and you are able to look at the microscope light throughout the procedure. It is an extremely effective technique and means that your vision, which may initially be a little blurry, improves remarkably quickly over the first 24 hours following surgery.
While topical anaesthesia successfully numbs the eye, it does not stop the eye from moving and it is very important that the eye remains as still as possible throughout the procedure. Sometimes patients need a little bit more help to keep their eye still. In these cases, a sub-Tenon block is used. A sub-Tenon block 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 numbing eye drops, the surgeon (or anaesthetist) uses 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. The anaesthetic takes approximately 8 hours to wear off. You need to wear an eye pad over the operated eye during this period, while the eye recovers movement, so that you do not suffer from double vision.
If a patient does not want to be awake for their surgery, general anaesthesia (GA) is used. Modern day general anaesthesia is very safe, but your overall health must be taken into account. If general anaesthesia is to be used, you would undergo a pre-assessment to ensure you are safe to be put to sleep. If it is thought a patent would struggle to tolerate the procedure, or the eye surgeon would not be able to perform the operation in the safest manner possible, the option of general anaesthesia would usually also be brought up during the consultation, discussing the pros and cons in detail.
Sometimes, patients ask about having their surgery under local anaesthetic but with some additional sedation. The sedation is sometimes given in the form of a tablet or an infusion of a sedative agent during the procedure. Some surgeons prefer not to offer this option as the effects of sedation can be unpredictable leading to reduced patient cooperation. This is obviously not ideal in the middle of a cataract operation.
In summary, it is important to choose the type of anaesthetic that is right for you. You can come to the correct decision through discussing it with your eye surgeon who, through experience, will usually have the ability to tell what anaesthesia would be most suitable for you.
Mr Steven Naylor MBChB (Hons), PG Cert (Dis) Surgical Science, FRCOphth, CertLRS