When should cataract surgery be performed?
Cataracts are best operated on as soon as effective vision is lost. This is especially important in diabetic cataracts, which can swell rapidly causing lens rupture. Diabetic dogs do not need to be fully stable on their insulin, but they should not be keto-acidotic.
We prefer to see cataract cases for an early assessment so that all options and best management can be discussed. It is great if we can see them whilst the cataract is immature and a view to the fundus is still possible. Cataracts used to be operated on in the veterinary world when they were mature/hyper-mature to facilitate extracapsular lens extraction. We now use phacoemulsification to remove the cataract, so get a much better long-term result if the cataract is less mature and has caused less damage to the eye.
What happens if cataracts are left untreated?
All cataracts can cause lens-induced uveitis (LIU or inflammation) of the eye and lead to glaucoma, which can preclude surgery at a later date. Chronic LIU also causes chorioretinitis (inflammation of the retina), which can lead to retinal detachment. These eyes may not be suitable for surgery, so we recommend an early appointment to give the patient every chance of return of vision.
What is the cost of cataract surgery?
Unilateral cataract surgery £3,800 – £4,400
Bilateral cataract surgery £5,000 – £6,000
The first post-operative check, the day after surgery, is included. Thereafter, all ongoing checks relating to this surgery only will be charged at a reduced post-operative consultation fee of £62.17.
(Prices correct as of 1st January 2021)
Should both eyes be done at the same time?
If both eyes are affected equally, then it is better to do them together, as it reduces the overall anaesthetic time, the overall costs, requires one set of post-operative checks and increases the chance of a good visual outcome.
What is the expected success rate?
We expect a 90% success rate, with a further 5% of cases still doing well, but requiring more drugs in the longer term. Complications can lead to the loss of an eye in about 1% of cases and less than 1% of cases will need further procedures, drugs or removal of the eye requiring further spending. Vision is present immediately after surgery, but it frequently takes several weeks for the eye to settle down and vision will often improve over the first few weeks.
What are the risk factors?
Complications can occur due to haemorrhage, infection, persistent inflammation (uveitis), persistent glaucoma (increased pressure in the eye) and retinal detachment. Some dogs have severe pre-existing uveitis, adhesions, glaucoma or sub-luxated lenses, which influences the expected success rate and the options offered. Microphthalmic eyes (congenitally smaller eyes) can be at a higher risk of complications such as retinal detachments. Labradors are known to have a 30% increased risk of post-operative glaucoma.
What are the risks of doing nothing?
Vision will deteriorate in most eyes with cataracts and render the pet blind. We should be able to give you an idea of what to expect, when the eyes have been assessed. When a cataract is present in an eye, the lens will release proteins, which cause inflammation of the rest of the eye (known as lens-induced uveitis or LIU). If left untreated, the chances of success through surgery will drop and painful glaucoma may develop in the longer term and require expensive drugs or removal of the eye if the eye is not responsive to drugs. One study of 77 eyes showed that eyes treated with anti-inflammatory drops only were 4x more likely to develop glaucoma than when cataract surgery was done, whilst eyes not treated at all were 255 x more likely to develop glaucoma.