Cataract Surgery


Cataract surgery is available at the following centres:

BMI Mount Alvernia Hospital
Manchester Royal Eye Hospital
Sheffield Royal Hallamshire Hospital


In the last 60 years, cataract surgery has evolved more than any other operation. Today, thanks to advances in technology, most patients experience little or no pain and return to their normal activities the day after surgery. And modern cataract surgery can even correct common vision problems, including short-sight, long-sight, presbyopia and astigmatism, to reduce your dependence on glasses or contact lenses permanently.

During cataract surgery, the cataract (the clouded natural lens) is replaced with an advanced artificial lens called an intraocular lens (IOL). There are many types of intraocular lenses. Depending on your goals after surgery, your lifestyle, medical concerns and your current vision, your doctor can help you choose the IOL that is right for you. Whilst the NHS offers an excellent service for cataract surgery, there is rarely an option for choosing your intraocular lens, meaning that glasses will almost certainly be required after surgery.

The decision to undergo cataract surgery offers a once-in-a-lifetime opportunity to insert the best lens for you. There are several designs of IOLs available, each having their own strengths in performance. The choice of lens has a major influence on the outcome of surgery and whether glasses would be required after surgery.

Below, you can learn more about the main types of intraocular lenses available, what the surgery involves, as well as some factors that will affect your decision about which IOL is right for you.

Standard / Monofocal Intraocular Lens

Toric Intraocular Lens

Multi-Focal Intraocular Lens

Accommodative Intraocular Lens

Monovision

To read more about the symptoms and cause of cataracts, please click here.

 

Surgery FAQs

 

What happens in Surgery?
Lens replacement is one of the safest and most effective surgical procedures. Each year in the UK alone, it is estimated that there are over 340,000 lens replacement procedures carried out to treat cataract alone.

The operation involves removing the natural lens through a tiny 2.2mm incision. Once the natural lens has been removed, s new replacement lens called the ‘intraocular lens, is gently inserted through the same small incision and set into its permanent position.

 

Is the surgery painful?
No. Anaesthetic eye drops are used in conjunction with a mild sedative if required to make this a painless procedure.

 

What is the recovery period?
98% of patients are legal to drive themselves the next morning. You can start reading and watching TV immediately. Most patients recognize a significant visual improvement immediately after surgery. Your vision continues to improve for about one week. We provide over the counter reading glasses while your eye heals. If patients want or need glasses they can be prescribed anytime after the first or second week.

 

When can I go back to work?
Most cataract patients can resume their work and everyday tasks within a few days of their surgery. You can lift and bend over but it is advisable to keep clear of physically demanding activities in the early recovery stage. You can wash your hair at any time but it is best not let water come in direct contact with the eye for 1 week.

 

What are the risks?
Approximately 400000 cataract procedures are performed in the UK each year and as many as 10 million worldwide. Naturally, with that many procedures there will be reports of almost every possible complication. Our data shows a complication rate lower than 0.5% with 99.5% patients having an excellent post-operative course and an excellent visual result. Infection occurs in less than 1 in 5000 cases and retinal detachment occurs in less than 1 in 3000 cases.

Other complications including corneal decompensation, persistent macular edema, implant instability, power calculation errors, and glaucoma. All of these problematic cases add up to less than one half percent. In almost all of these cases further surgery, additional medications, or additional time results in recovery and a net improvement in vision. It is extremely rare for patients to end up worse than they started.

 

How safe are the implants?
Extremely safe. The development of the intraocular lens was the single most important development in the field of Ophthalmology and Optometry over the last century. The refinement in lens design, materials, and manufacture since the 1940’s is one of the great medical success stories. Implants used since 1990 are safe, reliable, and effective.

 

Choosing your intraocular lenses
Many important factors will affect which intraocular lenses are the right choice for you, including:

  • Are you short-sighted or long-sighted?
  • Do you also have any astigmatism?
  • How do you feel about continuing to wear glasses or contact lenses after your cataract surgery?
  • Would you prefer not to need glasses or contacts after surgery?
  • How important is good night vision to your lifestyle?
  • In general, how well do you adjust to changes and learning new skills?
  • What activities or tasks are necessary for your daily life and for your job?
  • What hobbies do you currently enjoy or would like to engage in most often?
  • During which activities would you find glasses the most inconvenient or aggravating?

Click on the table below to read more about each type of intraocular lens to understand how each IOL performs.

There is no ‘best’ lens which will work for everyone. The correct lens for you will depend on your eyes, your lifestyle and your desire to be free from glasses or contact lenses. The surgeon led team will help you choose the right lens for you following an in depth consultation and explain what you can expect to achieve from each one.

 

Types of intraocular Lens

 

What do you need to do for your preoperative consultation?
If you use soft contact lenses you must refrain from wearing them for one week before your consultation; if you use rigid gas permeable lenses please stop wearing them for 4 weeks before your consultation. The examination will be thorough and included the use of drops to dilate your pupil. This can lead to blurred vision and so it is advisable to arrange not to drive to your consultation.

We would like you to be aware of any prescribed medications you are taking. You will probably be asked to continue these in the usual way, but some medications can cause complications during ophthalmic procedures.

These include warfarin, an anti-clotting agent; and tamsulosin (Flomax) or similar preparations given to some men with prostate problems. If you normally take these it is important you that let us know prior to admission. If you take a diuretic “water tablet” and are having surgery on a morning operation list, you may wish to postpone taking it until after your operation.

 

What type of anaesthetic will you have?
Local anaesthetic
Most cataract procedures are carried out under local anaesthetic, using just drops to numb the eye (referred to as “topical anaesthesia”). However some patients find there is a desire to squeeze the eye closed. In this case a small injection around the eye is performed to reduce eye and eyelid movement (known as a sub-tenons local anaesthetic).
With this type of anaesthetic there are no restrictions; you may eat and drink prior to admission. There is no pain during surgery and it is possible to leave hospital about an hour after the operation.

Sedation
Some patients are anxious. If required sedation can be used in the form of a tablet taken about an hour before the procedure, which can help relieve anxiety.

Intravenous sedation and general anaesthesia
Some patients wish more sedation, in which case an injection can be given. The alternative is a general anaesthetic. You must not eat or drink for 6 hours prior to intravenous sedation or general anaesthetic.

Remember, you should not drive yourself to the hospital. You may want a relative or friend to accompany you, or to drop you off and return to collect you when you are ready to go home.

 

What to expect on admission to the clinic
You will be shown to your private room. A nurse will carry out routine investigations including checking your pulse and blood pressure. The nurse will also record details of any medications you are taking and ask questions about your general health.

Once this has all been completed, the nurse will instil the drops, which dilate your pupil in preparation for the operation. You will also have another chance to discuss the operation with your consultant surgeon. You will be asked to sign a consent form which states that you have been provided with and understand all the information given relating to the operation (including the risks and benefits of surgery) and that you agree to the proposed treatment.

The ophthalmic nurse will come to see you to explain what will happen during and after the operation, and to answer any further questions you may have. You will be taken to the operating theatre in your own clothes, so it is important to wear something comfortable.

 

What happens during surgery?
You will be taken to the anaesthetic room next to the operating room. Here the staff will place anaesthetic drops in the eye and then clean the skin around the eye. You will be taken through to the operating room.

You will be made comfortable on the operating bed, following which the skin around your eye will be thoroughly cleaned again and a sterile cover (“drape”) will be placed over your eye and face. The cover will be lifted off your mouth so you can breathe and talk easily.

Your eyelids will be gently held open and you will be asked to look at a central light which positions your eye in preparation for surgery. Further anaesthetic drops are instilled at this point.
The operation will then commence. You will be asked to look up at one of the bright lights of the microscope. This will maintain the eye in the optimal position for your surgeon to perform the operation. You will see little of what is happening during surgery, but we will explain what we are doing as the operation goes along. The theatre staff will make sure you are comfortable and will help you relax.

Someone will be there to hold your hand if you wish. The operation usually takes about fifteen minutes, but in some cases may take longer.

The procedure is performed using an operating microscope and involves making a very small incision in the cornea of the eye (the clear part at the front covering the iris and pupil), through which a tiny probe is inserted. The incision is self-sealing so stitches are not required.

The natural lens of the eye is contained within a “capsular bag”. The lens is removed from within this bag using high frequency ultrasound, leaving the capsular bag intact. The new lens is then injected into the empty bag and allowed to unfold gently. Finally antibiotic will be injected into the eye as this minimises the risk of infection.

 

Immediately after your operation
After the operation you will be taken to the recovery room, and then back to your private room. Whilst resting after the operation, you will be offered refreshments.

You will be given a combination antibiotic and anti-inflammatory eye drop to take home, with written instructions on how to instil these and the frequency with which they should be used. They are usually to be used four times a day for two weeks and then twice a day for two weeks. You may leave the hospital when you feel ready.

After the anaesthetic wears off, about one to two hours after the operation, the eye may water and feel quite sore. This is nothing to worry about and your normal headache tablets should settle any discomfort. By the next day the eye will feel much better and feel only mildly gritty.

 

How long is it between the first cataract operation and the second operation?
We prefer to perform surgery between 3 days to 3 weeks apart to allow for first eye to settle and ensure a good result.

 

Do cataracts come back?
No. Once the natural lens is replaced by the manufactured intraocular lens implant (IOL) a cataract can not return. Intentionally, we leave the posterior skin of the natural lens (the capsule) to hold the implant. This capsule often opacifies with time. Twelve weeks to twelve years after surgery a painless in-office laser called the YAG removes the cloudy capsule.

If you notice that your vision has degraded slightly several months or years after cataract surgery you might need a YAG. Sometimes, your referring doctor will send you back to us for the YAG procedure.

A YAG laser is only needed once in each eye following cataract surgery. Some patients never require a YAG.

The implant remains stable after the YAG procedure. In fact, with the modern very small incision cataract surgery implant stability is outstanding.

 


Your LaserVision consultant surgeon can expertly guide you through the best treatments for you. Each treatment is personalised to achieve the best results.



In association with:
Sheffield Teaching Hospital NHS Foundation Trust, Greater Manchester University Hospitals NHS Foundation Trust