Cataract Surgery

Cataract surgery is one of the oldest surgical procedures recorded, and over the years technological advances have made it one of the safest and most frequently performed procedures worldwide.

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.

Introduction

The decision to undergo private cataract surgery offers a once-in-a-lifetime opportunity to correct common vision problems, including short-sight, long-sight, presbyopia and astigmatism, to reduce your dependence on glasses or contact lenses permanently.

Cataract surgery involves the removal of the cloudy natural lens of the eye (the cataract) and replacing it with a carefully selected intra-ocular lens (IOL). There are several designs of intra-ocular lenses (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. 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.

All our surgeons specialise in cataract surgery and have all performed several thousand cataract procedures, particularly for patients with high spectacle corrections, complex cataracts and following other types of refractive surgery.

Today, thanks to advances in technology, most patients experience little or no pain and return to their normal activities the day 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.

Understanding Cataract

What is the lens?
The lens is the part of the eye that helps focus light on the retina (just like the lens in a camera). The lens is made of a clear, jelly-like substance.  The retina is the eye’s light-sensitive layer that transmits visual signals to the brain (like the photographic film in a camera), to help produce a sharp image; the lens must remain clear and flexible.

What is a cataract?
A cataract is a clouding or frosting of the normally transparent lens of the eye, located behind the iris.

As the lens becomes more opaque, it prevents light rays from passing through the lens and focusing on the retina. The effect is  similar to looking through a frosted glass window. Contrary to popular belief, a cataract is not a skin that grows over your eye.

Although cataracts usually develop as part of the ageing process, they can also result from eye injuries, certain diseases such as diabetes, medications such as steroids, or genetic inheritance.

What are the symptoms of an eye with a cataract?
One of the earliest signs of a cataract may be a changing prescription. Early lens changes or opacities may not disturb vision, but as the lens continues to become more cloudy, symptoms including blurred vision, sensitivity to light and glare, increased nearsightedness or distorted images in may develop.

Cataracts are extremely common. It is estimated that approximately 70% of people in the UK aged over 65 years of age have cataracts.

Aside from surgery, there are alternative treatments such as medications that can reverse the effects of a cataract.

When does a cataract require treatment?
With modern surgical techniques it is possible to operate on a cataract at a relatively early stage, contrary to the misconception of the cataract needing to be mature or ‘ripe’. There is no specific level of vision at which cataract surgery is indicated, but it is usually recommended if the quality of your vision is reduced such that is affecting your lifestyle. Surgery is also indicated if you wish to drive and your vision no longer meets the necessary DVLA legal standard.

Refractive Cataract Surgery

Accurate measurements of the eye taken prior to surgery allow an IOL to be implanted which can correct for long or short sightedness and astigmatism so that as well as clear vision, vision can be optimized without the need to wear spectacles for normal distance vision.

Prior to the development of cataract, surgery to replace the lens can be employed to improve the vision by implanting an IOL, which can correct a high spectacle prescription; this procedure is known as RLE.

To improve the range of vision and depth of focus, multifocal lens implants can be used to reduce the requirement for reading spectacles as well as provide clear vision for distance visual tasks e.g. driving or watching the television. Although spectacles may still be required for some visual tasks, many patients rarely require spectacles after this form of surgery.

The Procedure
On the day of surgery and once in the hospital you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed. The operation is usually performed under a local or topical anesthetic, is painless and lasts less than 10 minutes in most cases.  The technology used is called phaco-emulsification and employs ultrasound energy to liquefy the lens which can then be aspirated. A new lens is then inserted using an injection system and is unfolded and positioned within the eye. We typically do not use stitches during surgery which allows for a faster recovery.

You will need to allow 3-4 hours for your hospital stay so that we can run through your treatment and aftercare with you. You will need someone to collect you or we can arrange transport for you.

Post Treatment
After the operation you will rest for a while and have refreshments then you can go home. You will be given a dressing pack to swab the eye clean the following day, some antibiotics and anti-inflammatory eye drops to apply at home after the surgery.

Timing of sequential cataract surgery
Surgery will normally take place with an interval of one week or less between each cataract surgery procedure.

How quickly will my vision be restored?
Your vision will be slightly blurred for a few days while your eye heals. It is not uncommon to feel some discomfort, usually a feeling that something is in the eye until your eye settles but there should be no pain.  After a couple of days you will start to notice a significant improvement in your vision.  You can quickly return to many everyday activities, although heavy lifting or other strenuous activities should be avoided for a week. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your surgeon or optometrist when you can resume driving.  You will see the surgeon again after 2 weeks and will visit your optometrist for new glasses if needed after 6 weeks.

Once you have been given your new glasses, you may notice that everything seems a lot brighter than you remember. Colours may be sharper and may have a blue-ish tinge. In bright sunlight you may feel you are looking through rose-coloured glasses. These colour tinges are normal and are because you are now looking at the world through a clear lens that is no longer cloudy. Within a few months your brain will get used to your new clear vision and these colours should go away.

Refractive Cataract Surgery Lens Options

Monofocal Intra-Ocular Lens
IC-8TM Lens
Accommodative Lens
Multi-Focal Intra-Ocular Lens
Toric Intra-Ocular Lens

More information about Cataract Surgery

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.

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.

No. Anaesthetic eye drops are used in conjunction with a mild sedative if required to make this a painless procedure.
98% of patients are legal to drive themselves the next morning. You can start reading and watching TV immediately. Most patients recognise 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.
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.

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.

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.

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?

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.

Standard IOL
Toric Intraocular Lens
Multi Focal
Accommodative IOL
Monovision

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.

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.

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.

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.

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.

We prefer to perform surgery between 3 days to 3 weeks apart to allow for first eye to settle and ensure a good result.

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.

As Seen On

Make an EnquiryAttend an Event