Your Guide to Cataract Surgery at Centre for Sight
Cataract surgery is one of the most common and effective procedures in ophthalmology, but how do you know if it’s the right option for you?
What is a Cataract?
A cataract is an eye condition where the focusing lens in the eye becomes cloudy and interferes with vision. With increasing age, the lens begins to harden, causing problems for seeing near (presbyopia), and eventually becomes cloudy blurring vision. While early changes may be corrected with glasses, the developing cataract eventually affects the ability to function normally, and cataract surgery is ultimately required to restore vision.
Cataract surgery is indicated when the clouded lens significantly impairs vision, reducing it below the DVLA standard for safe driving. This criteria is used by the NHS and accepted by insurance companies for coverage. While early cataracts can affect visual quality, surgery for these cases, not deemed “medically necessary,” is termed Laser Lens Replacement. This procedure is often chosen by individuals seeking vision correction to minimise or eliminate the need for glasses.
Candidates for this surgery must be in good health and able to lie flat for approximately 20 minutes.
This procedure is performed in many who wish to have vision correction surgery and eliminate or reduce the need for glasses.
Your Surgery Options
Laser Cataract Surgery
One-Stop Cataract Surgery
Overview of Lenses for Cataract Surgery
Our expert consultants will recommend the most suitable lens for your visual requirements and lifestyle.
At Centre for Sight, this advanced lens is the most popular choice for achieving full vision correction, used by over 90% of patients undergoing lens surgery since 2011. These lenses provide clear vision at all distances—near, intermediate, and far—often eliminating or significantly reducing the need for glasses.
During your consultation, your suitability for this lens will be carefully assessed through detailed tests, including an evaluation of your cornea and tear film. For optimal results, the cornea must have good optical quality, and the eye surface should be free of dryness or irregularities.
It’s important to understand the concept of adaptation, where your brain learns to adjust to the lens’s sophisticated optical system. The lens uses microscopic rings to provide a full range of focus, which may cause temporary halos around lights. However, these typically fade as your brain adapts, and your vision continues to improve over time.
For those who have already had lens replacement / exchange or cataract surgery and were not lucky enough to have a trifocal lens, there is an option of adding in a trifocal lens implant on top of the existing lens. This is also available at primary cataract surgery. For instance if someone has Glaucoma or macular degeneration, they may in time have a problem with the presence of a trifocal implant and may require removal. As an add-on lens placed on top of a monofocal, the lens can easily be removed from the eye. It is however reassuring that multifocal lenses have been in use at Centre for Sight since 2002 and to date no lenses have required removal for glaucoma or macular degeneration.
In those who have a significant amount of astigmatism, trifocal lenses with inbuilt astigmatism can be used to correct vision at all distances (Full range of Focus). These multifocal / trifocal lenses are specially ordered based on specific measures taken at consultation. In terms of performance, these are otherwise identical to Trifocal lenses discussed above. About 30% of patients at Centre for Sight require toric lenses.
This type of lens referred by some as an EDOF (Extended Depth of Focus) lens is one that reliably provides distance and intermediate vision. To improve the range of focus further, the non-dominant eye is adjusted so that this becomes very slightly short-sighted, and this provides most patients with near vision. The lens is considered in those who are unsuitable for Trifocals (a full range of focus lens). The type of IROF lens used at Centre for Sight has some advantages in that there are no significant halos, however some like with the trifocals still require a period of adaptation to obtain optimum use of the lenses.
The single focus lens is used in conventional cataract surgery for instance in the NHS and vision is often geared for distance only which means recipients will in all probability require glasses for intermediate and near vision. Monovision is where the lens power can be adjusted to provide near vision in one eye (usually the non-dominant eye) and distance correction in the dominant eye. This provides good depth of focus between the two eyes and is very useful. For many the disparity between the two eyes is a nuisance and not everyone is able to get used to this option of Monovision sometimes also called Blended Vision.
This is a lens that has astigmatism built in to the implant and used in those with astigmatism on their cornea of 1.25D and above.
For individuals with milder astigmatism, Centre for Sight offers laser-created limbal relaxing incisions during lens replacement surgery to achieve precise correction. Toric lenses are custom-made to match the unique needs of each eye, so they may take a little longer to prepare.
This may increase the lead time for surgery. Toric lenses are available in combination with both Monofocal and Trifocal lenses.
The Consultation & Procedure
The purpose of the consultation performed by a consultant ophthalmologist is to carry out a thorough evaluation of your eye(s) to ensure that cataract is the sole cause of reduced vision and that there are no other underlying problems like for instance Diabetic retinopathy, Glaucoma or Age Related Macular Degeneration AMD. At the same time, measurements and investigations are performed to determine whether a high performance lens is an option and if there is any astigmatism that needs to be corrected.
If you wear contact lenses, you will be asked to remove and not wear them for a period time leading up to your consultation. This is to enable us to accurately determine lens power.
Find out why Centre for Sight performs so many tests prior to laser lens / cataract surgery by reading our article “Pearls For Premium Lens Success“.
Usually, one eye is treated at a time although increasingly cataract surgery is being performed in both eyes on the same day. Modern cataract surgery is performed as a Day Case operation and while the procedure only takes 15 minutes, prepare to spend 2 to 3 hours at the Centre. You will be instructed when to arrive at the centre.
On arrival
A series of checks will be conducted and further investigations may be required to ensure absolute accuracy of the treatment plan. Your consent form will be checked.
Preparing for surgery
- You will then receive dilating drops to expand your pupil so that the surgeon can have access to your cataract.
- The Surgeon may need to mark your eye before the actual procedure to ensure accurate placement of laser astigmatic limbal relaxing incision or a toric IOL (astigmatic lens).
- You will receive strong anaesthetic and antibiotic drops.
- You may have a small IV cannula placed so that the anaesthetist can give you intravenous sedation or you may receive an oral sedative.
- Be wheeled into the theatre and then have to lie on the bed of the laser. More drops will be instilled and the surgeon will perform a series of pre-operative “flight checks” with the operating team.
You will feel a little pressure of the suction ring that connects to the laser.
You must hold still during this process where an online scan checks a series of measurements in your eye and determines where the laser treatment takes place. A beeping sound indicates the laser in action. The laser will create a perfectly circular opening in your lens, break the lens up into small fragments and if necessary create incisions to correct your astigmatism.
Once the laser treatment is complete, the consultant eye doctor /surgeon will continue to remove the fragmented cataract with fine instruments in a process known as phacoemulsification and implant an intraocular lens. You will probably see a series of colours and flashing lights – enjoy the show!
After the surgery
Once IOL implantation is complete and the procedure comes to an end, the Surgeon will inject antibiotic medication into the eye and ensure the eye is well sealed. The eye will be patched with an eye shield placed on your eye. This will be removed the next day. Cataract surgery recovery is very rapid and most patients notice a remarkable improvement in vision as soon as the patch is removed.
After the procedure, you will have time to recover and enjoy some refreshments. You will receive a toiletry bag with medications and instructions for usage. Afterward, you may go home and are advised to rest for the remainder of the day.
The next day, remove your shield and patch, keeping the shield for possible night time use. Start your eye drops as instructed. You may have a follow-up appointment scheduled that day, or if not someone from Centre for Sight will contact you to check your progress.
If you have surgery to both eyes on the same day, you will not have eye patches (as this will really be debilitating). Instead, you will have elasticated eye goggles and will need to start your drop regimen the same day. To ensure rapid recovery and reduce the risk of infection you must keep both eyes closed as much as possible on the day of the procedure.
Visual recovery is often very rapid with patients obtaining excellent vision the day following cataract surgery. Sometimes vision is blurred for one or two days and this might be the case if the cataract was particularly hard. If you have had a high performance lens like a trifocal lens implant, then you will find that you will also be able to read. If you have had a monofocal lens, then you might need to get a temporary pair of off the shelf reading glasses to help during the period of recovery (usually 4 weeks) before you see your optometrist.
Some patients may develop a secondary cataract or cloudiness of the membrane holding the intraocular lens implant, either in the following months or years after surgery. This condition is easily treated with a YAG laser capsulotomy during an outpatient visit..
FAQs
Most cataracts develop slowly over time and affect people over age 50. About half of the U.K. population has a cataract by age 65, and nearly everyone over age 75 has at least a mild cataract in one or both eyes.
In rare cases, infants can have congenital cataracts. These usually are related to the mother having German measles, chickenpox, or another infectious disease during pregnancy; but sometimes they are inherited.
Today rarely does anyone have to wear thick, heavy eyeglasses after cataract surgery these days. Most modern cataract procedures replace your eye’s natural lens with an intraocular lens (IOL) that often can correct your distance vision to 20/20 without glasses or contact lenses. At Centre for Sight, we aim to correct vision without glasses at the time of cataract surgery – so called “Refractive Cataract Surgery “which involves the use of high performance Trifocal lenses.
As with any surgery, pain, infection, swelling and bleeding are possible, but very few people experience serious cataract surgery complications. In most cases, complications or side effects from the procedure can be successfully managed with medication or a follow-up procedure.
To reduce your risk for problems after cataract surgery, be sure to follow the instructions your surgeon gives you and report any unusual symptoms immediately.
Because a cataract is a clouding or “opacification” of the natural lens, and cataract surgery entails removal of the natural lens, a cataract cannot come back after surgery. What can happen in about 5% of patients is clouding of the membrane holding the lens implant. If this were to occur then a simple YAG laser capsulotomy could be used to make an opening in the lens capsule.
In patients who have glaucoma and are on eye drops, there is an option available that reduces or in many cases eliminates the need for glaucoma eye drops and tablets. Microscopic Incisional Glaucoma Surgery ( MIGS ) involves a microscopic stent which can be inserted at a specific location inside the eye at the time of cataract surgery. While this is more costly (the stent is a very sophisticated microscopic device), it is a great option for those who wish to reduce the number of eye drops or stop them altogether. Combining Cataract and MIGS surgery also enables safe use of Trifocal lenses where there is less concern about progression of glaucoma.