Cataract Surgery

Cataract surgery is indicated when the clouded lens significantly impairs vision, reducing it below the DVLA standard for safe driving. This criterion 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 minimize 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.

All procedures (except those under the One-Day Cataract Service) are performed using Lasers (Victus Femtosecond laser or CAPSULaser) – no compromise.

Also as a standard, extra measures are taken to optimise vision by performing “Refractive Laser Cataract Surgery.” The intention is to provide good unaided vision by making considerable efforts to accurately calculate lens power, correct astigmatism (using the laser or specially made lens implants) and where suitable use high performance trifocal lenses or multifocal lenses. The goal is to leave no refractive error – in other words no residual power which will require glasses for correction.

The use of a femtosecond laser in cataract surgery takes safety and precision of surgery to a completely new level. Victus Laser and CAPSULaser assists the surgeon in performing perfect, repeatable and reliable surgery. With this level of perfection, cataract surgery and Lens Replacement Surgery have become even safer and more reproducible. Combined with high performance intraocular lens implants, like trifocal lenses, those with cataracts can look forward to elimination of glasses altogether!*

To address long NHS waiting lists and serve the community, Centre for Sight launched a One-Stop Cataract Service. This service allows patients to receive necessary scans, confirm a cataract diagnosis with a consultant, and undergo surgery all on the same day, at an affordable price.

The private cataract surgery offered at Centre for Sight matches or exceeds NHS standards, with consultants handling evaluations and procedures. The basic One-Day treatment includes a high-quality *monofocal lens, similar to those used in most NHS procedures. Additional refractive options like multi-focal lenses, toric lenses for astigmatism, or laser techniques are not included.

*The monofocal lens provides one point of focus, usually set for distance, so patients will need glasses for near (40cm) and possibly intermediate (60 to 80cm) activities.

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 – an article called “Pearls For Premium Lens Success” written by our Medical Director Sheraz Daya and published in the February 2022 edition of  Ophthalmology Managaement, USA.

View Video

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 nighttime use. Start your eye drops as instructed. You may have a followup 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..

Cataract surgery complications are uncommon. Cataract surgery is among the most common and most successful surgical procedures performed today.

Potential cataract surgery complications include:

Posterior capsule opacity (PCO)
Intraocular lens dislocation
Eye inflammation
Light sensitivity
Photopsia (perceived flashes of light)
Macular oedema (swelling of the central retina)
Ptosis (droopy eyelid)
Ocular hypertension (elevated eye pressure)
Infection – very rare and prevented by injecting antibiotics in the eye at the conclusion of surgery
Retinal detachment
Vision loss
When cataract surgery complications do occur, most are minor and can be successfully treated medically or with additional surgery.

Cataract surgery previously performed by the steady hand of a cataract surgeon is now performed by the laser and reproducible from eye to eye:

Microscopic laser made Incisions in the eye (rather than scalpels)
A perfect circular opening in the cataract capsule
Fragmentation / destruction of the cataract
Incisions to correct astigmatism
To further enhance accuracy, online cross-sectional microscopic imaging (OCT scan), a bit like an online MRI scan is used and guides the surgeon during the 30 second procedure!

The world’s 3rd Victus laser was installed at Centre for Sight in April 2012. Centre for Sight is a reference site for the manufacturers of lasers for cataract surgery (Technolas Perfect Vision / Bausch and Lomb and CAPSULaser, Excellens). Visitors from the United States, Canada and Europe regularly visit the Centre to see 21st century cataract surgery in action and observe the unique manner in which the procedure is performed.

Surgeons at Centre for Sight devised an innovative method of lens removal using the Victus Femtosecond Laser demonstrating a statistically significant reduction in time taken to remove the cataract. Quicker removal is safer for the eye and causes less trauma and eye reaction.

The technique named by Sheraz Daya the inventor called “Translenticular Hydrodissection3” was presented at the European Society of Cataract Surgery, Milan 2012 and American Society of Cataract and Refractive Surgery (ASCRS), Chicago 2013 has received great acclaim by international surgeons.

The video demonstrating the technique won an “Oscar” at the ASCRS film festival in 2013. The technique requires use of a device invented at Centre for Sight and developed in collaboration with Bausch + Lomb. The “Daya Trans-Lens Hydrodissection Cannula” is now commercially available from Bausch and Lomb.

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.