Surgery on both eyes is sometimes performed where clinically appropriate (This is called Bilateral sequential surgery). Patients suitable for surgery on both eyes are usually non-complex “middle of the road” cases. At Centre for Sight to ensure maximal safety, each eye is treated independently with different batch numbers of devices and medicines for each eye, as well as instruments that have had different sterilisation cycles.

If both eyes are treated on the same day, for practical reasons the eyes are not patched and instead goggles on an elastic band are placed to protect the eyes. Patients are advised to go home and keep their eyes closed to allow them to settle for at least 4 hours. Eye drops are also commenced on the same day and patients must be seen in consultation the following day.

Yes, but it may restrict the range of lenses available to you. We will need more information to find the most suitable option for you before booking consultation.

Adaptation (Neuro-adaptation)

When one eye is treated at a time, patients often report the following day that their vision in the treated eye is not quite as good as expected. This is often the case in those who were previously farsighted and can find that distance vision is blurred. This happens because the eye muscles which are trying to focus in the untreated eye, result in the implant being pushed forward making the patient short-sighted. For those previously shortsighted, distance vision is reported as very good, however near is initially a struggle and with adaptation improves. The brain eventually picks up the information that it needs and vision improves. With trifocal lenses, we emphasise preoperatively that it is only when BOTH eyes are treated that patients get the benefit from the lenses with no comparative reference points. The eyes see similarly and vision improves rapidly each day.

Visual side effects

Initially halos around headlights interfere with the ability to drive comfortably affects 10% of patients, but improves in all patients with time. With adaptation, the brain is able to suppress unwanted information and patients report noticing a reduction in the size of the halos over the next 6 to 12 weeks, eventually disappearing or being just a nuisance. A few patients take longer to adapt (12 to 18 months). In the worst case scenario the implant can be replaced at a cost with a monofocal lens, which will have the consequence of reducing the depth of focus and result in the need for glasses.

Dry eye

We check for dry eye before surgery and this is treated if found to be significant. Those with marked tear surface abnormalities are not suitable for multifocal lenses. The abnormal surface can affect the performance of the lenses and cause fluctuation in vision. This condition can be treated in advance and once better, patients can be considered for multifocal lenses. Dry eye after lens replacement surgery can occur as a result of a) no longer wearing glasses or contact lenses and being exposed to the elements or more commonly b) toxicity from the eye drops which are at a high concentration in order to penetrate and enter the eye. Preservatives in drops are also a contributory factor. Dry eye symptoms and effects do improve a few weeks after the course of eye drops has been completed.

Reading and intermediate vision

Trifocal lenses distribute light energy to three points of focus. The majority (60% or more is for distance and the remainder for intermediate and near. Also, some trifocals have more energy concentrated near the centre of the lens, as pupils typically constrict when one reads. However, in dim light, the pupils can dilate and thus affect reading performance, so reading menus in a dimly lit restaurant might be problematic. Using a light to illuminate the object should help. The ability to see at intermediate (computer monitors) can in some patients take time (6 to 12 weeks) and again this is to do with adaptation. The brain adapts and uses the information that is being transmitted from the retina.

The procedure does not stop one from developing eye problems or increase the risk of eye problems. Glaucoma and age-related macular degeneration can still occur and for this reason it is important to be regularly monitored by an eye care practitioner such as a local Optometrist. It is best to continue a relationship with your current Optometrist and maintain continuity of care and also contact us at Centre for Sight if there are ever any concerns.

As in all forms of surgery problems can occur during the operation or afterwards during the period of healing afterwards. Problems following Lens Replacement Surgery are fortunately rare. Common problems are easily remedied by medication or even further surgery. Serious problems are thankfully even more rare but could potentially lead to loss of vision, which can be permanent (a reduction in vision when compared to before surgery that cannot be corrected with glasses or contact lenses).

At Centre for Sight, quality standards over and above the minimal requirement by the Royal College of Ophthalmologists are collected and reported each month, which include unexpected complications during surgery, returns to the operating theatre, infections and enhancements. We are pleased to report that we have complication rates that are significantly below the national average.

Loss of vision whereby vision even with glasses or contact lenses is below the standard required for driving can occur after any eye procedure and following Laser Lens Replacement Surgery is between 1 in 500 and 1 in 1000 nationally.

The cause of this type of problem could be infection or inflammation after surgery, retinal detachment after surgery or bleeding at the time or after surgery and also posterior capsule rupture, which is where the membrane of the lens could break during surgery.

The UK rate of rupture is 1.5 to 2.0%. At Centre for Sight our rate over the last 3 years has been less than 1 in 800 (0.125%). A posterior capsule rupture may affect the ability to implant a multifocal/trifocal lens implant.

Second operations, although come at a price, are sometimes needed and these include re-centring or repositioning a lens and these include re-centering or repositioning a lens (for instance a Toric lens used to correct astigmatism), top-up laser surgery (1% at Centre for Sight) to correct the refraction of the eye (shortsighted, farsighted or astigmatism). Those who are shortsighted are at higher risk of retinal detachments for the first few years following Laser Lens Replacement surgery. Detached retinas are fortunately repairable by expert retinal surgeons.

The most common procedure required following LRS and Cataract surgery is a YAG laser posterior capsulotomy, where the membrane holding the lens implant becomes cloudy and impairs vision. This occurs in 5-10% of patients and is easily treatable at a clinic appointment.

More on YAG capsulotomy

Laser vision correction

Laser eye surgery procedures include LASIK (Laser in situ Keratomileusis) or Transepithelial Photorefractive Keratectomy (PRK), work by changing the shape of the cornea and therefore do not involve a lens implant.

Phakic Intraocular Lenses

These are lens implants inserted into the eye without removal of the clear natural lens.

Both the above options are better for those under the age of 50, who still have clear lenses and good quality of vision with glasses or contact lenses. Both laser vision correction and Phakic intraocular lenses are able to reliably correct one point of focus and usually distance, which means those in their mid-forties might still need to wear reading glasses afterwards. There are options for extending depth of focus and providing the ability to read and include “Monovision” or “Blended Vision” and in the case of laser eye surgery “Supracor Lasik”.

Monovision

Monovision is a technique whereby the non-dominant eye is planned for near vision and the dominant eye for distance. This means both eyes do not see equally at distance and near, however with both eyes open a good depth of focus is achievable. This is not suitable for everyone and a contact lens trial using this scenario is advised prior to undergoing the procedure. Some may already be using this method with their contact lenses.

Supracor Lasik

This is a Lasik laser eye surgery procedure where the cornea is purposefully made to be multifocal. As there is a period of adjustment and adaptation, only the non-dominant eye is treated. More information on Supracor Lasik.

Usually one or two days. You may return to work as soon as you are comfortable. Make sure you are able to take your eye drops regularly as instructed by your surgeon.

When your vision is clear and you are comfortable. You must be able to read a number plate at 25 meters. Your doctor will advise you if you meet the visual standards for driving.

You may return to all sporting activity after TWO weeks. For contact sports, you are advised to use protective eye glasses. Polycarbonate sports glasses are recommended. For swimming, usually after 4 weeks.

There are no restrictions and you may return to general activities like housework, shopping and gardening the following day. You must keep away from smoky and dusty environments and do not forget to wash your hands before using your eye drops.

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• Sheraz Daya PEARLS FOR PREMIUM LENS SUCCESS How to achieve a high level of patient satisfaction following refractive cataract surgery, February 2022 Ophthalmology Management
  Natural Lens Replacement also known as Laser Lens Replacement and branded by some as Clarivu™ or NuVu is a process where the natural lens of the eye is replaced with a high performance lens implant to correct vision. Use of these lenses such as the Trifocal lens, provides patients with spectacle independence*.

*Note those who have Diabetes may not be suitable for permanent Trifocal lenses, however a there is an option now available for a trifocal easily removable piggy back lens Your consultant at Centre for Sight will discuss these options in more detail with you at consultation.