Cataract Surgery with your Private Ophthalmologist

What is a cataract?

 

Cataract is the clouding of the clear lens inside the eye. The clouded lens that causes blurred vision which cannot be corrected with glasses, contact lenses or laser refractive procedures such as LASIK.

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It can sound scary but it a common condition associated with ageing. Cataract treatment is with an operation and is one of the most common performed operations and can help treat the cloudy vision and reduce your dependance on wearing glasses as well.

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It is one of the most effective and safest operations performed today by Ophthalmologists thanks to modern technology and appropriate training of surgeons. It is usually covered by your health insurance company but please check your policy to make sure.

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What can I expect after the surgery?

 

Before having the procedure, you will be advised about what to expect before, during and after your procedure to help you make an informed decision about whether or not to proceed.

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The surgeon then completes the cataract removal and implantation of the clear artificial lens by closing the incision in your eye (here a stitch may be needed but most commonly it can be closed without any stitches), and a protective shield is placed over the eye to keep it safe in the early stages of your recovery. As the cataract or natural lens can be yellow and brown in tone, patients often report seeing more vivid colours and blues after the procedure. 

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If you have any questions or concerns about the procedure, be sure to discuss them with your cataract surgeon before the operation.

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How painful is the surgery?

 

The cataract extraction typically is performed by Ophthalmologists like Mr Ahmad Aziz in prestigious London Hospitals with small incisions and there should be no pain.. It is on an outpatient basis which does not require an overnight stay in a hospital. It is performed in an operating room under sterile conditions to minimise the risk of infection. Most patient have the operation under local anesthesia and usually numbing eye drops but it can be done under general anesthesia if required. 

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Which lens is best for cataract surgery?

 

Today there are numerous many types of intraocular lenses to choose from for your cataract but not all lenses are suitable for all people. The selection of the correct intraocular lens depends on your specific needs and the outcome of the eye examination. In addition to intraocular lenses that correct short sightedness and long sightedness, there are lenses that perform astigmatism correction as well which are known as toric intraocular lenses.

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During the operation, the cloudy natural lens inside your eye is removed during the surgical procedure. Following its removal an artificial lens (called an intraocular lens, or abbreviated to IOL) in placed to restore clear vision.

Modern surgery is an outpatient procedure involves the use of a high-frequency ultrasound probe to break up the cloudy lens into smaller pieces, which are then gently removed from the eye leaving the lens capsule intact. You then have clearer vision through your new lens. It is for this reason why you cannot keep your cataract following the operation as the small particles are flushed out of the eye with fluid.

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Can I watch TV after the surgery?

 

You can watch TV and read straight after but you may find it blurry. You will find the vision improve over the following 1 week. After the eye has healed you ay find you still need to wear glasses particularly when it comes to reading.

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How many days rest is needed after the surgery?

 

The discomfort should start to settle within a few days. Most people are advised to take a week off work although some people particularly those who are self employed might take just a few days off. A full recovery varies from person to person but may take a few weeks right up to 4 or 6 weeks in most cases.

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Does cataract surgery give you 20 20 vision?

 

Prior to the operation, your ophthalmologist will perform a comprehensive examination for the eyes to check the overall health, evaluate whether there are reasons why you should not go ahead and identify any risk factors you might have. They will assess if there is any evidence of age-related macular degeneration or diabetic retinopathy which may also affect vision.

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A refraction or basic eye test also will be performed to accurately determine the amount of shortsightedness, longsightedness, and astigmatism you have prior to surgery. Additional measurements of your eyes will be taken to determine the curvature of your cornea (the front layer of the eye) and the length of your eye. These measurements are important to help your cataract surgeon select the correct intraocular lens and give you the best vision possible. The measurements are taken and equated to give a recommended lens power that gives the best estimate of the what the post operative refraction of the eye will be. If there are no other problems affecting vision, cataract extraction is likely to give 20 20 vision but this is not guaranteed.

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What are the disadvantages of the surgery?

 

You may have some mild refractive errors or astigmatism present after surgery which is common and this can be corrected with glasses. Double vision after the operation is rare.

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This procedure using high-frequency ultrasound, called phacoemulsification or "phaco," can be performed with smaller incisions than previous surgical techniques for cataract removal, which results in faster healing and reducing the risk of complications, such as a retinal detachment and vision loss. Returning to daily activities is now quicker than it was in the past with larger incision surgery.

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For some people they feel their eyeglasses are part of their identity and want to protect their eyes. They can still prefer wearing glasses after the procedure even if they have good vision.​

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If you choose to wear glasses after the operation, lenses with anti-reflective coating and photochromic lenses are highly recommended for the best vision, comfort and appearance. Ask your eye care professional for details and to demonstrate these lenses.

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Risks from the operation include a condition called posterior capsule opacification that can result in blurring of the vision but is relatively straight forward to treat. Other risks include ptosis (drooping of the eyelid), intraocular lens dislocation, sensitivity to light, inflammation in the eye, photopsia (perceived flashes of light), macular oedema (swelling of the central retina), and ocular hypertension which is an elevated pressure within the eye.

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Will I need reading glasses after surgery?

 

Having the operation will not mean that you no longer you need to see your optician. You will still need to see your optician routinely to ensure the health of the eye is maintained and that any other problems are picked up early. Unless you choose multifocal intra-ocular lenses, it's likely you will need prescription glasses for reading after the procedure to see near objects and read clearly. Even people who choose these multifocal intra-ocular lenses often have better vision with reading glasses for certain near tasks and seeing very small print.

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Should you wear your old glasses after the surgery?

 

There is no harm in wearing your old glasses after. Most likely however you will find that your prescription has changed and your old glasses won't be as effective as they previously were. Hopefully you will have clearer distance vision that will not require glasses if you have a new lens that is aimed for distance. You may require glasses for close up work.

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Which lens is better monofocal or multifocal?

 

A monofocal lens implant is most commonly used which still requires glasses to have the full range of vision. Often, only part-time use of reading glasses is needed after the insertion of monofocal intraocular lenses. If prescription eyeglasses are needed, your eye doctor typically will prescribe new glasses for you approximately two months later.

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​If you like the idea of being less dependent on glasses after the procedure for distance vision and reading vision, one way to correct presbyopia (the inability to focus on distance and near which happens in middle age) and reduce your need for reading glasses is to have your cataract surgeon adjust the power of one of your mono-focal IOLs (assuming you have the procedure performed in both eyes) to give you a mono-vision correction, similar to mono-vision with contact lenses. This is usually only recommended if you have had monovision before where one eye is adjusted for reading vision and one eye for distance vision. If you have not had mono-vision before then this is approached with caution and your doctor may recommend you trial mono-vision with contact lens first to see if you like it. Some people are unable to tolerate having one eye adjusted for near vision and the other for distance vision.

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Another option is to choose multifocal lenses to improve your reading vision and have glasses free distance vision.They are designed to provide a greater range of vision than conventional mono-focal intra-ocular lenses.

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Be aware that not everyone is a good candidate for lenses, part of their marketing is that they are termed premium intra-ocular lenses but this shouldn't make you feel that they are better; they just serve a different purpose depending on what your required outcome is. These lenses tend to be more expensive and will increase the out-of-pocket cost of your procedure.

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How long after surgery can I sleep on my side?

 

The procedure should not affect how you sleep. You will be required to wear a protective eye shield at night to avoid rubbing your eye whilst you sleep. You should avoid rubbing your eye during the day. For extra caution you might want to avoid sleeping on your side for the first 24 hours but usually it is fine so long as the eye shield is used at night.

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What should you not do after the operation?

 

During at least the first week of your recovery, it is essential that you avoid:

• Strenuous activity and heavy lifting.

• Bending, exercising and similar activities that might stress your eye while it is healing.

• Any activity that would expose your healing eye to dust, grime or other infection-causing contaminants.

• Keep your eye closed while showering or bathing. Also, avoid swimming or hot tubs for at least two weeks.

 

After 2-4 weeks you are able to resume normal activities. Your cataract surgeon may give you other instructions and recommendations for your recovery following cataract surgery, depending on your specific needs. If you have any questions at any time after the operation, speak to your cataract surgeon for advice.

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If you need both eyes treated, your surgeon may prefer that you wait one to three weeks between both eye procedures. This is so that your first eye has time to heal and you have good vision in that eye before the second eye is operated on.

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Are you lying down during the procedure?

 

The procedure is most commonly done under local anesthesia but sedation or general anesthesia are used if you are particularly nervous. You are lying down during the operation. For those that have difficulty laying flat some elevation of the operating bed can be done but it usually only a small amount.

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What happens if cataract is left untreated?

 

If a cloudy lens is left untreated it can result in even more blurred vision as it progresses with time. Sometimes changing your glasses can help keep the vision bt often it will not help as the cataract become advanced. It is recommended to have cataract surgery if your vision is blurred from it and it is affecting your quality of life.

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What is laser cataract surgery?

 

Femtosecond lasers — similar to the lasers used to create the corneal flap in LASIK refractive surgery — have been approved for use in cataract surgery.

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These lasers are used in a number of steps in cataract surgery, reducing the need for surgical blades and other hand-held tools but an incision still needs to be made to access the cataract just as in traditional cataract surgery:

1. Creating corneal incisions to allow the surgeon access to the lens

2. Removing the anterior capsule of the lens which is the front layer coating the cataract

3. Fragmenting the cloudy lens to break it into small pieces to be flushed out

4. Creating side corneal incisions to reduce astigmatism (when needed)​

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Laser cataract surgery is more accurately termed laser-assisted cataract surgery and due to the cost of the equipment significantly increases cataract surgery cost. It is not a laser procedure on its own but still requires surgery.

While studies have shown that lasers can improve accuracy during certain steps of cataract surgery, they may not necessarily improve cataract surgery safety, recovery time and visual outcomes in every case. Laser-assisted cataract surgery still creates an incision for the surgeon to access the cataract and cataract surgery cannot be performed with laser alone.

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How long does the operation take to do?

 

Routine cataract surgery takes about 20 minutes although your time in hospital will be considerable longer and typically half a day. This is because additional time is needed to prepare you for the operation, dilate the pupil and give any medication preoperatively that may be required. After the procedure you will be given instructions on how to care for your eye and when to re-attend or seek help before you leave to go home.

 

You must have someone drive you home after you leave the hospital; do not attempt to drive until your eye doctor confirms that you are safe to drive.

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You will be prescribed medicated eye drops to use several times each day for a few weeks. You also must wear your protective eye shield while sleeping or napping for about a week post operatively. 

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Also, many hospitals require someone to be with you overnight if you received sedation or general anaesthesia. Be sure to ask about this requirement prior to your cataract procedure so you are prepared on the day of the procedure.

While your eye heals, you might experience some eye redness and blurred vision during the first few days following the operation.

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