Video tutorials of Cataract Surgery

Initial Consultation

Your optometrist will most commonly be the professional who initially diagnoses your cataract and performs the primary refractive and ocular assessment. They send this information to me with your initial referral. I therefore already have a significant amount of essential information at the initial consultation. On meeting you, we will discuss how your cataract is affecting your vision, your driving, your sports, hobbies, work and preferred activities. I then check your eye is healthy from front to back, specifically your cornea and retina to confirm that the cataract is the cause of your reduced vision. With an otherwise healthy eye, you have a 99% chance of the cataract surgery giving you excellent vision.

Biometry

Biometry is the name given to the set of measurements taken on your eye that allow us to know the correct size and power replacement lens to insert into your eye once the cataract is removed. These measurements will also reveal any corneal astigmatism that may have been hidden by your cataract. I also like to have a pre-operative check of your retinal health with an OCT (optical coherence topography). This is sometimes already taken at your optometrist.

Intraocular Replacment Lens Choice

Modern refractive cataract surgery has developed rapidly over the last decade. The aim is no longer simply to remove your cataract, but to restore the best possible range of vision to suit your needs. The number of options can be a little bewildering and the premium lenses cost extra, so when and which are worth having?

At your consultation I will go into the options with you at length and in detail. The choice is based on your current vision, your current use of spectacles or contact lenses, your future preferred use of spectacles or contact lenses, your preferred sports and activities, your ocular health and your need to drive at night.

The lens categories have been divided into "Standard" and "Premium". This suggests that the "Premium" lenses are automatically better. This is not always the case. The "Standard" lens is a state of the art modern aspheric monofocal foldable implant that gives an excellent fixed point of focus. It is perfect for patients who feel naked without their spectacles, and wish to continue to wear them after surgery, for patients who have retinal or corneal problems, and for patient who are happy to need to wear glasses for either reading or driving. This is the type of lens used by the NHS and with excellent results.

The "Premium" lenses are divided into "Toric", "Extended Depth of Field" and "Multifocal". Extended depth of field and multifocal lenses can also have a toric correction.

If you have corneal astigmatism this can be corrected by a "Toric" lens. There is no risk to using this type of lens, it simply reduces your astigmatism and therefore improves your vision without a need for spectacles. I recommend a toric lens for anyone with over 1 dioptre of corneal astigmatism.

"Multifocal" lenses can give the largest range of vision without glasses to allow you to both drive and read, but are all associated with reduced contrast sensitivity and glare. This can affect your ability to drive at night. In my opinion their use is quite specialised, can need a laser touch up to work and are best given by clinics that specialise in laser surgery.

"Extended Depth of Field" lenses increase the range of clear vision and reduce your need for reading glasses. The aim is for you to be able to drive to a restaurant and read the menu without glasses. They are less powerful overall than multifocal lenses, so you will still typically need glasses to read in bed for example, but this is offset by the improved night driving and lack of glare.

I will take time to go through these options with you to ensure that the lens choice is bespoke for your eyes and your activities.

Anaesthetic Choice

I offer a full choice of anaesthetic techniques and options. The anaesthetic should be best suited to your needs, desires and general health.
The vast majority of patients choose a "no needle" painless local anaesthetic technique known as "topical with intracameral". In this technique the surface of the eye is numbed with drops to allow the initial incision through the cornea, after which the inside of the eye is made numb with additional anaesthetic through a cannula.
If additional local anaesthetic is required, this can be added via a "subtenons" technique. A small cut is made in the conjunctiva and local anaesthetic delivered by a cannula to pass behind the eyeball.
Some patients are aware that they would prefer to be sedated to allow the local anaesthetic technique, very mild sedation is possible by simply taking a sleeping tablet in advance of the surgery, full sedation involves an anaesthetist.
Some patients hate the idea of being awake and prefer a full general anaesthetic. This involves an anaesthetic assessment and booking an anaesthetist on the day.

I will be able to assess your suitability for local anaesthetic but ultimately the choice is yours. If an anaesthetist is required for either sedation or general anaesthetic there is an additional charge for their services.

Surgery

The day of surgery commonly causes some anxiety. This is completely normal. I think all patients remain nervous up to the moment that they realise they are not going to experience any pain. As a hospital visit it should be easy. On arrival you are booked in with standard paperwork, and either drops or a pellet applied to your eye to dilate your pupil. I will see you to check you're ready to go and confirm I have your consent. You wear your own clothes and take any required medication as normal. If you have local anaesthetic you eat all meals as normal. In the operating theatre we take time to lie you flat, ensuring your head, neck and back are as comfortable as possible. The eye is anaesthetised, cleaned and draped and the bright microscope light moves into place. You will feel my hands on your forehead and cheek, the pressure of a clip on your eyelids and the dazzle of the light, but there will be no pain.
The surgery typically takes 10 minutes and is quite psychedelic with lights and patterns. At the end of the surgery I tape a plastic shield over your eye and this remains in place until the following morning. Your are taken back to the ward for a welcome cup of tea or coffee and then home. The whole visit should be less than half a day.

Recovery

The recovery should be fast. The next morning your vision is often a little misty, the eye can be dry and gritty, but by lunchtime your vision should be significantly restored. You will have drops to apply to your eye. These are typically 4 times a day, but if your eye is sore or the vision slow to recover, I recommend applying the drops hourly for the first day or two, until the vision improves. You will have my mobile phone number. Please call me if at any point you have concerns.

Contact me urgently if you notice:
Increased pain
Rapid loss of vision
Increased redness or discharge
Flashes of light, floaters or a curtain across your vision.

I recommend that you wear your shield at night for the first week.

Using eye drops can be difficult at first. For a full set of videos showing all the different techniques for drop application please visit:

www.myeyedrops.info

Frequently Asked Questions

Can I shower and bath? You can most certainly shower and bath, but be careful not to rub or press on your eye, and do not go underwater in the bath.

Can I swim? Not for 2 weeks, and ideally do not go underwater for a full month.

Can I exercise? Yes, but try to avoid strenuous activity such as heavy lifting. You can bend down however, for example to tie shoe laces.

Can I drive? The legal limits for driving are the ability to read a number plate at 25 yards, with good health and an unimpaired visual field. As soon as you reach these limits you can drive. For some patients this may be day 1, but for others it may not be until you pick up your new glasses at 4 weeks.

Do I need time off work? Under most circumstances you would be able to return to work almost immediately, but it would be safe to book a week off in case it took your vision longer to recover.

Can I wear my old glasses? Under most circumstances your old glasses will now have the wrong prescription for the operated eye, but still the correct prescription for the other eye. You can wear them if they are comfortable, but may find you are more comfortable without your old glasses.

When can I see my optician for new glasses? You need to wait for 4 weeks to allow your eye to settle fully before measuring for new glasses. In the meantime if you are having difficulty reading you may choose to use a pair of the cheap "ready readers" for the first few weeks.

If my eye drops run out do I need to get more? Yes please. You can contact your GP, your surgeon or the hospital to pick up some more drops. If you stop the drops too soon you can have a rebound inflammation and the eye can become red and sore.