Cataract Surgery

Cataract surgery is one of the most common operations in Medicine. It is also one of the most successful operations.  In my 25 years of experience in eye surgery, I have performed more than 10,000 cataract operations with great success.

What are cataracts?

Our eyes are like a camera system. Lens in the eye is responsible for sharp focus of the image on the retina (film of the camera). When the lens of our eye becomes cloudy, we say that you have developed cataract. A cloudy lens interferes with light passing through to the retina, the light-sensing layer of cells at the back of the eye. Having a cataract can be compared to looking at the world through a foggy window. Cataract is an age related phenomena. Almost everyone will develop cataract although when it becomes significant differs in different individuals. Sometimes cataract can be caused by other conditions or can be seen in young individuals or even in babies.

When should I consider cataract surgery?

Not everyone with cataract needs cataract surgery. When this cloudiness of the lens starts to affect your daily activities and quality of life, cataract surgery should be considered.  Sometimes, your lens may be affecting the drain of the eye (angle) and may pose a threat to your vision, in that situation, cataract surgery may be recommended in early stage of cataract.

Cataract surgery by Phacoemulsification

Phacoemulsification (Phaco) is a surgical method used to remove a cataract. It is a relatively straightforward procedure that normally takes up to 20 to 45 minutes. It is usually carried out as day surgery under local anaesthetic, which means you are awake during the procedure and you can go home on the same day.

In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye. The probe breaks up the center of the lens. The fragments are suctioned from the eye at the same time. A small incision that often does not require sutures to close can be used, since the cataract is removed in tiny pieces. Most of the lens capsule is left behind and a foldable intraocular lens (IOL) is implanted permanently inside to help focus light onto the retina. Vision returns quickly and one can resume normal activities within a short period of time.

If you have cataracts in both eyes, this procedure will usually be carried out on separate occasions a few weeks apart. This gives the first eye time to heal and time for your vision to return.

Type & Choice of New Lens: Multifocal IOL (MFIols) vs. Standard IOL

On most occasions, we use single focus lens but there are options of newer multifocal lens nowadays. Standard lens is a single focus lens. You can choose to get main correction for distance (driving vision) or for intermediate vision or for near vision. We can choose slightly different power in your lens in two eyes and can provide a very good range of good clear vision.

If you want both distance and near vision correction, we have to discuss the option of multifocal lens.  There are mainly 3 types of MFIols. Diffractive MFIol / Sector Refractive MFIol and newer

Trifocal IOLs. If you speak to company of each of these-they will claim that there IOL is best. Perhaps Symphony IOL is the best option at present. In strict sense it is not a multifocal IOL. It gives extended range of vision but does not have any single point of focus. It has dual optics. They claim that there is no loss of contrast sensitivity. Halos or glare are similar to monofocal IOLs. It gives best intermediate vision. You are likely to require glasses for far distance and fine print reading but most of day to day living tasks you will be free from glasses. It is considered best for suspicious or anxious patient (not my terminology- but was used by so-called experts). As it gives increase depth of focus and good intermediate range vision-I will probably choose this MFIol over others. I shall also use this one because I use AMO lens and there is no difference in technique or surgery. It is a technis IOL which I have been using for more than 10 years. Calculations are done with IOL master-the instrument which we commonly use for lens calculations.

After the operation

You will normally be able to go home a few hours after having cataract surgery, although you will need to arrange for someone to collect you and take you home.

Take it easy for the first two or three days after the operation and make sure to use any eye drops you are given by the hospital. You can carry on with most of your normal activities after cataract surgery, although you will need to avoid touching your eye or getting anything in it (such as soap and water) for a few weeks.

You may read or watch TV almost straight away but your vision may be blurred. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract.

Please note that if you have another condition such as diabetes, glaucoma or age related macular degeneration, your quality of vision may still be limited after surgery.

What are the risks?

Cataract surgery is one of the most successful operations. Risk of surgical complications is less than 1% in my hands while I perform one the most challenging surgical cases.

Serious complications are much rarer. These include tearing of the lens capsule (the “pocket” that holds the lens in place)<1%; All or a bit of the cataract dropping into the back of the eye 1 in 200; inability to remove all of the cataract or insert a lens implant 1in 200; infection or bleeding in the eye3 in 1000.

Most complications that can potentially develop after cataract surgery can be treated with medication or further surgery, and don’t usually have a long-term impact on your vision. However, there is a very small risk (around 3 in 1,000) of permanent loss of sight in the treated eye as a direct result of the operation.

Tarun Sharma

Tarun Sharma is a consultant ophthalmic surgeon who carries out his NHS work at Worcestershire Acute NHS Trust since his appointment in 2007.