The decision to undergo private cataract surgery offers a once-in-a-lifetime opportunity to correct common vision problems, including short-sight, long-sight, presbyopia and astigmatism, to reduce your dependence on glasses or contact lenses permanently.
Cataract surgery involves the removal of the cloudy natural lens of the eye (the cataract) and replacing it with a carefully selected intra-ocular lens (IOL). There are several designs of intra-ocular lenses (IOLs) available, each having their own strengths in performance. The choice of lens has a major influence on the outcome of surgery and whether glasses would be required after surgery. Whilst the NHS offers an excellent service for cataract surgery, there is rarely an option for choosing your intraocular lens, meaning that glasses will almost certainly be required after surgery.
Rakesh has performed many thousands of cataract procedures, particularly for patients with high spectacle corrections, complex cataracts and following other types of refractive surgery. He teaches cataract surgery to doctors from the UK and internationally and has an exceptionally low complication rate.
Today, thanks to advances in technology, most patients experience little or no pain and return to their normal activities the day after surgery.
What is the lens?
The lens is the part of the eye that helps focus light on the retina (just like the lens in a camera). The lens is made of a clear, jelly-like substance. The retina is the eye’s light-sensitive layer that transmits visual signals to the brain (like the photographic film in a camera), to help produce a sharp image; the lens must remain clear and flexible.
What is a cataract?
A cataract is a clouding or frosting of the normally transparent lens of the eye, located behind the iris.
As the lens becomes more opaque, it prevents light rays from passing through the lens and focusing on the retina. The effect is similar to looking through a frosted glass window. Contrary to popular belief, a cataract is not a skin that grows over your eye.
Although cataracts usually develop as part of the ageing process, they can also result from eye injuries, certain diseases such as diabetes, medications such as steroids, or genetic inheritance.
What are the symptoms of an eye with a cataract?
One of the earliest signs of a cataract may be a changing prescription. Early lens changes or opacities may not disturb vision, but as the lens continues to become more cloudy, symptoms including blurred vision, sensitivity to light and glare, increased nearsightedness or distorted images in may develop.
Cataracts are extremely common. It is estimated that approximately 70% of people in the UK aged over 65 years of age have cataracts.
Aside from surgery, there are alternative treatments such as medications that can reverse the effects of a cataract.
When does a cataract require treatment?
With modern surgical techniques it is possible to operate on a cataract at a relatively early stage, contrary to the misconception of the cataract needing to be mature or ‘ripe’. There is no specific level of vision at which cataract surgery is indicated, but it is usually recommended if the quality of your vision is reduced such that is affecting your lifestyle. Surgery is also indicated if you wish to drive and your vision no longer meets the necessary DVLA legal standard.
Accurate measurements of the eye taken prior to surgery allow an IOL to be implanted which can correct for long or short sightedness and astigmatism so that as well as clear vision, vision can be optimized without the need to wear spectacles for normal distance vision.
Prior to the development of cataract, surgery to replace the lens can be employed to improve the vision by implanting an IOL, which can correct a high spectacle prescription; this procedure is known as RLE.
To improve the range of vision and depth of focus, multifocal lens implants can be used to reduce the requirement for reading spectacles as well as provide clear vision for distance visual tasks e.g. driving or watching the television. Although spectacles may still be required for some visual tasks, many patients rarely require spectacles after this form of surgery.
On the day of surgery and once in the hospital you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed. The operation is usually performed under a local or topical anesthetic, is painless and lasts less than 10 minutes in most cases. The technology used is called phaco-emulsification and employs ultrasound energy to liquefy the lens which can then be aspirated. A new lens is then inserted using an injection system and is unfolded and positioned within the eye. We typically do not use stitches during surgery which allows for a faster recovery.
You will need to allow 3-4 hours for your hospital stay so that we can run through your treatment and aftercare with you. You will need someone to collect you or we can arrange transport for you.
After the operation you will rest for a while and have refreshments then you can go home. You will be given a dressing pack to swab the eye clean the following day, some antibiotics and anti-inflammatory eye drops to apply at home after the surgery.
Timing of sequential cataract surgery
Surgery will normally take place with an interval of one week or less between each cataract surgery procedure.
How quickly will my vision be restored?
Your vision will be slightly blurred for a few days while your eye heals. It is not uncommon to feel some discomfort, usually a feeling that something is in the eye until your eye settles but there should be no pain. After a couple of days you will start to notice a significant improvement in your vision. You can quickly return to many everyday activities, although heavy lifting or other strenuous activities should be avoided for a week. 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. Ask your surgeon or optometrist when you can resume driving. You will see the surgeon again after 2 weeks and will visit your optometrist for new glasses if needed after 6 weeks.
Once you have been given your new glasses, you may notice that everything seems a lot brighter than you remember. Colours may be sharper and may have a blue-ish tinge. In bright sunlight you may feel you are looking through rose-coloured glasses. These colour tinges are normal and are because you are now looking at the world through a clear lens that is no longer cloudy. Within a few months your brain will get used to your new clear vision and these colours should go away.
Lasers can now be used to complete some stages of cataract surgery with extra precision. This includes the entry incisions, capsulorhexis and softening or fragmenting the nucleus. These lasers use very short pulses (femtosecond) of energy, which create tiny gas bubbles and employ the same principles that we have been using in LASIK for some years.
Rakesh introduced the Ziemer Z8 FSL to the UK and performed the first treatment in the UK using this system.
How long will the implanted IOL last?
The IOL implants are usually left in place for life, they are biologically inert and are made from acrylic polymers.
Lens implant choice
A lens implant is an artificial lens that is precisely manufactured and engineered. They come in a range of styles and strengths, and a key part of the consultation with Rakesh is deciding which type of lens would be the best to suit the requirements of the patient.
Lens technology has come along way since they were first conceived in the late 50’s. There are now lenses that can correct very high spectacle error, including astigmatism.
There are four main types:
These are the most commonly implanted lenses. Mr Jayaswal uses aspheric lenses, which are designed to give the best quality vision. These would be suitable for patients who are happy wearing reading glasses, although often it is possible to offset the focus in one eye to allow ‘blended’ vision. By varying the focal distance between each eye, improved depth of focus can often be achieved to minimize spectacle dependence after surgery. This can work well, especially if this has already been experienced with contact lenses.
Toric lens implants
These lenses are designed to correct astigmatic errors within the eye and thereby minimize dependence upon spectacles after surgery. Toric lenses can be obtained in single focus, multifocal and trifocal lens styles.
Accomodative lens implants
These lenses are designed to mimic the ability of the eye to accommodate prior to presbyopia by using a movable lens. These lenses often obtain excellent distance and intermediate vision. Reading vision is dependent on several factors but it is not uncommon to require reading glasses after surgery.
The benefits of these lenses are that they avoid the potential side effects of a multifocal lens but give an extended range of vision and therefore reduce dependence upon spectacles after surgery.
Multifocal lens implants
These lenses are designed to maximize the range of vision by providing multiple focal points at distance, intermediate and near vision. They are an excellent choice for motivated patients wishing to minimize dependence upon spectacles after surgery.
They are generally very successful, but there is a degree of compromise. Some patients will notice a degree of glare and haloes around lights, especially at night, due to light scatter. Although this is generally not too bothersome, a small minority of patients may find it troublesome. These effects often improve with time.
If patients do not tolerate these symptoms and rarely the lenses require removal and replacement with a monofocal lens (<0.5% of patients).
Approximately 3% of patients may require a minor adjustment with LASEK to enhance clarity of focus after surgery and obtain the best potential vision.
Click the headings below to find out more about the types of multifocal lens implants that Rakesh Jayaswal offers:
The LENTIS Comfort intraocular Oculentis offers an innovative lens concept which meets the high refractive outcome demands of patients undergoing cataract treatment.
Although a standard IOL treats cataracts to a satisfactory level, they do not satisfy the desire for increased spectacle independence when using screens and digital devices.”Normal” reading glasses are usually aligned to about 40 cm however this is not the ideal viewing distance for screen which are about 60-80 cm. This means that despite cataract surgery, patients still have to rely on special and expensive lenses for the intermediate range. The special design of LENTIS Comfort is optimized for long-distance and intermediate range and provides very good results. This will give cataract patients more spectacle independence in everyday situations, such as computer work, while shopping or while driving.
The trifocal lens provides the wearer with excellent vision not only for near and far, but also for intermediate distances from approx. 45 cm to 80 cm.
In principle, trifocal lenses are constructed and manufactured in the same way as bifocal lenses. However, they consist not only of a main lens and a segment, but also of an additional intermediate portion. The addition in this intermediate portion is approximately half that of the near portion.
The TECNIS® Symfony Extended Range of Vision IOL delivers a continuous, full range of high-quality vision with incidence of halos and glare comparable to a monofocal IOL. This technology provides patients with distance, intermediate and near vision and is available in both a Non-Toric version and a Toric version for patients with astigmatism.
Mimicking the natural crystalline lens, WIOL-CF® is designed to deliver premium visual quality at all distances. It provides a full range of vision: near, far and intermediate, with exceptional visual acuity through extended depth of focus. Thanks to the high contrast sensitivity, this capability remains also in low light conditions.