What is a Cataract?
Cataract describes a clouding of the natural lens of the eye thereby preventing light passing through to the retina. It comes with age but can develop earlier following trauma or in association with certain medical conditions such as diabetes or prolonged steroid medication. It is not, as is often thought, a “skin” over the front of the eye.
What are the Symptoms of a Cataract?
In the initial stages, cataract may cause very few symptoms, and indeed, because the progression can be very slow, on occasions, one may not be aware of the presence of cataracts even if they are quite advanced. They usually, however, cause symptoms such as blurred vision, difficulty reading, haloes around lights and dulling of colours. They may also cause a change in the focus of the eye resulting in the need to frequently change one’s glasses.
How is a Cataract Treated?
If a cataract is not causing any visual difficulties then no treatment is required. Sometimes a change in glasses may be all that is required. If, however, your vision is not sufficient for your needs, or you are finding you are having to change your spectacles too frequently, then you will need to consider surgery, the only definitive treatment for cataract. These days it is no longer a requirement that the cataract is “ripe” before undertaking surgery – we now operate at a much earlier stage, when the cataract is starting to affect your daily activities. This is because the benefits of surgery are now so much higher and the risks and drawbacks so fewer. The timing of surgery is an individual decision – the higher the visual demands eg if you are still driving or working, or have a hobby that requires sharp vision, the earlier surgery will be generally requested.
How is the Cataract Removed?
The cataract is removed by a technique called phacoemulsification. A small incision (less than 3mm) is made into the eye to allow insertion of a probe, that vibrating at a frequency of 30-40,000 times a second, generates high energy ultrasound waves which “emulsify” the cataract into tiny particles that are then aspirated from within the eye. The cataract is not removed by laser!
How is the Focus of the Eye Restored?
Years ago, in order to restore focus to the eye after cataract removal, the patient needed to wear very thick heavy glasses or a contact lens, neither of which were ideal, or without problems of their own. Today, however, a foldable intra-ocular lens (implant) is rolled up into a special syringe and literally injected into the eye through the original small wound, to then unfurl into position within the eye. The wound is small enough that no stitches are usually required for its closure.
What Anaesthetic is Required?
95% of cataract surgery is undertaken under local anaesthetic. Mr Hakin uses no-needle topical anaesthesia, whereby the eye is numbed by eye drops, and avoids the use of a painful injection, that patients in the past generally said was the worst part of the operation, and which can cause bruising and double vision. Most patients undergoing surgery under topical anaesthesia describe a little ache during the operation and comment that the procedure was much more comfortable than they had been expecting. Topical anaesthesia also has the advantage that it works almost immediately and the surgery is therefore over a lot quicker, usually in about 15 minutes. Cataract surgery under topical anaesthesia can be performed on virtually anyone, regardless of age or state of health (the oldest patient to date has been 106!). Of course if you should so wish, surgery under general anaesthesia is still an option.
What is the Aftercare?
Patients usually go home the same day. If a pad is applied after the operation, it is removed the next day, whereupon in most cases, the patient will notice an immediate improvement in vision, although it does usually take a week or two to settle completely. Most activities, including driving, can generally be resumed straight away although vigorous activities and swimming should be avoided for a while. Bending over or lifting objects after cataract surgery is no longer the problem it used to be. The eye may be a little irritable for a few days and drops will need to be instilled for a few weeks to reduce the risk of infection and to settle any inflammation.
Are There Any Risks?
Cataract extraction is a highly successful, safe and predictable operation. As with any operation, however, there are risks, such as haemorrhage and infection, which will be fully discussed at your initial consultation.
How Can Cataract Surgery Cure my Short or Long-sightedness?
The implants inserted after cataract removal are miniature lenses that are produced in a variety of optical strengths, just like spectacle or contact lenses. The dimensions of the eye are measured before surgery and are then used, employing a formula that has been refined over the years, to calculate the optical power of the implant to be used. Essentially, the power of your previous spectacles is incorporated into the implant power. In most cases, this will allow you to see well into the distance, drive and watch TV without the need for glasses, although glasses may help to sharpen the vision further.
If you have any significant astigmatism (where there is uneven curvature of the cornea) this may be also be corrected at the time of cataract extraction, thereby further reducing the need for spectacles.
Will I Still Need Reading Glasses?
Until recently, most patients had their vision improved with a monofocal IOL which can only focus at one point, usually at distance. Although the quality of their distance vision was excellent, most patients still needed reading glasses to see near objects.
A multifocal implant such as the Alcon ReSTOR, AMO Tecnis Multifocal, Topcon MPlus, however, provides a full range of focus and can therefore significantly reduce one’s dependence on any type of spectacles.
Do I Need to Have a Cataract to Have this Type of Surgery?
No you do not. If you are over 40 and are looking to reduce spectacle or contact lens dependence then you may wish to consider this procedure. Clear Lens Extraction (or Refractive Lensectomy) can be undertaken – it is essentially the same procedure as cataract extraction but is performed prior to cataract development. Particularly if there is evidence of early cataract formation, CLE is an worthwhile alternative to LASIK which employs a laser to alter the shape and therefore the focusing power of the cornea, and does not address the problem of cataract ie if present this will need to be removed in a separate procedure. Furthermore, CLE with subsequent insertion of a multifocal implant can, unlike LASIK, also correct presbyopia (the loss of ability to focus on a near target) and restore reading vision.
How Much Does It Cost?
The cost of the initial consultation is £150. The WELC at the Nuffield Taunton offer fixed-price all-inclusive packages, should you wish to proceed, from £2285 for cataract extraction with monofocal implant to £2585 for a multifocal implant (per eye).