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Cataract Surgery: The procedure

Cataract Surgery: The procedure

Cataract surgery is the most frequently performed operation in the United Kingdom, with more than 300,000 procedures performed in the NHS, plus a large number in the private sector.

Cataract surgery is very effective in restoring vision. Most patients undergoing the procedure return to having very good vision.

When symptoms of cataract begin to appear, you may be able to help your vision for a period by using new (stronger or even weaker) glasses, magnifying glasses for certain tasks, better lighting or other aids to improve vision.

The time for surgery is when cataracts have advanced sufficiently to significantly impair your eyesight and negatively affect your daily life.

Poor vision is not an inevitable part of getting older. Cataracts are the most common cause of reversible vision loss in the UK, and cataract surgery is a simple procedure to regain vision. Surgery is usually a walk-in, walk-out day case procedure carried out under local anaesthetic.

Overview of cataract surgery

During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).

Cataract surgery involves removing the cloudy lens through a small incision in your eye and replacing it with a clear, plastic one. In most cases, the procedure is carried out under local anaesthetic (where you’re conscious, but the eye is numbed) and you can usually go home the same day.

Almost everyone who has cataract surgery experiences an improvement in their vision, although it can sometimes take a few days or weeks for your vision to settle. You should be able to return to most of your normal activities within about two weeks.

After the operation, your plastic lens will be set up for a certain level of vision, so you may need to wear glasses to see objects that are either far away or close by. If you wore glasses previously, your prescription will probably change. However, your optician will need to wait until your vision has settled before they can give you a new prescription.

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Cataract Surgery steps -

Removal of the natural lens

The first step after anaesthetising the eye is to remove the cloudy cataract lens from behind the iris. Tiny keyhole entrance points are made at the edge of the cornea to allow access to inside the front part of the eye, either surgically using a miniature diamond blade or with a femtosecond laser.

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The lens is contained within a clear fibrous bag known as the capsule, which will remain even after the lens contents have been removed from within it. To access the lens material, a small round opening approximately 5-6 mm in diameter must be made in the top of the bag, called a capsulotomy.

The capsulotomy can be performed using a special instrument by a skilled surgeon, or with a femtosecond laser.

A special ultrasound-based device called a phacoemulsification tip is inserted through the keyhole opening at the edge of the cornea, and through the capsulotomy. The ultrasound tip dissolves the lens fibres and simultaneously sucks them up the central tube within the tip.

The cataract surgeon continues aspirating the lens material from all parts of the bag. It is important to ensure no lens cortex remains as this can lead to inflammation after surgery.

Inserting the new IOL implant

Once all the lens material has been removed, the clear opened capsular bag will remain in place, still suspended from the encircling doughnut-shaped ciliary muscle by fine fibres. The empty bag will be the new home for an artificial plastic intraocular lens (IOL).

Modern lenses are flexible allowing them to be folded and inserted via a lens injector, through a very small keyhole opening in the eye. Older lens implants were rigid and required a much longer incision, which would have required several stitches to close.

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The benefit of keyhole cataract surgery is much more rapid healing, less induced astigmatism post-operatively (so better vision) and, because keyhole ports are self-sealing, no need for any sutures.

There are a variety of lens types that can be implanted. The choice of IOL used depends on whether surgery takes place in the National Health Service (UK NHS), where only standard monofocal lenses are available, or in a private setting where the patient can opt for for advanced premium lenses.

Premium lenses offer the advantage of improving vision at more than one range, so helping to restore reading and computer range vision, as well as distance sight. Toric lenses are also available which are designed to correct astigmatism as well as and short- or long-sighted prescription.

Newer lens designs are in development that could improve functional vision even further. These so-called accommodating lenses will mimic the natural function of the lens, which is a continuous adjustable ‘zoom’ allowing clear vision at most distances, and without compromise of splitting light between various ranges.

Positioning the new lens implant

Once all the lens has been injected into the capsular bag, the surgeon will manipulate and rotate the IOL so that it is seated in the correct position. This will ensure the best possible vision after cataract surgery is complete.

This stage is also very important for premium and toric lenses, where position and angle of the lens is vital.

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Antibiotics are injected into the fluid in front of the iris, which is highly effective at protecting against bacterial infection after surgery.

Surgery is usually completed in 10-15 minutes per eye.

No sutures are needed as the keyhole entrance ports are self-sealing, removing the need to have stitches taken out at a subsequent post-operative clinic visit.

Cataract Surgery Summary

If your cataracts are still early or giving minimal symptoms, stronger glasses and better illumination when reading can help. However, as cataracts steadily progress over time, which may be months or years, it is expected that eventually you will need surgical treatment.

Surgery is the definitive of treatment for cataract, and to date is the only proven solution. The timing of surgery is based upon the degree of loss of vision and how much effect that has on your daily life and activities.

The introduction of premium multifocal intraocular lenses (MIOLs) has been a major development in helping patients to get a greater range of vision after lens replacement surgery, improving both reading and distance vision.

New technology such as femtosecond laser assisted cataract surgery (FLACS) could help make the surgery less complicated for surgeons and reduce the potential risks of the procedure. Even with laser-assisted procedure, choosing an expert surgeon is still the most important step in your journey to live without cataracts.

Contact Focus Clinic on 0207 307 8250 and we will be happy to discuss your treatment options and arrange an appointment to meet your surgeon.

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Mr Samer Hamada
laser and lens eye surgery specialist
 Samar Hamada