Cataract surgery: Consultant Ophthalmologist Mr Ian Subak-Sharpe answers your Cataract FAQs

Mr Subak-Sharpe, Consultant Ophthalmologist
The Holly Clinics: Monday AM & PM and Wednesday PM. 

What exactly is a cataract?
A cataract is clouding of the human lens inside of the eye which interferes with vision. It is a near universal consequence of ageing so that many people over 60 will have been told by their optician that they have or are starting to get cataract but it can also occur in much younger patients as a result of trauma, family history and diseases such as diabetes.

What are the symptoms of cataract?
The most common symptom of cataract is a reduction in vision that the patient’s optician cannot overcome by changing the glasses. Many patients also experience glare which makes their vision much poorer in bright light or at night time for driving.

When should I have my cataract removed and why?
There used to be an idea that cataracts needed to “ripen” before they could be operated on but today the key question for patients should be:

1. Is the cataract reducing my vision or causing me glare? and
2. Do I want to have surgery to resolve this?

How much correction will I be able to achieve?
Removal of a cataract and replacement with a plastic lens into the space where the human lens was frequently results in a dramatic improvement in vision. Unaided vision that is good enough to drive is usual and many patients have better vision than they ever remember

How long do I have to wait for surgery privately?
Many of my patients want to have surgery as soon as possible after the first consultation. For these patients I am usually able to offer surgery within two weeks although I do think that it is important to have at least two days between consultation and surgery in order to make sure that all of a patient’s questions have been asked and answered, and the process does not feel too rushed. Some of my patients have important events coming up and so want to delay surgery until afterwards and this is always made possible.

What can I expect on the day of surgery?
On the day of surgery, we ask patients to the hospital at the time outlined on their admission letter.

The nursing staff will apply a series of eyedrops to the eye that is having surgery in order to both numb the surface of the eye and to dilate the pupil. I come and see all my patients prior to surgery to answer any last minute questions and to confirm consent for the surgery. Some patients have surgery under general anaesthetic and if in that case we’ll ask you to fast for a certain period of time before surgery. These patients will also see the consultant anaesthetist.

How long does the procedure take?
Surgery is carried out under local anaesthetic for the vast majority of patients. This means that anaesthetic eyedrops are applied both by the nursing staff on the ward and also by the theatre staff in the anaesthetic room beside the theatres. Patients lie down on a theatre table. The area around the eye is cleaned with antiseptic and a sterile drape placed over to keep the eye sterile for the surgery. A microscope comes in from above and the patient should look directly into the microscope light. The operation itself usually takes between 15 and 30 minutes.

What can I expect after surgery?
At the end of surgery patients have a clear plastic shield placed over their eye to prevent them rubbing their eye. This is worn only for the first day and night after surgery. They will need to use eyedrops for about a month after surgery. These include both antibiotic drops to prevent infection and iso anti-inflammatory drops to keep the eye comfortable.

Vision is often dramatically improved even the following day, once the dilating eyedrops wear off, but for a few patients the improvement in vision is slower over the first one to two  weeks. I telephone all my patients the day after surgery to check how they are and plan to see all patients in clinic one to two weeks after their surgery.

Will my cataract come back?
Once removed the cataract itself will not come back but some patients experience similar cataract like symptoms a few years after the surgery which results from scarring of the capsule around the lens.

We can deal with this in Outpatients using a very safe laser procedure to remove the capsule from the axis of vision.

Will I need glasses?
During the consultation I measure the size and shape of a patient’s eyes so that I can work out which lens power will be needed to get the best vision for that patient.

The standard lens (monofocal) which is covered by insurance companies aims to give good vision in the distance but needs a top up of reading glasses for near activities.

Some patients are very keen to try to avoid using glasses and for these patients there are some premium lens options. These lenses are more expensive and are not covered by insurance companies. Patients can discuss these lenses at the time of their consultation.

What are these premium lenses?

Toric lenses
For some patients, the shape of their eye is such that they have a lot of astigmatism.

Most of these patients will have needed glasses or contact lenses to correct their
astigmatism before they developed cataract. If opting for a standard lens in the cataract operation, these patients would still need an optician to help correct their astigmatism afterwards, through wearing glasses or contacts.

Toric lenses are specially shaped lenses that can overcome the astigmatism of the eye to give better vision in the distance. They need to be correctly aligned in order to do this and so surgery often takes a few minutes longer. Patients opting for toric lens would still need to use reading glasses.

Multifocal lenses
Some patients are keen to avoid reading glasses as much as possible. Multifocal lenses are designed for these patients and are rather like variefocal glasses bringing light into focus for distance intermediate and near vision. No surgeon can promise patients that they will be spectacle free and it is important to remember that even with these multifocal lenses patients may need reading glasses at times, particularly for reading in poor lighting conditions. Because of the more complicated optics in these lenses, there is a small risk of patients experiencing glare or haloes around lights, however, I only use the lenses with the lowest risk of this and the great majority of my patients who have had these lenses are delighted with their near and distance vision.

Multifocal toric lenses
These lenses combine the benefits of both topic and multifocal lenses, for patients with significant astigmatism. They are individually made for each patient and so may take up to a month to be delivered for surgery.

What are the risks and complications of cataract surgery?
The major but very rare risks of cataract surgery are that infection or heavy bleeding could occur inside the eye resulting in reduced or even lost vision. This is very rare (1 in 1000 cases) and every care is taken to keep this risk as low as possible.

About once in every 100 cases there are difficulties during the operation that result in surgery taking much longer that the normal 15-30 minutes or requiring a further operation shortly afterwards. The end result of this is usually very good vision although it may take longer than normal to get there.

How long until I can resume my normal daily activities again?
I would advise patients to avoid swimming or strenuous exercise for 2 weeks after cataract surgery. Glasses may need to be changed and it is advisable to leave this until after the eyedrops have finished 5 weeks after the surgery although temporary, over the counter, reading glasses can be started straight away

What about my other eye?
Surgery is only carried out for one eye at a time because of the very small risk of infection getting into the eye and reducing vision. I usually schedule the surgery for the other eye after I have reviewed the patient in clinic and one to two weeks after the first operation. Surgery can always be delayed if this time schedule is not convenient to the patient.

An initial consultation with Mr Subak-Sharpe costs £250, if you don’t have health insurance. 

Package prices for cataract surgery at The Holly start from £1,975. 

For more information on self-pay pricing just call our friendly Self-Pay Team on 020 8936 1157 or email info@theholly.com

To book a consultation, call our friendly appointments team on 020 8936 1201.

You will need a referral letter from your GP or you can see one of our Private GPs if you prefer.

You can read more about Ophthalmology services at the hospital here.