Cataract Surgery

Cataracts is an eye disease in which a build-up of protein causes the lens in the eye to become cloudy. It is an extremely common condition and affects millions of people in the UK every year, with over 60% of those over the age of 60 being likely to develop them.

Cataracts are treated successfully through surgery, which can cost upward of £2,500 per eye at a private clinic. Cataract surgery is available for free on the NHS, but in order to qualify your cataracts need to be so severe that they interfere with your ability to carry out everyday activities.

Cataract surgery is considered to be a very low risk procedure, with the risk of serious complications occurring following surgery being very rare. Most patients only experience mild side effects for a few weeks.

What Are Cataracts?

A cataract is a disease of the eye where a cloudy patch develops in the lens of your eye, causing misty or reduced vision. It is a very common gradual change to the structure of the eye. In the UK, 1 in 3 people aged over 65 have Age-related Cataracts.

The lens is located just behind the iris (the coloured part of your eye) and this is used to keep things in focus. When it becomes cloudy, similar to a camera lens, the image reaching the back of your eye is also blurred.

Cataracts can develop in one eye or both. Over time the sufferer will experience reduced clarity of vision. Over a long period of time the lens (also called the crystalline lens) will begin to cloud and turn opaque.

Before the invention or application of cataract surgery most people with cataracts ended up blind. But now, thanks to years of medical research and surgical developments, this is no longer the case thanks to a relatively simple surgical procedure.

The viewpoint of a cataract sufferer.

A cataract is a cloudy patch on the eye that can make everything look misty, sometimes with a yellow or brown tinge


What Are The Different Types Of Cataracts?

Age-Related Cataracts

The most common type of cataract is age-related, with around one third of adults in the UK being affected by cataracts to some degree. Cataracts of this kind often develop over several years and the symptoms may not be noticeable at first. The lens of the eye becomes cloudy and increasingly affects vision.

Symptoms may include blurred vision, difficulty seeing in low light, and the dulling of colours and details.

If untreated cataracts can (in extreme circumstances) lead to blindness. However, prompt treatment of age-related cataracts is usually straightforward and successful.

Age-related cataracts affect both sexes equally. There is an increased risk with some factors such as poor diet, over-exposure to sunlight, a family history of cataracts and smoking.

Congenital Cataracts

This is also known as ‘Childhood Cataracts’ and is a condition that is present from birth or develops in early life. As with other kinds of cataracts, they can affect one or both eyes and the symptoms can vary widely in severity and how quickly they develop. The causes of congenital cataracts are often not known but they may relate to a genetic condition or an infection in the womb.

Secondary Cataracts

Secondary cataracts can occur in association with conditions such as diabetes. They can also develop following alcohol and drug abuse, exposure to certain toxic chemicals, long term use of drugs like steroids or exposure to radiation.

Traumatic Cataracts

As the name suggests, these can occur when the eye is injured. Often this is due to blunt trauma such as a sporting injury to the eye. In rare cases, electric shock may cause this type of cataract.

The last three types of cataracts may be more complex to treat than age-related cataracts.


What Is Cataract Surgery?

When your eyes are examined at a consultation the cataract will be identified by the optometrist. Many laser eye surgery clinics also offer Cataracts surgery. The operation will involve removing your cloudy lens and replacing it with a clear artificial lens (often referred to as an intraocular lens or IOL).

This artificial lens has no focusing capability, so you would still need to wear glasses if you suffered from poor vision prior to the operation. However there are modern procedures which allows focusing on near and distant objects.

If you have cataracts in both eyes, your surgeon will usually suggest you have them removed one at a time, starting with the eye that is most severely affected.

Watch Mr Alexander Ionides, Consultant Ophthalmologist at Moorfields Eye Hospital, explain how cataracts are treated and Ms Valerie Saw, Consultant Ophthalmic Surgeon at Advanced Vision Care, explain the latest innovations in cataract surgery.

 

Video Transcript

"Cataract and Refractive surgery are my specialties. The cataract side of it, a cataract is a cloudy lens and when we take out the cloudy lens we put a new plastic or acrylic lens into the eye. When we do that these lenses can either be monofocal which means they don’t focus for any distance, or multifocal and multifocal lenses we put in will for near and distance but with a compromise to the quality of the vision.

There are many multifocal lenses that do this to a varying degree of efficiency. Most cataract surgery are performed under local anesthesia, some people have cataract surgery very early on before their cataract even developed, even if they are in their 50s. If they want to treat high long-sightedness that’s hyperopia or myopia then they could do that at the same time.

There is more disease for people in their 80s and 70s, less so in their 60s and 50s, and occasionally, rarely in their 40s and 30s."

Mr Alexander Ionides, Consultant Ophthalmologist at Moorfields Eye Hospital

"Implant surgery is identical to Cataract surgery in people who are in the reading eyeglasses age group. The exciting thing that has happened in the last 25 years is to do the Cataract surgery using a laser, so laser implant surgery or laser Cataract surgery.

The advantage of that is it makes the procedure more predictable and safer, so the laser makes templates during surgery, the circular hole in the front part of the natural lens, and it also fragments the inside of the natural lens, and that makes the surgery more predictable and safer because the laser is doing that.

That’s more relevant for people who need to wear reading glasses, so using multifocal implants to give them freedom from needing to wear reading glasses as well as glasses for distance.

Using the laser to carry out the implant surgery is a really growing field."

Valerie Saw, Consultant Ophthalmic Surgeon at Advanced Vision Care

END


What Are The Different Cataract Operations?

There are three common types of cataract surgery. The type of surgery you will undergo will depend on the severity of your cataracts and how much trauma they have caused to your eye:

Phacoemulsification

The cataract (cloudy lens) is broken into little pieces using ultrasound and extracted via a thin tube. After the cloudy lens has been removed, a replacement lens is folded and inserted through the same incision.

This process requires minimal sedation and can usually be performed within 30 minutes. Patients might not even need to wear an eye patch after the operation.

Extracapsular Cataract Surgery

This form of surgery is usually performed when cataracts have become too advanced to be broken down using Phacoemulsification. This technique is performed under a local anaesthetic and the patient may also take an oral sedative to relax. Eye drops are used to dilate the patient’s pupils, allowing the surgeon to see the whole of the lens clearly.

The surgeon will carefully make a small incision in the surface of the eye and remove the cloudy, opaque lens. After which the artificial lens is then inserted. The recovery time is a lot longer than Phacoemulsification and the patient will be required to wear an eye patch for a number of weeks post surgery.

Intracapsular Cataract Surgery

This technique involves a larger incision than the extracapsular surgery and is used only for cases of extreme trauma. Using this larger incision the surgeon removes the entire lens and capsule and then the artificial, intraocular lens would then be placed in front of the iris.


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How Much Does Private Cataract Surgery Cost?

The cost of private cataract surgery can range from just £1,995 per eye up to £3,000 per eye. The table below provides you with information about how much you should expect to pay for cataract surgery at some of the UK's leading eye surgery clinics.

Clinic Price Per Eye
Advanced Vision Care From £2,950
Focus From £3,000
Optegra From £2,495
Optical Express From £1,995
Optimax From £2,995
Ultralase From £2,995

The reason for the varying costs are due to many factors including the location of the clinic, its reputation, and the experience of the surgeons at the clinic. Other major cost considerations might be the type of cataract surgery you’re undertaking and the clinic’s aftercare service.

Since the cost of cataract surgery is high, many of the UK's leading eye surgery clinics now offer their patients finance options to help you spread the cost of the procedure. These typically involve you paying an upfront deposit (often 10% of the overall cost of your surgery), followed by small monthly payments over a pre-agreed period of time, usually 10, 12, 24 or 48 months. The longer the payback period of your financial package, the higher the interest rate typically is meaning you will repay more than the price of your surgery. The terms and conditions of finance options will vary between clinics, so it is essential that you fully understand them before entering into any financial agreement.

In all cases, we would recommend that you compare a selection of clinics and not make a decision until you are happy with the reputation of the surgeon and clinic as well as the details of your treatment package before you commit to a procedure.


Is Cataract Surgery Available On The NHS?

Cataract surgery is offered on the NHS, but you would need to check your eligibility with your doctor or optician. Generally speaking, your daily activities have to be severely affected by cataracts to qualify for treatment.

However, as laser eye surgery is not available on the NHS unless you have an eye condition that can lead to blindness, the operation will focus only on repairing your vision due to cataracts. You would still need glasses or contact lenses to focus clearly, and will need to book a private appointment to receive vision correction surgery.

NHS Vs Private Healthcare Treatment

There are a number of differences between the UK healthcare services which may affect your decision between private and NHS treatment. These are the main points we feel you may want to consider:

Service NHS Private
Free Surgery
Treat Only Cataracts
Emergency Care
Short Waiting Times
Newest Technology
Consistent Care

The major benefit of the NHS is the reduced cost of the cataract treatment. Dependent on the type of surgery you have, the cost at a private clinic can start from £1,995 per eye and increase to £3,000 per eye. In order to qualify for free surgery on the NHS however, you would first need to qualify for treatment after an optometrist or doctor’s assessment.

As mentioned, the NHS does not provide refractive error correction surgery when the cataract operation is performed, meaning you will still need to wear corrective glasses or undergo a second round of surgery to correct problems with vision such as myopia (nearsightedness) and hyperopia (farsightedness). You will need to pay for this yourself as this type of surgery is not offered on the NHS. Many private clinics will offer packages that remove your cataracts and repair your vision however, eliminating the need for a second round of surgery.

Should you encounter any problems following your cataract surgery, the NHS is highly equipped to manage any emergency care. This may be harder to receive at a private clinic. Whilst there might be no need for it, you may find it comforting to know the service is available if necessary.

How long you will have to wait to have your cataract surgery will depend on a number of factors, such as whether you choose to have surgery through the NHS, or to pay privately. Legally speaking, you have a right to start your non-emergency treatment no longer than 18 weeks from the date of your referral. However, recent studies have shown that some patients are waiting upwards of 15 months for surgery on the NHS owing to the “postcode lottery”, meaning patients living in certain areas of the UK may have to wait longer as local health services are strained. If you do wait longer than 18 months, the NHS has a duty to investigate and arrange suitable alternatives.

In order to combat this, you may wish to obtain treatment privately. Although this means paying out of pocket, private care often means lower wait times as a result, which are typically around only 4 weeks.

Whilst many clinics possess the latest eye surgery technology, sometimes the NHS offers more advanced equipment than the private sector due to its access to funding. Some private clinics may struggle to purchase all the equipment necessary for a higher level service. It is always worth checking with any provider that they will be using the latest certified technology.

With NHS treatment, it is unlikely you will see your surgeon until the day of the operation. As a private patient, once you have chosen your surgeon you will see them for the initial assessment, the operation and at follow-up appointments. This should help you answer any important questions you might have and to build a relationship with the surgeon.


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What Are The Side Effects?

Surgery to remove a cataract is generally considered to be a low risk procedure. Research carried out by the RNIB suggests that fewer than 2% of patients who have cataracts removed experience a serious complication. However, it is important for you to know the risks involved with the surgery.

Normal side effects after a cataract procedure include:

  • Itching and crusting of the eye
  • A gritty feeling in the eye
  • Bruising of the eyelid
  • A slight ache around the eye

These side effects should pass within a few days to a week.

Floaters (shadowy dots or floating strands in your field of vision) can also occur, but these should settle down after a couple of weeks. If problems with floaters occur after this time, you should contact the clinic as posterior vitreous detachment (PVD) may have occurred. If you also experience flashes of light, blurred vision or a dark curtain across your vision, then you should seek medical attention.


Cataract Surgery Complications

While rare, more serious complications can occur, including:

Posterior Capsule Opacification (PCO)

In PCO, the capsule that encases the lens thickens due to additional cell growth, causing the patient's vision to become cloudy. This condition can develop at any time up to around five years after the initial operation and requires minor laser surgery to correct it.

Cystoid Macular Oedema (CMO)

In PCO, fluid builds up between the layers of the retina causing a loss of vision. While this can be alarming for patients, it is relatively easy to treat. Common anti-inflammatory drugs such as diclofenac or ibuprofen are normally prescribed.

Other potential complications include the following:

  • A detached retina
  • Bleeding in the eye
  • Infection in the eye
  • Inflammation of the eye
  • Damage to the cornea
  • Part of the cataract dropping into the rear of the eye and tearing the lens capsule

The surgery may also alter the shape of your lens, which may mean you will need to use glasses for distance or close-up vision.

Anyone who experiences increasing pain or loss of vision after surgery is advised to seek medical aid as soon as possible.


Driving After Cataract Surgery

Following surgery, you’ll have to prove that you meet the DVLA minimum sight standards for drivers. You must be able to demonstrate that you can read a car number plate from a distance of 20 metres. Secondly, you will also need medical confirmation that your eyesight is not worse that 0.5 on the Snellen scale (the alphabet tests you have in opticians). If you do not meet these standards; driving on a public road in the UK is an offence.

"Cataracts can affect your vision such that you may find you are no longer legal to drive. It is each individual's own responsibility to check that their eyesight fulfils the legal requirement for driving, which being able to read a number plate at 20m. Failure to fulfil this can result in problems should an accident happen. Cataract surgery usually improves the vision within a matter of days allowing people to get driving safely again." Alexander Ionides BSc FRCOphth MD, Consultant Ophthalmologist, Moorfields Eye Hospital

The amount of time it will take to regain driving standard vision will vary from patient to patient. For some, it may only be a matter of days but this cannot be guaranteed prior to surgery. It's still important to get confirmation from your surgeon that you have reached the required standard.

If you have had surgery in one eye and your other eye has no medical issues, you may be able to drive as soon as the sedation has worn off. However, only having sight in one eye can take adjusting to and it's generally considered wise to wait a few days.

Snellen chart

A guide showing how to use a Snellen chart

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