Cataracts are an extremely common eye condition and affect millions of people in the UK every year. Over 60% of those over 60 are likely to experience them at some point. Due to their frequent occurrence, cataract surgery is now the most frequently performed operation in the UK and can cost between £1,800-£3,000.
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.
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.
How Are Cataracts Treated?
Watch Mr Alexander Ionides, Consultant Ophthalmologist at Moorfields Eye Hospital, explain how cataracts are treated:
"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
How Much Does Cataract Surgery Cost?
Cataract surgery in a private clinic can cost anywhere from £1,800-£3,000 including the doctor's and hospital fees.
The reason for the varying costs are due to many factors, including the location; reputation and the quality 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.
|Private Cataract Surgery||£1,800 - £3,000 per eye|
|Surgery Time||30 - 45 mins|
|Discharge Time||After a few hours|
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; contact lenses or 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:
The major benefit of the NHS is the reduced cost of the treatment; dependent on treatment cataract surgery can £1800 and £3000 privately. Remember, you would first need to qualify for treatment after an optometrist or doctor’s assessment.
The NHS is highly equipped to manage any emergency care. Whilst there might be no need for it, you may find it comforting to know the service is available if necessary.
Types of Procedure
As mentioned, the NHS does not provide vision correction surgery when the cataract operations is performed. Many private clinics will offer packages that remove your cataracts and repair your vision.
Sometimes the NHS offers more advanced equipment than the private sector due to its access to funding. Some private hospitals 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 you will be added to a waiting list and seen based on the severity of your symptoms. Private treatments patients are eligible for treatment as soon as the condition starts to impact on their vision. From surgeon assessment to treatment, the whole process in private treatment takes around four weeks.
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 the follow up appointment. This should help you answer any important questions you might have and to feel comfortable in the surgeon’s skills.
What Types Of Cataracts Are There?
Age Related Cataracts
The most common type of cataract is age related. Around one third of adults in the UK are 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 blurring of vision, visual disturbances, difficulty seeing in low light and dulling of colours and details.
If untreated, cataracts can, in the worst cases, 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.
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 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.
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.
What Are The Different Cataract Operations?
There are three types of cataract surgery and the technique used in each case will depend on the severity of the trauma and how developed the cataracts have become:
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 cataract 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.
The last three types of cataracts may be more complex to treat than age related cataracts.
What Are The Innovations In Cataract Or Implant Surgery?
Watch Valerie Saw, Consultant Ophthalmic Surgeon at Moorfields Eye Hospital, explain recent innovations in cataract surgery:
"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 Moorfields Eye Hospital
What Other Intraocular Lens (IOL) Treatments Are There?
Intraocular Lens or IOL is the name given to the artificial lens that is used to replace the natural lens. Other than the standard cataract procedure, there are two main types:
Implantable Contact Lenses (ICL)
ICLs are similar to contact lenses with the main difference being that they are placed into the eye rather than sitting on top. These lenses work by changing the way that light is focused on the retina. This procedure is not a way to treat cataracts. As the natural lens is not removed, it will not prevent a cataract forming, and if it does the ICL will need to be removed.
Refractive Lens Exchange (RLE)
RLE involves removing the crystalline lens of the eye and then replacing it with an artificial lens implant. This procedure is very similar to cataract surgery but instead of simply removing the cataract, it changes the refractive properties of the eye. This sharpens the eye’s focus and reduces the need for glasses or contact lenses.
The Risks Of Cataracts Surgery
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:
PCO (Posterior Capsule Opacification)
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
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 could include the following - A detached retina, bleeding in the eye, infection in the eye, posterior vitreous detachment, inflammation, damage to the cornea, part of the cataract dropping into the rear of the eye and tearing of the lens capsule. Finally, the surgery may alter the shape of your lens which may mean some patients 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.
What Are The Potential Side Effects?
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, the patient should contact the clinic as PVD (posterior vitreous detachment) may have occurred.
If the patient experiences flashes of light, blurred vision, a dark curtain across vision or an increase in floaters, then contact should be made with the clinic.
Cataract Surgery Recovery & Results
After the effects of the local anaesthetic have worn off you will be allowed to go home to recover.
Ensure that you take eye drops to prevent infection and aid with the healing of your eye. You should also be given a 24-hour helpline number in case of any initial problems. Finally, you will need to book a follow-up appointment between one to three weeks after the procedure.
In the unlikely event of the eye becoming red, loss of vision or feeling more than a mild pain; we would suggest getting in touch with clinic, doctor or local hospital.
Driving After Cataract Surgery
Following cataract 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.