Cataracts is an eye disease in which the eye's lens becomes cloudy. It is an extremely common condition and affects millions of people in the UK every year.
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 to qualify your cataracts need to be so severe that they affect your everyday life.
Cataract surgery is considered to be a very low risk procedure, with the chance of serious complications occurring following surgery being very rare. Most patients only experience mild side effects for a few weeks.
Cataracts are a disease in which the eye’s natural lens becomes clouded due to an abnormal build-up of protein. This causes your vision to become misty and out of focus.
The lens is located just behind the iris and the pupil (the black dot in the centre of the eye), and is responsible for directing light onto the retina at the back of the eye to allow you to see clearly. Because cataracts obscure the lens, light is prevented from reaching the retina therefore causing your vision to become impaired. Cataracts can affect the lens in both eyes or just one.
Cataracts are extremely common. Every year, millions of people are diagnosed with the disease and it is the leading cause of vision loss worldwide. They occur most frequently in individuals aged over 60 years old, with 1 in 3 UK residents aged 65 and over having cataracts.
Whilst most cases of cataracts are related to the normal aging process, they can also develop in babies and young children (known as childhood cataracts), or as a result of eye injury, inflammation and some other diseases.
Eventually, the eye’s lens will need to be removed and replaced through surgery to prevent cataracts from causing blindness.
Symptoms Of Cataracts
Cataracts often develop slowly, meaning their symptoms can go undiscovered for several years. The most common symptom of cataracts is cloudy or blurred vision, with some people developing small patches or circles of hazy vision. Other symptoms to be aware of are:
- Difficulty seeing at night
- Sensitivity to light
- Dependency on bright lights for reading
- Halos around bright lights, such as vehicle headlights
- Frequent changes to your optical prescription
- Yellowing or fading of colours
- Double vision
If you are suffering from blurred vision, you should make an appointment to see your optician. They will carry out an examination of your eyes using a series of tests. If they believe that you have cataracts, they will refer you to an ophthalmologist for a formal diagnosis and treatment plan.
Mild cataracts can initially be treated using prescription glasses. However, as cataracts become more advanced and start to severely disrupt your everyday life, you will need to undergo surgery to remove them. The type of surgery you will need will depend on the severity of your cataracts. Your ophthalmic surgeon will be able to advise you on which treatment is best for you.
Cataract surgery involves the removal of the lens affected by cataracts from the eye. This is then replaced with an artificial lens, known as an intraocular lens (IOL), which is inserted into the eye. Because IOLs are made of plastic, cataracts are unable to form on them in the future meaning you will only need to undergo cataract surgery once.
The four main types of cataract surgery are:
- Phacoemulsification surgery: in this type of surgery, the eye’s natural lens is broken into little pieces using ultrasound. These fragments are then extracted from the eye using a thin suction tube which is inserted into the eye through a tiny incision. An IOL is then inserted into the exact same position as the old lens, just behind the iris.
- Extracapsular surgery: this type of surgery is used when a person’s cataracts have become so advanced that their lens is unable to be broken down using phacoemulsification. Instead, a larger incision is made on the surface of the eye through which the whole lens is removed in one go. An IOL is then inserted behind the iris to replace the damaged lens.
- Intracapsular surgery: in rare cases, this type of surgery is performed on individuals with extremely aggressive cataracts that have caused significant trauma to the eye. A large incision is made on the eye, through which the entire lens (and the capsule that holds the lens in place in the eye) are removed. Because the lens capsule is also removed, the IOL is placed in front of the iris rather than behind it (like with other types of cataract surgery).
- Laser cataract surgery: this is a new type of cataract removal which uses a femtosecond laser to perform the procedure. Unlike traditional cataract surgery where the incision on the eye is made by a surgeon using a mechanical tool, laser-assisted cataract surgery uses a laser to create a custom incision. The old lens is then removed through the incision and replaced with an IOL.
Cataract surgery typically takes between 30 to 45 minutes to complete and is carried out on an outpatient basis, meaning you can return home shortly after the procedure is finished.
If you have cataracts in both eyes it is possible to have surgery on them at the same time. However, your surgeon will often recommend that you have them operated on one at a time (usually 6 to 12 weeks apart) in order to give your first eye time to heal from the surgery and for your vision to stabilize. The surgeon will usually recommend starting your cataract surgery with the eye that is most 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.
"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
Cost Of Cataract Surgery
The amount you will pay for cataract surgery will largely depend on how severe your cataracts are and the type of surgery you have. The table below provides you with a guide to the starting price of cataract surgery at some of the top eye surgery clinics in the UK.
|Clinic||Starting Price (Per Eye)|
|Centre for Sight||From £2975|
|Moorfields Eye Hospital||From £3000|
|Optical Express||From £1995|
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Finance Options For Cataract Surgery
With the price of cataract surgery starting from as much as £3,000 per eye, many clinics now offer payment plans to help to make the procedure more affordable, whatever your budget is.
A typical finance deal for eye surgery involves you paying an upfront deposit (often 10% of the overall cost of your procedure), followed by small monthly payments over a pre-agreed period of time, usually 10, 12, 24, 36 or 48 months. You should be aware that the more months you spread the cost of your surgery over, the more likely it is that you will need to pay interest. This will drive up the overall cost of the treatment.
The table below shows some examples of the finance options available for cataract surgery at different eye surgery clinics in the UK.
|Centre for Sight||Available On Request||
Cataract Surgery 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 NHS-funded treatment. If you suffer from only mild to moderate cataracts, you will instead be offered glasses to restore your eyesight which you will need to pay for yourself.
Cataract Surgery Recovery
You will be able to return home on the same day as your surgery, but won’t be able to drive so you must arrange for someone to pick you up and take you home.
Following surgery you will have a plastic shield placed over your eye that was operated on. You will be required to wear this for the first day after your surgery, and at nights for at least a week to prevent you from touching or rubbing your eye while sleeping.
You will also be given eye drops which you must use for at least 4 weeks following surgery to prevent inflammation and infection.
You may need to wear prescription glasses or contact lenses following surgery for short or long distance vision. This is because IOLs are unable to focus at a range of different distances.
There are some mild side effects to be aware of which you might encounter:
- Slight pain in or around your eye
- An itchy or sticky eye
- Blurred vision
- The feeling that you have something in your eye
- A mild headache
- Bruising around your eye
- Sensitivity to light
All of these side effects are entirely normal and usually disappear within a week after surgery. The mild symptoms of pain you might experience can be easily treated with over-the-counter painkillers, whilst sunglasses are also recommended to ease any light sensitivity.
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Complications From Cataract Surgery
Cataract surgery is extremely safe, with less than 2% of patients developing a serious complication as a result of the surgery.
The risk of something going wrong however, can be more common for people with other eye conditions including uveitis, severe myopia (short-sightedness) and diabetic retinopathy. Other complications can arise if you are unable to lie flat easily, have breathing problems or if you are undergoing treatment for prostate issues.
Most complications are easily treatable and do not permanently damage your vision, but you should always make sure that you discuss the risks of the surgery with your ophthalmologist before the procedure.
The most common complication that can arise following cataract surgery is posterior capsule opacification (PCO). In PCO, part of the lens capsule thickens due to cell growth over the back of the artificial lens, causing cloudy vision. It can be easily treated with laser eye surgery, in which the thick part of the lens capsule is removed to restore normal vision.
Other complications which could arise during the surgery include:
- Inability to remove all of the cataract
- Tearing of the lens capsule
- Bleeding inside the eye
- The cataract dropping into the back of your eye
- Damage to the eye, like the cornea
After the operation, there is the risk of the following complications arising:
- Swelling and redness in the eye
- Swelling of the retina
- Swelling of the cornea
- Retinal detachment
- An eye infection
If you think you might have a serious complication following cataract surgery then you should seek immediate medical advice. Any loss of vision, increasing pain or redness after surgery should be treated seriously.
Driving After Cataract Surgery
After cataract surgery you can get back to your usual activities very quickly, however it is vital for your safety and the safety of other road users that your vision meets the minimum standards for drivers before you get back behind the wheel.
The DVLA’s regulations stipulate that motorists can resume driving following cataract surgery once they can read a number plate 20 metres away with both eyes open. Your vision must also be no worse than 6/12 on the Snellen scale. You should schedule an appointment with your optometrist or doctor to get your eyes tested to ensure your eyesight is of a sufficient quality. You are of course permitted to wear prescription glasses or contact lenses to meet the DVLA’s standards.
In addition to the eyesight requirements being met, you also need to consider the following factors before you get back on the road:
- Are you free from any pain that could distract you whilst you’re driving?
- Are you free from the effects of any medication you might have been taking?
- Do any of your medications contravene the drug-driving legislation?
- Are you comfortable in the driving seat?
- Do you feel like you can safely control your vehicle?
- Are you able to perform an emergency stop?
For over 90% of patients, their vision returns to a good enough level following cataract surgery that they are able to resume driving again. The recovery time of course varies from patient to patient. For some it can be a matter of days, but for others it can take up to 4 weeks before they are able to get back on the road.