A cataract is a clouding of the natural lens inside of the eye. Normally the lens is clear, and allows light to focus on the retina at the back of the eye. As a cataract develops, light is scattered and therefore affecting vision. The most common cause of cataract development is increasing age, but other factors such as diabetes, steroid medication injury and inflammation can cause a cataract to develop earlier. Common symptoms of cataracts include:

• Blurry vison – e.g., watching TV, reading, seeing a golf ball, seeing road signs becomes more difficult

• Sensitivity to glare – such as night driving or in bright sunshine

• Double vision in 1 eye

• Difficulty distinguishing colours or colours appearing dull

If your cataract is early and you are managing with your vision, then no treatment is required or perhaps updating your glasses prescription is sufficient. However, if your cataracts are significantly impacting on your vision and glasses can’t improve on this, the surgery is the only option.

Cataract surgery is a highly successful and effective procedure that can quickly restore your vision, with results lasting a lifetime. It is important to have a thorough assessment and discussion with an experienced ophthalmologist (eye surgeon) who can advise you on the best course of action for you.

You will be asked to arrive at the hospital approximately 1 hour before your operation. It is advisable to have someone accompany you as you won’t be able to drive home after the procedure. You will then be taken to your room and have tiny pellet inserted under your lower lid to dilate your pupil, ready for the operation.

The operation normally takes 5-10 minutes and is performed under local anaesthetic eyedrops whilst you lie on your back. A transparent sterile plastic drape covers the area around your eye. A small incision is made into the eye, your cloudy lens is removed, and then a new, clear artificial lens is inserted. During the surgery you are likely to be aware of bright lights and feel some water on the eye. A plastic shield is placed over the eye and the end of the operation.

You will then be taken back to your room where you will receive post-operative instructions and guidance on eye drops to use. Normally you can go home about an hour after your operation. You will also be given follow-up appointment and advice on who to contact in case of emergency.

The most common form of anaesthesia for cataract surgery nowadays is topical anaesthesia, where eye drops are used. These work immediately and patients are still able to move their eye, however they are guided to look a light during the surgery.

Some patients may require a local anaesthetic injection around the eye if they are unable to keep their eye still or if there are communication difficulties.

Some patients feel uneasy with the thought of having the operation performed whilst they are fully awake, so opt to have a sedation which makes them drowsy during the surgery, or a general anaesthesia with which they are fully asleep.

You should discuss with your surgeon as to which option would suit you best and make you feel most comfortable.

Cataract surgery is one of the most common operations performed and the procedure has advanced tremendously in recent years. The surgery today is normally performed under local anaesthetic as a day case. The operation typically takes 5-10mins, with vision restored and patients able to return to most normal activities with a few days.

There is a less than 1 in a 1000 risk of a serious complication such as infection, bleeding in the eye or retinal detachment. These can occur either during the surgery or shortly after. Treatments are normally available to treat these complications but in very rare cases, vision can be significantly worse than before. 

There is approximately a 1 in a 100 risk of a complication during the operation, such as a lens capsule rupture. If this occurs, the operation may take a little longer to perform additional steps and sometimes a different lens to originally planned may need to be used instead. In about 1 in 500 cases, it may not be possible to insert a lens/or a second operation may be required.

Following the surgery, there is a 1 in a 100 chance of developing swelling on the central retina (macular oedema) – this normally responds well to further eye drops. Some patients may experience some shadowing in their peripheral vision, but this normally resolves after a few months. Patients can also experience a gritty eye, but this typically improves after a few weeks. 

There are various pre-existing eye conditions such as diabetic retinopathy, macular degeneration, glaucoma, corneal issues which can have an outcome on the success of your surgery. Therefore, it is essential to have a thorough assessment and discussion prior to surgery, so that any of these can be identified and optimised to give you the best chance of visual success.

The day after cataract surgery you are likely to experience some blurring of vision and mild discomfort/light sensitivity.

Occasionally the vision can be very blurred the next day, especially if your cataract was thick and more energy is required to remove the lens.

Over the next few days your vision will gradually improve and should reach most improvement after a week. It can take up to 5 weeks for the eye to fully heal and vision stabilise, at which point you will have had your follow-up visit, and can then see your optician if necessary.

Cataract surgery has developed tremendously over the last 50 years. When once patients had to lie flat on their back for a week after surgery with sandbags to stabilise their head, nowadays patients are back to most activities with a few days. This significant change has occurred because in early days of the operation a large (10mm) incision was needed to remove the lens from the eye. Nowadays, with advanced technology and instruments, this can be achieved with 2mm incisions.

The following are guidance on common activities:

• Avoiding rubbing or pressing on your eye for 4 weeks.

• Patients can return to their normal activities they do around the house and in the kitchen and the next day.

• Light exercise such as walking or picking up babies/young children can be done the next day.

• You can wash and shower from the next day, but try to avoid getting water directly in the eye.

• Gentle exercises such as yoga, Pilates and light weight can be resumed after 1 weeks.

• More intensive physical activities (running, cycling, golf) and gardening should be avoided for 2 weeks.

• Swimming should be avoided for 4 weeks ideally, or after 2 weeks with keeping your head out of the water whist wearing goggles.

• You can go on a flight after week. Advisable to wait 2 weeks for long-haul flights.

• General makeup can be applied the next day, but avoid eye makeup (mascara, eyeliner or eye shadow) for 2 weeks.

• Driving can be resumed as soon as you feel comfortable and can see a car licence plate at 20m, with either eye.

During cataract surgery, your natural cloudy lens is replaced with a clear artificial intraocular lens (IOL) that will last a lifetime. There are various categories of IOLs which have different characteristics and functions: 

Monofocal lens – these are the most traditional type of IOL and focus at a specific point, usually allowing for excellent vision in the distance (driving), however you will most certainly need to wear glasses for reading and possibly computer screen use.

Premium monofocal lens – these IOLs allow for a slightly greater range of vison, enabling some intermediate vison (computer screen, car dashboard) and larger near print vision, in addition to excellent distance vision. This is a good option for people who like would like to see their phones or iPads without glasses.

Extended depth of focus (EDOF) lens – the shape of these IOLs allows for a more continuous range of vision from distance to near. Reading glasses may still be required for small print.

Multifiocal lens – these IOLs have different (usually 3) zones that focus at distance, intermediate and near. Whilst they can provide veery good vison at all ranges, some patient may experience glare/haloes with bright lights.

Typically, there is no right or wrong lens choice, but instead it depends what your particular visual requirements and wishes are. It is important for you to discuss your individual case with an ophthalmologist who is experienced with the different IOLs on offer, so they can advise you appropriately.

Cataract surgery is an operation with results that will last a lifetime. Therefore, choosing the correct surgeon to suit your particular needs can be of significant benefit.

Private cataract surgery generally allows more opportunity to discuss the procedure in further detail with the specialist, address any concerns or questions about the operation, and also the option to choose different lens implants which can provide a greater range of vision that are not available in the public sector.

In addition, you are more likely to have more flexibility on the timing of your surgery and have the operation performed in a more private and comfortable setting.

Also, your follow up care will be with the individual operating surgeon.

A cataract operation is a once in a lifetime operation that will have a significant impact on the quality of your life. Successful surgery can restore and enhance your vision, allowing you to return to the activities that you love and need to do the most. Therefore, choosing a cataract surgeon with the sufficient knowledge and skills to meet your personal requirements is essential. Considering the following will help you with your decision:

1.     Ensure the surgeon is adequately trained with consultant level fellowship qualifications from the Royal College of Ophthalmologists

2.     Ask about how m any operations they have performed and how many they perform per year – over 500 cases/year would be considered a good amount

3.     Enquire about the different lens options they offer and their experience with them

4.     Ask about their complication rates. Top surgeon would have significant complication of less than 0.5%

5.     Enquire about what post-operative follow up arrangements there are and what to do in case of emergencies

6.     Check verified patient feedback reviews