Consultant questions - cataract surgery with Mr Aris Konstantopoulos

What is a cataract?

A cataract is when the natural lens of your eye becomes cloudy. The lens of the eye is found behind the iris, the coloured structure of the eye that gives us our green or brown eyes, and is normally clear and transparent. As we get older the lens loses its elasticity and clarity, resulting initially in difficulty in seeing close up (presbyopia) and the need for reading glasses. Later in life cataract development causes poor quality and blurred vision.

Are cataracts found only in older people?

Cataracts are usually a natural development with age. Although most cataracts are related to ageing, cataract can also be associated with diabetes, previous eye surgery, other eye conditions or trauma and the use of steroids.

If I have a cataract should I wait or get it sorted as soon as possible?

If a cataract is affecting the quality of your eyesight and life, it is best that it's sorted as soon as convenient. Although the presence of a cataract is rarely an emergency, it is known that more established dense cataracts and older age are associated with a higher rate of complications and poorer outcomes.

What does cataract surgery involve?

Broadly speaking, cataract surgery involves removing the natural lens that has become cloudy, the cataract, and replacing this with a clear artificial lens that is called the intraocular lens (IOL).

Initially, two small incisions are made in the eye to function as entry points. A small instrument is then inserted to break up the cataract into small pieces that are removed through this same instrument. Once the natural lens has been cleared away, the new IOL is inserted and placed in the position of the natural lens where it will securely stay for life. Finally, the incisions are closed, usually without sutures and the operation is complete.

Cataract surgery normally takes less than 30 minutes and is day surgery; it is almost always carried out under local anaesthesia, usually just with the use of topical numbing drops to the eye.

What are the risks?

Cataract surgery is the most common operation performed in the UK, with more than 400,000 operations performed each year. It is generally a safe operation with a high success rate; the risk of a significant complication during surgery or loss of vision due to the surgery is less than one in a hundred.

I hear people talking about different lenses, what does this mean? How do I know what lens is best for me?

Cataract surgery is a refractive procedure that provides a unique opportunity to address underlying refractive errors of the eye, such as short-sightedness, long-sightedness, astigmatism, and thus minimise the use of spectacles for both distance and near. At your consultation your surgeon will examine your eyes in detail, including the cataract and the shape of the cornea, and discuss your hobbies and lifestyle and what you would like to achieve with your cataract operation. This will allow them to suggest what intraocular lens or lenses may be best for you and your visual requirements.

The type of intraocular lens that may be recommended includes:

Monofocal lens: this is the standard lens used on the NHS. It provides good quality vision, but it does not provide clear vision for both distance and near. It provides clear vision at one focal point, usually for distance, and requires the use of near glasses for reading and intermediate tasks.

Multifocal lens: this lens provides overall good quality vision, achieving clear vision for both distance and near without glasses. The vast majority of patients can read small print without reading glasses however, a weak pair of glasses may be needed for prolonged computer use or reading. This lens can also be combined with astigmatism treatment in order to achieve the best possible vision without glasses.

Toric lens: this lens addresses the presence of astigmatism, a common refractive error due to irregularity in the curvature of the cornea. Correcting astigmatism is very important to the function of intraocular lenses; using a toric lens in patients with astigmatism, either on a monofocal or multifocal platform, is key to achieving the best distance and near vision without glasses.

To find out more or book a consultation, please visit Mr Konstantopoulos' profile.