Cataracts and lens replacements Mr Subramaniam answers the FAQ's

03 September 2018

What is a cataract?
A cataract is a clouding of the lens in your eye. It can affect one or both eyes. Cataracts are treated by surgery, where the cloudy lens is removed and replaced by a clear artificial lens.

Does everyone get cataracts?
Cataracts are the most common cause of curable blindness globally. Most cataracts develop slowly over time and affect people over the age of 60. However, in some cases, cataracts can start at an earlier age, especially in someone who is diabetic, or on steroid medication or in people who have had trauma to the eye.

What happens if cataracts are left untreated?
In most cases, cataracts will continue to slowly worsen over time, causing progressive reduction in vision. Other symptoms include altered colour perception and a frequent change of glasses. In some cases, a change in the glasses prescription may improve your vision if the cataract is worsening, but other times it will not. Driving can be affected, as well as overall quality of life. If unsure, it is better to have a comprehensive eye examination and discuss this with your Ophthalmologist. The examination is also useful to exclude other eye conditions that could affect the vision, such as macular degeneration, other retinal diseases and glaucoma.

When should I have my cataract surgery?
Cataracts can be removed at any stage. Making the decision to have your cataracts removed depends on several things, including how badly your sight is affected, whether you have any other eye conditions, if you only have sight in one eye and how you use your sight daily. Surgery should be carried out if the benefit of the operation outweighs the small risk associated with the surgery.

Cataract Surgery
Cataract surgery is performed by phacoemulsification. This means an instrument uses sound waves to break up the lens in the eye and remove it. A small incision is made in the front surface of the eye. Once the cataract is removed, it is replaced with a clear lens implant, known as an intraocular lens, or IOL. This is done under local anaesthetic as a day-case procedure and on average takes 15 to 20 minutes. Sometimes the patient may prefer an injection beside the eye or a general anaesthetic. This will be discussed at the outpatient appointment. In most cases, stitches are not required, and the eye heals very quickly.

Complex Cataract Surgery
Modern cataract surgery, which is done as a keyhole procedure, is extremely safe, and serious complications are rare. There are some situations where features of a person’s eye may increase the risk of complications. One of the complications is when the support structure that holds the lens in place (the capsule) tears or loses its attachment to the wall of the eye. This may lead to parts of the cataract falling to the back of the eye and some of the jelly coming to the front of the eye. A number of additional steps may become necessary to complete the operation safely, and sometimes a second procedure is needed. This may include a vitrectomy operation by a surgical retina specialist.

What lenses are used for cataract surgery?
The most common lens used is a mono focal lens. This provides excellent image quality but has extremely limited focussing range. Therefore, people who have mono focal lenses after cataract surgery end up wearing glasses for close work and/or distance vision.

Are newer lenses available?
Newer lenses, also called premium lenses or multi focal lenses, are now available. They significantly reduce the need for spectacles. However, a few patients can experience side effects such as seeing glare and halos around lights or a difficulty in focussing on artificial light soon after surgery. In most cases this improves with time.

It is worth noting that a refractive surgeon who does cataract and laser refractive surgery (LASIK AND LASEK) may be able to correct any residual error which persists after cataract surgery.

What are the restrictions after surgery?
There are not really many restrictions after surgery. Patients may notice a mild discomfort for a day or two after the cataract surgery. They can resume most normal activities within a few days of surgery. Patients are prescribed drops for about a month and if replacement glasses are needed, these are usually prescribed by their own optometrist, about a month after surgery.

If you’re worried Mr Subramaniam specialises in cataracts (including complex cases) and lens replacements. A private consultation with Mr Subramaniam at Spire Nottingham Hospital costs £180 if you don't have private health insurance. For more information or to book an appointment call our Bookings team on 0115 937 7735.

Cataract removal surgery

Mr Srinivasan Subramaniam


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