Mr Amar Alwitry answers questions on bespoke cataract surgery and premium lenses

01 August 2019

Do I need to have a cataract to be suitable for lens replacement surgery?

No, some patients who undergo lens exchange surgery are simply fed up of wearing spectacles for distance or near. They wish to have some degree of spectacle independence and therefore they opt for lens exchange surgery.

Isn’t all cataract surgery the same?

No, in “routine” cataract surgery we remove the lens and replace it with a synthetic one that tries to set you for distance. Any pre-existing astigmatism (rugby ball shape of the cornea) remains meaning that you are still highly reliant on spectacles. With bespoke cataract surgery your eye is scanned with the latest technology to determine its exact shape. This allows the operating surgeon to place incisions on the cornea to take away a small amount of astigmatism. If there is more than 1D of astigmatism then a premium toric lens can be used.

What premium lens options are there for astigmatism?

If you have an “ordinary” monofocal lens you can be set for distance but the astigmatism will mean that you still require spectacles for TV/driving etc. If you have a lot of astigmatism then a special lens can be ordered specifically for your eye to take away the astigmatism – this is called a toric lens. It is vital that this toric lens is placed at the correct angle in the eye. At Spire Nottingham your surgeon may have access to the latest technology from Zeiss, the Callisto Cataract Suite. This scans the eye and provides the surgeon with a head up display during your operating procedure allowing him or her to track the eye in real time and place the lens at the correct angle for optimum vision.

What other premium lens options are there?

An ordinary monofocal lens should provide you with reasonable distance vision after cataract or lens surgery as long as you do not have too much astigmatism. This will hopefully allow you to see well in the distance but your near and intermediate vision will be blurry without spectacles. There are several new lenses available which can allow some degree of spectacle independence such as bifocal or trifocal intraocular lenses. These allow you to see in the distance, near and intermediate without requiring spectacles. Not everyone is suitable for these lenses and it is important that you discuss this with your surgeon.

It is worth mentioning that some surgeons have had specialist training in cataract and refractive procedures over and above the normal training to be an eye consultant.

Are there any downsides to these premium lenses?

Every lens has its good and bad points. A few patients can experience side effects such as seeing glare and halos around lights or a difficulty in focusing in dim illumination. In most cases this improves with time. One in 100 patients may require lens exchange after this procedure.

I have macular degeneration, is there a lens for me?

Yes, the EyeMax lens has been specifically designed for patients with macular degeneration and it works via a completely different way to ordinary monofocal lenses. This lens aims to give better vision in the short and the long term in patients with age-related macular degeneration.


Will my insurance cover these procedures?

No, the insurance company will only pay for monofocal lenses. There are however top-up fees which can be paid as well as various finance options.

Mr Amar Alwitry, Consultant Ophthalmologist sees private patients at Spire Nottingham Hospital. A private consultation with him costs £180. To book an appointment, call our Private Patient Team on 0115 937 7735 or book online.

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