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Cataract surgery or refractive lens exchange surgery is where the natural crystalline lens inside the eye is replaced with an artificial lens as either the natural lens has become cloudy (cataract), or to change the focus of the eye (refractive lens exchange). The operation is essentially the same, with only the indication for surgery being different.

The modern technique of cataract surgery (phacoemulsification and intraocular lens implant) has been performed routinely for at least 20 years, and the incremental improvements in safety and outcomes over the years are such that it is now a well established technique too for the correction of short sightedness (myopia), long sightedness (hyperopia), astigmatism and to minimise the need for reading glasses (presbyopia) in those with no cataract. The quality of the vision after surgery and degree of spectacle independence is determined primarily by the lens implant chosen and astigmatism management.

Phacoemulsification and lens implant is a low risk, but never a zero risk procedure. Of course, no surgery – or any other type of medical intervention, for that matter – is completely devoid of risk. The good news is that this type of surgery is carried out hundreds of thousands of times a year in the UK with an extremely reliable safety record. As such, it is much better for patients to be informed about the sorts of risks they face with lens replacement surgery, so they can make an informed choice about if the surgery is the right option for them.

Side effects may be normal, as in part of the normal postoperative healing, or complications which require a change from the usual operative technique or postoperative eye drops. 

What follows is a general guide to the risks associated with this type of surgery that is suited to a general readership. If you choose to undergo a lens replacement surgical procedure with Mr Alex Day, then you will receive a much more detailed information beforehand. This will inform you of all of the relevant safety information you need, relative to your age and health. Factors related to your general health such as diabetes, or certain medications, or for example any previous eye injuries will influence your own personal surgery risk profile.

Common Postoperative Events “Normal Side Effects”

-The vision is soft focus immediately after surgery and will take a few days to settle. Most patients can go back to work or drive again within a week of surgery.  

-Your eye may feel gritty or scratchy, or be light sensitive for the first week or so after surgery. It is important to use the postoperative eye drops as given to help the eye heal. Sometimes the white of the eye may have red blotches after surgery which is particularly the case if you are on any blood thinners such as warfarin.

-The focus of the eye will change slightly over the first few weeks as the natural lens capsular bag shrink wraps itself over the new lens implant.

Complications

-Serious complications are rare, with the “standard risks” of phacoemulsification and lens implant being quoted as a 1/1000 risk of significant vision loss. 

-The overall risk of needing more than one surgery to complete the procedure is <1/100. 

-Approximately 1 in 10 to 1 in 20 patients will need a change in their postoperative eye drop regime to help any inflammation settle (such as postoperative anterior uveitis or macular oedema). It is important to use the eye drops as given to help prevent this.

-1 in 5 may need a laser treatment typically within the first couple of years of surgery to remove any misting of clouding of the natural lens capsule (posterior capsule opacification) that develops as it shrink wraps around the new lens implant (YAG capsulotomy). [link to YAG capsulotomy page please]

Differences in Risk Between Cataract Surgery & Refractive Lens Exchange.

Even though cataract surgery and refractive lens exchange are essentially the same operation, differing only by the indication for surgery; there are some differences in risk to the above summary. For example, refractive lens exchange is performed in younger people than those who typically undergo cataract surgery and complications such as retinal detachment differ in risk by age. A study of over 2.5 million cataract surgery operations in France found the risk of retinal detachment to be approximately 4 times higher in those who have had cataract surgery compared to those who have not, with the risk being 5 times more for those <55 years old compared to those 75 years old or more undergoing cataract surgery.

For this reason, it is important to choose an experienced eye surgery who can advise you on the options available to you, so you can make an informed choice about what is best for you, and also to choose a surgeon who is easily contactable in case you have any queries or issues at all after your surgery. You will always be given Mr Alex Day’s emergency contact mobile number in case you have any queries or worries in the postoperative period.

1 Daien V. Le Pape A. Heve D. et al. Incidence, risk factors, and impact of age on retinal detachment after cataract surgery in France. Ophthalmology. 2015; 122: 2179-2185