Laser Cataract Surgery & Treatment

Cataract surgery is one of the most effective and safe surgical procedures. Alex is a highly experienced cataract surgeon, having performed his first cataract surgery almost 20 years ago and now works as a Consultant surgeon specialising in this area at Moorfields Eye Hospital.

Alex is also a NHS cataract surgery trainer and invited lecturer on the latest advances in cataract surgery. His research at Moorfields including the FACT trial, which compared to femtosecond laser cataract surgery to conventional phacoemulsification cataract surgery.

This was the largest NIHR funded trial to have been done at Moorfields to date and the results were published in 2020 in Ophthalmology and the Journal of Cataract and Refractive Surgery.

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What is a Cataract?

Cataract is where the natural lens inside the eye becomes cloudy. The natural lens is located just behind the iris and pupil and focuses light on the retina. Cataract development usually happens gradually but can be more rapid with symptoms developing over a few month and can cause a variety of visual symptoms including blurred vision, glare and halos particularly in sunlight or at night, and also cause changes in glasses prescription.

Cataract surgery is the only treatment for cataracts, and involves replacing the natural lens that has become cloudy with a clear artificial lens (intraocular lens, IOL). The focussing power of the lens can be chosen to refocus the eye. This give the opportunity for any pre-existing short or long sightedness or astigmatism to be corrected, so minimising the need for glasses.

What Are The Intraocular Lens Options?

Premium or refractive cataract surgery differs from standard cataract surgery in the NHS as there are no restrictions on intraocular lens choice and there is a strong emphasis on astigmatism management to achieve the clearest distance vision without glasses.

The two main types of intraocular lens are monofocal and multifocal.

A monofocal lens is where the lens is of uniform fixed focus and so gives clear vision at a single point of focus. A monofocal lens is usually chosen to correct distance vision as clearly as possible, however some patients who are short sighted choose to remain short sighted and so have good near vision without glasses, but then need glasses for distance and intermediate vision.

If there is high astigmatism that needs correcting, then a toric monofocal lens will be needed. Usually the monofocal lens implant is chosen for clear distance vision and if the very best distance vision without glasses is wanted and without compromise, then monofocal lens both eyes with both focussed for distance is preferred. Some patients may choose to have a different focus for each eye (termed monovision, or micro-monovision).

This is where the focus of one eye is set for distance and the other for intermediate and some near vision such as computer use. Glasses for are still likely needed for comfortable near work or prolonged intermediate vision tasks.

Monovision works well if you are already used to this with previous monovision contact lens use. Monovision doesn’t suit everyone and may require some months of adaption after the surgery. Mr Alex Day’s premium monofocal lens of choice provides excellent distance vision and significantly better intermediate vision (measured at 66 cm) when compared to a basic monofocal lens.

Multifocal lens are those with multiple focal points, so providing distance and middle vision, and some near. Multifocal lens work well in people who want to minimise the need for reading glasses and are prepared to accept some compromise as even with the latest advanced multifocal lens there may still be a mild glow or halo around lights or glare in some lighting situations. Multifocal lens work best with femtosecond laser assisted surgery as the laser can be used to reduce any pre-existing astigmatism. Multifocal lens are not suitable for people with eye conditions such as retinal problems macular degeneration, or diabetic retinopathy, or those with glaucoma.

Extended depth of focus (EDoF) lens are the next generation in multifocal lens design. These provide greater spectacle independence than monofocal lens, but with less optical side effects such as glare and halos that traditional multifocal lens have. Mr Alex Day’s EDoF lens of choice provides excellent vision for everyday activities such as driving and also computer work, using a mobile or reading price tags. Glasses may still be needed for night driving and for reading small print or other near tasks.

Mr Alex Day will specifically advise you about your situation and the lens choices available.

Femtosecond Laser Assisted Cataract Surgery

Some of the stages of cataract surgery can be completed more precisely using a femtosecond laser than can be done by the surgeon’s hand.

Femtosecond laser cataract surgery also allows for correction or reduction of mild to moderate astigmatism at the time of surgery. This is done by making femtosecond laser intrastromal astigmatic keratotomies in the cornea, these result in precise flattening of the corneal where they are located so correcting the astigmatism. The gas bubbles disappear within a matter of minutes and their effect remains.

The laser part of the procedure only takes a few minutes and is painless, and the remainder of the procedure is then completed as usual in theatre.

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Cataract Surgery Outcomes and Complications

Cataract surgery is one of the safest and most effective operations and greatly improves visual quality in the vast majority of patients.

However, no surgery is without risk of complications. Surgeon experience and the number of cases performed per year are the biggest determinants of surgical outcomes. The NHS publishes cataract surgery outcomes for each Consultant, each year, that allow a basic comparison of surgical outcomes and attempts to adjust for differences in overall case complexities.

Alex Day’s outcomes can be found here. The majority of complications are minor and are treatable with the overall rate of significant vision loss due to a surgical complication that cannot be corrected by glasses or contact lens being about 0.1% (1 in 1000 operations).

More detailed, transparent information about possible complications will be provided for your consultation.

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Consultation

To arrange a consultation call my team at Moorfields Private Eye Hospital, 9-11 Bath Street, EC1V 9LF, London, or complete the contact form.