Alex Day Cataract and LASIK PRK Laser Vision Correction

Private Cataract Surgery & Treatment For London

Cataract surgery is refractive surgery. This means you can choose to have the best vision after cataract surgery with less dependency on glasses, if premium intraocular lens are used and astigmatism is carefully managed. Many clinics and private Ophthalmology Consultants only offer standard cataract surgery using non-premium intraocular lens and no astigmatism management.

Mr Alexander Day is a highly experienced cataract surgeon, having performed his first cataract surgery almost 20 years ago and works as a Consultant ophthalmologist 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 treatment to conventional phacoemulsification cataract treatment. 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 Differences Between Private Cataract Surgery & NHS Cataract Surgery

Cataract surgery is refractive surgery. Refractive or premium cataract surgery differs significantly from standard cataract surgery in the NHS, and also that offered by many private cataract surgeons as there are no restrictions on intraocular lens choice, and correction of any pre-existing short- or longsightedness or astigmatism is done to achieve the clearest distance vision without glasses. Many private cataract surgery surgeons offer basic monofocal lens implants only and make no effort to correct astigmatism as they are not refractive surgery trained.

What Are The Intraocular Lens Options?

In brief, there are two main types of intraocular lens are monofocal and multifocal. Extended depth of focus (EDOF) lens are a modern variant of both these lens types and as the name suggests, these extend the depth focus achievable that would otherwise require glasses to do so.

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.

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. These lens are best combined with femtosecond laser assisted cataract surgery so that astigmatism can be corrected at the same time as the treatment of the cataract. 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 intraocular 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 unaided vision for most daily activities such as driving, computer use and using a mobile phone or reading menus and price tags. Glasses may still be needed for night driving and for reading small print or other near tasks.

Mr Alex Day will advise you about the options available to you.

Femtosecond Laser Assisted Cataract Surgery

By using a laser, some of the steps of the surgery can be performed more precisely than if manually performed by a surgeon’s hand.

Femtosecond laser cataract treatment also allows for astigmatism to be treated at the time of surgery. This is done by creating very precise laser intrastromal astigmatic keratotomies that correct the astigmatism. The gas bubbles absorb within and their effect remains so improving the vision. The laser component is very fast, taking only a couple of minutes and is painless too.

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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 treatable, and the rate of significant vision loss that cannot be restored by glasses or contact lens being about 0.1% (1 in 1000 operations).

Detailed, transparent information about surgery outcomes and possible complications will be provided at your consultation.

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Frequently Asked Questions

What Are The Symptoms of Cataract?

A cataract is where the natural lens inside the eye becomes cloudy resulting in light being scattered or blocked when it passes through it. Symptoms include:

– Blurred vision that cannot be corrected by glasses or contact lens

– Glare or halos around lights at night, or glare in sunshine

– Difficulty seeing in dim light or at night

– Rapidly changing glasses prescriptions

When is it The Right Time For Cataract Surgery?

Many years ago, cataract surgery was only considered when cataract had developed to an advanced stage (“ripe”). Today cataract surgery is performed as soon as a person has symptoms as cataract surgery in advanced cataracts has a slightly higher risk of complications.

What Affects The Outcome of Cataract Surgery?

-The level of experience and skill of your cataract surgeon.

-The accuracy of the preoperative measurements and calculations for the intraocular lens implant (ocular biometry).

-The type of lens implant used.

-The technology used during cataract surgery: modern technology is small incision phacoemulsification cataract surgery or femtosecond laser assisted cataract surgery.

-The presence of other eye conditions such as age related macular degeneration or glaucoma, or health problems such as diabetes or previous trauma to the eye.

-The healing of the eye after surgery, and the use of the postoperative eye drops.

Am I Too Young to Have Cataracts?

Most cataracts are age related, and so patients tend to be in their 60s or older. However cataracts can develop at any age, for example even babies in their first few years of life can develop cataracts that require surgery.

Does Cataract Surgery Hurt?

Most cataract surgery is performed under local anaesthetic drops and sedation. There is no pain or discomfort, and just the occasional sense of pressure.

Can Both Eyes be Treated at The Same Time?

Many patients can have, and choose to have both eyes operated on, in one treatment session and so there is a faster recovery period after surgery than if the surgeries were performed a few weeks apart.

How Long Does Cataract Surgery Take?

Cataract surgery is a short procedure, typically taking 10-20 minutes per eye. It is not a race and the key is for a safe surgery.

Do I Have to Stay Overnight?

Cataract surgery is a day case procedure, and there is no need for an overnight stay.

How Quickly Does The Vision Improve After Surgery?

The vision is usually soft focus immediately after surgery and rapidly picks up over the next couple of days. Many people can resume work and safe driving with a few days of surgery.

Will I Still Need to Wear Glasses After Surgery?

Almost all do not need to wear glasses for clear distance vision after surgery, however there can never be an absolute guarantee this is the case. Glasses may still sharpen distance vision a little for example to help with prolonged night driving. If there is clear distance vision then reading glasses will be needed unless an advanced Extended Depth of Focus or multifocal lens implant has been used. Again reading glasses may still be needed even if these lens are used for prolonged reading, performing very find tasks, or reading in dim light.

Do I Still Need to See My Optician After I’ve Had Cataract Surgery?

Yes, once all follow up appointments have been completed, you will discharged and you should continue to see your local Optician yearly for normal sight tests as people can still develop other eye conditions such as glaucoma or age related macular degeneration.

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