Bright Sight

Oliver Backhouse, Consultant Eye Surgeon

Frequent Questions

Frequently Asked Questions in Cataract / Lens Surgery

1] Do I need a letter of referral?

This is not essential for a private consultation but it is helpful if you have one and especially if you have health insurance as it will be needed for policy claims. Both the GP and your Optometrist can directly refer you.

2] Will I need glasses after my Cataract Surgery?

Cataract symptoms include: glare, dazzle, halos, blurred dim vision and occasionally double vision. Once the cataract (the cloudy lens of your eye) is removed, an artificial lens is implanted. Using a standard artificial lens which has a fixed distance of focus, almost all people will need glasses especially for intermediate and near vision. With the use of special artificial lenses (Accommodating or Multifocal) the need is much less. Scientific studies have shown that over 90% of patients with a Multifocal lens such as the Mplus HD are completely free of glasses for distance, intermediate and near vision with the rest needing them only occasionally.

3] Will Laser improve my eyesight?

If you are over 40 and are considering Laser surgery (LASIK or LASEK) then you should consider Multifocal intraocular lenses. This is because Laser will only give you a fixed distance of focus whereas a multifocal lens will give you both distance intermediate and near vision. Laser is not used to remove your lens / cataract. Your options will be carefully discussed with you at your appointment.

4] Does a cataract need to be ‘ripe’ before surgery is done?

No. Modern Cataract Surgery in skilled hands is very successful. This means that the threshold for recommending surgery has changed over the years. Because my audited complications are low (over 99% surgically uncomplicated), I am happy to offer clear lens surgery for people who are short or long-sighted. The chance of making your vision permanently worse following uncomplicated surgery is under 1%. If you are in poor health it may be advisable to have your cataract operation at an early date.

5] Am I too Old for Cataract Surgery?

No. There is no age limit for Cataract Surgery. Not too long ago I performed surgery on a lady who was 102 years old. She was delighted with the outcome and wished that she had had the operation years ago.

6] I don’t like needles or the thought of a General anaesthetic. Is it true a Cataract Operation can be done under just eye drops?

Yes. Usually Cataract surgery performed under local anaesthetic involves the injection of anaesthetic around the eye. This has a small rate of complications but some can be serious such as a bleed behind the eye or accidentally entering the eye. My preferred method of Cataract Surgery is under eye drops. This allows for faster visual recovery as well as avoiding the fear of needles around the eye. This eye drop technique also means that the eye will not look bruised after. Infact by looking at the eye you will hardly be able to tell that the operation has taken place.

7] What may happen if I don’t have Cataract Surgery?

The natural history is for the cataract to get worse with time. This will make your vision more and more misty over the months and years ahead.

8] I have Macular Degeneration (ARMD). Does this stop me from having Cataract Surgery?

No. Many patients with macular degeneration will get benefit from removing the cloudy cataract lens. Vision, especially peripheral vision, will be much brighter. A magnifying glass appointment should occur following the surgery as this can improve some of the central vision as well. The IOL-VIP is a new lens specially designed for people with macular degeneration and can further improve vision due to the effect of magnification and deflection of the light onto a healthy part of the retina.

9] Who will do my operation?

In the NHS the cataract waiting list is shared. You may be operated on by a different team who initially saw you and the surgeon could be a consultant or supervised training eye doctor. Although listed under a particular named consultant team, this does not mean that the consultant is the person doing your operation. With a Private operation you specifically choose the surgeon and can have the second eye done a week later.

10] How long does the Artificial Lens last for?

We use artificial lenses (intraocular lens implants) in children now as well, so these lenses are designed to last for life.

11] How long is the Operation?

This essentially depends who performs the surgery. Under a Consultant Ophthalmologist it will take approximately 15 minutes. Under a training eye doctor it is more likely to last 30 – 45 minutes.

12] How much does it cost?

All treatments are unique to every patient I treat, therefore its best to get in touch to discuss the treatment that would work best for you. All appointments in person or on the telephone are non obligatory. Lens surgery is between £2,450 and £2,950 per eye.

13] Will I stay in overnight?

No. The majority of Lens surgery is undertaken as a day case procedure. You will be in the hospital for approximately 2 hours.

14] Do I have stitches in my eye after Cataract Surgery?

No. The operation takes place through a small wound of under 3mm in size. This is self sealing so no stitches are needed.

15] Will I have a shield over my eye after?

No. The operation is performed using eye drops only so all needles are avoided. This means that no shield is required after the operation.

16] When will the Cataract Operation date be? How long for the second eye to be done?

For the NHS, the current recommendation in Leeds is for the first eye surgery to be done within 3 months with a similar additional wait for the second eye. Only one eye is done at a time. By going Privately not only do you chose your surgeon but also the time and date of your surgery as well as the comfort of free easy parking. Privately the second eye can be done 1 week following the first eye.

17] How soon can I drive?

It is sensible to have a few days off from driving. Legally, if you can see the number plate at 67 feet and your visual field is fine, you can drive a normal vehicle. Only drive if you feel safe.

18] How soon can I go back to work?

Be sensible and don’t exhaust yourself. Vision can be quite strange for the first few days. The exact answer to this question really depends on the type of work you do but I usually suggest a few days off is all that is really needed.

19] What must I not do after Cataract surgery?

It is perfectly safe to use your eyes immediately following lens surgery. After a week most normal activities can be undertaken including hair washing. What I do suggest is the avoidance of swimming and heavy physical exertion for at least a month and importantly do not rub your eye. Please report any bad pain or sudden vision deterioration.

20] When can I get my new glasses?

The eye takes a few weeks to settle properly so it is advisable to wait at least a month. In the meantime you can wear your old glasses as they can not damage the operated eye but the prescription will be wrong for you and so the vision may blur. Cheap reading glasses (approximately +2.5) are available from shops such as Boots and can tie you over this period before you get your proper glasses. For the first few days following the operation dark glasses can make the eye more comfortable as it will be sensitive to bright light.

21] I have had previous refractive Laser surgery so can I still have cataract surgery?

Yes. Unfortunately the calculations for a precise result are less predictable following Laser surgery to the cornea. By knowing what your corneal measurement were before and after the laser surgery helps to get better accuracy.

22] Can you correct my Short sight (Myopia) or Longsight (Hypermetropia) at the same time?

Yes. This is because accurate measurements before the operation allows us to precisely calculate the power of the artificial lens needed to focus the image on the retina. By choosing a multifocal lens such as the Mplus HD, this allows unaided distance, intermediate and near vision in over 90% of people.

23] I have astigmatism. Can this be corrected at the same time as well?

Yes. Astigmatism is an irregularity of the window of the eye (cornea) which blurs the image on the retina by producing two points of focus. By using a Toric artificial lens, this special lens will correct the astigmatism and so produce a clear image.

24] I have already had Cataract Surgery but am frustrated at still having to need glasses for reading. Can anything be done for this?

Yes. Rather like the advantages of the multifocal Mplus HD lens which produces no need for glasses for distance, intermediate and near vision in over 90% of people, so a similar lens called the AcriVitalis can be put on top of your cataract operation lens and give you the benefits of unaided intermediate and near vision as well.

25] Can Cataracts come back following the surgery?

No. However the bag the artificial lens sits in can become cloudy months or years later – people oftern refer to this as an ‘after cataract’. You will realise this as the vision will not be as sharp as it was before. It appears as if the cataract has come back. A Laser Capsulotomy can easily restore the good vision. It is done on an outpatient basis and takes only a few minutes to do in the clinic on a machine similar to the small slit-lamp you are examined on.

26] What are your results like?

A continuous audit of my NHS and Private cataract work shows over 99% to be surgically uncomplicated. Please contact my secretary on 0845 456 1729 should you wish to make an appointment.

Frequently Asked Questions Macular Degeneration ARMD Lens IOL-VIP

1] What is the IOL-VIP?

This new lens is specially designed for people with macular problems. The macula is the part of the retina that sees things in fine detail. IOL-VIP stands for intraocular lens for visually impaired people. The IOL-VIP works on the principle of magnification as well as deflecting the image by 10 degrees onto healthy retina.

2] Does it stop my macular degeneration from getting worse?

No. When you are being assessed for suitability for the IOL-VIP any signs of active changes in the macular means the lens should not be used. People with stable macular change (dry are old wet changes) are suitable for the lens trial. Those with small macular scars have the better outcome.

3] How do I know if this lens will benefit me?

This requires a detailed examination and measurement of the eye. On your visit to the IOL-VIP specialist you will be tested on a simulator to see if you significantly gain vision in which case the IOL-VIP is likely to be of benefit to you.

4] Will I still need my glasses and magnification visual aids?

Yes. The IOL-VIP has magnification of around 30% but will not really change your glasses prescription which you should continue to wear. You should have your glasses checked and be reassessed for magnification aids following the IOL-VIP surgery to gain the best benefit.

5] Can I have the IOL-VIP if I have already had cataract surgery.

In theory yes but currently only very few patients have had these 3 lenses implanted and extreme caution should be given if this approach is to take place. Seeking an opinion from the IOL-VIP specialist is advised.

6] Can I get this on the NHS?

Currently the IOL-VIP is not available on the NHS. We are hopeful that further research will allow the National Institute for Health and Clinical Excellence (NICE) to agree that it should be used in NHS hospital for the benefit of patients but this process can take a long time.

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The thought of surgery was a bit scary but I needn't have wasted the energy because the procedure was simple and straightforward.

Mrs Moira Bury. CLARIVU multifocal lens surgery

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