Refractive Cataract Surgery

We usually carry out refractive cataract surgery as day surgery under local anaesthetic with some mild sedation. That means you’ll be awake during the procedure and can go home on the same day.

The operation itself is keyhole surgery. I perform it through 2 or 3 tiny incisions (no longer than 3mm) in the white of the eye.

I fragment the natural lens and remove it through the keyhole incisions. After I remove it, I implant a small plastic lens called an intraocular implant or intraocular lens. I insert it folded up through the keyhole incision, and it unfolds inside your eye after I place it in the correct position.

If you have cataracts in both eyes, I will discuss the option of operating on both eyes at the same time.

If you have mild cataracts, then this is possible, and the vision typically takes 24 to 48 hours to clear. Therefore, surgery on both eyes on the same day is perfectly acceptable.

Essential parts of the assessment are

1. An eye health assessment to ensure that the eyes are healthy and that there are no eye diseases present.
2. Biometry – this is a particular test which is used to work out which lines implant to use in each patient. Every patient needs a different strength or power of the lens implant.
3. Corneal topography to measure astigmatism. Correction of astigmatism during cataract surgery is essential to ensure good outcomes. If you have significant astigmatism, then you’ll need a toric lens implant to get good vision following surgery.

The final parts of the cataract examination are related to counselling you about:

1. Whether or not you will need glasses after surgery. We will determine this by the type of lens implant that we’ll use. Standard monofocal lens implants can correct the distance vision if you do not have astigmatism, but then you will need reading glasses.
2. If you have astigmatism, you will need glasses for both the distance and for reading if I don’t implant a toric lens. A toric monofocal lens will correct your distance vision with astigmatism, but you’ll still need reading glasses.
3. To ensure that you do not need glasses after your operation we nearly always use a multifocal lens implant to enable you to see at all ranges without the need to wear glasses.
4. If you have astigmatism and want to be completely glasses-free, then a toric multifocal lens implant will correct every aspect of the vision.

Over the past 15 years multifocal lenses have evolved to the point where there are now 2 types of optical multifocal lenses that can be used:

An Extended Depth of Focus (EDoF) multifocal lenses

EDoF lenses are perfect for golfers where the golf ball needs to be in focus from 1 meter to several meters.

70% of patients with these lenses are entirely free from glasses including for reading, but 30% of patients find that although they can read in good light, they need a weak pair of reading glasses to read in dim light.

B Trifocal multifocal lenses

B Trifocal multifocal lenses are perfect for people who want to read and use a computer without needing glasses but are happy to have a very slight compromise in distance vision.

95% of patients are completely free of glasses after we implant B Trifocal lenses, and only 5% of patients find that they need a pair of weak reading glasses on occasions to read in low light levels.

Occasionally very short-sighted patients find that although they can see their computer without glasses, they feel more comfortable using a pair of weak computer glasses when working for many hours at the computer.