Cataract Surgery
What is a cataract?
Cataract is a clouding of the natural lens in the eye. The natural lens changes with age and begins to lose its transparency becoming a cataract. When cataracts begin to form, the vision becomes increasingly cloudy. Patients with cataract experience reduction in vision, cloudiness of vision, a sensation of a film covering the eye, reduction in the brightness of colours and reduced contrast sensitivity (ability to see shadows of grey). Early symptoms include also dazzling from car headlights at night and a progressive shift towards short sight, which can interfere with many aspects of everyday activities such as reading, working, driving and playing sports.
Your Questions about Cataracts
Typical early symptoms of cataract are light scatter (e.g. dazzle from oncoming car headlights during night driving) and a progressive shift towards short sightedness causing frequent changes in spectacles prescription.
Other symptoms may include:
- Blurred or hazy vision
- Double vision
- Poor vision in bright light
- Seeing halos around lights
- Poor vision at night
- Yellowish tinged vision
Cataract surgery is the most common elective procedure in medicine, with most people over 65 requiring surgery at some stage. Broadly speaking, cataract surgery is beneficial for patients whose visual impairment is bothersome and interferes with important aspects of their lifestyle such as the ability to work, play sports, drive or read. If cataracts do not impair the person’s vision, then no surgery is necessary.
The only way to establish whether cataract surgery is appropriate for you is at consultation, where we perform a series of comprehensive eye tests to confirm the diagnosis of cataract and assess the suitability for treatment. We also ensure your eyes are healthy, and advise you fully on the benefits and risks of cataract surgery and your options to minimise spectacles dependence with specially designed lens implants.
Because surgeons no longer need to wait for the affected lens to harden in order to be shelled out like a pea, cataract surgery is now commonly performed at a much earlier stage than previously. However, waiting for cataract surgery does not harm the health of your eye, and equally good results can be obtained from cataract surgery performed at an early or a later stage.
Modern cataract surgery is a form of keyhole surgery in which the natural lens is removed through a 2 mm incision. A Femtosecond Laser can be used to perform only the first steps of the cataract surgery: the corneal incisions, the capsulotomy (opening of the cataract) and the lens fragmentation/softening. No laser can be used to perform the whole cataract procedure.
However, current laser cataract technology has failed to show any advantages compared to ultrasound phacoemulsification. Mr Maurino has not been using laser assisted cataract surgery for the last 18 months due to the proved lack fo superiority of laser cataract surgery. He has published extensively on the failed of cataract surgery and laser cataract surgery and he is in a unique position to advice his patients –see Vincenzo Maurino scientific cataract publications by clicking here–. Many surgeon with lesser expertise continue to use the laser for very few parts (never the whole) of the cataract surgery but the clinical overwhelming evidence does not hold up. We will discuss the options of femto laser cataract at the time of your consultation.
When the natural lens is removed during cataract surgery it is always replaced with an artificial intraocular lens (IOL) to minimise spectacles use.
Once inside the eye, the IOL unfolds within the lens capsule to lie in the natural position, focusing light accurately on the retina. The small corneal incisions (around 2 mm) are self-sealing, and do not affect the strength of the eye wall.
Cataract surgery
Cataract Surgery is an operation to replace the eye’s natural lens with an artificial one. With around 1 in 3 people over 65 requiring surgery at some stage, cataract surgery is the most common elective surgical procedure in medicine. An identical technique, known as Refractive Lens Exchange (RLE), is used where the purpose of cataract surgery is primarily to reduce a person’s dependence on glasses or contact lenses, rather than to clear blurred or cloudy vision resulting from a cataract. RLE is an effective treatment for patients with presbyopia (the age-related condition characterised by the need to wear reading glasses in later life) or whose short- or long-sight prescription is too high for laser eye surgery.RLE is usually performed in patients above the age of 50.
Your Questions about Cataract Surgery
You should allow approximately 1.5 hours for your consultation, since it entails the following:
- Full ophthalmic assessment, including dilation of the pupils, eye pressures check and examination of the back of the eye (the retina).
- Comprehensive eye test (known as refraction when needed).
- Autorefraction & Corneal Topography
- Laser Biometry
The above diagnostic tests are carried out by Mr Maurino’s team. You will then be seen by Mr Maurino, who will explain the results of the eye tests and discuss which of our range of treatments may be most appropriate for you. All procedures are carried out by Vincenzo Maurino who is a leading cataract at Moorfields, one of the best eye hospitals in the world. He has performed close to 30.000 of those procedure with excellent results second to none.
Ideally, attend your initial consultation wearing an up-to-date spectacle prescription. Although we do not rely on this for choosing the artificial lens power to be implanted, this will make your assessment quicker Read this information on this website as carefully as possible and prepare a list of questions in advance so that we can answer your questions during the consultation appointment.
If you wear contact lenses prior to your appointment:
- Remove daily soft contact lenses for a minimum of 3 days before appointment
- Remove at gas permeable or hard lenses at least two weeks before appointment
Temporary changes in corneal shape are commonly associated with contact lens wear so it is important for you to remove contact lenses for the prescribed period above prior to your consultation appointment. This will enable accurate measurements of the corneal surface shape and the eye, which is critical for selecting your artificial lens and to exclude abnormalities in corneal shape that might influence the results of your surgery.
Once we have all measurements taken at the time of your consultation, we can set the dates for your surgery and you can even resume wearing the contact lenses until then.
Mr Maurino will also discuss the type of artificial IOL to replace your natural lens, which is part of the cataract surgery procedure and the options to correct astigmatism and presbyopia.
Cataract surgery is usually straightforward, taking around 10-15 minutes in very experienced surgical hands and it is normally performed under topical anaesthetic (just drops to numb the eye). Light sedation can be used to make patients relaxed. For patients requiring surgery to both eyes, we can schedule the operations in the same session. The international society of bilateral cataract surgery estimates that the risks of sight threatening complication in bilateral simultaneous surgery is circa 1 in 300.000 or less when proper asepsis protocols are followed. It is ultimately your choice, but Mr Maurino will be happy to discuss the options further with you.
Although visual recovery after cataract surgery is quick, we advise a few days off work after surgery. This is not obligatory, and provided you are able to put eye drops in 4 times per day, a return to office work two days after surgery will not damage the eye. Light computer work should be fine. Dusty environments should be avoided for a minimum of 1 week after surgery.
For cataract patients coming from overseas, we recommend a minimum of 1-2 weeks in the UK. For patients having surgery it is normally considered safe to fly out after a review consultation one week after surgery. However, further follow-ups may be recommended.
You can be as active as you like (within common sense) after modern cataract surgery. Bending over and lifting lightweights are no problem. Flying is permissible after surgery. The main limitations are:
- No swimming and contact sports for 3-4 weeks after surgery
- No eye make-up for 5 days after surgery
- Avoid gym/running/exercising for 5 days after surgery
- Wear the protective plastic clear shield provided after surgery for one week but only when sleeping to avoid inadvertent eye touch
- Driving is fine, as long as you meet the legal minimum driving standard of vision, i.e. reading a car number plate at a distance of 20 metres.
- Dusty environments/work/hobbies should be avoided for at least 1 week after surgery.
Aftercare is simple (just eye drops, 4 times per day for a few weeks) and there are few restrictions on activity.
Surgery is virtually painless, and there is little discomfort afterwards. In most cases, patients can expect to see quite well within just 1-2 days of surgery.
Cataract surgery is the most commonly performed surgery in the world. Like any type of eye surgery, sight damaging complications can occur, but are very rare. The rate of complications is at its very lowest when in the hands of a very experienced and specialist cataract surgeon like Mr Maurino.
Mr Maurino and all UK cataract surgeons have a duty to audit their results. The audits in terms of complication look at the rate of the commonest complication named rupture of the posterior capsule -PCR- (rupture of the back of the thin original lens container) which is around 1.5% for the average consultant eye surgeons. Mr Maurino PCR rate has been consistently at zero for the last few years.
Please note that Mr Maurino performs circa 100 cataract per year on the NHS (usually the most complex cases and patients with one eye only). However, he teaches cataract surgery to other surgeons and supervises them in more hundreds of cases per year on the NHS.
Mr Maurino performs hundreds of cataract surgeries per year in his private practise and again his PCR complication rate has been zero for all of his cataract surgeries for the last 5 years.
In cataract surgery, the IOL is implanted within the natural lens capsule, a thin transparent membrane that encases the natural lens and is often likened to the skin of a grape. This can commonly become opaque and hence vision will be affected. Whilst posterior cataract opacification is relatively common after cataract surgery, it can be sorted quickly with an office based 2 minutes laser procedure called YAG laser capsulotomy. Read more about YAG laser capsulotomy.
Mr Maurino has been performing laser cataract surgery at Moorfields from 2012 to 2018 and has successfully executed thousands of laser cataract procedures. He has presented the results of his personal series of laser cataract procedures at international meetings such as the ESCRS and ASCRS (European and American Societies of Cataract and Refractive Surgeons). On top of this, he has been a senior investigator for the Moorfields fentosecond laser cataract randomised controlled clinical trial.
Please be aware that at present we are not using routinely laser cataract surgery since it has now been proven that laser assisted cataract surgery has no benefits compared with ultrasound cataract surgery.
The most important factor in exacting cataract surgery remains the surgeon experience and Vincenzo Maurino has unrivalled expense and expertise. Having performed close to 30,000 cataract/RLE procedures with excellent outcomes, Mr Maurino is an internationally recognised authority in cataract surgery.
Cataract surgery is the most commonly performed surgery in the world. Like any type of surgery, complications can occur but are very rare. The rate of complications is the least with a very experienced and specialist cataract surgeon like Mr Maurino.
- In the absence of other eye problems that may limit vision, most of patients having cataract surgery will be able to achieve driving standard of vision or better without glasses after treatment. In patients with other eye disease associated with cataract, around 70% will achieve driving standards. These results are greatly improved by combining state of the art surgical and lens implant technology with great experience and expertise thus significantly increasing the safety and the outcomes of surgery.
- Reading glasses are normally required after surgery, but dependence on spectacles for near vision can be reduced by using premium lenses (trifocals, EDoF or toric).
- Implants should not deteriorate after surgery , in the absence of any new problems in the eye, clear vision should be permanent once recovery from the cataract surgery is complete provided no other pathology appear later in life. However, some implants may become opaque in time and need changing. This is rare and can be dealt with in the unlikely event it does happen.
- The most common reason for visual deterioration after cataract surgery is a frosting-over of the tissue surrounding the IOL, known as posterior capsular opacification (PCO or Secondary Cataract). This is treated by a quick and effective YAG laser capsulotomy procedure in the office. Whilst PCO is not uncommon , it can be sorted by a quick in office laser procedure lasting 2 minutes.
- Although very rare, cataract surgery can result in visual loss. Complications that can cause serious visual loss after cataract surgery include infection, spontaneous rupture of sub-retinal blood vessels during surgery (choroidal haemorrhage), or untreatable retinal detachment. Such complications are extremely rare; it is important to be aware that you should immediately attend our Casualty Department at Moorfields (open 24/7) for an emergency eye examination if you experience either a progressive increase in pain or sudden loss of sight after cataract surgery.
- Sight-threatening complications such as retinal detachment or infection can often be treated successfully if they are caught at an early stage. Any patients experiencing sudden onset or worsening of flatters, flashing lights and shadow in the vision must be seen by an eye surgeon immediately.
- Approximately 1 in 100 patients will require a second operation to correct problems resulting from cataract surgery. In the vast majority of these patients, the final visual outcome is good, but visual recovery may be delayed.
- Approximately 1 in 100 patients will require a laser procedure to further reduce spectacle dependence (such as for instance Femto LASIK or No Touch LASEK) if desirable.
- Approximately 1 in 50 patients can experience sudden onset of floaters after cataract surgery. This can happen naturally with age and more commonly in patients with short sight. Floaters are usually well tolerated, and the brain is able to ignore them, but you must be aware of this possibility. Also, if you experience a sudden onset of flashing lights, floaters or any similar symptoms, you should be examined immediately to exclude a retinal involvement, which could cause a detached retina.
- Dysphotopsia: It is common after cataract and RLE surgery to become aware of some unawanted visual side effect. Dysphotopsia is awareness of glare, halos and starburst especially at night when driving and in artificial light. Can happen with any type of implants and usually is temporary and improves with time. It is more common with premium presbyopia correcting implants (multifocal/trifocals/EDoF and similar) due to the more sophisticated optical design needed to achieve less spectacles dependence. Mr Maurino will explain in details the risks and management of dysphotopsia at the time of consultation. Having performed premium lens implants surgery in hundreds of cases and published studies on premium IOL technology, he is in a unique position to advise you and help to choose the best implant for you.
Other eye problems are also more common with age. 1 in 3 patients undergoing cataract surgery will have some other problem with eye health that may influence vision after surgery. A common example would be age-related macular degeneration (ARMD), where the central part of the retina (the macula) deteriorates causing problems with reading and overall visual clarity. Although unrelated problems such as ARMD may limit the visual improvement that can be obtained from cataract surgery, treating the cataract will still normally result in a worthwhile visual gain.
IOL (Intraocular Lens Implant) Choice.
Lens Implant or Intra Ocular Lens (IOL) Options
Monofocal IOL have a uniform focus and provide excellent image quality but have a limited range of focus. It is very useful to be able to see clearly at a range of distances after surgery, and surgeons using conventional lenses commonly aim for to minimally spread the focus between the two eyes to achieve a greater depth of focus. This strategy is called blended monovision. Typically, for patients with good vision in both eyes, the aim is to achieve a clear focus for one eye in the distance and the other at arm’s length. This helps to minimise spectacle dependence for most activities. However, reading glasses are normally needed for reading , and a distance prescription may be preferred for some activities – especially in low lighting conditions (e.g. theatre, cinema, night driving).
These lens implants are well tolerated and provide enhanced spectacle independence, allowing good unaided vision for both distance, computer and reading. However, whilst premium IOLs produce a greater depth of focus than conventional lenses, there can be a compromise on image quality. Some patients can be troubled by dysphotopsia – light scatter symptoms (e.g. starburst, glare and haloes) and therefore premium IOLs may not be the right choice if you do a lot of night driving. At your consultation, Mr Maurino, who has published extensively in the fields of premium lenses, will be in able to advice you on IOLs choice.
Toric IOLs (for the correction of astigmatism) are used to correct astigmatism on the cornea. Toric IOLs are inserted at a specific position within the eye and are very effective at correcting up to 8 dioptres of astigmatism. Mr Maurino uses Toric IOL routinely and has published extensively on the subject. Best results are achieved in patients with at least 1.5 D of corneal astigmatism.
n special situation Vincenzo Maurino will advice also the IC-8 IOL that uses a pinhole technology to minimise need for spectacles for any distance and help correcting astigmatisms and presbyopia. This technology is best for patients with abnormal corneal shape (after corneal transplants, eye traumas, keratoconus, radial keratotomy and high prescription laser vision correction) to achieve better spectacles independence and minimise the risk of dysphotopsia.
Private cataract surgery
The main advantage of private cataract surgery is that you will have your eye surgery performed by a consultant eye surgeon of your choice, giving you the reassurance that your eyes are in experienced hands. This will ensure the best possible outcome and that your surgery is carried out with the lowest possible risk.
Private cataract surgery also gives patients far greater choice in terms of getting access to the latest, cutting-edge technology. Patients have a much wider choice in lens technology including the possibility of having a toric lens to eliminate astigmatism or a trifocal/multifocal lens to give greater independence from glasses for both distance, computer and near vision. Combining advanced cataract removal technology with the latest lens implant choices (trifocals/multifocal and toric) increases the chances of eliminating the need for glasses and leading an active life
Choosing Vincenzo Maurino at Moorfields
Vincenzo Maurino is Consultant Ophthalmic Surgeon at Moorfields Eye Hospital NHS Foundation Trust and the Director of the Cataract Surgical Service at Moorfields.
Vincenzo Maurino primary areas of expertise include cataract surgery and he has great experience of premium implants (trifocals/multifocal/toric IOL) in cataract surgery . Mr Maurino has published scientific papers on cataract surgery and advanced lenses implants more than most surgeons at Moorfields and having performed close to 30.000 cataract/RLE procedures, he is able achieve the safest possible surgery for his patients and to advise on the best options to suit the patients specific needs.
Vincenzo Maurino is one of the few surgeons to been named by his colleagues as one of the best cataract surgeon in UK. In 2018 Vincenzo Maurino was voted by his peers as one of the best cataract surgeon in the UK, click here to read more.
He is a natural surgeon, effortless and very slick. The hallmark of an excellent cataract surgeon is someone who manages to do a very good job every time. That’s him.
The only way to discover which of our procedures is appropriate for you is to come to us for a consultation to one of our clinic locations at Moorfields Eye Hospital or at the London Claremont Clinic. Lasting around 1½-2 hours, our team will perform a series of comprehensive eye tests, some of which will be familiar to you, and some are specific to the assessment process for cataract surgery.
All of our patients will meet their surgeon , Vincenzo Maurino, at all consultations, not just on the day of treatment. Mr Maurino will fully examine your eyes and go through the results of your eye tests with you and will advise you as to the treatment most appropriate for you. This gives you the chance to ask questions so that you have all the information you need to decide whether or not to go ahead with the procedure. It’s entirely up to you and there’s never any pressure from us.
