Cataract Surgery

A combination of the latest  cataract surgery technology, multifocal/trifocals and toric lens implant choice and an accomplished expert Consultant Eye Surgeon for your cataract surgery. With more than 30000 cataract surgeries  performed and who has taught cataract surgery to hundreds of surgeons from UK and all over the world. What more?

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 and becomes a cataract. When cataracts begin to form, 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 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.

What is 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.It is usually performed in patients above the age of 50.

About Cataract Surgery

A cataract is when the eye’s natural lens becomes cloudy or opaque over time, leading to a decrease in vision. Cataracts can occur at any age, but the older you are, the more likely you are to develop one. Cataract surgery is the most common elective procedure in medicine, with around 1 in 3 people over 65 requiring surgery at some stage

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 and thus 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 life 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 assess 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 the first steps of the cataract surgery: the corneal incisions, the capsulotomy (opening of the cataract) and the lens fragmentation/softening. However, current femtolaser technology has failed to show any advantages compared to phacoemulsification. Mr Maurino will discuss the options of femto laser cataract or RLE surgery 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. 

During Cataract Surgery

You should allow approximately 1.5-2.0 hours for your consultation, since it entails the following:

  • Full ophthalmic assessment, including dilation of the eyes, eye pressure 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 Mr Maurino who is a leading cataract and RLE surgeon at Moorfields, one of the best eye hospitals in the world. He has performed more than 30000 of those procedure with excellent results second to none.

Yes, you must 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 easier.  Read this information as carefully as possible and prepare a list of questions in advance so we can answer your questions during the consultation appointment.

If you wear contact lenses, follow these instructions 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 an accurate measurement of the corneal surface shape, 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.  

Learn more about lens choice options

Cataract surgery is usually straightforward, taking around 10-15 minutes in very experienced surgical hands, and 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 one week apart. We can operate on both eyes during 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 4 million or less when proper asepsis protocols are followed. It is ultimately your choice, but Mr Maurino will be happy to discuss with you about bilateral sequential same session cataract and RLE surgery.

There is no overnight stay.

Although visual recovery after cataract surgery is quick, we advise few days off work after each procedure. 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 week in the UK.  For patients having surgery it is normally considered safe to fly out after a review consultation the week after surgery. However, further follow-ups may be recommended.

You can be as active as you like (within common sense) after modern cataract/RLE surgery. Bending over and lifting lightweights are no problem, and flying is permissible after surgery. The main limitations are:

  1. No swimming and contact sports for 3-4 weeks after surgery
  2. No eye make-up for 5 days after surgery
  3. Avoid gym/running/exercising for 5 days after surgery
  4. Wear the protective plastic clear shield provided after surgery for one week but only when sleeping to avoid inadvertent eye touch
  5. 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.
  6. Dusty environments/work/hobbies should be avoided for at least 1 week after surgery.

Aftercare is simple (just eye drops, 4 times per day) 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 surgery, complications can occur during cataract surgery but are very rare. The rate of complications is the least with 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 lens container) which is around 1.5% for consultants eye surgeons. Mr Maurino PCR rate has been 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). He teaches cataract surgery to jother surgeons and supervises them in more than 200 cases per year on the NHS. 

Mr Maurino also performs more than 400 cataract per year for his private patients and his PCR 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.  Read more about YAG laser capsulotomy.

Why choose 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 with best possible outcome and the lowest possible risk.

Private cataract surgery also gives the patients far greater choice in terms of cutting edge latest 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 running an active life.

Why choose Mr 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 principal areas of expertise include cataract surgery performed with laser and phacoemulsification with trifocals/multifocal and toric IOL implants. Vincenzo has great experience of premium implants (trifocals/multifocal IOL/toric IOL) in cataract surgery and has run several studies on those type of IOL.  Mr Maurino has published scientific papers on cataract surgery and advanced lenses implants and having performed more than 30,000 cataract/RLE procedure, he will be able to advice on the best options to suit your specific needs.

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 or RLE.

We think it’s important that all of our patients have the chance to meet their surgeon at the consultation, 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. It’s your chance to ask questions so that you have all the information you need to make the decision whether or not to go ahead. It’s entirely up to you when/if to go ahead with the surgery – there’s never any pressure from us.

We use the most advanced form of blade-less laser cataract surgery

Mr Maurino has used laser cataract surgery at Moorfields since 2012 and has performed hundreds of laser cataract procedures. He has presented the results of his personals series of laser cataract procedure at International meetings such as the ESCRS  and ASCRS  (European and American Societies of Cataract and Refractive Surgeons). 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 there has been a lack of scientific evidence on the perceived laser benefits in cataract surgery. 

The most important factor in exacting cataract surgery remains the surgeon experience and very few will have such a great expertise as Mr Vincenzo Maurino who has performed more than 30000 cataract/RLE procedures with great outcomes and his an interntional recognised authority in cataract surgery.

Benefits & Risks

Cataract surgery is the most commonly performed surgery in the world. Like any type of surgery, complications can occur during cataract surgery 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, around 95% 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 impact 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 or toric).
  • Implants should not deteriorate after implantation and, 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. 
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  • 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 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; but it is important to be aware that cataract surgery may result in loss of sight, and 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.
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  • Approximately 1 in 200 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.
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  • Approximately 1 in 100 patients will require a laser procedure to further reduce spectacle dependence (such as for instance LASIK or LASEK) if desirable.
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  • 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 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 implants (multifocal/trifocals and similar) due to the more sophisticated design needed to achieve the utmost spectacles dependence. Mr Maurino will explain I details and discuss the above with you at the time of consultation. Having performed premium lens implants surgery in hundreds of cases and published studies on dysphothopsia he is in a unique postion to advise you and help to choose the best implant for you.

Other eye problems associated with cataracts

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.

Consultations & Enquiries

We welcome any questions, information requests, and first consultation bookings via our website. Please continue to fill out the form below and a member of our team will contact you.