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Cataract surgery is the most common operation to be performed on the NHS.
A total of 516,073 people aged 65-plus were admitted to hospital for cataract surgery in England in 2023 (the last year for which figures are currently available).
“Cataracts happen when the natural lens inside the eye becomes cloudy,” says consultant eye surgeon and researcher Alex Day, who works for the NHS and privately at Moorfields Eye Hospital.
Normally the lens is crystal clear because the proteins inside it are neatly arranged, allowing light to pass through easily. “However, as we age these proteins become disorganised and clump together causing the lens become cloudy and vision to be less sharp due to light scatter,” Day explains.
Keep an eye out for these tell-tale signs:
The most common symptom. Your vision may seem dull or misty, like looking through a haze.
It’s a result of protein clumping and preventing light from passing through the lens.
“During autumn, when we rely more on artificial lighting, people often notice halos or glare around streetlamps, car headlights or taillights,’ says Day.
“When you have a cataract, light scatters as it enters the eye, creating those classic rings or starbursts around lights.”
The paintings of some artists including Van Gogh and the Impressionists may even be a result of cataracts, according to private eye surgeon Allon Barsam, director of OCL Vision.
He notes that the halo-like swirls in Van Gogh’s Starry Night painting are typical of the effects cataract patients describe.
“Cataracts are like nature’s sunglasses causing darker vision overall,” says Day. “You may notice at the theatre or cinema that you can’t see very well to walk down the aisle.”
Deterioration is usually gradual, sometimes over a couple of years or so. “Most people don’t realise how much their vision has declined,” Barsam explains. “But if you could show them what they were seeing three or four years ago, they would be shocked at the difference.”
As cataracts develop colours tend to fade and appear more sepia-toned. “Whites can look yellow and blues duller,” says Day. “The cloudy lens filters out more blue light than other colours.”
After surgery, patients – especially photographers and artists – often remark on how vivid colours are again.
“It’s like taking off a yellow filter,” Barsam says. “People rarely notice the gradual change until one eye is fixed, and then the difference is striking.”
As cataracts develop, clouding of the lens can cause light to “split” creating two images. Experts call this monocular diplopia, double vision in one eye that often appears like a faint shadow or “ghost” image.
When a cataract is advanced the pupil can look dull or even white in colour if the cataract is very severe.
Cataracts blur vision in a way that that glasses or contact lenses can’t correct. An “unstable” prescription when your glasses or contact lenses need changing more often than usual after previously being stable is a crucial tell-tale sign, says Mr Day.
Many years ago people were advised to wait until the cataract was “ripe” – that is more advanced. However, as Mr Day points out, “modern cataract surgery is extremely safe, the risk of complications very low and is diminishing all the time.”
Both surgeons agree that surgery is best done as soon as cataracts begin to interfere with everyday life – things such as driving, reading, and recognising faces.
“If you wait until cataracts are advanced, the risks increase as the surgery can be technically more difficult,” Day comments.
Barsam agrees: “The decision is personal, but cataracts only ever get worse. Once they’re interfering with your activities, it’s time to consider an operation.”
“There is about a one in 1,000 risk of significant vision loss and a one in 100 chance of needing more than one operation but usually surgery is extremely successful in the vast majority of patients,” says Day. “Cataract surgery can be life changing.”
Traditionally, the NHS treated one eye at a time. But so-called bilateral simultaneous cataract surgery – when one eye is done after the other during the same procedure – has become more common especially since the pandemic. NICE (The National Institute for Clinical Excellence) advises considering it for people:
Barsam says, “You avoid the imbalance of one corrected eye and one uncorrected, and recovery is quicker. In the past there was concern about the risk of infection in both eyes, but with modern sterile techniques that risk is extremely low.”
Cataract surgery is one of the shortest, easiest operations you can have, usually taking 10 to 15 minutes per eye. “Most people just need drops to numb the eye and go home the same day with a clear shield that is taken off after a few hours,” explains Day.
“The procedure is painless. You lie back with your eyelid gently supported so you don’t need to worry about blinking and look at a bright light. You might see shadows or feel a little pressure but that’s it.”
| NHS | Private | |
|---|---|---|
|
Lens |
Monofocal lens implant only: Most people opt for clear distance vision but will still need glasses for reading/computer work. |
No limitation on lens implant choice: In addition to monofocal lens, other lens optical designs are available which give higher degrees of freedom from glasses: Multifocal/trifocal: “full range of focus lens” providing clear near, middle and distance vision. Most people with these lenses are spectacle free but trade-off is mild halos/glare at night. Does not work for everyone. Discuss with surgeon. Extended depth of focus lens: provides excellent distance vision, intermediate vision (computer distance) and larger print without glasses. Glasses are still needed for reading and near tasks. Minimal or no glare/ halo at night. |
|
Astigmatism correction (rugby ball shaped eye causing blur) |
Monofocal toric lens availability varies by NHS Trust/region. Generally not available or only available if high astigmatism. |
Astigmatism correcting versions of all lens implant types are available and used to correct even low amounts of astigmatism to help give the best vision without glasses. |
|
Care and follow up |
Generally limited continuity of care due to health care pressures. You don’t know who the surgeon will be until the day of the operation and you are unlikely to see the same doctor again for your follow-up appointment. |
You can choose your surgeon and meet them prior to your surgery to discuss your wants and needs. They perform your cataract surgery as well as more personalised follow up. |
|
Cost |
Free at point of use to all. |
Typically £2,990-£4,400 per eye. Costs vary by lens type and sedation. |
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