Cataracts is a term used when the lens of your eye becomes cloudy. Over time the clouding becomes more extensive, causing blurred, misty vision, glare, and worsening colour vision. Eventually, cataracts can cause significant vision loss and even blindness.

Cataract Surgery Quick Links

What is cataract surgery?

How do I know if I need cataract surgery?

What causes cataracts?

Can you prevent cataracts?

What should I expect from cataract surgery?

How long will it take to recover?

Do I need to take any precautions?

How long before I can exercise?

How long before I can drive?

Do I need to take time off work?

Will I need to choose a specific lens?

Will I need new glasses?

What happens if I have another eye condition?

Can I have cataract surgery on both eyes at the same time?

Cataract surgery is a highly successful procedure where we remove the cloudy crystalline lens from the eye and replace it with an artificial one to help improve your eyesight.   

Although cloudy cataracts are not harmful to the eye, they can affect your vision, making activities such as driving, reading and chores a burden or impossible. In addition, in rare cases, untreated cataracts can cause glaucoma and even blindness.   

During the early stages of cataracts, prescription glasses may help maintain your eyesight. However, even when this is the case, symptoms of glare, particularly in bright light or when driving, can be very bothersome. Over time your cataracts will slowly get worse, leaving no other option but cataract surgery. If you delay cataract surgery, it is very unlikely that the outcome of future surgery will be compromised, but you will live with the symptoms for longer.

Cataracts do not harm the eye, so surgery needs to be considered when -

• You no longer feel safe driving, 

• You do not pass your DVLA test or have been told you are borderline

• You struggle to see and move around safely in low light 

• Your vision is blurry, and you find daily tasks difficult

• You are struggling with reading

• You experience ghosting of images or double vision 

• Your sight becomes tinted with browns or yellow tones 

• You need to change your prescription more than once every 12 months

Your ophthalmologist will be able to guide you to the best possible options. Cataract surgery can be performed at any stage of cataract development, and although advice is given, it is down to the patient when they feel ready to opt for surgery.

Most cases of cataracts are age-related, but we do see this issue in patients born with congenital cataracts and earlier presentation in people with previous eye surgery or injury and if you are particularly short-sighted, also, in those with medical conditions such as diabetes.

There is no known method of preventing cataracts. Studies do suggest that in some cases, there are higher risk categories, these include -

• Smokers

• Prolonged use of corticosteroids

• Excessive alcohol abuse

• Obesity

• Those with high blood pressure

• Excessive sunlight exposure

To lower the risk of cataracts, we should consider the risk categories and avoid these where possible.

Cataract surgery can take as little as 10 minutes to perform under local anaesthetic given through eye drops.

At the Spire Lea where Mr Sullivan practices, you will be admitted at reception half an hour or so before your operation and taken to a private room. A nurse will look after you, and the room is equipped with excellent facilities and refreshments.

First, drops to enlarge the pupil will be given. Once your eye is ready for surgery, the nurse will take you to theatre. You will lay down on a reclining surgical chair. The eye will be thoroughly cleaned, and a surgical sheet will be placed to cover the eye and surrounding area. A small metal clip will hold the eyelids open. Next, Mr Sullivan will make a small 2mm cut in your eye, remove your cloudy lens, and replace it with an artificial lens. The wounds are self-sealing, and most patients do not need a stitch.

Most patients will be awake for the operation, but a general anaesthetic is used when a patient has a particular need or desire to do so. In general, you will not feel any pain during the cataract surgery; you will notice the eye being washed during surgery and may feel occasional pressure during a couple of points. Mr Sullivan will chat with you during the procedure to reassure you.

Once the surgery is complete, you will need one to two hours to recover before being allowed home. You must arrange to be collected after surgery. You will be unable to drive home, and public transport is not advised.

Directly after surgery, you are likely to feel your eye is gritty and the vision blurred for the first day, don't worry; this is normal as the pupil is still enlarged, the eye has been exposed to bright lights, and there has been a lot of fluid and energy flowing in and around the eye.

Each patient varies, but you are likely to have improved vision and a comfortable eye within a few days. Full recovery with the best vision is expected by four weeks, at which point you can update any spectacle correction as needed. You may find occasional sensitivity to light and grittiness persists during initial recovery. You will have an eye shield in the first week to protect the eye at night.

You will usually be given eye drops which you must use for four weeks after surgery. These will be initially quite frequent. One of the drops is only for one week and will need to be kept in the fridge. The other drops will continue at a reducing intensity each week over the remaining period.

Cataract surgery has advanced significantly over the years. It is now performed through a very small incision in the eye, and the eye is very robust after only a few days following surgery.

However, you should aim to:

• avoid rubbing your eye

• not swim or submerge your head in the bath for a month

• avoid water running into your eyes when showering or washing for at least two weeks.

• use your eye drops as and when instructed by your surgeon

• return to gentle exercise after a few days (walking, golf, gentle cross-trainer)

• avoid very strenuous exercise or contact sports for a month

• not initially use any face or eye creams, makeup and mascara

You may find that when outside, protecting your eyes using sunglasses is more comfortable

Depending on the vision in your other eye, you should plan to avoid driving for at least a week after surgery. Returning to driving is often quicker in some and a little longer in others, and your specific circumstance should be discussed with your surgeon.

Although the surgery is quick and straightforward with a same-day return to home, it is not advised you return to work straight away.

Each patient will be advised depending on the nature of their job. This can be done and planned before surgery so you can book off adequate time.

As a private patient, you have a variety of options when it comes to lens choice. This differs from the standard lenses used in the NHS, which are termed monofocal spherical lenses.

Monofocal lenses correct vision at one focus, for example, in the distance. Most patients will be able to see without spectacles in this plane but will need correction for intermediate and reading vision. This can be achieved with an updated pair of spectacles after surgery. Many patients opt for this lens and are very happy with the outcome. This is the most common option if you don’t mind wearing glasses or have additional ocular conditions.

If you have astigmatism, you will benefit from correcting this with a Toric lens which can be personalised to your eye refraction and reduce the need for glasses correction with cylindrical lenses.

If your main aim from cataract surgery is to be spectacle independent, you can consider an extended depth of focus or multifocal lens. The objective of these types of lenses is to allow for the focus of near, intermediate, and distant objects. Unfortunately, these lenses have some drawbacks and are not suitable for all eyes. The total light entering the eye is split by the lens, which means the quality in each focal plane can be slightly compromised, and unwanted glare and halos in the vision are possible.

An enhanced monofocal is a midway point between a monofocal and a multifocal lens, aiming to give distance vision plus some intermediate vision with a lower risk of glare and halos.

Depending on the lens chosen, you are likely to need glasses after surgery for some tasks. However, you should wait until your eye/s are fully recovered before getting a new prescription or eye test.

What focus do I choose if I am very short-sighted or very long-sighted?

This is a very personal preference. Most patients opting for monofocal lens implants will choose to have their primary focus in the distance, which is termed emmetropic. Being left long-sighted has minimal advantages, and you reduce any chance of intermediate vision. The alternative is to be left short-sighted, termed myopic, if you prefer this.

If you have always been short-sighted and love to read without glasses, you may choose to remain slightly short-sighted after cataract surgery to continue to read without spectacles. However, if you are very short-sighted, we will often reduce the prescription to only the amount needed to read comfortably so your spectacle lens will not need to be as thick. Alternatively, if you have always wanted to wake up and not reach for your spectacles, we can focus the lens in the distance.

Some patients like to have a different focus in each eye. One eye will be focussed in the distance and the other at a closer range. This is termed monovision or mini monovision. Patients can be delighted with this approach as it reduces the need for glasses without the unwanted effects of multifocal lenses. This approach needs to be trialled with contact lenses before cataract surgery to ensure that the brain can cope with the difference.

Yes. It is very common to have more than one eye condition, with almost half of cataract surgery being performed in a patient with another eye condition. For example, around 20% of patients who have cataract surgery also have a retinal problem such as age-related macula degeneration or diabetic retinopathy. In addition, approximately 10% of patients will have glaucoma, and 5% will be very short-sighted (High myopia).

This does not tend to affect cataract surgery, but the surgeon may need to consider additional precautions before or after the surgery.

It is uncommon that we perform surgery on both eyes simultaneously. Most patients who need to have cataract surgery on both eyes have this performed sequentially, usually 2- 4 weeks apart or at a date of their preference. For example, suppose you have a very high glasses prescription. In that case, we will plan to perform the surgery closer together so that you do not have to live with any potential difference in the focus (anisometropia) between the two eyes for too long. However, in specific circumstances, where there is a need to avoid repeat surgeries or disruption to your daily life, we may consider surgery on both eyes simultaneously.

Mr Liam Sullivan - Consultant Ophthalmologist Mb ChB, FRCOphth

I perform personalised small incision cataract surgery at the Spire Lea with options for monofocal and premium lenses, including Toric, enhanced monofocal, extended depth of focus (EDOF) and multifocal lenses. I perform the majority under local anaesthetic as a day case and have readily available options for general anaesthetic.

I am a high-volume cataract Surgeon at Addenbrookes and teach trainee registrars and fellows. In addition, I have taught and am part of the faculty for the international RCOPHTH microsurgical skills course since 2015.

I have extensive experience in operating on patients with retinal co-morbidities. In addition, I have extensive experience operating on complex cases and am fellowship trained in complex cataract surgery. I have performed over 2500 cataract surgeries. My safety profile, complication rate, and visual results are consistently better than the national average benchmark figure recommended by the Royal College of Ophthalmologists.

I can usually see patients within 1-2 weeks for the initial consultation and schedule surgery within 1-2 weeks after that. Most patients are seen only once after surgery at 1-2 weeks. Occasionally I need to see them again, but more than twice is uncommon.

My initial consultation fee is £225, and single eye surgery costs under £3000, including the hospital and surgeon fees. A follow-up appointment is included, and any care required for the first month after surgery which covers the vast number of patients.