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Thread: Cataract surgery - experiences?

  1. #1
    Master thieuster's Avatar
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    Cataract surgery - experiences?

    Time has caught up with me: my eyesight has gone worse over the last 6 - 8 months. New lenses for my glasses did the trick for a few weeks, but then it worsened even more. In fact, I feel unsafe driving at night. I can't distingush people wearing dark clothing when it's late at night. Luckily I haven't hit anything (yet...). Anyway, I've just returned home from a visit to the ophthalmologist: I have cataract on both eyes. The right eye is worse. I'm getting old!

    There's a long waiting list for a cataract surgery in the Dutch general hospitals, so I turned to my cousin for help: she's GP and she suggested that I would turn to a private clinic for a proper diagnose. I made an appointment last Friday for the visit to the ophthalmologist of a private eye surgery clinic this afternoon. The eye surgeon was very clear: cataract.

    She (the surgeon, not my cousin) gave me a ton of reading material and a schedule for a new appointment next Thursday. Then, I'll be heading back to the clinic for the correct lens. But there are options: she can provide me with a -more or less- 'standard' lens; that will include that I'll still need specs for reading. Or, I can opt for a more specialized lens - a lens that will take away all my 'troubles': I would not need specs anymore. I'm currently wearing glasses with multifocal lenses. And I wouldn't mind wearing glasses for reading. As a matter of fact, I don't mind wearing glasses at all.

    I'm curious to know if you have experience when it comes to cataract related eye surgery and if you have experience chosing a lens for your need. Furthermore: additional info would be great.

    Menno

  2. #2
    Hi Menno,

    I am sure there has been at least one previous thread on this, but my quick search did not find it!

    My wife had both eyes done about 4 years ago. At that time, the UK NHS only used single focus implants. (that situation might have changed?).
    She had astigmatism in one eye anyway so that option would have meant she would need to continue with corrective glasses for this and for reading.

    She opted for multifocal implants privately and they have been successful for her. She was warned at the time that MF implants might gave "halo" visions from oncoming cars whilst driving at night etc but it proved barely noticeable for her so she became glasses free for the first time in...."quite some years".

    The then cost was just under £3K through a UK health provider "Benenden" in deepest Kent.
    The operation took about 30 minutes and no driving for a couple of weeks I recall. Eye drops each day for about a month.

    Hope that is of help!

  3. #3
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    I had mine done by the NHS about 7 - 8 years ago. After 50 years of wearing glasses it was a huge (and welcome) change. What they did not tell me was that there can be a couple of issues after; there can be a growth shortly after the operation on the back of an eyeball - very simply treated by being zapped by a laser. I went for a check, and they said if I was prepared to sit around and wait they would do it immediately.
    Another was that I do not think that you have quite the same brightness filters, so I bought a couple of pairs of plain glass with very faint coatings - though in my local (Pinner) Sainsburys, I find the lighting there very bright, especially with reflection off the tiled floor, and keep wishing I had proper sunglasses with me.
    Final one, which just seems to be unusual to me, I struggle to tell the difference between a very dark blue, dark purple and black - only noticeable with clothes, and anyway, even before this my wife would rarely let me leave the house without checking me first...

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    Master thieuster's Avatar
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    Thanks guys. 3K is also the sum mentioned here among colleagues and friends. As said, I don't mind wearing glasses - I'm nearly 62 and wear glasses since I was 16 y/o. Big chance I will opt for the 'pane-glass' solution. I'm currently wearing a titanium frame made by Lindbergh. My second frame of that brand. The first was a dud: the frame came apart... but was replaced by the company for my current one. I don't know if I want to keep this fragile frame as 'reading specs only'. But that's another problem.

  5. #5
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    Hi Menno,
    I send dozens of people up to have their cataracts done every year and whilst I won't pretend every one goes exactly to plan the vast vast majority do. Its a fantastic procedure made much more effective by current phaco techniques. The improvement in quality of life can be huge. It takes about 18 mins to do an eye under local anaesthetic so home in a couple of hours.

    Now lens choice. I can't recommend any of the multifocal implants. I know the Ophthalmologists will recommend them and there is an element of people have to have them to improve the optics but I have yet to see a patient truly happy. I read a surgical paper that spent 50% of its time talking about patient selection and the gist of it was if a patient asks about their level of vision post op they aren't suitable as they will be too critical and ultimately disappointed in the results. Undoubtedly it is where the technology is going but they aren't there yet.
    You tend to get usable vision at all distances without spectacle correction but that vision isn't "clear". You lose some of your contrast perception so images aren't as "black" as they might be. Its a side effect of the blur margins the lenses use to give you the huge depth of field you need to do all distances. If the primary aim is to be free of spectacles afterwards then fine as you will be tolerant of the downsides but if not don't do it. A spherical single vision lens or a toric one if need be would be my choice.

    Realistically you will still need a distance vision correction to see as well as you can post op (but that should then be very good). It won't be anything like the magnitude you have now but it will almost certainly be there. Don't necessarily believe the surgeon if they tell you otherwise! In my experience only a very small percentage of patients genuinely don't need one. Surgeons like to think they are perfect, but often the truth is a little way away from what I'd call perfect. But we can fix it! And yes you'll need a near rx too.

    Have a really good think about how you would like your prescription post op. You don't have to have good distance without glasses you could have good reading. If you are short sighted now you may be used to, and like, being able to read or see small fuses or wiring under bonnets without your glasses. If they correct for distance you won't be able to but they can change this it just means you'll need a stronger distance prescription but again less than you have now. I can go into more detail if it helps.

    Is the £3k per eye or for both. Privately £2k ish per eye is the norm here if you fancied coming over here. A lot of patients locally use Newmedica and the results are good but I'm not particularly advocating them. Lots of others available.
    https://www.newmedica.co.uk/services/private-surgery

    Hope that's useful and if I can help drop me a line.
    David

  6. #6
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    Having spent much of the last year having cataract/lens replacement surgery I'm happy to relate my experiences & suggest some things you might want to consider. The post above by DavidL covers many points very well.

    As you probably know in general there are two types of lenses: monofocal & multifocal. Multifocal lenses are touted as giving good vision over a wide range of distances but the results are very variable. Many people get on with them perfectly well but there are a substantial number of patients who cannot cope with the flares, halos & contrast reduction that can occur (pilots are not allowed to have multifocal implants for instance). The problem is you will not know to what extent you are going to suffer until the lens is implanted & then it's too late.

    I had a type of multifocal lens in my left eye & could not cope with the issues - primarily halos, poor low light resolution & poor contrast. The issues are very dependent on the type of lighting; I found my local Sainsburys particularly bad & stopped shopping there. Fortunately it was a dual lens implant (main lens is monofocal with a secondary multifocal lens in front) & I had the secondary lens removed to leave me with much better monofocal vision. I went with a monofocal lens in the right eye.

    A major, but often neglected, consideration is where your new lens should correct your vision to (as DavidL says). Apparantly most men say they want good distance vision but my experience is that might not be the best option. I found that the vast majority of the time I spend focused on items up to around 3m away ie the range from reading a book or tablet to seeing the PC screen to watching the TV. Outside of this absolute sharpness is not quite so useful (provided you meet the driving standards of course) & in real life it's much more useful to be able to read the label on a packet than see the leaves on a tree 100m away. You can always keep pair of driving glasses in the car which correct to give good distance vision.

    One area you might explore is monovision; this is where your dominant eye is corrected for good distance vision & your other eye is corrected slightly less so you can read with it. If you can cope with this it can be a good compromise. Your consultant should discuss this with you & if he's really good actually give you contact lenses to try it out.

    Pick your consultant very carefully & make sure you will be seeing him at every check up. Here in the UK there are a number of High Street chains that offer all sorts of procedures & I know of someone who used them & was operated on by a surgeon who flies in from South Africa for two days & then he never saw him again. In the UK the whole private eye surgery business is unregulated & a real swamp - one very high profile surgeon was found to be so bad he was struck off recently & even Moorfields consultants have quietly been dropped following investigation.

    Don't believe anyone who says they will give you perfect vision like you had 30 years ago; they cannot guarantee that. If you reach the driving standard without glasses that's good (& the minimum vision driving standard in the UK is pretty shocking). Many get better results, some will not. I was -7.5/-8.25 & ended up -0.25/-0.75 which gives me the best vision I have had in 50 years, but it's not perfect. With my left eye I cannot read & if I'm driving all day I use a 0.75 contact lens in the right. I could have a bit of laser treatment to tweak it up but I'm wary of that.

    With all those caveats it's a brilliant operation to have if it goes well. The actual operation is 20 minutes of rather weird feeling as the surgeon presses on your eye but there's no pain & you can't see anything. Recovery was painless (much less painful than laser surgery I'm told) & you should be seeing well in a week or so. Everything is very bright & much whiter than it used to be but you soon get used to it.

    If you have any other questions I'm happy to try & answer them.

  7. #7
    Master thieuster's Avatar
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    Thanks for the information. Very useful.

    I contacted my insurance company (we have a system that's different from the NHS) and they agree paying for all sorts of lenses, including multifocal. However... reading this, I suppose I skip those and opt for the monofocal version.

    The comments about what to chose: reading or distance glasses (to put is bluntly) is an interesting one. I think I will opt for the 'easy reading' option and glasses for distance, like driving a car. (That's what I had between 16 and 50! Only after that age I slowly needed multifocal for reading. Only the last 10, 12 months, my eyes have gone bad due to the cataract.

    It always amazes me how this forum works: the tons of information and good advice on so many parts of life make me glad to be a member here.

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    I had my cataracts attended to about 12 months ago, both eyes. I had previous laser correction in 2002 and the clinic did tell me they couldnít guarantee perfect vision as previous laser surgery alters the anatomy of the eye and that makes it difficult to match the lenses.

    In reality my distance vision is now as good as it was in 2002 and I just need reading glasses, I am 74 and have almost 20/20 vision.

    My surgery was carried out by SpaMedica, a private clinic, but funded by the NHS.


    Sent from my iPhone using Tapatalk

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    Great posts both from David and MrPointy.

    I had my eyes done about four years ago, both within a couple of months and regret that I was not given the option of good near sight or good long sight. The implanted lenses give me good long sight but, given the option, I would rather be able to read without glasses as I could prior to the ops.

    Having said that Iím grateful I can see clearly again!

    A couple of years after the implants I experienced retinal detachments in both eyes within a couple of months of each other. I have since been told that there is an increased risk of this happening following cataract surgery.

    Luckily(?) for me at least, one of my wifeís friends experienced retinal detachment about 10 days before I did so I knew exactly what the symptoms were and went to A&E as soon as I experienced these. I was operated on within hours, time is of the essence here, which undoubtedly saved my sight. The same thing occurred in my other eye 2 months later.

    A couple of years after the cataract operation I was beginning to experience slightly cloudy vision in my dominant eye but a simple laser procedure appears to have remedied that.

  10. #10
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    Jeremy, I think you were unlucky to experience bilateral detachments post op as it's not a usual side effect. I think the likelihood is only 1-2%.
    Equally likely was that as a myopic patient you are at a higher risk of RD anyway and even though your prescription isn't myopic anymore you still have myopic eyes. Occasionally they need to perform a partial, anterior, vitrectomy if the capsule is damaged (the only part of the old lens that is left post surgery) and this can escalate into full vitrectomy and then RD is more likely but procedures are infinitely better than they were.

    The capsule can opacify and this is what has been alluded to in a couple of posts. It can happen for a number of reasons and gives you the impression that the cataract is coming back; it can't of course as it isn't there any more. It can happen from a couple of months to several years post op but it is likely at least one eye will need treatment. The good news is that it is a 5 minute laser procedure to fix. Basically they sit you down and blow a big hole in it with the laser. Its a simple outpatient appointment, no anaesthetic required.

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    David, you may well be right thatI was unlucky here, Iím just grateful I can see clearly again!

    As you say the laser treatment re opacification is very quick and easy, I was amazed how simple it was.

  12. #12
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    Quote Originally Posted by JeremyO View Post
    A couple of years after the implants I experienced retinal detachments in both eyes within a couple of months of each other. I have since been told that there is an increased risk of this happening following cataract surgery.
    Although I didn't mention it I too suffered a retinal detachment a couple of weeks ago & have found the aftermath or the operation quite debilitating. Was your resolved with laser surgery or did you have to have a vitrectomy?

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    Quote Originally Posted by Mr Pointy View Post
    Although I didn't mention it I too suffered a retinal detachment a couple of weeks ago & have found the aftermath or the operation quite debilitating. Was your resolved with laser surgery or did you have to have a vitrectomy?
    Both retinal detachments were done under local but Iím not sure what procedures were used. I did have a lot of bruising and it was very uncomfortable for a while afterwards.

    The most difficult bit was having to lay in certain positions for a protracted time for a number of days afterwards

    My out patient laser surgery took place about 18 months after the cataract op, also after retinal detachment procedures, as I had some opaqueness of the capsule in one eye. That was a very quick and easy procedure and, touch wood, seems to have done the trick.

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    Quote Originally Posted by JeremyO View Post
    Both retinal detachments were done under local but Iím not sure what procedures were used. I did have a lot of bruising and it was very uncomfortable for a while afterwards.

    The most difficult bit was having to lay in certain positions for a protracted time for a number of days afterwards

    My out patient laser surgery took place about 18 months after the cataract op, also after retinal detachment procedures, as I had some opaqueness of the capsule in one eye. That was a very quick and easy procedure and, touch wood, seems to have done the trick.
    Thanks, it sounds like you had vitrectomys as well. I was fortunate that I only had to lie left side down for five days, not face down which would have been very difficult. It's the sudden ban on not flying for five months or being able to drive for 6-8 weeks that is proving difficult to work with. As you say the YAG laser to clear the PCO cloudiness is a relatively trivial procedure.

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    Quote Originally Posted by Mr Pointy View Post
    Thanks, it sounds like you had vitrectomys as well. I was fortunate that I only had to lie left side down for five days, not face down which would have been very difficult. It's the sudden ban on not flying for five months or being able to drive for 6-8 weeks that is proving difficult to work with. As you say the YAG laser to clear the PCO cloudiness is a relatively trivial procedure.
    We had to cancel our summer holiday as I was unable to fly, luckily we had travel insurance which covered most of the cost.

    As you say, not being able to drive was a real pain, especially as the second retinal detachment occurred about 5 weeks after the first so it seemed months before I could drive again.

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    My wife has had both her eyes done the latest being last year and the other one none months previous.
    She has always wanted to be able to learn to drive for years but at -11.5 and -12 her vision was very poor.
    She hated wearing thick glasses then went onto contacts.

    Her operations took place at Leicester Royal Infirmary once on a Saturday and the other on a Sunday and including waiting time was around 2 hours
    Eye drops daily and from then on no problems at all, she now doesn't need to wear glasses for anything and has changed her life.

    Good luck with your choices and hope all goes well.

  17. #17
    Master thieuster's Avatar
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    An update:

    I went back to the clinic to discuss the type of lens and the surgery date. An interesting meeting with lots to talk about - for a large part I was able to use the info gathered here!!

    First we discussed the 'only one eye/both eyes' choice. For now, I've opted for the right eye only. My left is indeed significantly better than my right. Then we discussed the type of lens: I've opted for a monofocal lens. Largely because the information on this forum made me rethink my options. With an operation on only one eye, I will be needing glasses for my other eye. The need for reading glasses will still be there after the op.

    Then time: next Thursday afternoon. That's quick! I will receive a bottle containing eye drops and a thorough instruction how to use them.

    I'll keep you posted!

  18. #18
    Master Xantiagib's Avatar
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    good choice - bloke at work (in his 40s) had one eye done first recently to see how it goes
    I think he got tri-focal lense replacements.

    His hobby is microsoldering electronics and so far so good
    Last edited by Xantiagib; 11th February 2020 at 13:27.

  19. #19
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    Quote Originally Posted by thieuster View Post
    First we discussed the 'only one eye/both eyes' choice. For now, I've opted for the right eye only. My left is indeed significantly better than my right. Then we discussed the type of lens: I've opted for a monofocal lens. Largely because the information on this forum made me rethink my options. With an operation on only one eye, I will be needing glasses for my other eye. The need for reading glasses will still be there after the op.
    Glad to hear you will be having the operation soon & hope it goes well. Personally I found the period between my two operations to be the most arkward due to the disparity between my vision in each eye meaning I was always wearing the wrong glasses for one eye. There's also an issue with differing image sizes on the retina (one through a lens & one not) & the brain really struggles with this difference.

    Everyone's eyes are different though so you may be ok, but don't be surprised if you decide to go back & have the other one done quite soon after the first.

  20. #20
    Master thieuster's Avatar
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    An update:

    Surgery is DONE!

    It took the best part of two hours to get prepared for the op. Dressing-up for the operation, drops of liquid to prep the eye itself etc. The whole operation took less than 10 minutes. Looking into the harsh light with your eyes open wasn't easy. I really felt uncomfortable with that. But, as said, in the end it was an under 10 min job.

    I went home with a pirate-like eye-pad and apart from a light stingy feeling, there was no pain etc. And now, it's completely okee, pain-wise.

    I was allowed to remove the eye-pad around 8 AM this morning. The first impression: everything is SO BRIGHT and LIGHT! It's like going from candlelight to xenon light! The difference between the 'new' right eye and the 'old' left one is unbelievable!

    All is a little vague and everything has a halo. Earlier, I looked outside and the streetlights all had halos around the light itself. And for now it looks as if I'm looking though a fish-eye lens. I cannot say I can do without glasses. But that wasn't the ultimate goal. Let's see what happens in the days to come.

    Later today I'll receive a phone call from the clinic and we'll discuss what I've written here and hear what their comment is.
    Last edited by thieuster; 14th February 2020 at 08:24.

  21. #21
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    Quote Originally Posted by thieuster View Post
    An update:

    Surgery is DONE!

    It took the best part of two hours to get prepared for the op. Dressing-up for the operation, drops of liquid to prep the eye itself etc. The whole operation took less than 10 minutes. Looking into the harsh light with your eyes open wasn't easy. I really felt uncomfortable with that. But, as said, in the end it was an under 10 min job.

    I went home with a pirate-like eye-pad and apart from a light stingy feeling, there was no pain etc. And now, it's completely okee, pain-wise.

    I was allowed to remove the eye-pad around 8 AM this morning. The first impression: everything is SO BRIGHT and LIGHT! It's like going from candlelight to xenon light! The difference between the 'new' right eye and the 'old' left one is unbelievable!

    All is a little vague and everything has a halo. Earlier, I looked outside and the streetlights all had halos around the light itself. And for now it looks as if I'm looking though a fish-eye lens. I cannot say I can do without glasses. But that wasn't the ultimate goal. Let's see what happens in the days to come.

    Later today I'll receive a phone call from the clinic and we'll discuss what I've written here and hear what their comment is.
    My mum just had both done - after a week your vision will be almost perfect. Well done biting the bullet.

  22. #22
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    Quote Originally Posted by thieuster View Post
    I was allowed to remove the eye-pad around 8 AM this morning. The first impression: everything is SO BRIGHT and LIGHT! It's like going from candlelight to xenon light! The difference between the 'new' right eye and the 'old' left one is unbelievable!

    All is a little vague and everything has a halo. Earlier, I looked outside and the streetlights all had halos around the light itself. And for now it looks as if I'm looking though a fish-eye lens. I cannot say I can do without glasses. But that wasn't the ultimate goal. Let's see what happens in the days to come.
    Congratulations on a successful operation. As you say the diference is quite amazing & perhaps one more reason why you will the the other eye done. The halos & general vision should settle down & I was told it would be at least a month before I should even think about any tests for new glasses.

  23. #23
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    Good news Menno, glad it went to plan. The oedema causing the halos should subside in a few days but yes leave it a good 6 weeks before you consider being retested.
    You can do it before but that prescription may well not be optimal after only 6 months or so.

  24. #24
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    Congratulations pleased it all went well for you and good luck.

  25. #25
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    The surgery itself can be very simple depending on the type and maturity of cataract you have. Usually the ophthalmologist would apply local/topical anesthesia as this is enough to make small incisions. You have to cooperate with your surgeon and stare directly to the ceiling or light. They also have the option for retrobulbar anesthesia for uncooperative patients looking all over the field. You can opt for general anesthesia while doing cataract surgery but the anesthesiologist would take a longer time to induce anesthesia than the ophthalmologist would take to perform phacoemulsification with IOL placement. The surgery will be wet as it needs constant application of saline to prevent dry eye. You can observe colorful swirls while the phaco probe is doing its thing and you wont observe instruments because you're eyes are aphakic so everything still appears to be blurry. Top surgeons pride themselves with 10-20minute procedure. Think of it as a spa visit, it's a very quick procedure.

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