You should expect to be at the clinic for 2-3 hours in total, most of which will be before the procedure waiting for your pupil to dilate. You will be greeted by one of our lovely nurses, who will check you and tell you more about what to expect during your brief stay with us.When the time is right, you will meet your surgeon who will examine your eyes and offer you a relaxation pill, such as diazepam; this helps you relax without sending you to sleep and can greatly help both you and the surgeon in the procedure.When you enter the procedure room, all members of staff will be introduced to you and you take a seat in a very special reclining chair. As you lie down, the chair is adjusted to make it as comfortable as possible. Gentle music and holding one of our nurses’ hands helps you to relax.Your surgeon will clean around the eye being treated, before carefully covering your face with a light, paper drape to help keep things clean. A gentle clip is used to look after your blinking. Your role will be to keep nice and still and quiet, hold someone’s hand, listen to music and look up at a bright light.The anaesthetic is just eye drops and there are no injections to fear. During the procedure, you should feel no pain or sharpness, but you do feel pressure sensations from time to time, as well as seeing bright lights and moving shapes.Your surgeon will carefully remove the cataract using ultrasound and replace it with a new lens (intraocular lens). Antibiotics are given directly into the eye, which greatly reduces the chance of infection. The whole procedure can take as little as five minutes, but usually takes about 15 minutes, or perhaps longer in more difficult cases.If you are having surgery on both eyes, there will be a short gap of 5-10 minutes between the two eye procedures, while preparations are made for the second procedure.

After the procedure, you will usually notice how bright the world is and it is common to have lots of optical effects especially on the drive home, as your pupil will still be large.Your vision remains blurry while your pupil is still large, which can be for 24 hours or so. That being said, many people wake up the next morning to good vision, although the sight continues to improve hour by hour during the first postoperative day.It is important to use the eye drops that you have been given after the procedure. These are anti-inflammatory drops, which help the eye to heal, and are usually given for four weeks.You can drive as soon as you can read a number plate at 20.5 metres, the DVLA assessment distance, provided you do not have double vision or other symptoms. Depending on the choice of focus that you have decided upon, this might mean that you need to wait until you have seen your optician for a new pair of spectacles.

CATARACT SURGERY

What is a cataract?

Put simply, a cataract is a cloudy lens inside your eye. They can develop at any age and in many cases are simply maturity-related, but can also be brought on by the use of steroid medication, diabetes, and some other medical conditions.

The speed of development of cataract is highly variable, with some coming on very quickly over weeks, while others develop changes in the lens over many years, with the resultant change in vision appearing so slowly that people are often unaware that there is much of a problem.

Once cataracts have developed, they do not disappear by themselves and typically they only ever worsen with time; eye drops cannot treat them and the only corrective treatment is a procedure, during which the cataract is carefully removed and replaced by an artificial lens.

Can anyone have NHS cataract surgery in Herefordshire?

Within the NHS setting, funding for surgery is provided by regional integrated care boards (ICB). Your optometrist (optician) will let you know if you meet the local ICB’s criteria for NHS cataract surgery.

In general, most people with symptoms are eligible for NHS treatment, however, the criteria are:

The vision in the affected eye is 6/12 (about the level of the driving standard) or worse

OR better than 6/12, providing you meet at least one of the following clinical circumstances:

difficulty continuing to work, giving care or living independently
reduced mobility including difficulty with steps or uneven ground
difficulty carrying out everyday tasks such as recognising faces, reading, watching TV, cooking and playing sport
experiencing glare or reduction in acuity in daylight or bright conditions (if you have posterior subcapsular cataracts and those with cortical cataracts
significant optical imbalance (anisometropia or aniseikonia) following cataract surgery on the first eye OR
diagnosis of Glaucoma and requiring cataract surgery to control intra-ocular pressure

diagnosis of diabetes, where clear views of their retina are required to screen for retinopathy
diagnosis of Wet Macular Degeneration or other retinal conditions, where clear views of the retina are required to monitor the disease or treatment (e.g. treatment with anti-VEGFs)
difficulty with driving due to cataracts, for example, experiencing significant glare due to cataracts, which affects driving at night
borderline visual field defects that impact on driving, where cataract extraction would be expected to significantly improve the visual field

If, for whatever reason, you do not meet the NHS’s criteria for cataract surgery, you are still able to request a referral for cataract surgery privately.

What symptoms might you have with cataract?

Clouded or blurred vision
Difficulty in seeing during the night or in dim conditions
Sensitivity to light and glare
A change in your spectacle prescription
Need for brighter than normal light to read or see objects
Seeing halo around lights
Seeing objects in faded or yellow colour

Your local optometrist (optician) will be able to diagnose the earliest signs of cataract and refer you to BHA, if you meet the NHS criteria for surgery.

Tell me about the patient journey.

Referral

Your optometrist will tell you if you have an operable cataract and give you the option to be considered for cataract surgery. If you decide to proceed with referral and you wish to be seen by BHA, then your optometrist will refer direct to us; one of our lovely administrative team will contact you to discuss the next steps and book you in.

If you have already been referred elsewhere but now wish to be seen by BHA, please simply contact your optometrist and request that they forward on your referral to us; we will then make contact with you directly.

Assessment for cataract surgery

You will meet several members of our team at your preassessment, which will take place at The Wye Clinic in 2024-5.

During your visit, you will meet one of BHA’s cataract experts, who will examine your eyes carefully and discuss what can be achieved for you and your eyes; this assessment will necessitate eye drops to make your pupils big and this can lead to blurring of vision for a few hours after the assessment. You should therefore not drive to and from your appointment.
You will also have your eyes measured for the new replacement lens for the eye after the cataract has been removed, as well as meeting one of our nursing staff.
At the end of your appointment, you will have a clear idea as to what to expect when your procedure happens.

The procedure

You should expect to be at the clinic for 2-3 hours in total, most of which will be before the procedure waiting for your pupil to dilate. You will be greeted by one of our lovely nurses, who will check you and tell you more about what to expect during your brief stay with us.

When the time is right, you will meet your surgeon who will examine your eyes and offer you a relaxation pill, such as diazepam; this helps you relax without sending you to sleep and can greatly help both you and the surgeon in the procedure.
When you enter the procedure room, all members of staff will be introduced to you and you take a seat in a very special reclining chair. As you lie down, the chair is adjusted to make it as comfortable as possible. Gentle music and holding one of our nurses’ hands helps you to relax.
Your surgeon will clean around the eye being treated, before carefully covering your face with a light, paper drape to help keep things clean. A gentle clip is used to look after your blinking. Your role will be to keep nice and still and quiet, hold someone’s hand, listen to music and look up at a bright light.
The anaesthetic is just eye drops and there are no injections to fear. During the procedure, you should feel no pain or sharpness, but you do feel pressure sensations from time to time, as well as seeing bright lights and moving shapes.
Your surgeon will carefully remove the cataract using ultrasound and replace it with a new lens (intraocular lens). Antibiotics are given directly into the eye, which greatly reduces the chance of infection. The whole procedure can take as little as five minutes, but usually takes about 15 minutes, or perhaps longer in more difficult cases.
If you are having surgery on both eyes, there will be a short gap of 5-10 minutes between the two eye procedures, while preparations are made for the second procedure.

Recovery

After the procedure, you will usually notice how bright the world is and it is common to have lots of optical effects especially on the drive home, as your pupil will still be large.

Your vision remains blurry while your pupil is still large, which can be for 24 hours or so. That being said, many people wake up the next morning to good vision, although the sight continues to improve hour by hour during the first postoperative day.
It is important to use the eye drops that you have been given after the procedure. These are anti-inflammatory drops, which help the eye to heal, and are usually given for four weeks.
You can drive as soon as you can read a number plate at 20.5 metres, the DVLA assessment distance, provided you do not have double vision or other symptoms. Depending on the choice of focus that you have decided upon, this might mean that you need to wait until you have seen your optician for a new pair of spectacles.

Postoperative assessment

Your local optometrist will assess you 4-6 weeks after the procedure. BHA will send to them notification that you have had surgery and request they provide a post-operative report. We hope that you will be fully satisfied with the process but welcome feedback so that we may improve still further. Most people require spectacles at least for reading after NHS cataract surgery but some patients will still require them for more frequent use. At BHA we aim to reduce the need for spectacles after cataract surgery to a minimum but the choice of lens options available for NHS cataract surgery is limited, regardless of the provider of NHS cataract services.

What do I do if I have concerns after the procedure?

Contact your optometry practice immediately for advice.

Most of the time they will be able to offer reassurance or advice but may see you in practice to examine you if necessary. Out of hours, should there be a significant concern, the County Hospital in Hereford has an eye casualty department and can be contacted for advice.

What are the risks of cataract surgery?

Cataract surgery is the commonest surgical procedure within the UK and carries an excellent safety profile.

Some possible complications during the operation:

Tearing of the back part of the lens capsule with disturbance of the gel inside the eye, which may sometimes result in reduced vision, and / or delayed recovery from the procedure. This occurs in less than 1:300 procedures.
Loss of all or part of the lens into the back of the eye requiring a further operation, which may require a general anaesthetic. This is extremely uncommon with BHA surgeons (around 1:1,000 cases).
Bleeding inside the eye (exceptionally rare with modern techniques, but conceivably could lead to loss of vision or even the eye itself).
In the highly unusual event of a significant complication, it may not be safe to place a lens implant – temporarily or very rarely permanently. In this case a subsequent procedure may be necessary to implant an IOL at a later stage (contact lens wear would be an alternative).

Some possible complications after the operation:

Mild allergy to, or intolerance of, the eye drops used. A change in eye drops helps.
Some eye surface discomfort is common in the early months after most forms of eye surgery. This is typically mild after cataract surgery and may be asymmetrical. Lubricant eye drops can help with these symptoms and are usually safe to take in addition to the normal eye drops given after surgery, but please check with your optometrist.
Some variability of vision is normal in the early weeks after surgery and patience can sometimes be required.
Bruising of the eye or eyelids. This is uncommon, but can manifest as red blotches on the white of the eye (particularly under the upper eyelid). These are nothing to worry about and will settle spontaneously; their presence does not reflect the underlying health of the eye.
Floaters. The development of floaters in middle age is exceptionally common, a change occurring as a result of maturity of the jelly of the eye. Cataract surgery can hasten the development of such changes, however, in many cases the extra light that a new lens allows into the eye simply makes you more aware of pre-existing floaters.
High pressure inside the eye. This is more common in patients predisposed to glaucoma.
Clouding of the cornea, which could conceivably lead to a requirement for a corneal graft and imperfect vision.
Incomplete removal of the lens. In cataract surgery, the native human lens is broken up into tiny pieces, which are then removed by suction. On rare occasions, tiny fragments of lens can become sequestered either behind the pupil during surgery, or in the angle between the cornea and the iris. In such an event, a further very quick procedure, washing out the front of the eye may be necessary. Recovery should then otherwise be uneventful.
Incorrect strength or dislocation of the lens implant.
Swelling of the retina (macular oedema), approximately 1:100 eyes. Drops are given following surgery to reduce the risk of this happening.
Detached retina, which can lead to loss of sight. It is important to state that cataract surgery does not change the underlying ‘medical’ state of the eye; initially short-sighted patients continue to have a higher underlying risk of retinal detachment than non-short-sighted patients. In addition, however, the risk of retinal detachment is approximately five times higher in the first four years after surgery.
Infection in the eye (endophthalmitis), which can lead to loss of sight or even the eye, despite prompt treatment. We go to great lengths to reduce the risk of postoperative infection to as low a level as we believe is possible, including the use of antibiotics, special eye cleansing techniques, mask wearing during the procedure and no-touch techniques. In the exceptionally unusual event of infection (less than 1: 4,000 with BHA), the scientific literature suggests that the organism in question is nearly always borne by the patient, rather than being ‘cross-infected’ from the clinic / staff.
Glare and associated symptoms. Even with standard NHS monofocal lenses, some patients are aware of a shadow in their peripheral vision, although generally such side effects diminish with time as the new lens settles in. Very rarely, optical side effects may initially interfere with driving, work and leisure activities, but it is uncommon for such side effects to persist in the medium and longer term.
Most intraocular lenses are not visible, but people may occasionally notice a glint in your eye caused by a reflection from the front of the lens.
Perhaps the most common complication is that of posterior capsular opacification, which comes on months to years after surgery, and is easily treatable with the YAG laser. Find out more about YAG laser capsulotomy.