Cataracts
What a cataract is, how it's diagnosed, and your options for treatment.
What is a cataract?
A cataract is the last stage of the natural ageing process that affects the lens in the eye. When we are young, the lens is transparent and quite pliable, so it can change shape to help us focus on things clearly in the distance as well as up close, such as for reading and using mobile phones and tablets.
As we get older, the lens becomes less flexible — this is called presbyopia, and reading glasses help with near vision. Over the years your reading prescription changes; the lens is still clear at this stage. Later, the lens starts to thicken and affects distance vision too, so people who never needed glasses for driving or watching TV may need bifocals or varifocals — but vision is still clear with glasses.
Finally, the lens becomes yellowed and opaque: this is a cataract. Vision becomes dull and hazy, and glasses no longer help as much. Your optician may then advise you to consider cataract surgery to regain clear vision.
What can I expect after cataract surgery?
Vision is usually brighter, crisper and clearer, with better colour perception. In many cases I can select a lens implant that gives you clear distance unaided vision, so you won't need to depend on glasses or contact lenses for distance so much. Depending on the outcome you choose, your spectacle dependence can be reduced further with a premium lens implant.
Do I have to have cataract surgery?
You can have cataracts but be managing well enough for your needs, and put off surgery until things become less clear. You may notice difficulty with dim lighting, recognising faces or bus numbers at a distance, night driving, or glare from oncoming headlights. If you've had a recent fall, it's important your doctors establish whether poor vision from cataracts contributed.
Questions Rahila usually asks
- You struggle to see things clearly, especially if the lighting is not bright.
- Are you having difficulty seeing the TV screen or reading subtitles?
- Are you struggling to recognise bus numbers or faces until people are close?
- Is reading small print difficult unless lighting is very bright?
- Are you having difficulty reading music?
- Has your optician said a new glasses prescription can't improve your vision?
- Do you have glare with night driving or in bright lights?
- Is your vision affecting your work or a hobby you enjoy?
It's fine to leave cataract surgery and rely on your better eye for as long as you're comfortable, unless the cataract is advanced with severe vision loss.
You may also be advised to consider cataract surgery if you have a sight-threatening retinal condition but the cataract is interfering with my ability to examine the back of the eye — in this case, I will discuss whether there is a risk of vision loss if the retina cannot be adequately monitored or treated.
If you are a driver and your vision does not meet the DVLA standards for driving, I will usually recommend surgery if you wish to continue. The standard is being able to read a number plate made after 2001 at 20 metres in daylight, with glasses or contact lenses if you use them, and a visual acuity of 6/12 or better with an adequate field of vision. In milder cases, a change in glasses prescription may restore legal driving standards for a year or two, but you will need to keep this checked.
What does cataract surgery involve?
Cataract surgery is usually done as a day case under local anaesthetic — drops or an injection to numb the eye — though sedation or general anaesthesia can be arranged for anxious patients. You'll have dilating drops beforehand and lie down for the procedure, performed through an operating microscope with a drape over the other eye.
Most patients don't need stitches, though occasionally one is placed to secure a leaking wound. Patients who have had previous vitrectomy surgery are more likely to have a fine dissolving stitch in the main wound as an added precaution. At the end of surgery you'll have a clear plastic shield over the eye to reduce the risk of accidentally rubbing it.
Follow this link to watch a short video about cataracts, cataract surgery, and aftercare: Cataract surgery video (English).
Meri Hindi/Urdu video mein cataracts, cataract surgery, aur aftercare ke baare mein jaankari: Hindi/Urdu cataract surgery video.
Your choices for lens implant outcome
When the natural lens is removed, it's replaced with an artificial lens implant (IOL). We'll discuss which visual outcome suits you best. Rahila offers a full range of lens options, from standard single-focus lenses to premium lenses that can reduce your dependence on glasses.
Lens implant options
Single focus (monofocal) lens
The most common and reliable choice. Usually set for clear distance vision, with reading glasses for near. Monofocal lenses can also be used to leave you slightly short-sighted if you prefer — particularly if you are happy with your low myopia for near vision and comfortable wearing glasses or contact lenses for distance.
Rahila routinely offers an enhanced monofocal lens as standard — sometimes called a monofocal plus lens — which gives a slightly extended range of focus compared to a traditional monofocal, at no additional visual compromise. This is included as part of your surgery. NHS patients choosing the Western Eye Hospital for their cataract surgery also benefit from this enhanced lens as standard.
Extended depth of focus (EDoF) lens
EDoF lenses are designed to give clear distance vision with an extended range of focus into the intermediate zone — useful for activities like cooking, using a computer, and seeing a car dashboard. They provide a more natural quality of vision than multifocal lenses, with less risk of glare and halos at night. Most patients find they need reading glasses only for small print or prolonged close work. Rahila can advise whether an EDoF lens is a good option for your eyes and your visual needs.
Toric lens (astigmatism)
Recommended when there's significant astigmatism, for the best visual outcome with reduced spectacle dependence. Toric versions are available in standard, EDoF and multifocal designs. Requires extra pre-surgery tests and a specially ordered lens. Not all insurers cover toric lenses — please check your policy.
Monovision
Standard lenses set for clear distance in one eye and clear near in the other. Suits people already comfortable with this from contact lens wear; you may still need glasses for the clearest distance or detailed near vision.
Multifocal lens
Designed to provide clear vision at distance, intermediate and near. Not suitable for everyone — possible glare and halos at night, and some loss of contrast. Not recommended if you've had previous macular problems. Many patients who want reduced spectacle dependence find EDoF lenses a better balance of performance and visual quality.
What are the risks of cataract surgery?
Risks are low and in most cases manageable with good visual outcomes, but no procedure is without risk and no surgeon can guarantee an outcome. Factors such as previous vitrectomy, high myopia, small pupils or dense cataracts can increase risk, and Rahila will discuss any relevant factors with you before surgery.
Infection (endophthalmitis)
Rare, generally within the first week. Watch for increased pain, redness, or blurred vision and seek prompt advice.
Bleeding
Less common with modern small-incision surgery, more relevant in highly myopic eyes or those with previous vitrectomy.
Ruptured posterior capsule
Usually managed at the time of surgery, though it may mean a toric or multifocal lens can't be implanted.
Dropped nucleus
If the posterior capsule ruptures, pieces of the cataract can fall into the back of the eye and require vitrectomy surgery to remove them. As Rahila is both a cataract and vitreoretinal surgeon, she can manage this complication herself at the same operation — without the need to refer you to another surgeon on another day.
Retinal detachment risk
The risk of retinal detachment is slightly increased after any lens surgery, and is higher in people who are myopic (short-sighted), or who have surgical complications such as a ruptured posterior capsule. Be aware of new floaters, flashing lights, or a shadow or curtain in your vision in the months and years after cataract surgery, and seek prompt advice if these occur.
Macular oedema
Swelling at the macula some weeks after surgery, causing blurred or distorted vision. More common in people with diabetes; drops are prescribed to reduce this risk.
Eye pressure changes
High eye pressure is common in the days after surgery, usually temporary and controlled with drops. Low pressure generally settles spontaneously, but occasionally requires a stitch to the surgical wound.
Refractive surprise
Rarely, the visual outcome differs from what was predicted. Usually the vision adjusts; very rarely the lens implant needs exchanging.
Further reading: Royal College of Ophthalmologists — specific questions related to cataract surgery · Shared decision making for cataracts.