Alternatives to standard cataract surgery Q&A

Shahriar NabiliDr Shahriar Nabili is one of our top Consultant Ophthalmologists at BMI Ross Hall Hospital. Mr Nabili is also part of Eye Care Scotland, the new eye care centre at BMI Ross Hall Hospital in Glasgow.

Here he talks about what are the options for those who do not want to undergo a standard cataract surgery.

Dr Shahriar Nabili
The only treatment for a cataract (or multiple cataracts) is surgery. The standard surgery has a good success rate but laser assisted surgery provides greater accuracy and control during the surgery.

Dr Shahriar Nabili
The surgery requires an incision in the cornea and also the front part of the lens. In standard cataract surgery, the incision is made manually by a blade and a fine needle. In laser assisted cataract surgery these incisions are made at the precisely corrected location measured by the femtosecond laser machine.

Dr Shahriar Nabili
The laser assisted surgery is suitable and recommended for all patients who are considering having cataract or natural lens replacement surgery.

Dr Shahriar Nabili
The laser assisted surgery allows the surgeon to create the necessary incisions with greater accuracy. This potentially makes the surgery safer. It also allows precise control over the location of excisions, which in turn, can result in less astigmatism (need for spectacles following the surgery).

Both forms of the surgery are very successful but currently scientific research indicates that laser assisted surgery provides an extra degree of safety and better visual outcomes.

Dr Shahriar Nabili

It is the same as days standard cataract surgery. The patients can usually resume most of their daily activities 2 after the surgery.

Dr Shahriar Nabili
The standard lenses used for cataract surgery are usually chosen to provide good unaided distance vision. Most patients will need near and intermediate vision glasses.

The patients who have pre-existing astigmatism might also require distance glasses as well. Premium lenses such as multi-focal and toric lenses can overcome this limitation and potentially deliver a degree of spectacle independence, which simply will not be possible with standard lenses.

Dr Shahriar Nabili

There are 3 categories of lenses.

Standard lenses are used widely in the NHS. These lenses are usually folded and positioned in the eye to replace the natural lens/cataract. These lenses can only correct distance vision and do not correct astigmatism. There are also the same versions of the lenses available which are not foldable and therefore require a larger incision to be made. These lenses (category 1) are rarely used and not usually recommended.

Toric lenses are also folded and positioned inside the eye to replace the natural lens/cataract. Toric lenses correct distance vision and any significant pre-existing astigmatism. These lenses are very good to reduce the need for distance glasses.

Multifocal lenses have varying power in the same lens. These are also foldable and can potentially improve distance, intermediate and near vision.

Multifocal-Toric lenses are a combination of both lenses. These lenses correct astigmatism and also near/intermediate and distance vision.

Dr Shahriar Nabili

The main benefit of premium lenses is to provide much better chance of not needing expensive glasses following the surgery. These lenses are not suitable for everyone. Your health care provider would be able to guide you after a complete assessment of your suitability. The multifocal lenses can have adverse events such as creating halos around the lights.

In most patients the benefits of these lenses outweighs the inconvenience of such side effects. 

Dr Shahriar Nabili
The recovery time is similar for all forms of cataract surgery/natural lens replacement. Multifocal lenses work best if used in both eyes.

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