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Ophthalmology

Expert assessment and treatment for a wide range of eye and vision problems

Of all the things we have trouble with, top of the list is our eyes. That may surprise a few people, but in fact the world's most common operation is cataract removal, which amongst many other operations both ophthalmic and otherwise are carried out regularly at Werndale Hospital in Carmarthenshire, southwest Wales.

According to the World Health Organisation, just over a quarter of the global population (2.2 billion people) have vision impairment caused by refractive errors and cataracts.

But although cataracts and vision impairment are up there as one of the biggest single medical problem areas in the world, there are many other areas of ophthalmology that are just as vital for our health. 

Werndale Hospital's ophthalmology department has recently been upgraded with new specialist equipment that includes the Lenstar, which, in a single scan records the entire biometry of the eye, so an ophthalmologist can see all the data necessary to understand the eye's optometry in one data set. 

It's technology like this along with the rigorous training that all ophthalmologists must undertake that puts private hospitals like Werndale at the top of the referral list when it comes to healthcare. 

If you live in the southwest region of Wales and have medical insurance, there's a good chance you will be referred to Werndale through your GP or optometrist, or via your insurance company if you've contacted them. 

But you can also contact Werndale direct if you want to discuss your options, get a second opinion, or you're worried about your eyesight and want to have it checked as quickly as possible. Please call reception on 01267 225600

The vast majority of eye operations involve cataract removal and the replacement of the lens the cataract formed in (a cataract is the name given to the cloudiness that can form in a lens).

Our eye lenses contain crystallin proteins. These proteins are generally thought to help refract light to the retina at the back of the eye. However, as we age, the structure of these proteins can change, and over time, can block light thus reducing our vision.

It's the change in the structure or chemical makeup of the proteins that causes the tell-tale signs of someone with a cataract - an opaque or cloudy looking eye. 

Technology has advanced a long way from the early days of eye surgery involving cataract removal and lens replacement and can now be completed in around 15 to 20 minutes without needing a general anaesthetic. So you will be in and out of hospital within an hour or two of arriving and checking in and your sight will return to normal by the time you're ready to leave.

The surgery involves making a number of tiny incisions in the cornea, then using a process called phacoemulsification, the damaged lens is emulsified using ultrasound, and removed (aspirated) from the eye. The new lens is then implanted to restore vision. No stitches are required, and the eye will heal naturally over the following few weeks.

We recommend all strenuous activity (including swimming) is avoided for a few weeks after the operation, although very light exercise is fine after a few days. 

Cataract removal is one half of the operation, lens replacement is the other. While the operation is very fast and pain free using a local anaesthetic for both the removal of the cataract and lens replacement, the choice of lens is an important decision.

Luckily, technology has advanced a great deal, and the choice of lenses covers almost every situation you can think of, including lenses that completely replace the need to wear glasses (the general condition of your eyes and other medical circumstances will be taken into account, and may have a bearing on this).

The lens you choose depends on your current eyesight of course, so if you're short sighted (you suffer from myopia) then the lens chosen can correct this. Once replaced, barring other medical conditions, you will never have to have the lens replaced again.

The same is true if you have hyperopia (you are long or farsighted) or if your eyesight is slowly deteriorating through age, even without cataracts. This happens to most of us, particularly once we get past 40, and it's when many of us start using reading glasses.

This is called presbyopia and can also be corrected at the time of cataract surgery by lens replacement. Unfortunately it's not available through the NHS. However, it is available through private hospitals who have an eye clinic including Werndale. 

Replacement lenses are available from a number of manufacturers and it's now possible to implant monofocal or multifocal lenses.

Most patients have a monofocal intraocular lens set for one distance so they can see the environment around them clearly. However, this doesn't replace the need for reading glasses.

The other type, multifocal intraocular lenses are designed to replace bi-focal glasses, although they can compromise the clarity possible from monofocal lenses and reading glasses. 

Although laser treatment can be used to correct eyesight by reshaping the cornea (the clear window at the front of the eye) without replacing the lens, it's not suitable for everyone, and in particular, as we age, our lenses start to harden, and laser treatment of this type becomes less and less effective.

Laser treatment is also sometimes required to correct residual problems with clear lens exchange surgery, in fact, clear lens exchange surgery can only be offered if follow up laser treatment is also available.

However, laser treatment of a different type does have an important part to play in all cataract and lens replacement surgery. In approximately 40% of cataract removal operations, the patient will need laser surgery at some point in the future to correct any problems with the replacement lens. 

Age-related macular degeneration (AMD) is a disease that generally affects people over 50. People suffering from AMD notice a gradual deterioration in their sight (called dry AMD), which can make it hard to recognise people or see things in the centre of our vision.

AMD can also happen over a short period of a few weeks or months. This is called wet AMD. The cause is unknown, but according to NHS research it has been linked to high blood pressure, smoking, and obesity. 

Glaucoma mostly affects older people, and happens when pressure builds up in the eye resulting in damage to the optic nerve. It's not obvious at first and the symptoms are many and varied including reduction in peripheral vision, eye pain, and blurred vision.

Glaucoma is usually spotted by an optometrist during an eye test, in which case the patient will be referred to a suitable specialist for further investigation and to confirm if the disease is present. It's important this happens, as if left untreated, glaucoma can lead to loss of vision.

Glaucoma is usually treated with eye drops, although surgery may be required if the condition is advanced. 

Whether you've been referred to Werndale or are contacting us direct, you will be looked after from beginning to end by the same surgeon. This ensures that you get the best care.

As most operations are same-day, you won't need to stay overnight, but should you need to, you will be taken good care of in one of our private rooms with full en-suite facilities and 24 hour medical care. 

If you'd like to find out more about lens replacement or cataract removal or other conditions that are affecting your sight, please call us on 01267 225600. We'll be pleased to advise you on your next steps. 

Specialists offering Ophthalmology

Mr Manoj Kulshrestha

Consultant Ophthalmologist

MB ChB FRCSI FRCOphth

BMI Werndale Hospital 1 more BMI The Alexandra Hospital

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Miss Eirini Skiadaresi

Consultant Ophthalmologist

Consultant Ophthalmic Surgeon, MD, MSc, FEBO, Honorary Senior Clinical Lecturer Swansea University

BMI Werndale Hospital

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