why should you consider private care for cataract surgery?
1. continuity of care
If you have private treatment I will see you at every stage of the process. I will carry out all the examinations needed for pre-operative assessment including eye measurement for the implant lens (biometry), I will discuss your preferred timing and venue for surgery, I will carry out the procedure and I will follow your progress closely in the post-operative period. I will write personally to your GP and optician so that they remain fully informed about your progress.
2. consultant delivered surgery
Cataract surgery is a highly skilled micro-surgical procedure. It depends on a theatre team, high tech equipment and staff who have experience of delivering high quality surgery. The surgeon is not least in this team and should be able to handle the full range of surgical manoeuvres to deliver excellent outcomes.
You should be reassured that my particular skill set is devoted to intra-ocular (inside the eye) surgery. With my retinal surgery expertise I have been referred patients over the years by all my colleagues who have difficult cataract situations either as a result of eye disease or complications during a first procedure. I have the experience and the track record of dealing with complex cases and this allows me to carry out routine cataract surgery with a degree of confidence.
3. surgery when you have symptoms
The NHS locally has brought in thresholds for surgery which might mean that you will be required to wait until your vision drops to a certain level before surgery is allowed to go ahead. At this point you will be added to the waiting list that may be as long as 18 weeks. This may result in a delay to treatment that you would prefer not to have and I am happy to discuss private treatment with you.
A frustrating situation can arise where you have had surgery in one eye and still have a cataract in your fellow eye that does not reach the threshold level. There is good evidence that patients feel more comfortable with their vision if they have had surgery in both eyes and you might choose to have private care in this situation.
4. avoiding complications
Complications in cataract surgery occur and all surgeons are required to audit their practice closely. There is range of possible problems but it is widely agreed that surgeons should assess their performance by measuring their posterior capsule rupture (PCR) rate. This particular complication –PCR- may occur and it requires different surgical steps to avoid serious vision problems after surgery. It is associated with a higher risk of inflammation, infection, lens implant dislocation, retinal fluid accumulation (macular oedema) and late retinal detachment.
While there are a number of recognised features seen before surgery that are associated with PCR e.g. previous trauma, extreme cataract density and small pupil size, there is also a large element of this figure that depends on the surgeon and his/ her skill.
National audits of PCR among consultants show a reduction from 3% to 2% over the last 10 years with many surgeons well below 1% for a wide range of cases. My personal audit series stands at 0.5% PCR for NHS surgery and a 0.3% in my private practice. This is mainly due to the type of case I am required to treat in the NHS with the most difficult cases reserved for surgeons who also have retinal surgery skills. You should be prepared to ask any surgeon about his / her PCR rate and I would be very happy to explain more detail to you if required. If a surgeon did not answer this question openly you should be very concerned about going ahead with any procedure.
5. refractive planning
Lens implant choice
In the NHS patients are offered a standard single vision lens implant. Patients have a choice to have a fixed focus for distance or near vision and this may depend on your existing spectacle correction. You may be expected to make a decision about this when you meet your surgeon on the day of surgery and the doctor who sees you should guide you to this decision.
In the private setting this discussion will begin at the time of your first consultation and I will help you to decide which refractive outcome you desire.
I will carry out the measurements that this process depends on and ensure that the most accurate data is used for calculation.
For patients who have single vision implants I do not routinely use a standard NHS lens. My preferred lenses currently are the Alcon IQ lens with a filter to protect the macula or the Bausch &Lomb MI60 lens may be implanted through a much smaller 2.2mm incision.
Many patients have a degree of astigmatism i.e. an eye shape that is not perfectly spherical (similar to the shape of a rugby ball). Modern cataract surgery allows for this shape to be corrected with the aim of even better uncorrected vision (without glasses). This may be achieved by careful placement of surgical incisions or altering the incision type and can be useful in many patients. Some patients have more astigmatism than can be treated with this method and for them there are special implants, known as toric lenses that can achieve this correction.
Toric lenses are not generally available for NHS patients and require a careful assessment process to achieve success.
The lens is ordered direct from the manufacturer (I usually recommend the Alcon IQ Toric range) prior to the operation. During surgery the lens is implanted in the same way as single vision lenses but then rotated into an exact position to correct astigmatism. Again precision is required to achieve optimum results and I am pleased with my outcomes for this type of procedure. I am happy to discuss this with you if required.
For a number of years lenses with a multifocal capability have been available for cataract patients. While this seems attractive I have tended not to recommend these for the following reasons: -
Some patients still have significant glare and haloes around lights that may affect night driving
. Some patients require lens implant replacement to deal with these symptoms. This may not be a minor operation. This area is always changing and I keep up to date with current developments in lens design. As products improve I may offer multifocal lenses to carefully selected patients who have the best chance of satisfaction with this type of implant.
Piggyback Lens Implants
I have used a number of these lens implants to correct vision for patients who already have a lens implant. The piggyback lens is inserted on top of the original lens and will allow fine-tuning of refraction to try to help patients gain spectacle independence. This is now a routine procedure with better outcomes than replacement of the original lens.