Cataract Extraction & IOL

Cataracts are a clouding of the lens of the eye which tend to form as we age. Experts are not sure as to why the lens changes as we get older but they have identified a variety of factors which may be a trigger:

Diabetes: people with diabetes appear to be at greater risk.
Exposure to sunlight/ultraviolet light.
Exposure to radiation such as cosmic radiation.
Excessive salt consumption: a diet high in salt may contribute to cataracts.
Steroid, diuretic or tranquiliser use.
Cigarette smoke
Pollution
Heavy alcohol use

However, cataracts can be treated in a variety of ways. These include bifocal glasses, new glasses or magnification. Another option is cataract surgery.

What is a cataract?

A cataract is where protein within the lens itself starts to form a ‘clump’ which then grows and eventually obscures the lens. It is seen as a ‘cloud’ over the lens.

There are three types of cataracts: subcapsular, cortical and nuclear.

Subcapsular cataracts start at the rear of the lens and can be caused by diabetes, retinitis pigmentosa or a severe level of presbyopia.

Cortical cataracts tend to form in the cortex of the lens. This is particularly noticeable in diabetics.

Nuclear cataracts are the most obvious form of cataracts. They form in the centre of the lens or nucleas.

What are the symptoms with a cataract?

You may notice that your vision is poor at night or that it appears to be blurred. You may have double vision (very rare) or find that objects appear to have a yellow tinge.

If you find that your prescription needs to be changed more often or if you have any of these symptoms then consult your GP.

Cataract surgery

Cataract surgery is a very successful form of eye surgery that results in improved or ‘20/20’ vision.

As part of this procedure the surgeon will replace the clouded lens with an Intra-Ocular Lens or IOL.

What is an ‘IOL?’
What is it used to treat?
Who should consider an IOL?
What are the risks of an IOL?
What are the benefits of an IOL?
What should I ask the surgeon at the consultation?
How much does an IOL cost?
What is the IOL procedure?
How long do the effects of an IOL last for?
What does recovery from an IOL involve?

What is an ‘IOL?’

An IOL or Intra-Ocular Lens is a clear, plastic lens, similar to your normal contact lens which can be implanted inside the eye. It is inserted inside the cornea and sits behind the iris.

This lens can either be inserted into the cornea, as an additional lens or as a replacement for the lens itself as part of a ‘Refractive Lens Exchange’ (RLE) procedure.

There are 3 different types of IOL’s. These are Phakic, Aphakic and Pseudophakic IOL’s.

Phakic IOL’s are used to treat refractive errors such as short-sightedness, long-sightedness and astigmatism. They do not replace the natural lens in the eye.
Aphakic IOL’s are part of the Clear Lens Exchange procedure (CLE). They are used to replace a faulty or absent lens in the eye.

Pseudophakic IOL’s are used to replace a faulty or diseased lens of the eye with a synthetic alternative. They are used as part of the CLE or Refractive Lens Exchange (RLE) procedure.

The most popular type of Phakic IOL is the ‘Artisan’ lens. These are either spherical (rounded) or toric (sphere/cylinder combo).

Another type of Phakic IOL is the ICL or ‘Implantable Contact Lens’ (ICL). An example of this is the STAAR ICL.

What is the difference between the intra-ocular lens (IOL) and the implantable contact lens (ICL)? The main difference is that the IOL is used to replace a cloudy or defective lens in the eye, whereas the ICL is implanted into eyes which still have their original lens.

What is it used to treat?

This treatment is a good alternative for those patients excluded from laser eye surgery. They can be used to treat refractive errors such as short-sightedness and presbyopia. This means that the patient does not have to wear glasses or contact lenses (an IOL can be considered a ‘permanent’ contact lens).

Other conditions include cataracts and unusual ‘problems’ of the cornea.

Who should consider an IOL?

If you are advised against laser surgery then consider having an IOL. They are a safe and reliable form of vision correction and are very similar to a standard contact lens except there is no need for cleaning or disposing of!

You have a choice of two different types of IOL’s:

Single vision (monofocal) IOL
Presbyopia-correcting (multifocal) IOL.

Your age, lifestyle and budget will determine which one is the most suitable for you.

What are the risks of an IOL?

IOL’s along with other types of eye surgery are safe procedures as many patients will testify to.

But, nothing in life is risk free. Complications are rare but they do occur and these will be mentioned to you at the time of your consultation.

Risks include:

Inflammation of the iris
Complications of the retina
Glaucoma
Corneal decomposition

There can be problems in the Clear Lens Exchange (CLE) or Refractive Lens Exchange (RLE) procedure. This is where the lens of the eye is exchanged for a synthetic one. What can happen is that fluid can leak into the tissue of the retina or vitreous jelly detaches itself from the back of the eye.

There are risks with both the Artisan lens and CLE/RLE.

Complications inherent to cataract surgery include:

Retinal detachment: this is the condition whereby the retina becomes detached from the rest of the eye and is unable to function properly. The danger with this is that if left untreated it can lead to a permanent loss of sight.
Infection
Dislocated lens
Inflammation
Posterior Capsule Opacity (cloudy or blurred vision)
Corneal or retinal swelling
Ptosis (droopy eyelid)
Increased air pressure inside the eye

Important: if you are male and are taking any prostate drugs then be aware that you are at an increased risk of developing a condition called ‘Intraoperative Floppy Iris Syndrome (IFIS). Plus, there is a higher than normal risk of developing a detached retina.

If you are taking any prostate drugs then let your surgeon know.

If you are taking any other form of alpha-blocker, for example, to control high blood pressure then again, let your surgeon know. This equally applies to any women who are taking alpha-blockers for urinary problems, hypertension and kidney stones.

What are the benefits of an IOL?

These include high quality, improved vision, durability and the option to reverse the treatment.

Patients are very happy with the results of IOL treatment.

For those patients with cataracts, the RLE procedure is the most suitable as this involves removing the cloudy lens and replacing it (exchanging) with a synthetic variety.

What should I ask the surgeon at the consultation?

The main questions to ask are to do with the surgeon him/herself, the procedure, success rates, cost and outcome.

Visit Question 23 in our General FAQS section for a list of suggested questions.

If there is anything you don’t understand then ask. And, keep asking until you are satisfied with the answer. Don’t feel embarrassed about this. Surgeons are usually more than happy to answer questions and would rather you were fully informed before making a decision about treatment.

How much does an IOL cost?

There are different types of IOL’s (toric, spherical, multifocal etc) and as you can imagine they come with different price tags.

Every clinic will have their own pricing scheme so it is a good idea to contact a few and then compare their prices.

Here is a rough guide as to what you can expect to pay for this procedure:

Phakic IOL (toric) = £3,150 (per eye)

Phakic IOL (spherical) = £2,750 (per eye)

Cataract surgery = £1,900

What is the IOL procedure?

This is an outpatient procedure so need for a stay in hospital. You will be asked to avoid food and drink on the day of your surgery and not to wear any make up.

You will be given a sedative followed by local anaesthetic eye drops to help numb the area.

The surgeon will clean the area around the eye and will place sterile coverings around it and your head. He/she will then use an ultrasonic instrument which breaks up the cataract. The cataract deposits are then suctioned out of the eye.

Once he/she has done this, he/she will then insert a plastic IOL into the eye. You will have a choice between the single vision IOL or the multifocal IOL. This plastic lens is ‘folded up’ when inserted but will naturally unfurl itself once in place.

Note: if you are aged 40 or over then the multifocal IOL may be the best option as this can correct presbyopia. Presbyopia is a common eye condition in middle age.

This procedure itself takes around 20 to 30 minutes although you will be there for longer to take into account pre-surgery preparation and recovery.

A protective eye shield (similar to an eye patch) is placed over your treated eye. You will spend a few hours recovering at the clinic before going home. Arrange for someone to drive you home.

The surgeon will usually operate on one eye to start with. If there are no complications then he/she will arrange to operate on your other eye at a later date.

How long do the effects of an IOL last for?

Cataract surgery is a very successful procedure and the effects appear to be permanent. The surgeon will discuss this with you along with other issues.

What does recovery from an IOL involve?

This starts with a few hours rest at the clinic before going home. You will be given antibiotic eye drops which will help to safeguard you against infection. You will be given advice on how and when to use these.

You will be wearing a special eye patch (bandage) which must be worn for 24 hours following surgery.

There are a series of aftercare visits which are designed to check on your progress. The first one will take place the next day and the others will be spaced out over a period of a few months. These are a vital part of the treatment process and are designed for your benefit so please attend them.

The first week after surgery, wear sunglasses to protect your eyes against direct sunlight. Avoid any strenuous activities and sports (e.g. weightlifting) and cover your eye when washing or taking a shower.

You will be given a set of instructions at the clinic on what to do during the recovery period. These will include advice on when to return to work, when to resuming driving etc.

If you notice anything untoward during this time then contact your surgeon.