Blog Posts- scroll for more info about Cataract Surgery, Dry Eye and Blepharitis and Sharmina
More about Cataract Surgery
What is the recovery time for private cataract surgery?
Ready for clear vision without the wait? Private cataract surgery offers fast scheduling, personalised care, and a quicker return to daily life. Say goodbye to long waits and hello to dedicated, attentive post-op support with a very experienced surgeon who works at a world renowned eye hospital! Book a free video assessment to explore your options today!
How do I choose the right surgeon for my private cataract surgery?
Choosing the right surgeon for your cataract surgery is crucial! Discover tips on finding the best fit, from qualifications and experience to patient reviews and costs.
Can cataracts cause headaches?
Can cataracts cause headaches? Discover how the visual impairment from cataracts can lead to eye strain and discomfort. Learn ways to manage symptoms and find relief.
Is refractive lens exchange safe?
Refractive Lens Exchange (RLE) is a popular procedure that offers clear vision without glasses or contact lenses. But is it safe? In this post, we explore the procedure, its benefits, and potential risks to help you make an informed decision. Book a free video assessment to learn more today!
More about Dry Eye and Blepharitis
More about Sharmina
FAQs
A cataract is a gentle, gradual clouding of the eye’s natural lens that can make vision look misty and increase glare, especially at night. It is a very common part of ageing and develops at different speeds in different people. With the right care, it is a highly treatable cause of blurred vision.
For the technically minded: Cataract formation arises from oxidative modification and aggregation of crystalline lens proteins, which increases forward light scatter and reduces optical transparency. The change disrupts the orderly arrangement of lens fibres and alters refractive index uniformity. As scattering rises, retinal image quality and contrast sensitivity decline, particularly under mesopic conditions.
Ageing is the most common reason, but diabetes, long‑term steroid treatment and previous eye injury can speed things up. Ultraviolet light exposure and smoking may also contribute, which is why good UV protection and healthy habits are helpful.
For the technically minded: Reactive oxygen species drive protein denaturation and pigment deposition within the lens, leading to yellow–brown discolouration (brunescent change). Disruption of lens epithelial cell metabolism impairs antioxidant defences such as glutathione, accelerating protein cross‑linking. These biochemical changes underpin nuclear sclerosis, cortical opacities and posterior subcapsular cataract patterns.
Typical signs include blurred or hazy vision, haloes and glare around lights, and colours looking less vibrant. Many people notice that night driving becomes difficult or that their glasses prescription changes more often than usual; an eye examination confirms the diagnosis.
For the technically minded: On slit‑lamp examination, nuclear sclerosis reduces contrast and induces myopic shift, cortical cataract produces radial spokes causing disability glare, and posterior subcapsular cataract near the nodal point disproportionately impairs near vision and bright‑light acuity. Objective scatter index and contrast sensitivity testing can quantify functional impact.
When vision begins to limit day‑to‑day life — reading, driving, recognising faces or enjoying hobbies — surgery becomes sensible. I will plan the timing with you so that recovery is smooth and life can return quickly to normal.
For the technically minded: Indication is primarily functional rather than based on a fixed visual acuity threshold; measures include best corrected visual acuity (BCVA), contrast sensitivity and patient‑reported outcome measures. Earlier surgery may reduce ultrasound energy requirements and endothelial cell stress by avoiding very dense nuclei.
Glasses and brighter lighting can help for a time, but once the lens is cloudy, only surgery restores clarity. No drops have been proven to dissolve a cataract or reverse the misting of the lens.
For the technically minded: There is no pharmacological agent that reverses protein aggregation or restores lens transparency in vivo. Experimental antioxidants and glycation inhibitors have not shown durable clinical efficacy, so surgical lens extraction remains the gold standard.
Often, both eyes eventually need treatment, although one eye is usually worse. I operate one eye at a time for safety, comfort and the chance to fine‑tune the plan for the second eye.
For the technically minded: Sequential unilateral surgery lowers the already small risk of bilateral endophthalmitis and allows refractive feedback from the first eye to adjust the second eye’s target. Inter‑eye optimisation can improve refractive accuracy by accounting for effective lens position behaviour in the individual.
Vision usually continues to decline, with more glare and difficulty in dim or dazzling light. In very advanced cases the lens can become dense and hard, which can make later surgery more complex.
For the technically minded: Progressive swelling or leakage of lens proteins may trigger phacomorphic angle closure or phacolytic inflammation with secondary ocular hypertension. Dense nuclei require higher phacoemulsification energy, increasing endothelial cell loss and corneal oedema risk.
Through a tiny, self‑sealing opening at the edge of the cornea, the misty natural lens is gently removed and replaced with a clear intraocular lens implant. Typically, no sutures are required to close the wound, and the operation is highly refined and completed in minutes while you remain comfortable.
For the technically minded: Standard care is micro‑incision phacoemulsification via approximately 2.2 millimetre clear‑corneal incision, with continuous curvilinear capsulorhexis, hydrodissection, nucleus division and cortical aspiration. A foldable intraocular lens (IOL) is implanted into the capsular bag to maintain stability and centration.
No. Anaesthetic eye drops numb the eye thoroughly, and most people feel only gentle pressure or a cool water sensation. In addition, I typically employ oral sedation so that you feel relaxed and at ease before we begin.
For the technically minded: Topical anaesthesia with preservative‑free intracameral lidocaine provides effective sensory blockade while avoiding extraocular muscle akinesia. Oral sedation reduces sympathetic arousal and improves patient experience without the risks of deeper intravenous sedation.
The procedure itself usually takes around ten to fifteen minutes per eye. You will be with me longer to allow time for calm preparation beforehand and unhurried recovery afterwards.
For the technically minded: Surgical duration varies with lens density and pupil behaviour; maintaining low cumulative phacoemulsification energy protects the corneal endothelium. Efficient fluidics and appropriate chopping technique reduce post‑operative corneal oedema and accelerate visual recovery.
Almost all cataract operations are performed under local anaesthetic eye drops while you remain comfortably awake. I typically employ topical anaesthesia and oral sedation given thirty minutes before the start of surgery to help you relax.
For the technically minded: Topical or sub‑Tenon’s anaesthesia avoids the risks of retrobulbar injection and allows rapid visual rehabilitation. Oral anxiolysis administered pre‑operatively enhances cooperation and comfort while maintaining spontaneous respiration and cardiovascular stability.
Cataract surgery is one of the safest operations, and most people heal quickly with clearer vision. The risk of infection (endophthalmitis) is about one in one thousand, and the risk of a complication that requires a second procedure is about one in one hundred; I work carefully to minimise and manage these risks.
For the technically minded: Principal risks include endophthalmitis, posterior capsular rupture, cystoid macular oedema and corneal decompensation. Prophylactic intracameral antibiotics, meticulous asepsis and careful wound construction significantly reduce infective and wound‑related risk.
Many people notice clearer, brighter vision within twenty‑four hours, with steady sharpening over the first few days. It is normal for vision to fluctuate a little as the eye settles.
For the technically minded: Speed of visual recovery correlates with minimal corneal oedema and low effective phacoemulsification energy. Neural adaptation to new optics, particularly with multifocal or extended‑depth‑of‑focus designs, may continue for several weeks.
Light sensitivity, watering and a scratchy feeling are common for a short time and usually settle quickly. You will go home with simple eye drops and clear instructions, and I am available if you need reassurance.
For the technically minded: Typical regimen includes a topical fluoroquinolone and a steroid with or without a non‑steroidal anti‑inflammatory agent, tapered over about four weeks. Corneal epithelial integrity usually restores within twenty‑four hours, and a protective shield can reduce inadvertent rubbing overnight.
Most people are back to everyday activities such as reading and gentle exercise within one to two days. Corneal remodelling takes approximately three months, and outcomes in the literature are commonly cited at three, six and twelve months after surgery as the vision continues to refine.
For the technically minded: Capsular fibrosis and in‑the‑bag intraocular lens fixation mature by four to six weeks, at which point a stable refraction can be recorded. Longer‑term assessments at three, six and twelve months capture changes from neural adaptation and ocular surface optimisation.
The removed cloudy lens does not return. Months or years later, the fine membrane that holds the implant can become cloudy, which is easily treated with a quick outpatient laser procedure.
For the technically minded: Posterior capsule opacification results from residual lens epithelial cell proliferation and migration onto the posterior capsule. Neodymium‑doped yttrium aluminium garnet laser capsulotomy creates a central opening of approximately three to four millimetres to restore the visual axis.
An intraocular lens is a fine, clear implant that replaces the misty natural lens to focus light accurately on the retina. It stays in the eye permanently and is not felt or seen by others.
For the technically minded: Modern intraocular lenses are foldable hydrophobic or hydrophilic acrylic designs that can be inserted through a small incision. Aspheric optics reduce positive spherical aberration and can improve contrast sensitivity, particularly in mesopic conditions.
There are several options: monofocal lenses for a single clear distance, toric lenses to correct astigmatism, and premium designs such as multifocal, trifocal and extended‑depth‑of‑focus lenses that offer a wider range of vision. I will help you choose what best fits your daily life and preferences.
For the technically minded: Multifocal and trifocal designs use diffractive echelette step profiles to create multiple focal points, while extended‑depth‑of‑focus lenses lengthen the focal range through wavefront‑shaping or small‑aperture mechanisms. Material and haptic design influence capsular bag interaction and long‑term stability.
Monofocal lenses provide crisp vision at one chosen distance, usually far, with glasses used for other distances. All multifocal intraocular lenses cause some degree of glare and haloes; the level of tolerability varies from person to person and is not fully predictable, and I will help guide you through this decision. Extended‑depth‑of‑focus lenses offer a smooth range of clarity and may lead to fewer night‑time haloes for many people.
For the technically minded: Extended‑depth‑of‑focus optics modulate longitudinal spherical aberration and the modulation transfer function to maintain image quality across a wider vergence range. Diffractive multifocals split incoming light into discrete foci, increasing photic phenomena; centration, ocular surface quality and expectation‑setting are critical to satisfaction.
The best lens matches your lifestyle, visual priorities and eye health — for example how much you read, use screens or drive at night. Whilst the literature references mini‑monovision, I will discuss my strategies bespoke to your needs so that the result suits your daily life.
For the technically minded: Pre‑operative planning incorporates axial length measurement, corneal topography and tomography, mesopic pupil size, angle kappa, tear film stability and macular status. These factors guide lens choice and inform target refractions, including custom blended strategies where appropriate.
Yes. Modern multifocal, trifocal and extended‑depth‑of‑focus lenses are designed to provide clarity at more than one range, which can reduce or remove the need for glasses day‑to‑day. Neural adaptation is typically quick within twelve weeks, although for some people it can take many months.
For the technically minded: Diffractive designs apportion light to multiple focal points, while wavefront‑shaping extends the depth of focus without discrete foci. Neural adaptation time varies with personality traits, pupil behaviour and ocular surface quality.
Many people find they need glasses much less, and some not at all for everyday tasks. Very fine print or long reading sessions may still feel easier with a light pair of readers, depending on the lens chosen.
For the technically minded: High satisfaction relies on achieving a small residual refractive error (within plus or minus 0.50 dioptres) and maintaining a stable, smooth tear film with low higher‑order aberrations. Ocular surface optimisation before and after surgery improves uncorrected performance.
For suitable eyes and lifestyles, premium lenses can offer greater visual freedom and convenience. The ocular surface must be healthy first; if dry eye is present, I will treat it before surgery to optimise your outcome.
For the technically minded: Ocular surface disease elevates higher‑order aberrations and destabilises tear film metrics, degrading image quality with multifocal and extended‑depth‑of‑focus optics. Pre‑operative treatment improves measurement repeatability and post‑operative visual performance.
Toric lenses correct corneal astigmatism, helping to deliver crisp distance vision without relying on glasses. They are contraindicated in irregular corneal astigmatism, where other strategies may be more appropriate.
For the technically minded: Toric intraocular lenses have built‑in cylindrical power aligned to the steep corneal meridian, and one degree of rotational misalignment reduces cylinder effect by approximately 3.3 percent. Irregular astigmatism undermines predictable axis alignment and effective cylinder; topography and tomography guide candidacy.
Yes. I use precise scans and advanced calculations to personalise the lens power for each eye so that the result aligns with your visual goals. I generally advise patients who have undergone previous laser vision correction such as LASIK or SMILE to avoid multifocal intraocular lenses, and I have experience using “monofocal plus” designs in these situations.
For the technically minded: Third‑ and fourth‑generation formulae including Barrett Universal II, Holladay 2 and Olsen integrate axial length, keratometry, anterior chamber depth and lens thickness to predict effective lens position. In post‑LASIK and SMILE eyes, posterior corneal power and altered corneal asphericity complicate prediction; enhanced monofocal optics can be advantageous.
Yes. Some people benefit from a blended approach, where one eye is set slightly nearer and the other more for distance to balance everyday vision comfortably. I typically advise that emmetropia and monovision using monofocal intraocular lenses can be delivered on the NHS, while my private practice focuses on premium intraocular lenses so that glasses are optional or there is less reliance on them.
For the technically minded: Mini‑monovision and hybrid strategies such as extended‑depth‑of‑focus in one eye with multifocal in the fellow eye leverage binocular summation while preserving stereopsis. Clear counselling about night‑driving priorities, depth‑of‑field needs and occupational tasks supports appropriate targeting.
A gentle, computer‑guided laser performs some of the key steps with remarkable accuracy, helping to soften the lens and create precise openings. Instead of employing arcuate corneal incisions, I always employ toric intraocular lenses for the smallest magnitude of astigmatism that an intraocular lens is designed for, often well below one dioptre. I employ femtosecond laser cataract surgery at Moorfields Private in City Road.
For the technically minded: The femtosecond laser (wavelength around 1,053 nanometres) creates an anterior capsulotomy, fragments the nucleus and can plan corneal incisions, although I prefer refractive correction with toric optics. These steps can reduce phacoemulsification energy, improve capsulorhexis geometry and assist centration of premium optics.
Digital guidance provides a live overlay in the operating microscope, helping me position your lens with precision. I have experience using both the VERION and CALLISTO systems and I currently employ CALLISTO z‑alignment at Moorfields Private Eye Centre, 50 New Cavendish Street.
For the technically minded: Systems such as Zeiss CALLISTO eye and Alcon VERION register limbal landmarks and scleral vessels from pre‑operative images, projecting intra‑operative alignment cues. Sub‑degree rotational accuracy improves toric axis placement and centration of multifocal optics.
I measure the eyes carefully — including length and corneal shape — and use sophisticated formulae to select the power that suits your goals. I currently employ the Barrett formula and associated Lens Factor (LF) constants, which provide reliably predicted refractive outcomes in my practice.
For the technically minded: Optical low‑coherence interferometry provides micron‑level axial length measurements, while corneal tomography informs anterior and posterior corneal power. Effective lens position prediction using Barrett Universal II with optimised constants reduces refractive surprise across a wide range of axial lengths.
This is uncommon, and there are several solutions — from a small laser refinement to an additional lens or a lens exchange. I will review your vision carefully and talk you through the simplest, safest option step‑by‑step.
For the technically minded: Enhancement pathways include corneal laser refractive adjustment, additive sulcus‑fixated “piggy‑back” intraocular lens implantation or primary intraocular lens exchange. Wavefront analysis and anterior segment optical coherence tomography guide the decision by revealing optical quality and lens position.
