Vicky

Okay, so once again, good evening, and a very warm welcome to our webinar on cataract surgery and special lenses. My name is Vicky, and I'll be your host for this evening. I'm delighted to be joined by our expert speaker, Sarit Lesnik-Oberstein, Consultant Ophthalmic Surgeon here at Benenden Hospital.

Tonight's session will begin with a presentation from Sarit, followed by a live Q and A.

So if you have any questions at any point, please feel free to submit them, using the Q&A icon at the bottom of your screen.

You're welcome to ask anonymously or include your name. Just a quick note that this session is being recorded. So any name shared will be visible in the recording.

If you're interested in booking a consultation, we'll share all the relevant contact details at the end of the session.

And I'll hand over to Sarit.

Sarit Lesnik-Oberstein

Good evening, everybody. Thank you for joining this evening, so I'm just going to give you a bit of information about cataract, surgery, and various lens options that are on offer and actually what a cataract is.

So I'll just introduce myself. I'm one of the Consultants at Benenden and I've been here for more than eight years now, and I've trained in ophthalmology. I'm originally Dutch, but I have trained in England and Moorfields and at St Thomas's Hospital, and I've also done fellowships there, both in retina surgery and cataracts, and I worked in the Netherlands for 13 years before coming back to the UK which is when I also started working at Benenden.

And so we'll look at types of cataracts and the causes and symptoms of cataract surgery, lens, options, and various bits that might be interesting in the recovery of cataract surgery and obviously we'll answer any questions that we can.

So, most importantly, if we look at the eye from the side. The lens is the white area you can see in the center. It looks like a Smartie like a sweetie that we see the chocolate sweet, and it has a very similar shape, and it hangs in the eye in a little bag suspended by thousands and thousands of little hairs.

This is seeing from the front. So the lens which is the cataract, is actually just where the pupil is just behind that area behind the iris, the color bit.

And what does the lens do in normal life? It functions very much like in a camera. It does your focusing for you, so that the image you see is clear on your retina, which is the film at the back of the eye, like in a camera that does the seeing for you.

Now when a cataract develops, what tends to happen is that the lens itself? So the whole lens? It's not a skin on the eye or anything like that. The whole lens just goes cloudier as we get older. Usually, so, age is the most common cause of cataract.

And when you get a cloudier lens. It means the image is less sharp, so it becomes blurrier and also you might have problems with dazzle or not being able to read things properly.

So what you can see here in the colored picture of the eye is actually what we call nuclear sclerosis, which is when the actual lens goes yellowish in center, and everything loses its blue tint. So quite often, patients who've had cataract surgery will say that everything looks quite blue for a while, because that brownish color has been removed from their vision, and their vision is much clearer, and colors are much clearer.

But here you can quite obviously see that instead of the lens being a nice, clear, transparent lens, it's become a brownish, murky lens.

This is a cortical cataract that means it's on the outer layers of the lens, so almost like the outside of the smarty, and that again, can cause a lot of dazzle. And you can imagine that looking through that lens can be quite challenging because of all those little white, what we call spokes that are in the way. And sometimes people have a combination of the two types of cataract, the way you can see both cortical and nuclear sclerotic. So the yellow murky one combined.

This is what we call a posterior subcapsular cataract, and it's difficult to see on this image, but it's actually right at the back of the lens. It's like somebody's breathed on the bathroom window, and it's steamed up, and that can occur quite quickly.

So those are cataracts that develop in quite a short space of time, and they can make vision very poor, very, very quickly.

And this is a posterior polar cataract. It's right in the center of the lens in the middle. Sometimes people are born with these there can be a little more challenging to operate on because if you're born with a cataract, it means that actually, it's part of the structure of the eye. So that's the fourth type of cataract. And I'd say here at Benenden we definitely operate on the first three. But we'd have to assess the 4th one. To make sure we can actually do the surgery safely here.

The important thing for all of these cataracts is, it doesn't matter, except for the posterior polar. What type of cataract you have? The surgery is always the same for the different types, unless it's a very unusual cataract.

So what causes cataracts? Well, as I said earlier, mostly it's aging. As we get older, hair goes grey, we get more wrinkles, and the cataract in the eye is a sign of aging. Now this is influenced by various factors, one of the important one being smoking. If you smoke, you will have more cataract and earlier, but also certain diseases like diabetes can cause

earlier cataracts. Sometimes you're born with them. So that's congenital cataract, which is not something we tend to treat here at Benenden. You can have cataract from trauma if you've had a knock on the eye, certain medications can give you cataract, and of course there's also a genetic element.

So if a lot of people in your family had cataract very early on then you might get cataract earlier as well.

And the symptoms of cataracts are usually what people describe when they come here is that the colors aren't as bright, but mostly blurry vision, and especially also glare when driving at night or being outside at night, that, like, there's almost a scatter of light caused by these changes in the lens that means the light doesn't go straight through the lens, but gets scattered all around the eye, which is extremely uncomfortable.

Sometimes prescriptions keep changing. You keep going to the optician. You start thinking I can't get my glasses right? So you keep getting different prescriptions. Sometimes people notice some double vision. If you look at the cortical cataract with those little lines in the middle. You can imagine you can get double images so that can be very irritating and distressing.

But mostly people say they've got blurry vision. They've got glare at night. Those are the most common things we hear. The color change, a lot of people don't notice, because it tends to happen very, very slowly.

So why do people have cataract surgery? Well obviously, if you're not seeing as well as you were, or you can't drive safely, because the scatter of light is too much in the evening you get too much dazzle, then it's going to affect your enjoyment of your daily life and also your ability if you're still working to work and to just get on and get things done.

So as soon as you find that you have things that you cannot do anymore, because we all get cataract as we get older. Then at that point, when your quality of life is affected, or you can't live your life the way you want to. That would be a time to consider having cataract surgery, and that depends per person. Some people have cataract surgery much later than others, just depending on what they are doing in their day to day life.

So if it affects your daily activities, or if you cannot drive legally and safely, if your glasses keep changing, or you can't do the hobbies you enjoy. We see a lot of people who play golf, who just cannot see where the ball has gone or you can't do your hobbies like painting or model building, or just caring safely for grandchildren. If you can't see them, you're not going to be a safe carer.

So those things just depending on your personal circumstances, will push you toward that decision to have a cataract operation. Sometimes there are medical reasons to have a cataract if you've got very long sighted eyes, which means they are smaller and shorter. If you've got a big cataract that can cause problems like glaucoma.

Sometimes surgeries are done combined with other surgeries. Those aren't done here at Benenden, so it's important that we can see the back of the eye to assess that everything is healthy, especially in people like diabetics who have eye checks. So those are all reasons you could have a cataract surgery. But most patients, we see, have cataract surgery to improve their quality of life.

So very famous person, Claude Monet, the painter. He was diagnosed with cataract and his symptoms worsened because there was no real option for cataract surgery that was safe at the time. His paintings changed significantly, and if you look at the paintings here of his garden in Giverny. You can tell that as his cataracts got worse, the garden was becoming more and more brown and blurred, and he himself described that the colors weren't as vivid anymore.

But it's a very clear deterioration in his vision which could not be treated at the time. But it is very telling of what people notice as their vision gets worse.

So what happens if you do get referred for cataract surgery, or you feel that you need cataract surgery because your vision is not as good as you want it to be? You will come to the unit, and you'll have a preoperative assessment. That means that one of the eye nurses will see you, and she will take a history and check your general health and see which medications you're on.

And then, after that you will have various tests and measurements. first of all, to see what your vision is, what your prescription of your glasses is. We'll do measurements to see what new lens would be appropriate for you, and we check that the rest of the eye is healthy, and that is done by the eye doctor, who is in the unit at that time, who will go through your eye history with you if you've had any previous problems with your eyes, and they will check the rest of the eye as well to make sure that there's no other ongoing problems that might be affecting your vision.

So the eye doctor, does the eye examination. They'll discuss your history, they'll check the investigation results that have been done by the nurses and they'll discuss the anesthetic that we will use.

Usually this is actually just drops for eye surgery. You don't need anything else, and that we will obviously discuss the risks and benefits of surgery, and which lens because the lens we have to exchange the lens that you have, your dirty, cataracty lens for a new clean lens.

So we discuss which type of implant we're going to give you, and we ask you to sign a consent form where we go through all the risks and benefits of surgery, and we'll explain those to you at the time.

So lens options. Now, most commonly we use what we call a monofocal lens. This means that the lens corrects for one distance only, which is usually in the distance. So that means that you can hopefully see fairly well or very well in the distance without any correction. We can't guarantee that, but that is what we aim for. But then you will still need reading glasses afterwards.

Sometimes people prefer to have reading vision without glasses, especially if that's what they've been used to, because they're short sighted, and they can choose to have reading vision without glasses, and then they will need glasses for distance, so you can either choose distance or near if you're having a monofocal lens.

And sometimes people, if they've got significant astigmatism will need glasses for everything, just because astigmatism, when the eye isn't completely round, but shaped more like a Rugby ball. Sometimes people will still need glasses after the procedure, even though we can try and decrease the astigmatism, we can't get completely rid of it with a monofocal lens.

However, there are other types of lenses, where these are premium lenses, where we can do something called a multifocal lens, and this can be a lens that is both good for distance and for near. So you would be able to see in the distance whilst you're driving, and you should be able to read and do computer work without glasses.

So sometimes they can also give those lenses what we call a Toric element, where they correct the astigmatism as well. And there's also monofocal lenses where the astigmatism can be corrected again, that's a premium lens. So these are various options depending on your personal choice that can help you attain the vision that you would like to have.

So this is the toric lens I was discussing. The astigmatism is common, it's not a disease. It's just the shape of your eye that, instead of being round like a sphere, is more like the shape of a rugby ball, which means that the lens correction, prescription in one angle is different to the lens prescription in the other angle.

That can make vision blurry even if you have the right monofocal lens, because one of the axes is not corrected, and at this point you could consider either wearing glasses both for reading and for distance, or, if you so wish, you could consider the option of having a premium lens and a toric lens, which means that the astigmatism can be corrected.

So what happens on the actual day of the operation? Well, first of all, you'll come in. You'll be admitted by one of our nurses or our healthcare technicians who will check your blood pressure, and if you're diabetic. They'll check your blood sugar, and then they will put lots of drops into your eyes, firstly, to numb the eye. They sting a little bit when we start numbing the eye, but then the anaesthetic works, and you won't feel the drops, and we put a tiny pellet into the lower lid. It looks like a grain of rice, and this actually has the dilating medication in it, so that whilst you're sitting in the waiting area and waiting for the pupil to dilate. That little pellet actually gives you the medication. You need to dilate the pupil, so you don't have to have drops every few minutes.

And, as I said. We check your blood pressure and your blood sugars. If you feel extremely anxious, we do have some diazepam, some oral sedation, but most patients are actually quite happy to have the procedure without that.

And we want you to wear something that's comfortable to wear, and preferably not your best white shirt, because sometimes we do have some fluid, just clean water or some iodine that can get on your clothes. So you don't want to have something that can stain, and obviously don't drink any alcohol before you come in, but you can eat and drink as normal. Take your medication as normal, and we have coffee and tea in the unit if you want anything whilst you're waiting and biscuits.

So what does the operation entail? Well, first of all, you will be lying quite flat for the operation. When you come in it's like a dentist chair you'll be sitting up. We'll put a hat on your head which holds your hair out of place, and also there'll be a little swab over the side that we're operating on your ear just to catch any drips and any water, and we'll also ask you to take a hearing aid out of that side, so we don't get it wet because it doesn't work very well after it's been wet.

And then we'll bring the chair back and lie you down just like at the dentist. It'll be fairly flat, and we'll make sure that you're comfortable, and your back is comfortable as well, and then we put more anesthetic drops on the eye, and we put some iodine on the eye to make sure that the eye is well cleansed.

Then we'll clean around the eye a bit more around the skin, and then we'll cover you with a bit of a paper tablecloth that'll also cover the vision of the other eye. So you're not going to see anything that's happening.

And then we put a little clip between the eyelids to keep the eye open on the side that we're operating on, and we make sure there's some fresh air under the drape, so you can breathe normally if we really need to, and you feel that the drape is too close to your face, we can actually stick it away from your face. So there's fresh air blowing at you.

And then what you'll be asked to do is to look at the operating light. It's three little lights. You don't need to follow them. Just look in the direction of the lights, and we'll get on and do the procedure, and what you will tend to feel is just lots of water, lots of bright lights and some pressure.

So what we do is we make a tiny incision into the cornea, the front window of the eye. It's 2.2mm so it is absolutely tiny. And then we open the bag where the little lens that matie is located very carefully, and we use some ultrasound to fracture the little lens into tiny, tiny bits, so we can remove the whole lens.

We tidy up the little bag, so there's no remnants of lens in there, and then we put the new lens, whichever one is appropriate for you for the refraction that you would like after the operation so usually for distance, vision, or if you have a special lens, the special lens which will be ordered for you, and then we check the eye looks fine, that everything is in the right place, and then we give you some antibiotics in the eye and on the eye, and then you'll have a little shield over the eye is see-through plastic shield, which is stuck down with some tape, just to make sure that the eye is safe for the first day after the operation, and that shield stays on till the next morning.

So this is just a little bit of an image of that lens hanging there on those little little hairs, those little fibers that keep it in place.

and you can see that there's a little circular opening on that little bag now, and that we use that little. What we call the phako emulsification. Probe that ultrasound probe to remove the lens, and then the artificial lens is actually completely rolled up a bit like a bath mat goes into the eye, and then it unrolls in the appropriate position inside that little bag, and it stays there for life so it will be there for the rest of your natural life.

And then the recovery is very straightforward. Sometimes people feel the eye might be a little bit scratchy or a little bit uncomfortable after the operation. But actually, most people don't feel very much discomfort at all. If you feel you need to, you can take some paracetamol.

And then we will give you drops for four weeks after the operation, because we want to avoid any infections or anything else in the eye, because those are very not good for the eye. So we ask you to stick to certain rules, I would say which is using the drops for four weeks, and then initially, your vision will feel blurry, but it will improve quite a lot by the next morning.

And the eye is covered with that little shield, just to give the eye some time to recover, but also for the anesthetic to wear off.

And then the whole healing process is about four weeks till we consider the eye healed.

And then there is always support from our unit if you have any issues or any questions you'd like to ask after the surgery. But after the surgery you'll have a discharge Nurse go through all the do's and don'ts explicitly. You'll also be giving a leaflet which has everything written in there, including an emergency number. If you feel that you need to talk to us urgently, so all those things are provided for.

Now, cataract surgery is very safe. We have a very, very low complication rate, which is good, and people's quality of life improves significantly after cataract surgery. But as with any surgery, there are risks.

The most important risk, even though it's very unusual. Is that the little bag that we put the new lens into can either be damaged prior to surgery from either trauma or weakness that's natural to the eye, or sometimes it can tear during the surgery, and if that happens, it means that you will have what we call a complicated surgery. It does not mean it's the end of the road. It just means the surgery itself will take longer and we might have to put the lens in a different position, and very, very rarely you would have to be referred on, but that is extremely unusual for that to occur.

The risk of visual loss. It says, here is one in a thousand, so that doesn't mean one in a thousand patients. It means per patient. It's one in a thousand. However, I would actually say, that's even lower, but that is the number that's used by the Royal College of Ophthalmologists. But I'd say it's a lot lower than that. And obviously this will be discussed with the doctor that you see, when you would come in for your consultation.

So we have a dedicated eye unit here at Benenden, where we do only ophthalmology and mostly cataract surgery. It's a very friendly and very gentle environment and we have all the latest equipment for both your investigations and your lens measurements and the surgery itself, and we have a good team of very experienced Consultants. We don't have trainees here. Everybody who works here is a Consultant, and we work across different hospitals within the NHS, but also at Benenden, and our nursing and Admin team are also completely dedicated ophthalmic people, and we have a good cataract patient pathway which we've been using for years, and we are considered by the CQC As outstanding for what we do here.

So these are our group of ophthalmic Consultants, Han bin Lee and Mr Aboshiha, Jonathan Aboshiha. Both do the special lenses, the premium lenses, so they would be doing the toric lenses and the multifocal lenses and the other doctors you see on here, including myself, do the monofocal lenses either for distance or for reading.

So if you have any questions, I'm going to pass you back to Vicky, and she can go through things, and I can answer the questions as best as I can.

Vicky

Thanks Sarit, please do ask your questions, and we'll go through them until we run out of time.

The first question is, I have intermittent double vision which goes away when I close one eye. I have a prism in my glasses, but I still find myself reading with one eye closed when in bed. Sometimes will the lenses I'm given help this?

Sarit Lesnik-Oberstein

So usually they will not, because the double vision you have is what we call binocular double vision. So it means that whilst one eye is closed you don't have the double vision. So that means it's probably a muscle imbalance, because it's corrected by prisms. So we can make your vision clearer with cataract surgery. But we can't get rid of the double vision, so you'd still need glasses with a prism in there, even if you have cataract surgery. It's unusual for it to resolve that problem.

Vicky

Okay, thanks Sarit. So I think we've already answered this one. Perhaps perhaps you could say a bit more. Will the implanted lens correct astigmatism?

Sarit Lesnik-Oberstein

So the implanted lens, if you have a toric lens would correct astigmatism. It depends very much on how much astigmatism you have. So some people have quite significant astigmatism. We can't operate that away. You would need a toric lens, which is a premium lens to get rid of the astigmatism if it's a small astigmatism. Sometimes we can operate it away.

But we usually, if people have a significant astigmatism. first of all, we will mention the fact that you could have a toric lens to improve that. But astigmatism of less than one diopter, which is how we measure these things would probably not even be noticeable if you have surgery, so you wouldn't worry about that. It's more significant when you wear glasses than when you have your lenses done.

Vicky

Thank you. Hope that helps. And next question, does the shape of the eyeball change during one's life that's necessitating new glasses or new lens implants?

Sarit Lesnik-Oberstein

So the shape of the eye does change in life. That's why people sometimes become more short sighted. But that happens especially when you're much younger. So as you get older, there is less change.

Now, obviously, we can't guarantee that you would never need glasses because I don't think we can ever guarantee anything like that. But usually the lenses last for the rest of your life, and especially if you have distance vision, you should be fairly good for distance.

People occasionally need a polish of the little bag what we call the lens capsule. So this happens to 30 to 40% of patients, they'll need a yag laser, as we call it, which is a clinic procedure, just to brighten up that lens again if it goes a little bit foggy. But that is not a complication. Just we know that 30 to 40% of people will get this. But you won't keep needing new glasses, because your prescription is changing. That's unlikely. The only exception would be if you're very, very short sighted and short sighted. People have a very stretched out eye, and sometimes that can continue to change even at older age.

So that would be the kind of the exception that confirms the rule. But other people won't tend to need glasses all the time.

Vicky

Okay, lovely. And I think that answers the next question as well. So we'll go on to Suzanne's question, and she asks, I only have vision in one eye. I'm very short sighted, minus 13 in my good eye, also with astigmatism. Can I go home the same day?

Sarit Lesnik-Oberstein

So, Suzanne, thank you for that question. That's obviously quite a vulnerable place to be. But we do do surgery on only eyes quite often, and also on very short sighted people.

Now the astigmatism again. I don't know how big it is, and because you're short-sighted, you'll have a slightly what we call a slightly more stretched eye. So it's less predictable in the astigmatism sense.

But the question you're really asking is, can I go home the same day? And the answer would be, yes, my thought would be that you make sure you have somebody staying with you at least till the next day, if you're living on your own, but otherwise, to make sure there is somebody at home with you, because you will be quite blurry on the first day, so it would be very much a sofa day where somebody is taking care of you, not because you're in pain, but just because you'll be a little bit vulnerable on your own, because your best eye has been operated on.

But if your vision is not good enough for you to function, and you feel you need to have a cataract surgery, then that is absolutely acceptable. And we do do cataract surgeries on people with only eyes. But you'd have to make sure that you have somebody to go home with you.

Vicky

Okay, thank you, Suzanne. I hope that's reassured you.

Next question is from Andrew and Andrew asks, I've had laser surgery many years ago. Is that a problem with getting the right lens? So these days, Andrew, we get a lot more people who've had laser surgery in the past.

We have special formulae that calculate the lens for us and we also have ones that calculate the lens for us when people have had previous laser surgery for us, it's really helpful if you have any letters about the surgery you had, or about your prescription before you had surgery.

So if you've had surgery, and you knew you were very short sighted before you had the surgery and then you were less short sighted afterwards. That's already helpful. But if you have any paper information, or old letters that always helps for us to make a good calculation, and the only thing that's important to know if you've had laser surgery previously is that there is a slightly higher risk that you might need glasses afterwards, just because it's called a refractive surprise because the front window of the eye, the cornea has been affected by the laser it sometimes behave slightly, unpredictably after surgery, as in sometimes we think we've got the right correction to make you good for distance, but we don't always come out exactly where we expect to be, but on the whole we managed to get a fairly good result, or even a perfect result.

But it's just something that we do have to warn you that sometimes the result isn't exactly what we expected, because of the previous laser. As I said, if you have information that would be extremely helpful.

Vicky

Lovely thanks, Sarit. Andrew hope that helps. Next question is from Linda, and Linda asks, Do does she need to be referred by an optician.

Sarit Lesnik-Oberstein

So it depends. Obviously, if you're coming as a private patient, you can just come and see us to say, Do I have cataract? And do I need surgery. If you're coming as an NHS or Benenden patient, you would need a referral from your optician. Yes.

Vicky

Next question, people talk about the cataract needing to be ripe before surgery is considered. Can you say a bit more about this?

Sarit Lesnik-Oberstein

Needing to be ripe is quite an old fashioned concept before we had modern cataract surgery. Cataracts were a very risky operation for the eye, with quite a few issues after the surgery, so people wouldn't do the surgery until they absolutely needed it.

These days. With modern cataract surgery the risks are extremely low. It's one of the safest surgeries that is done on any part of the body, so you don't need to have a ripe cataract. Our criteria these days is that you feel your vision is impaired, and you cannot do the day to day activities that you want to do because of the cataract.

So it doesn't need to be ripe. It just needs to be that you're ready to have a procedure done to improve your vision.

Vicky

I hope that's reassured you. Our next question is from Paul, and Paul asks, Can I wear lenses for close reading after surgery?

Sarit Lesnik-Oberstein

Do you mean contact lenses? Because we actually ask you to not wear any contact lenses for four weeks after surgery at least, but and you can just then wear a pair of cheap reading glasses to tide you over till you see your optician to get your proper glasses for reading.

But so it depends on what kind of contact lenses you're used to wearing. But the answer is, no contact lenses for at least the first four weeks when you're still using drops.

Vicky

Lovely. Thank you.

And next question is from Myra and Myra asks, when can I start driving after surgery?

Sarit Lesnik-Oberstein

So we basically have a guideline of about a week. Again, it depends on you being compliant with DVLA guidelines. You have to be able to read a number plate at 20 meters with both your eyes open, and if you are compliant, it means you are insured. If you are not compliant, you're not insured. It's very important to make sure that you are compliant, and you feel safe driving. So you don't want to be a hazard to yourself or to others. But normally, we say, about a week.

Vicky

Okay, lovely. Thank you. Hope that was useful, Myra. And next question, Do you have to have both eyes done? I've got problems with my right eye, but not my left.

Sarit Lesnik-Oberstein

Absolutely not. You can have one eye done. It depends completely on your circumstances how you want to go about this, so you will come and see us, and we'll do all the measurements on both eyes, because we always do as you're here, and it doesn't take any extra time.

But if you say, Look, it's my left eye that's bothering me, and I'm absolutely fine with my right. Then we do the left eye if you want, but we wouldn't touch the right. So this is an elective surgery, and we only do an operation if you feel you want to have it done so. Some people, even if they have some cataract, are like, well, it's not the right time of my life, or I'm a carer. I'm taking care of somebody I don't have time to take off at the moment, because I can't bend or lift after the operation, so I'm just going to wait a bit. It doesn't matter. You can wait with cataract surgery. It can be done at a later date as well.

Vicky

Okay, lovely. Thank you, Sarit. And next question from Joanne. I don't have cataracts, but I'm interested in lens replacement. I'm shortsighted, minus 5.2 5. Can I have both eyes corrected at the same time.

Sarit Lesnik-Oberstein

So for kind of refractive elective surgery, where you don't have cataract, there are various options. There's obviously laser surgery, and there's cataract surgery. What we call clear lens replacements. Now, the important thing to consider is your age. I don't know how old you are, but if you are under 45 quite often. Laser is the best option so there are different options. I'm not a refractive Surgeon. I'm a retina Surgeon, but I think it is. It might be worth talking to somebody about having a lens replacement. But that's something that is not done on the NHS. So you'd have to discuss that with a Consultant, refractive Surgeon. So Miss Hanbin Lee or Mr Aboshiha. But chances are that potentially laser surgery might be more appropriate for you than having a cataract operation.

It depends very much on various factors like your age and your eyes. So this is something that you would further have to investigate to make sure that you're making the correct choice for yourself.

Vicky

Okay, lovely, thank you. Linda has also asked, do you have to have a consultation before deciding to have surgery?

Sarit Lesnik-Oberstein

Well, you will always see a Consultant before you have an operation also, because you have to go through a consent form.

So you have to sign a consent before we can do the operation, just to make sure that you are aware of the risks and benefits, and that you feel comfortable going ahead with the surgery. So you will have to come to Benenden to have your measurements done, so that we are sure we have the correct lenses for you, and also to make sure that you know what's going on, and that we've seen your eyes and we're aware that there's no other causes of poor vision for example.

So we do a full eye check to make sure that the eye is completely healthy, or if there are any other issues going on that we can refer you for those or deal with those.

Vicky

Lovely. Thank you.

Next question is from Sheila, and Sheila says, I've been told I'll continue to need glasses because I need prisms similar to the first question. I also need to have both eyes done. How does one cope between the first surgery and getting new glasses after the second surgery.

Sarit Lesnik-Oberstein

So, Sheila, it's a really good question. It's an awkward time between the two eyes. It is for anybody, but especially for someone like yourself. One of the things that your optician might be able to do is actually put a blank glass in your glasses and put a fresnel prism on there. It depends on how helpful your own optometrist or optician is, but that Fresnel is a temporary prism that helps you be able to do things if you are very short or long sighted, and there's a big difference between the eyes. It will be an awkward time, and one of the reasons one of the things that might make us want to consider doing your two surgeries closer together than the normal four week period we give between the two eyes, just to make the time that you are kind of discombobulated, a bit shorter. So that would be something we would consider as well. But it would be an awkward time for you.

Vicky

Okay. Next question I have mild ptosis. Will this complicate the procedure?

Sarit Lesnik-Oberstein

No, ptosis is absolutely not a problem for the procedure. The only thing is that sometimes, after the procedure, ptosis might be a little bit worse, and this also has to do with the fact that we use something called the speculum to hold the eye open, and these sometimes temporarily, but can make the ptosis a little bit worse. That's just something you need to be aware of.

Vicky

Okay, lovely, thank you.

And next question is from Geoff. And Geoff says you mentioned four to six weeks of eye drops after the OP. But can normal activities continue after 24 to 48 hours, eg playing golf.

Sarit Lesnik-Oberstein

So you have four weeks of eye drops. We advise people not to do exercise, including golf for the first two weeks after the operation, because it can cause problems for the eye. So there's always stories of people saying I was on the golf course the next day we disadvise that just like we ask you not to swim for four to six weeks, because water getting in the eye is not good. We ask you not to go to the gym for two weeks, because, first of all, we don't want you lifting heavy weights or bending, but also the gym environment is usually got more bacteria than at home. So there are limitations for the first two weeks after surgery, but after that you can get back to normal activities, including golf.

Vicky

Okay, lovely. I hope that's reassured you, Geoff.

Next question got time for a couple more. I have dry eyes. Does this represent a risk for surgery?

Sarit Lesnik-Oberstein

So dry eyes tend to happen, especially to women after the age of 50, but also does happen to men. Of course, most important thing to know is that for four weeks you'll be having drops after surgery that tend to help the dry eye quite a lot.

The drawback is that when you finish your drops the eye might feel much drier for a short while, or even quite gritty, and we advise you to use a lot more dry eye drops after you finish your medical drops from the surgery.

So eye dry eyes can occur a little bit more after the operation also because we do make a tiny opening in the eye, and that can be like any little wound anywhere whilst that's healing. It can be a bit irregular, and that can feel like a bit of grit, or make your dry eye slightly worse for a while, but that does tend to settle, and if you use more dry eye drops, that shouldn't be an issue.

Vicky

Okay, I hope that was helpful to you.

Next question, are there prescription numbers to show that my astigmatism will still need glasses after a mono lens replacement? And are there prescription numbers which indicate that a toric lens replacement will still need glasses?

Sarit Lesnik-Oberstein

That's more difficult to say. If you're having a toric lens replacement, you probably wouldn't need glasses for distance if it's done the way it should be done. If you have a small astigmatism that's lower than, say, one diopter. Then usually after a mono lens replacement, you wouldn't need glasses. However, sometimes the actual surgery itself can induce a very small astigmatism that might for you, if you like your astigmatism has got worse, and then you would need glasses, as I say, we try and aim to get you without glasses for distance most of the time.

However, we cannot guarantee that just because the eye is actually a living structure, and sometimes like when you glue wood together, it can do things that you don't quite expect it to. As the healing happens. So that's something to take into account is that 95% of our patients get exactly to where we want them to be.

Another 3% get no glasses. But there will be people who will need glasses for driving, even though we have aimed for no glasses, and if a little bit of astigmatism is induced, and you already have some that could be one of the things that's something to discuss when you come in.

Vicky

Okay, lovely. Thank you.

Next question. I had cataract surgery 15 years ago, and I've managed my 3.25 prescription variation since the new lens is not good. I can't see clearly in the distance or up close. So I'm not sure what lens I used because of this. I'm very worried about losing the sight in my remaining eye, which it now also has a cataract, can both lenses be replaced?

Sarit Lesnik-Oberstein

So my suggestion to you would be is to come and see us, because I think that's the most important thing, so we can assess why, the vision is poor in the first eye.

I think, having your cataract done in your cataract eye, like, I said to the lady who has only one eye, I think, doing the cataract. If you're not managing in the eye that hasn't had a cataract done yet, would be your first step. We do not do lens exchanges of one type of artificial lens for another here at Benenden that would have to be done elsewhere.

It can be done. It's not always a completely straightforward operation depends on why your lens is cloudy. So that's one that's not really part of the remit of this, we'd have to assess your eyes and then discuss with you what your options are. But my feeling would be to have the cataract done in the eye that hasn't had the cataract done yet, and then to see how you get on, because you might find with the two eyes together, that you can actually manage much better.

Vicky

Okay, lovely hope that was helpful, and time for one more question. And would macular degeneration rule out cataract, surgery?

Sarit Lesnik-Oberstein

No macular degeneration does not rule out cataract surgery. It actually is something that sometimes helps people with macular degeneration to see more clearly with the vision they still have.

You will not go back to having the vision you had when you were 20 years old. Obviously because you've got a problem at the back of the eye and the retina. But having cataract surgery can actually improve your quality of life, even though it cannot get rid of the macular degeneration.

Vicky

Do you think a cataract can develop again?

Sarit Lesnik-Oberstein

Cataracts don't develop again. As I said, you might need some yag laser at a certain point, because 30 to 40% of patients do that can develop after a year or two years or three years. But that's a clinic procedure. It's very quick and it's painless. So that's just something that if it does develop.

We can get rid of that in the clinic. But an actual cataract cannot develop again. Once the cataract's gone, it's gone.

And just for the last person. How long do you have to avoid bending and lifting? We say, two weeks at least, of no heavy lifting and no bending down with your head below your shoulders, but other than that, that will all be explained to you when you do come in to have your operation.

Vicky

Lovely. That's great. Thank you. And thanks to everyone for your questions and for being part of this evening session

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So on behalf of Sarit and all of us here at Benenden Hospital. Thank you once again for joining us this evening, we hope to hear from you soon. Thank you, and goodbye.