Jane Styche

Good evening, everyone, and welcome to our webinar on cataract surgery. My name is Jane Styche, and I'm the Eye Unit Manager. I'm joined by our consultant, Miss Sarit Lesnik Oberstein. She's our consultant ophthalmic surgeon. This presentation will be followed by a question-and-answer session.

If you'd like to ask a question during or after the presentation, please do so by using the Q&A icon at the bottom of your screen. This can be done with or without your name. Please note that this session is being recorded. If you do provide your name and would like to book your consultation, we will provide you with contact details at the end of this session, and I'll now hand you over to Sarit. You'll hear from me again shortly.

Sarit Lesnik Oberstein

So good evening. All I'm going to do is talk about what cataracts are and what can be done about them if necessary, give you a few explanations, and, as Jane just said, we can do some questions afterwards if you want to ask any particular questions.

As Jane said, I'm Sarit Lesnik Oberstein. I'm a consultant ophthalmic surgeon. and Jane is the lead of our Eye Unit, the Eye Sister.

We're going to go through the types of cataracts, the causes, the symptoms of cataracts, and what cataract surgery entails and what it might mean for you. We'll also go over some of our consultants who work here and what the options are for different types of lenses. If you want to go for cataract surgery, I will explain that to you in a second.

I myself am Dutch, but I trained my ophthalmic training mostly at Moorfields, and then I'm also a retina surgeon as well as a cataract surgeon, though we do not do retina surgery at Benenden, and I also did a PhD.

I'm also an academic, and I worked in Amsterdam for years before I came back to the UK, where I now work in Benenden and some other locations.

First of all, what is a cataract? A cataract is when the lens inside the eye goes a bit cloudy, so the lens is the white bit that you can see on your screen, and that basically, when you're born, should be clear. And as we get older, like everything else, it changes its structure, which means it becomes cloudy or ambition can become less clear.

It's like a camera. Every camera has a lens in it, and the lens needs to be clear, and that lens paints a picture on the retina, which is the film at the back of the eye, like in a camera that sends messages to the brain that lets you see things now as you can imagine. If that lens gets cloudy or isn't working properly, the image that goes to the brain will be cloudy as well. So here you see a picture of that where there is a picture of an eagle, and what the eye sees is a clear eagle, and when you have cataracts, it either goes cloudy or blurry, or what some people notice is that it? Because things become dazzled, like when you're driving, night lights will dazzle you, or if you look at a bright light in the sunshine, that dazzles you as well. There are different types of cataracts, and the most common one we see is nuclear sclerosis. Now, obviously, you don't have to remember the name. It's just one of those things that, as you get older, the lens will change colours, so it'll become browner, which means that you will see colours differently. and al

that it is more difficult for the retina to get all the light that is falling into the eye because it is basically being filtered out by this brownish cataract. And that means that the image that you are seeing will be less clear.

This is another type of cataract. It's a cortical cataract where you can see the little spokes that are kind of coming over the lens, the little white lines, and those will cause lots of dazzle, especially when you're in bright sunlight or when you're driving at night, and will make it very awkward to drive because you can't see properly, especially in the evening or when it's dusk. And then this is what we call a posterior subcapsular. This is right at the back. a surface of the lens, which is a very specific type of cataract, and that again causes lots of light sensitivity, but it is also

If it becomes larger quite quickly, it can actually make your vision go very badly, making it very poor in a short space of time. So those are just typical types of cataracts. And then this is a posterior polar. We don't see those very often, but they're bang in the middle of the lens. So again, they cause a lot of dazzle and can make vision very awkward in bright-light situations.

What can cause cataracts? Now the most common cause of cataracts. As I said, all it is that the lens has gone cloudy or unclear. It's not skin growing over the eye or anything like that. But what can cause cataracts most commonly is age. As we all get older, we will all get cataracts, and we only do something about them when they start bothering us.

The other thing that causes cataracts is smoking. Things like diabetes can cause cataracts. You can be born with them. But obviously, we don't deal with that here, and that is not relevant to people interested in having cataract surgery here. You can have it after an accident if you've had a big knock on the eye that can cause cataracts, and sometimes certain medications can cause cataracts. But most of the cataracts that we see here at Benenden are related to age, occasionally to diabetes, or a mix of both.

What are the typical symptoms of a cataract? As I said, faded colours, blurry vision, because that lens has gone cloudy sensitivity to glare, especially at night when driving car lights become horrible. and you have another symptom, which is that you constantly change your prescription. You constantly feel like your glasses aren't right, that the glasses aren't clean, and that you need to clean them all the time, and that is a common first symptom of having cataracts. And then there's a bit of double vision, though that is less common.

So why would you want to have cataract surgery? Well, the most obvious thing is that you are affected by your daily life if you cannot do the things you enjoy or the things you need to do. If you're still working, then it is worth considering cataract surgery. The other reason would be if you can't drive legally. There is a legal limit for driving, and if you fall under that limit because of your cataract, then obviously it is worth having cataract surgery if you want to continue driving. If you need to change your glasses frequently because the prescription keeps changing, then that becomes a very expensive proposition for every pair of glasses. It might be worth considering having the cataract done as well. And then, if you can't do your hobbies, if there's something you really enjoy, like sports, a lot of people play golf. If they can't see the golf ball, painting, reading, or just doing normal activities that you enjoy, then it's worth considering having cataract surgery if that is what the problem is that is causing your vision to not be as good as you want it to be. What are some clinical reasons? So, there are medical reasons to have cataract surgery? There's something called angle closure glaucoma, where the lens inside the eye, the cataract, becomes quite large, and it compromises the drainage of fluid from the eye, but that is a medical indication. or sometimes as part of other procedures, or sometimes your diabetic eye screening clinic might send you over to have your cataract done because they can't see the back of the eye properly to make sure that you're not developing any problems with your diabetes at the back of the eye, but these, on the whole, are less likely than your normal age changes, personal reasons for having the cataract light, or quality of life.

A nice example of what cataracts can do to your vision is the painter Claude Monet, who, when he was painted, painted in the impressionist style. and one of the reasons that he started painting in the impressionist style is because he had cataracts, which were diagnosed, and it meant that things he was seeing were blurry. His garden which used to be a nice green garden with beautiful colours, became murkier and browner because the cataract is brown, and it became indistinct. And it's very clear as his paintings progress that his cataracts were getting worse, and they didn't have the option of normal cataract surgery at the time. So that's just an example of a very famous person who did suffer from cataracts and what it did to his vision.

Cataract surgery itself. What does it entail? Well, first of all, you have to come in for a preoperative visit. And at that visit, we'll first check your general health and make sure that you're fit and well to have surgery, that your blood pressure is all right, and if you're diabetic, that your blood sugar is all right. And then we do some other investigations that are important for deciding which lens we're going to put in the eye, because if we take the cataract out, which is the lens of the eye, we have to put another lens in. Otherwise, you wouldn't be able to see clearly, just like a camera.

We do something called biometry, which measures the front curve of the eye and the length of the eye, and that gives us an idea as to which lets you would need to see properly. and then we also scan the back of the eye to make sure that the back of the eye, the retina, and the centre of your vision are healthy and that there's no other underlying problems that might need treatment. At the same time, you will also see your consultant, and there is a group of consultants here that I'll show you later on. They will do an eye examination, and we'll discuss what's going on with your eye and make sure that you're otherwise fit for surgery, and then we will also discuss the local anaesthetic. Most of our eye surgeries are done by just using drops on the eye. So, eye surgery is actually painless. You don't feel it. It's nothing horrible. It's just lots of water and lights, and all we need to do is use drops for that. So, nothing nasty happens. And then we obviously have to discuss the risks of the operation as well as the benefits, and then we choose which lens is most appropriate for you. And then we ask you if you're happy with everything, and if you've asked your questions, you need to ask, if you understand the explanations, whether you want to sign the consent form that we need before we do an operation on you. Soap. There are different types of lenses that we use for cataract surgery. The most straightforward one is a monofocal lens. This means that we make you good for one distance and not different distances, and most commonly, that would be driving vision or distance vision, so that you can see well in the distance, but you would still need reading glasses now.

The other option for some people who've always been shortsighted and who like to read without glasses is to make you good for reading, but then you would still need glasses for distance. So those are the most commonly chosen. But the most common is really good for distance vision, so that you can actually do your day-to-day activities without wearing glasses. But you would still need glasses for the computer or for reading. Some patients have something called astigmatism, which means that the eye isn't round but shaped like a rugby ball. At that point, if the astigmatism is very big, it means that you would still need glasses for distance, and for reading, we do have different lenses that can actually solve the problem of the rugby ball-shaped eye by putting a slightly different lens inside the eye that corrects for that abnormal shape and basically makes what you are seeing look like a round ball, and that way you would be able to hopefully see in the distance without glasses at all. So that's important. If you do have enough astigmatism to realise that there is that option, though you don't have to take that option, that is due. That is a personal preference of yours. And then we have something called extended depth focus lenses. which are lenses that work for distance, but they also give you the option of seeing things slightly closer up. So, you're not completely dependent on reading glasses, and those won't let you read the tiny, tiny print, but they'll make you mostly independent of glasses. They're very nice lenses to use. And they're called Edoff's extended depth of focus. And if you really want, you can also have an astigmatic correction in those. And those are basically good for distance. And most days, there are things that you need to read quickly. So, you're not scrambling for your glasses when you're in the supermarket to read a package or something. And then the last type of lens is something called a multifocal lens, and, as you can see in the picture, there are lots of little lines within this lens, and that lens actually lets you see in different zones of vision. So, you can see in the distance, and you can see close up to read, and in between, and those are the most flexible lenses. If you want to do everything without wearing glasses, they're not always suitable for everybody, and some people don't like them as much because they can cause glare and reduce contrast sensitivity. So, if you're going to have those, you have to be very aware of what the possible drawbacks can be. And again, they can have an astigmatic correction as well. But they definitely wear these lenses. It takes a little while to get used to after surgery for some people. And so that is something that you would discuss with the consultant should you decide to think about this type of lens as well.

So, what happens on the day when you come in for your surgery? First of all, we do the pre-OP checks. We make sure your blood pressure is normal. Your blood sugars are normal. and we make sure that all your paperwork's in order, and then we dilate up your pupils, which we need to do, so that we can see what we're doing during surgery. So, it'll just be the side that we're operating on that side unless you're having both eyes done. And if you really need it because you're feeling very anxious, we do have some oral sedations and some diazepam, should you need it to feel a bit calmer. But most people don't need this at all. Make sure you're wearing comfy clothing, preferably in a slightly dark colour, just because we do use iodine, and it can get on your clothes. You don't want your nice, crisp white shirt covered in iodine drops. and make sure that you just eat and drink normally. It's a bit like going to the dentist. You don't have to be fasting. You don't have to. Stop anything. You take your normal medication, but don't drink any alcohol, obviously beforehand, just because you'll feel a bit unusual if you do that.

So, what happens when you come in for the operation? One of our staff will come and collect you from the waiting area where your pupil has been dilating, and they'll remove the little pellet that we put in the lower lid just to help the eye dilate. It's got some medication in it, and they'll check your details and make sure you're the correct patient and that we've got everything ready. You'll also have been seen by the consultant to make sure that we're going to give you the correct lens. Then we will walk you to the small operating theatre we have. and we put you in a chair that's exactly like a dentist's chair, and we'll give a hair net to get your hair out the way, and a little swab over your ear, because water does tend to run down, and then we'll lie you down and we'll clean around the eye, and we'll dry around the eye, and then you'll be covered in a little paper tablecloth just to keep everything tidy, and it's got some fresh air underneath, so you can breathe normally, and we put a pillow under your knees to make sure your back's comfy, but you will be lying completely flat with your head, so you can't have a little pillow under your head, because then we can't do the operation. and then you'll have a little clip between the eyelids. It sounds a bit awkward, but actually you don't feel it once it's in, and that helps keep the eye open. So, you don't have to worry about keeping the eye open or anything like that. All you have to do is lie there, relax, and breathe, and we'll take care of the rest. And then there's an operating microscope that's going to be hanging over you, which is a very bright light. And we ask you to basically look at the light while we get the procedure done, because if you can see the lights, we can see your eye, and you can listen to music, which is usually on in theatres; you can blink normally; there's nothing you have to worry about specifically; and we can help you along. And, you know if there is anything worrying you, you can let us know. So that the procedure itself doesn't take very long. It usually takes under a minute, and then you'll be out again. So, some of the surgical things that are important are that we make a very small incision in the eye. It's not a big incision. It doesn't need stitches. And then we basically open the little bag that the lens hangs in inside the eye, and we take out the lens using some ultrasound. So, it's not a drill or anything nasty. You'll hear a little vibration noise, and you'll hear the noises from the machine. and then we remove all the little bits of lens, and we put a new lens inside the eye, which goes in like a ship in a bottle. It's all folded up, and then it unfolds when it's in the eye, and it goes right into that little bag where your old lens was, and then we give you some antibiotics in the eye and on the eye, and you have a little transparent shield at the end, over the eye, just to protect it till the next day, and you can take it off the next morning, and you use it to sleep for nights, just to protect the eye at night.

These are the little steps that I took. The is called the capsular axis, where we open the little bag that holds the lens very carefully, and then we remove the lens by something called fake emulsification, which is the ultrasound, and then you can see the rd. picture is the lens being injected into the eye very gently, like a ship into a bottle where it unfolds, and the little legs that you can see on it keep it in place. Excuse me, so. The recovery. You might feel a bit of a scratchy eye, a slightly uncomfortable eye, or a slightly bruised sensation. There's nothing that you can't manage with simple painkillers like paracetamol, and then you're going to have eye drops for weeks. That's to make sure you don't get any infections in the eye, and the vision will feel blurry for a day or and then after that, it starts clearing. and then. At a certain point, you will find that the eye is healing nicely. After a few weeks, you will go to see the optician, and then you will also be called by the clinic after your surgery, usually a week later, to make sure that you're doing all right and that you're not having any problems or anything else you're worried about. We do also have a helpline. Should you have any worries after surgery, you can always call, and we can answer any questions on that as well. like any surgery anywhere on your body. Eye surgery also has risks. Thank goodness, they're very, very low risk, but they're not. So, the most important risk that you would have to worry about is that the little bag that we put the lens in can tear. It's a very low risk, but it does mean that the surgery changes. It then becomes what we call a complicated surgery, which means that the surgery might take longer. The recovery might take longer, and sometimes you might even need a second operation, but that is extremely unusual, and it is something that you need to be aware of. If you go into an operation, the other ones that are really important, like anywhere on the body, are infections or bleeding, but those are extremely unusual. Infections tend to happen after the operation, either due to poor hand hygiene or other issues, but are very, very rare. Thank goodness. All of this will be discussed with you by the consultant when you come for your consultation. So, we have dedicated our unit to Benenden, and it's a very friendly, gentle environment.

We've got the latest equipment. Everything's very high-level, and we have consultants working here. Who are all the consultants? There are no trainees, and all of our team members are dedicated to ophthalmology and eye care. So, all our nurses and everybody who works with us—we've been doing this for a long time, and thank goodness, successfully. So, we're rated as outstanding by the CQC. Which is always reassuring, and we have a high rating with the NHS care we give as well. So, these are our consultants, Mr Devereux does cataract and ocular plastic surgery. Mr Kwok does cataract and retina care. Mr Lake is a refractive surgeon. I am a cataract and retinal surgeon. Miss Hawkes does plastics and cataracts. Mr Poon does retina and cataract, and then there's Mr Borg, who does cataract. Miss Luo who does retina and cataract, Mr Aboshiha, who does refractive surgery. So, he does the special lenses like Mr Lake. And then there's Mr Shahid, who does retinal surgery. Mr Ong, who does the cataract; and Miss Bin Lee, who does refractive as well. So should you decide to go for special lenses, you'd be seeing Mr Lake, Mr Aboshiha, or Miss Lee. But you would be seeing any of us surgeons for your first consultation or for your cataract surgery otherwise. So, we have a cataract patient who just wanted to give a testimonial. She had surgery with us.

Delia Worth

Hi, my name's Delia. I'm a Benenden member. I had my cataracts removed in February and March. I have severe astigmatism, which was corrected over the last year. I've really struggled with reading. I couldn't read very small print, and driving was a real problem, a real struggle, so much so that I had to give up driving. At night, I was offered toric lenses to correct astigmatism, and I chose to have one lens for distance and one lens for reading, which has been mined changing because I've now been able to totally dispense with contact lenses and glasses. The procedure was really short—about a minute—and nearly painless. There was really good follow-up after the operation. I was given a phone call, and afterwards I had a booklet given to me. I also had a droplet charge to help me put the drops in, and there was also a helpline provided as well. It's been months since I've had the procedure. It's been life changing. I've been wearing glasses and later lenses since the age of 12. I can now drive at night. I can read. I can swim without worrying about water getting in my eyes. It's an absolute miracle. Colours. The world seems a brighter place, and the colours almost jump out at me. I would 100% recommend Benenden Hospital. My treatment has been exemplary from start to finish. It couldn't be better.

Sarit Lesnik Oberstein

So, I think there are some questions. I can see one, so Jane will take the questions, and if I can answer, then obviously I will.

Jane Styche

Thank you so much, Sarit. That was really informative. We have a question from Mr. Hardy, who asks, Can you benefit from cataract surgery if you have an epiretinal membrane in one of your eyes?

Sarit Lesnik Oberstein

So good evening. So, one of the things that is important is: how much epiretinal membrane is there? Obviously, it's a separate problem. One is the cataract, and one is the epiretinal membrane. I think the thing is that if the vision is clearer, that can already be because the cataract's gone, which can make things easier for you. However, if you have a dense, separate membrane that's really disrupting your vision, then that would in and of itself need surgery. But if it's a very mild epiretinal membrane, then you would definitely benefit from having the cataract done. If you have sufficient cataracts to be causing you problems, yes, so it is worth having it assessed. And then, when you're seen in the clinic because we do the OCT scan, you would know, or we would know and discuss with you, how bad the epiretinal membrane is, and how would that affect your outcome as well. So, we would discuss that with you. But I think it's worth having it assessed. So, you know what to expect. More likely is that you wouldn't have the multifocal lens option because, with an epiretinal membrane, that would not work as well.

Jane Styche

Thank you. Mrs. Beveridge asks, Will it make a difference in recovery to have both eyes done on the same day?

Sarit Lesnik Oberstein

So, the recovery is pretty similar, whichever way you do it. If you have a monofocal lens, we tend to do one eye and then do the other eye a short while later, while if you have multifocal lenses, we tend to do both eyes in one go because it's easier for you. It doesn't really make a difference. The main thing is that you will be putting drops in both eyes, and you obviously have to be careful. But that happens anyway if you're having one eye done. Having both eyes done is not really a big difference. It just means that what we do is start off with the first surgery. Do the first eye, and if you are happy to proceed and everything has gone well, that's when we do the second eye. So, there's always a little break between the eyes, where we discuss with you that you're happy to go ahead and have the second one done, and that we're happy to proceed with the second one before your recovery. It wouldn't make a difference.

Jane Styche

Thank you. I have a question from Mr. Baxter. He had cataract surgery in 2010, and in the past years, he's noticed that his vision has worsened, and he thought that cataract surgery was a permanent solution.

Sarit Lesnik Oberstein

Mr. Baxter, it depends on what's causing your vision to worsen again. That's something that needs to be assessed. One thing is that you might have something called posterior capsular pacification, or PCO. For short, it means that the little bag that the lens is in has become a little bit blurry, and that happens because, actually, there are still little cells in there. It's live material, and sometimes that can blur over a bit. Now, if that is what is the case for you, then that would benefit from some laser treatment, which we just do in clinics called YAG laser YAG capsulotomy. If there is another reason for your vision to have deteriorated, obviously, that would be something that would need to be assessed. So, if there's something going on with the retina or any other part of your eye, but if it is just a little bit of blurring coming from the bag—the capsule, as we call it—then that can be treated with laser, and you would be back to the vision you had before. With your new cataract surgery, as it were, it's something that happens to up to % of patients who need a little bit of laser treatment of the capsular bag after cataract surgery at some point to improve their vision. So that's something that we should assess.

Jane Styche

Thank you. So Ms. Wade has asked. I'm told I have astigmatism plus. I had Lasik eye treatment about a year ago, as well as a torn retina about a year ago. Is she still a viable candidate for new lenses?

Sarit Lesnik Oberstein

Right, Miss Wade, you've been through the wars. You've had quite a lot done. So, The most important thing is that Lasik eye treatment does not stop you from having cataract surgery. So, if you've got cataracts, it's definitely not a problem to have cataract surgery for your astigmatism. You could discuss toric lenses; however, because you've had Lasik, chances are that that would be less appropriate for you because it's less predictable what the outcome will be because you've had previous laser surgery. The other thing is that a torn retina does not make a difference in having cataracts done. The only thing is that you have to be aware that you have the tendency to have retinal tears, as it were, and that you are at risk. So that's something you have to keep at the back of your mind if you ever have symptoms again. But none of the above stops you from having cataract surgery, and it can improve your vision significantly. So that's not a problem and not something to worry about.

Jane Styche

We have a question from Miss Gurney, who says that she lives a long way from Benenden, and are there facilities for patients to stay at the hospital? So, I'll take this one. We do not have any facilities at the hospital for you to stay in, but fortunately, we are located in a very lovely area that provides B&Bs and hotels close to the hospital. So, should you make contact with the hospital? We can give you a list of these different hotels and B&B's that you can stay in. And I think at the moment, that is all of the questions that we have received. So should anybody have any questions, please feel free. If you call the hospital or the ICU, we'll be able to answer any further questions that you might have. Yeah.

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Thank you, and goodbye.