Cataract surgery.
Lens choices and recovery.
Clear, balanced guidance to help you prepare and make an informed choice. These pages bring together the patient leaflets created for the practice; your individual assessment and discharge instructions remain essential.
Replacing the cloudy natural lens.
A cataract clouds the natural lens and can cause blur, glare, faded colours and difficulty driving at night. Surgery removes the cloudy lens contents and places a clear intraocular lens (IOL) inside the remaining capsule, the thin bag supporting the lens.
- The pupil is widened and the eye is numbed.
- Through a small incision, ultrasound breaks up the cloudy lens and suction removes it.
- A folded implant is placed inside the capsule.
- The wound is checked. It usually seals without stitches, although a stitch is sometimes needed.
Routine surgery often takes about 15–30 minutes; complex cases can take longer. Allow several hours for preparation and recovery. You usually remain awake and go home the same day. Bright lights, colours, water, touch or pressure can be normal. Tell the team immediately about sharp pain or discomfort, and do not move your head suddenly.
The timing of surgery depends on its effect on your daily life, your eye health and the balance of benefit and risk. Waiting and alternatives should be discussed. Same-day surgery for both eyes needs its own discussion.
Before your measurements and surgery.
Biometry and corneal measurements inform the implant power. The cornea, tear film, retina and optic nerve are assessed because other eye disease can limit improvement. No calculation guarantees an exact final prescription.
Unless advised otherwise: soft lenses for 1 week; hard or rigid gas-permeable lenses for at least 2 weeks. This is before measurements, not just the operation. Some rigid-lens wearers need longer or repeat measurements to confirm corneal stability.
Report LASIK, PRK, SMILE and any other eye surgery, even many years ago. Bring records if available. Previous laser correction affects lens calculations and makes the final prescription less predictable.
Allergies and intolerances: report all allergies, especially penicillin anaphylaxis, cefuroxime allergy and latex allergy, plus intolerance or sensitivity to preservatives in eye drops. Describe the reaction and product if known.
Bring a medicine list. Mention blood thinners, diabetes, current or past tamsulosin or similar prostate medicines, anxiety, claustrophobia, cough, breathing problems, tremor or difficulty lying back. Do not stop regular medicines unless instructed by the responsible clinician. Arrange transport, interpreter support and help with drops if needed.
Local anaesthetic and sedation.
| Topical / intracameral | Sub-Tenon’s block |
|---|---|
| Drops numb the surface. Intracameral solution is placed inside the front chamber through the surgical opening, to improve comfort. It is not an injection behind the eye. | After numbing drops, a blunt tube introduces anaesthetic under the thin tissue layer around the eyeball. It numbs more deeply and usually reduces movement. |
| The eye usually still moves, so following instructions and keeping the head still matter. Fewer injection-related surface effects and relatively quick recovery of sensation. | Brief stinging or pressure, surface redness, swelling or bruising can occur. Numbness, blur or double vision may last several hours. |
Both methods can require additional anaesthetic. All have risks, including inadequate pain relief or allergy. Sub-Tenon’s blocks also carry rare risks of serious bleeding, damage to the eye or surrounding structures and sight-threatening injury. The choice is individual.
Sedation helps you relax
Medicine, usually through a vein, reduces anxiety alongside local anaesthetic. Light sedation does not guarantee sleep or no memory: you may hear conversation, remember events and need to follow instructions. An anaesthetist assesses, administers and monitors it. Sedation can slow breathing, lower blood pressure and cause nausea, drowsiness, confusion or unsteadiness; rare serious reactions can occur.
A light meal is permitted beforehand without a set fasting interval. Avoid a heavy meal and follow any individual advice about drinks or medicines. Deeper sedation or general anaesthesia requires a separate fasting plan.
After sedation, have a responsible adult collect and support you as advised. For at least 24 hours do not drive, cycle, drink alcohol, operate machinery, cook, sign legal documents, make important decisions or care for dependants alone. Follow any longer restrictions in your discharge instructions.
General anaesthesia, in which you are unconscious, is occasionally more suitable. It needs a separate assessment, fasting instructions and consent discussion.
Presbyopia and trifocal correction.
Presbyopia is the age-related loss of near focusing ability as the natural lens becomes less flexible. Trifocal implants can reduce reading-glasses dependence by providing near, intermediate and distance focal ranges. They do not restore the natural lens’s flexibility, and glasses, halos and glare remain possible.
If there are no significant lens changes, PRESBYOND laser blended vision may also be considered after assessment. It reshapes the cornea while retaining the natural lens, and has separate suitability requirements and risks. Learn about PRESBYOND.
Refractive lens exchange.
RLE replaces the natural lens to reduce dependence on glasses or contact lenses when cataract is not the main reason for surgery. Lens power and design determine the planned vision. It permanently removes the natural lens and carries surgical risks, including retinal detachment and, rarely, severe loss of sight. Suitability and alternatives need individual assessment.
Choose a range of focus, then consider astigmatism.
Monofocal
One principal focus, usually distance, with reading and often computer glasses needed. It generally has fewer optical side effects than multifocal designs, but is not immune to them. A near target is possible, with distance glasses then needed. Enhanced monofocals may modestly improve intermediate range; readers remain expected.
Extended depth of focus (EDOF)
Extends focus mainly from distance through intermediate. Reading glasses should be expected, especially for small print and sustained close work. Glasses may also be needed for computer work. Models differ in optical technology, contrast and halo profiles.
Trifocal
Aims to reduce glasses use for distance, intermediate and near tasks. The compromise can include halos, glare, starbursts and reduced contrast, particularly in dim light. Glasses may still help for small print, long reading sessions or residual prescription.
Toric: an option across all three designs
Toric corrects suitable regular corneal astigmatism; it does not add another focal distance. It must be aligned at a calculated angle. Rotation can reduce correction and sometimes requires repositioning. Residual astigmatism and glasses use remain possible.
Dry eye, previous corneal surgery or irregular astigmatism can reduce predictability. Not every eye or every model is suitable. A more expensive lens is not automatically the best choice for you.
Mini-monovision needs a separate discussion.
One eye is targeted for distance and the other slightly nearer. It may broaden useful vision but can compromise binocular distance sharpness or depth perception. Reading glasses may still be needed.
It is offered directly only to suitable patients who already routinely use monovision with glasses or contact lenses. For anyone else, it is considered only after a special contact-lens trial, which incurs an additional charge. This applies to monofocal and EDOF planning.
A successful trial does not guarantee the surgical result. Monovision with natural lenses (phakic monovision) differs from mini-monovision with implants (pseudophakic mini-monovision). The visual experience and satisfaction achieved with glasses or contact lenses cannot always be replicated after surgery.
A different lens. A different optical system.
The implant is manufactured, with a different shape, thickness, material and edge profile from your natural lens. Its supporting arms hold it in the retained capsule. It is not an anatomical replica and does not restore a young eye’s natural focusing ability.
The optical change happens during one operation. In effect, overnight you are asking the brain to interpret vision through a different system after years of using the natural lens. It needs time to adjust, a process called neuroadaptation. Healing, the final prescription and the balance between the eyes also matter.
It may take weeks or months, with no fixed deadline or guarantee of improvement. Persistent or troublesome symptoms should be assessed rather than dismissed as a need to adapt.
Positive and negative dysphotopsias.
Positive dysphotopsia means added light effects: rings, arcs, streaks, glare or starbursts. Light interacting with lens surfaces, its edge and optical design can contribute. Halos are generally more associated with multifocal optics, but all lens categories can cause visual phenomena.
Negative dysphotopsia often appears as a dark crescent on the outer, temporal side of vision. The implant’s relationship with the capsule, iris and paths of light may contribute. Other causes must be excluded before this diagnosis is made.
Monofocal, EDOF and trifocal lenses, including toric versions, can all cause these effects. Many symptoms lessen; some persist. Examination can identify dry eye, residual prescription, capsule changes, lens position or retinal disease. Further treatment, including lens exchange in selected severe cases, has risks and cannot guarantee resolution.
New flashes, a sudden increase in floaters, a curtain or shadow, or reduced vision require urgent eye assessment. Do not wait for a routine visit.
Clareon Vivity.
A non-diffractive EDOF lens aimed mainly at distance and intermediate tasks, commonly assessed around 66 cm, with some functional near vision. It offers an extended range rather than three separate sweet spots.
Expect readers for close tasks, especially small print, prolonged reading, detailed work and dim light. Brief phone use without them is not a promise of comfortable book reading.
Reported bothersome light effects are generally low, but symptoms can occur and become severe. Alcon specifically warns that most Vivity recipients are likely to have significant loss of contrast sensitivity compared with a monofocal lens. Take particular care in dim light, fog or night driving, especially with oncoming traffic. Discuss essential night-driving needs before choosing.
Individual results differ; neither the lens nor further treatment guarantees satisfaction.
Download the full Vivity leaflet ↓Clareon PanOptix.
A trifocal lens with intended focal ranges at near (about 40 cm), intermediate (about 60 cm) and distance. These are three main visual sweet spots, not exact points that every patient experiences identically.
Reading ability depends on print size, contrast, light, viewing distance, eye health and adaptation. A good chart score is different from comfortable sustained reading. Readers may still help for fine print, prolonged close work and poor lighting.
Glare, halos, starbursts, reduced contrast and night-driving difficulties can occur even after uncomplicated surgery. Adaptation may help but is not guaranteed. Persistent blur or ghosting needs assessment for treatable causes. Lens exchange is additional intraocular surgery and cannot guarantee complete resolution or satisfaction.
Download the full PanOptix leaflet ↓Healing, drops and getting back to daily life.
Blur, mild grittiness, watering and light sensitivity can occur initially and should improve. Vision often improves over days; full settling can take several weeks. Take care on steps if an eye is covered or vision is unbalanced.
- Use prescribed drops exactly as directed. Wash hands and avoid touching the bottle tip to the eye or lashes. Ask for help if needed.
- Do not rub or press on the eye. Use the shield as advised and avoid soap or direct water jets entering the eye.
- Reading, screens and television are safe as comfortable. Gentle walking can usually restart early.
- Follow individual restrictions on lifting, strenuous exercise, swimming, eye make-up and return to work.
- Do not drive on the day of surgery or for at least 24 hours after sedation. Resume only when you meet the legal standard, are free of troublesome double vision and feel safe.
- Glasses are usually considered after stabilisation, often around 4–6 weeks and sometimes after second-eye surgery. Attend follow-up and long-term eye checks.
Increasing pain, worsening vision, increasing redness or sticky discharge require prompt assessment. New flashes, a sudden increase in floaters, or a curtain/shadow are also urgent. Use the clinical emergency contact details in your discharge paperwork—not the routine appointment email—and do not wait for follow-up.
Understand the risks and expectations.
Cataract surgery improves visual function in around 98% of cases. Very rarely, it can make vision significantly and permanently worse. Outcomes depend on the health of your eyes and your individual circumstances. Recognised risks include infection, bleeding, inflammation, pressure changes, corneal swelling, retinal swelling or detachment, capsule tears, weak lens supports, loss of vitreous gel, retained lens material, implant movement, pupil changes, drooping lid, double vision, unexpected prescription and permanent reduction or severe loss of sight.
This list is not exhaustive. Other rare or unexpected complications can occur and further treatment or referral may be needed. High myopia, diabetes, previous inflammation, earlier surgery and other eye disease can change individual risk or limit improvement.
Months or years later, the capsule behind the implant may cloud: posterior capsule opacification. This is not the cataract returning. Nd:YAG laser capsulotomy may be advised as a separate procedure with its own risks and possible charges.
Further treatment and fees
If intervention is needed because of a surgical complication, most associated surgeon’s charges may be waived. Hospital, anaesthetic, medication, investigation or other consultant charges are not necessarily included. Elective treatment to change an uncomplicated prescription, improve spectacle independence or address lens-related dissatisfaction attracts additional charges. Options, risks and anticipated fees will be discussed before elective treatment.
Most people are very happy with their vision following surgery. Although every effort is made to achieve the best possible visual outcome, I cannot guarantee that you will be satisfied with your vision following surgery.
Reading or acknowledging these pages or leaflets does not waive or restrict your legal rights and does not replace the individual consent discussion.
Your patient leaflets.
The web guide includes the latest practice policy on mini-monovision. Please discuss the intended lens and prescription target at consultation.
Sources and further reading
The downloadable leaflets contain their bibliographies. Key sources include: