Laser Eye Surgery Frequently Asked Questions

A cataract is the clouding of your eyes natural lens. The lens is just behind the pupil of your eye, and it helps to make a clear image on your retina. Usually, this lens is crystal clear.

As a cataract develops, the lens becomes increasingly milky, causing a greenish cloudiness. It may also cause a glare in bright lights and change in the focus of the eyes, resulting in the need for frequent changes in glasses prescriptions.

Eventually, the sight does not improve with a change of glasses. As cataracts develop slowly, many people are not aware of this creeping change. They only appreciate how poor their vision had been after the restoration of vision with cataract surgery.

The only way to remove the cloudy vision caused by a cataract is with surgery. You have different options for how the eye focuses after cataract surgery by choosing a replacement lens that matches your individual preference.

Your two main options are to aim for clear vision with or without glasses after surgery.

When we strive for clear vision with glasses after surgery, you could either have both eyes focused for distance and have glasses for reading or vice versa.

For clear vision without glasses after surgery, there are three possible options:

• You could aim to have one eye focused for reading and one for distance, which we call monovision;
• You could have laser refractive correction after cataract surgery, called Presbyond;
• You could have a multifocal lens implanted.

No, we cannot treat cataracts with a laser. We remove a lens with cataracts using ultrasound. Many people assume modern cataract surgery by ultrasound is done by laser. There are new lasers which help in some of the steps of cataract surgery, but ultrasound is still required to complete the surgery.

It is alright to resume normal activities within a few days of cataract surgery, depending on how you feel. Most people can resume gentle exercise such as returning to the gym, yoga and running within a week. The one exception is swimming, where we advise you to wait at least a week to reduce the risk of infection.

Some patients worry about being hit in the eye during sports such as squash, tennis and golf. However, the risk of being hit in the eye by the ball, stick or racquet, is the same as prior to surgery.

Once a cataract has been removed, it cannot recur. However, the capsule – the fine, natural support on which the replacement lens implant rests – can become cloudy. This may cause your vision to deteriorate again. If this happens, we can remove this cloudiness with a laser. We perform this laser procedure in the outpatient’s clinic. It is painless and takes about 2 minutes.

Most people are able to drive the next day, but tend not to as they are quite busy with drops and taking it easy.

If you have cataract surgery at My-iClinic you can wash your hair 24-48 hours afterwards. We recommend that you do so with your head tilted backwards. This is to prevent shampoo or soap getting in your eyes. A splash of shampoo would not damage the eye, but as the eye would be more sensitive than usual, it could be quite uncomfortable.

You can bend and stoop straight away after cataract surgery. We recommend you take things easy initially. We find that patients who don’t rest after surgery tend to take longer to heal.

You can cook straight away after cataract surgery. However, we recommend you take things easy initially and allow your friends and relatives to pamper you at least for the first few days after your surgery. We find that patients who don’t rest after surgery tend to take longer to heal. If you experience any pain or blurring or have any concerns, you should call the eye clinic or mobile number we have given you for advice.

Everybody worries that they would not be able to stay still or would have to cough during surgery. But you will be surprised at how easy it is to stay still for about half an hour.

If you have to cough or become uncomfortable during the surgery, speak, and we will stop.

Some people worry they won’t be able to keep their eyes open. We have a little device that supports your eyelids for you, so you don’t have to worry about keeping them open.

At the moment, cataracts can only be treated surgically. There have been attempts to treat cataracts with eye drops, but until now, these have not been successful.

Modern cataract surgery is done by using ultrasound to break up the lens, which is then washed out through a small incision. At My-iClinic, we remove cataracts using the latest technology through the smallest incision. We then choose the best-matched lens for your eye to bring your sight into your desired focus.

We use anaesthetic drops, and anaesthetic infusion to numb your eye, so that cataract surgery does not hurt. After the anaesthetic, most patients experience no pain but can feel movement. You would feel the hands of the surgeon on your forehead, and many people describe seeing a kaleidoscope of bright lights.

The anaesthetic may begin to wear off a couple of hours after your surgery. We advise that you take your usual painkillers in the first 24 hours after your surgery.

Most patients stay awake at the time of their surgery because it is usually over in less than 30 minutes. Occasionally, some patients are so relaxed that they fall asleep. If this happens, we would wake you gently. This is because we want to avoid any sudden movements that could occur if you were startled from a deep sleep.

On the day of your cataract surgery, you will be in the clinic for 2-3 hours in total. We advise that you organise for a friend or relative to bring you in and pick you up after your surgery. It helps if they also plan to spend some time to settle you in at home immediately after your surgery.

Most people notice an improvement in their vision within two days of having cataract surgery. This change depends on how bad the vision was before surgery. It takes most people about six weeks for their vision to completely settle. We advise you to wait about six weeks before seeing your optometrist to continue your eye health care and upgrade your prescription if required.

Nothing in life is risk-free. However, it is more dangerous to live with cataracts than to have cataract surgery.

The intended benefit of cataract surgery is to improve vision. 95% of patients have improved vision if no other eye problems are present. There is a 5% risk of rectifiable surgical or refractive problems. There is also a very low risk – less than 1 in a thousand – of infection or haemorrhage, that could result in severe or permanent loss of vision.

After a few months, some patients get membrane thickening behind the lens implant, which we can easily treat. You may need new reading glasses and/or distance glasses after surgery.

The lens replacement after cataract surgery is permanent and does not need to be replaced. After a few months, some patients get membrane thickening behind the lens implant, which causes cloudy vision. We can treat this easily in the clinic with a quick, non-invasive laser procedure called a YAG laser capsulotomy.

Yes, it is all right for you to have a light meal a few hours before your cataract surgery, as we perform the surgery under local anaesthetic. Avoid having anything heavy which may make you feel uncomfortable, as you need to lie flat for about 30 minutes for your surgery. If you have reflux, remember to take all your usual medications.

You should take all your medication as usual on the day of cataract surgery, particularly your high blood pressure tablets. It is all right to continue to take aspirin and warfarin. If you are on warfarin, please get your INR checked to confirm ‘it’s in the correct range within a week of your planned surgery. Please show your warfarin anticoagulant record book and a list of all your current medication to the nurse at the time of your admission.

There is no restriction on flying after a cataract operation. Remember to bring all your post-op eye drops with you and use them as instructed. ‘It’s essential that you prioritise attendance at your post-op appointments when making any travel arrangements. If there is no urgency, it’s best to wait till after your routine post-op appointment, which typically would be between 2 and 4 weeks after surgery.

On the evening of your surgery, your eye may feel a little bit gritty as the numbing drops wear off. It is advisable to take your usual painkillers. Your vision may be blurred in the first 24 hours because of the dilating drops and also because you may have had some antibiotic eye ointment. In the next couple of days, the grittiness should wear off.

Patients report that things are much brighter, possibly with a blue hue. If you experience any unexpected pain or blurring, or have any concerns, ‘don’t hesitate to call the eye clinic or mobile number ‘you’ve been given for advice.

You should take things easy for the first few days. You may bend and stoop, but it is probably better to avoid heavy lifting for about ten days.

The greatest danger is poking or rubbing the eye, as this can cause the valve to open, making the wound leak. Because some people rub their eyes in their sleep, we advise you to wear a protective shield (provided by the clinic) at night in bed for the first week only. After this time, you may gradually get back to full normal activities.

Once a cataract has been removed, it cannot recur. However, the fine membrane on which the implant rests can occasionally become cloudy, causing the vision to deteriorate again. If this happens, we can remove this cloudiness with a laser. We do this in the outpatient’s department; the treatment is painless and takes about 2 minutes. There is a misconception among some people that this laser can remove a whole cataract; it cannot, but it can remove the cloudiness that sometimes comes after the operation.

Most patients are able to drive the next day. However, many prefer to rest for the first few days.

Call us immediately and tell us what you feel is wrong. We will see you immediately if necessary. We can be contacted 24 hours a day every day.

Just because you have a cataract does not mean that you have to have it removed. Cataract surgery only becomes necessary if you are not happy with your vision and want to see better. Talk to us if you have any questions or concerns about your vision.

Patients commonly spend only a few hours at the hospital or surgery centre and are allowed to go home the very same day.

Although this would be unlikely, the IOL can be replaced with a different one if needed.

Every patient is different. Be sure to ask us for specific advice on caring for your eye after the procedure. We may ask you to refrain from rubbing your eye or engaging in any strenuous activity for a few weeks after surgery.

Yes, having a lazy eye can be inherited. Have your child checked as early as possible.

Emerging evidence is beginning to show that spending time outdoors in the very early years of life protects against developing myopia. What the child does outdoors doesn’t matter; just being outdoors is enough.

In its early stages, chronic glaucoma has no symptoms, which is why it is called the silent thief of vision. Early diagnosis is only possible by regular sight tests by your optician or eye specialist. As such everyone over the age of 40 should have a sight test at least once every two years. There is a higher risk of earlier onset and more severe glaucoma if you are:

• Of black African origin;
• Have a close relative with glaucoma;
• Short-sighted;
• Diabetic;
• Have high eye pressure

Anyone with one or more of these risk factors should have their first check for glaucoma much earlier, perhaps as early as 25 years old. There is a risk of sight loss with late presentation of glaucoma.

If you are at risk of glaucoma and neglect getting tested, you risk damage to your sight. Everyone over the age of 40 or with a family history of glaucoma should have an eye examination at least once every two years. Chronic glaucoma has no symptoms. Without eye tests, glaucoma presentation is late, and the risk of sight loss is high.

Patients only become aware of tunnel vision when severe and irreversible damage has occurred. Even in the late stages, some patients remain unaware. However, friends and relatives may observe that the patient has become more clumsy and prone to accidents with a greater tendency to trip and knock things over.

Thankfully, if you regularly attend your sight test and comply with the recommended treatment, you will retain your vision.

When attending an eye test, it is better not to drive yourself, as you may need to have drops that blur your vision. Be prepared to spend at least 90 minutes in the clinic. Please bring your current glasses and a list of your current medication with you.

A full glaucoma assessment includes:

• General history and detailed questions asked relating to your eye health;
• An assessment of how wide and detailed your field of vision is;
• An eye pressure check;
• A thorough examination of your eye with a bright microscope and sometimes a special contact lens examination called gonioscopy;
• Various scans and images of the front and back of your eyes.

After all these tests, we will review the results and discuss your diagnosis and treatment plan with you.

The treatment options for open-angle glaucoma are:

• Eye drops;
• Laser treatment called trabeculoplasty;
• Eye Surgery

The treatment chosen for you would be personalised to the severity of your glaucoma, your general health, and any allergies or sensitivities you may have. We usually start treatment with eye drops. If the response to initial treatment with eye drops is inadequate, we may offer additional glaucoma drops, laser treatment or surgery.

The treatment aims to maintain your vision. You must comply with your recommended treatment and attend your clinic appointments regularly.

The various drops used to treat glaucoma have different side effects. About 1 in 3 patients experience some redness and stinging in their eyes on commencing eye drops for glaucoma. These symptoms tend to improve within 6-8 weeks. Other side effects include breathlessness if you are asthmatic, sunken eyes, dark rings around the eyes and lengthening of the eyelashes. Please mention any side effects you may be experiencing to your eye specialist as you may benefit from a change to alternative treatment.

Yes, children can have glaucoma, but it is very rare. Congenital glaucoma occurs in infants, and juvenile glaucoma occurs between the ages of 5 and 35. The signs of congenital glaucoma is a large eye with a glazed appearance. This may be accompanied by eye rubbing redness and watering. If your child has a combination of these signs, bring them to your general practitioner or nearest eye specialist. On the other hand, there are no early signs of infantile glaucoma. If you have a family history of early-onset glaucoma or are concerned that your child is having trouble with their sight, get them an appointment at your local optometrist for a sight test.

To be able to see, a healthy eye has to have transparent parts with no blood vessels. Nutrients and oxygen are supplied to these areas by a clear fluid called the aqueous. The exit route for the aqueous is the angle that lies between the coloured iris and the transparent cornea. If the angle becomes too narrow or closes, the fluid is not able to escape, and the pressure builds up.

Narrow-angle is more common in older age as the natural lens gets thicker, particularly in long-sighted people. Your optometrist may observe this narrowing on routine examination and refer you to the hospital for further tests and treatment.

Angle-closure glaucoma is the sudden build-up of pressure in the eye. Its symptoms are:

• Severe eye pain;
• Redness;
• Seeing halos around lights;
• Nausea and vomiting.

If untreated, this would result in loss of vision.

Angle-closure glaucoma is more common in:

• Older people;
• Long sighted people;
• Women

The treatment of narrow-angle helps prevent painful angle-closure glaucoma, which happens in about 1 in 20 people with narrow angles. If tests confirm that the angle is dangerously narrow, then you would be offered laser treatment or surgery to create a safer fluid drainage route. The laser treatment is YAG Laser iridotomy. The surgery is called clear lens extraction. We will discuss which treatment is more appropriate for you.

The interventions to help conserve your sight once you have a diagnosis of glaucoma are:

• Be compliant with your prescribed treatment. To achieve this, use your eye drops every day without fail, as prescribed;
• Attend all your clinic appointments regularly;
• If you are a smoker, it is beneficial to reduce or stop smoking altogether. Consider attending the smoke cessation clinic for support;
• If you are diabetic, make sure you have good control of your blood sugar;
• Ensure your blood pressure is optimally controlled. Too low or too high blood pressure are bad for glaucoma.

No, there is no such thing as an “eye exercise” or routine eye massage for treating glaucoma. If you are concerned you have glaucoma, arrange to see your local optometrist or eye specialist for initial testing and advice.

The target eye pressure is the pressure at which the likelihood of symptomatic loss of vision from glaucoma becomes negligible. This pressure is typically around 30% less than the eye pressure at the time of the first presentation with glaucoma.

Factors your specialist considers when setting your target pressure includes:

• Your age at the time of diagnosis;
• Your life expectancy;
• Your race and family history of glaucoma;
• The severity of your glaucoma;
• The condition of your other eye;
• Side effects of treatment and your preferences.

Treatment aims to stop or at least slow down the rate of progressive loss of sight from glaucoma, such that good useful sight outlives you.

There is a much higher risk of losing vision.

We will work out what your target pressure is by assessing your eye and family history.

We will tell you when the target pressure is achieved.

Yes. There are no restrictions on lifestyle.

Yes. People with a close relative with glaucoma have a slightly increased chance of developing it themselves.

Yes. There are inherited macular degenerations which affect mostly younger people, but these are very rare. Most macular degeneration is categorised as “age-related” meaning that it occurs mainly in older people.

In the age-related group, there are two main types, dry and wet. The wet type is so-called because fluid leaks out of the blood vessels at the macular and this damages vision. However, there is an effective treatment for wet type macular degeneration, which involves injecting a drug into the eye.

The dry type is characterised by a process best described as “wearing out” of the retinal cells at the macular, so you can no longer see. Currently, there is no effective treatment for the dry type.

A group of drugs known as anti-vegF can reverse and improve wet macular degeneration. Currently, there are three different brands of these drugs, two of which are licensed. These are Lucentis and Eylea. Because they have been through the regulatory process, they are far more expensive. Another drug of the same group known as Avastin is equally effective and equally safe. However, it has not been through the regulatory process and therefore is much cheaper.

Macular degeneration damages the central vision only. However, the central vision is very important as it allows us to read and to see fine detail. One way to imagine what it would be like to have macular degeneration is to remember the effect of someone taking your photograph with the flash. In the seconds after the camera flash, you can see a black spot in the centre of your vision that moves around as you try to look about. Imagine a much larger black spot, but instead of wearing off in a few seconds it’s permanent. This is the effect of macular degeneration.

People who suffer from macular degeneration will always have enough vision to get about and will never be entirely in the dark. However, they may not be able to read, drive or see the fine detail that they enjoyed previously.

Macular degeneration is more commonly seen among smokers and in people who have a poor diet. Diets rich in dark leafy vegetables such as spinach or kale contain nutrients that are believed to protect against the disease. Some practitioners advocate the use of supplements in the form of tablets, but the evidence for their efficacy is very scant.

Children need glasses to see clearly if their eyes are out of focus.

This could be as a result of:

• Short-sightedness, when close up items are clear and far items are blurred;
• Long-sightedness, when far items are clear and close items are blurred;
• Astigmatism, when objects do not come into single focus.
• Glasses are also sometimes needed to help control a squint.

The need for glasses in children is determined by genes they inherit from their parents, defects before birth and environmental factors. If you are concerned that your child has an eye problem, visit your local optometrist for an eye test.

Myopia is near-sightedness. Myopes have longer eyes and the light rays fall in front of the retina. This results in blurring of the vision for mid and far distance. This means the myopic person is able to see objects held close to their eyes, but distant objects are out of focus and can only be brought into focus with visual aids such as glasses, contact lenses or laser eye surgery.

There is a greater risk of vision, limiting retinal problems later in life with high myopia.

Current theories suggest that short-sightedness, also known as myopia, can be triggered by a lot of indoor living and close work activity. Having natural lighting in the house and spending a lot of time outdoors is protective against the development or progression of myopia. An easy reminder for preventing or reducing the severity of short-sightedness is the 20-20-2 rule:

• For every 20 minutes of close work, look into the horizon for 20 seconds.
• Spend at least 2 hours every day outdoors in daylight
• If you are concerned about your child’s eyesight, get them an eye test as soon as possible at your local optometrist’s.

The easiest way to find out if your child needs glasses is to take them to your local optician for an eye test. If either parent needs glasses or had a squint or lazy eye, then the likelihood of them needing glasses is higher.

At the moment, there is no cure for myopia, but it can be controlled. Interventions aimed at controlling myopia are a new and growing field.

Low-dose atropine eye drops are currently considered to be the most effective intervention for controlling myopia.

Research on the long term effects of atropine and other interventions are ongoing, and no conclusions have been reached. Other helpful interventions are:

• Lifestyle changes
• Adopting the 20-20-2 rule
• For every 20 minutes of close work;
• Look into the horizon for 20 seconds;
• Spend at least 2 hours outdoors daily.
• Use of special multifocal contact lenses;
• Use of night-time contact lenses also called orthokeratology.

Current myopia control treatments are lifestyle changes, use of special contract lens and use of very low-dose Atropine. Atropine eye drops can be preserved so that they last 28 days. Preservatives in eye drops are used to prevent contamination. Preservatives may cause red eyes discomfort and changes to the ocular surface, especially if used for long periods.

There is a great risk of vision-limiting retinal problems later in life with severe or high myopia. We believe the risk of permanent long term damage from myopia is reduced with successful myopia control treatment compared with no treatment.

Low-dose Atropine (0.01%) is a hundredth of the dilution of Atropine 1% eye drops that have been used in clinical practice for decades. It is such a low concentration that the side effects that typically occur with 1% atropine have not been known to occur at a bothersome level.

The common side effects of 1% atropine are mainly blurred vision, sensitivity to light and, less common, erratic behaviour, skin rash, dry mouth, nausea and dizziness. Atropine eye drops may be preserved so that they last 28 days. Preservatives may cause red eyes, discomfort and changes to the ocular surface, especially if used for long periods of time.

Before starting the myopia control treatment, your child will have an assessment of historical changes in glasses prescription, family history of myopia, a detailed examination of the front and back of their eyes, test for glasses after eye drops and various non-invasive scans of the eyes.

Please bring all of the child’s old glasses prescriptions, a summary of their general health and a list of all current medications.

Myopia is on the increase in modern society, and there is speculation that the reason for this is that much less time is spent outdoors in normal daylight. Modern living also involves a lot more close-up work on smartphones, tablets and computers. Myopia research is an ongoing and evolving field.

If your child has myopia, you may find that they have trouble seeing things from a distance. You may find that they sit too close to the television, squint or don’t pay attention in school because they can’t see the board from where they are sitting. They may also complain about having headaches or tired eyes when they are trying to focus on something from far away.

Don’t ignore these signs and think they are just habits of children. Early recognition and care can have a significant impact on the health of your child’s eyes.

Currently, there is no cure for myopia. It’s a refractive error caused by the eyeball growing too long during childhood. When this occurs, light entering the eye fails to form a clear focus on the light-resulting in blurry distance vision.

Yes, there are proven methods that we can prescribe to slow the progression of myopia during childhood. My iClinic will be introducing myopia control methods such as specially designed contact lenses. These are contacts that are worn during the day in order to temporarily reverse myopia by reshaping the cornea.

There will also be the option of low-dose atropine drops. Atropine has the power to slow down the progression of myopia. Children all around the world have begun to receive treatment in clinics that have these drops.

The lenses and drops that we prescribe can correct the blurry distance vision caused by myopia and relieve associated symptoms of myopia such as headaches, eye strain and squinting.

No! As your child may be new to contact lenses or eye drops, sometimes there can be discomfort while they get used to them – this is natural. Over time they will become more comfortable with the treatment.

A study was undertaken to see if low-dose Atropine would influence the progression of myopia in young children. The children who took part in the study showed no side effects. This proves that low-dose Atropine may be a solution to help slow down the progression of myopia in your child’s eye.

If you believe your child may have myopia you will need to schedule a consultation with our specialist. During this consultation, we will examine your child’s eye to discuss the best course of treatment for your child, as recommended by the consultant from the test results.

If you have any letters from previous clinicians, please bring them along. Other than that, we need the patient and any glasses they may wear.

We will carry out a detailed ophthalmic assessment to assess whether or not you can adapt to Presbyond. Most people have no difficulty adapting to Presbyond vision.

No. With Presbyond, your natural lens is left in place as we do not enter into the eye. The procedure is carried out by a laser on the surface of the cornea.

Having Presbyond surgery in no way affects cataract surgery if you require it at a later time. After we remove your cataracts, your vision should return to normal, and you should remain independent of glasses.

The preoperative assessment usually takes about 2 hours, and your vision will be a little blurry until the drops wear off. This normally takes 6 to 8 hours. Many patients return to work the day after the surgery itself, but many prefer to treat themselves to a little time off.

Yes. It is usual for us to treat both eyes at the same session.

The vision is clear immediately and continues to improve in the days afterwards.

Laser vision correction does not prevent the eyes from being suitable for transplantation.