Cataracts

sassy_one

Hi,


Unfortunately at some point I am going to have to have Cataract surgery following discovery of it.

I wanted to ask, if anyone here has had one removed while being very high myopia (nearsighted).

I understand there is a smaller increase in risks, but I wanted to hear from anyone of positive outcomes also.

I would be delaying the operation until such time that I need it due to a serious impact in my lifestyle due to vision loss, given the risks.


Finally, the sedation used, would that be the same as what a dentist would use in extremely nervous patients?


Thanks 

Millerdog

Hi . I had high myopia ( -14.5) and had IOL's done on both eyes during lockdown, the procedure is exactly the same as cataract surgery.

 I had the ops 6 weeks apart in case of any adverse effects. I opted for standard monofocal lenses with blended vision ie one eye for close up vision and one for distance vision.as recommended by my surgeon. I had no sedation and it was painless. You can feel a little pressure but no pain as your eye is anesthetised The Op takes less than 30 minutes all in. I had to keep my eye patch on for a couple of days.

I am absolutely delighted with the outcome and now have 6/6 vision. Still cant believe it when I open my eyes in the morning and can see the leaves on the trees outside my window when I couldn't  read my alarm clock before. I know Ill have to wear glasses for reading but compared to the glasses I wore I had I don't even mind that!

PterionPterion

High myopia does increase risk of any eye procedure though with the current equipment and technology it isn't a high risk op (unless there are other underlying issues). 

The success rates of cataract ops are high (including high myopes) and complications low. Post-op problems are also generally dealt with promptly and there are different approaches to the surgery depending on the ocular status. It is important to highlight that delaying cataract ops for too long results in dense & hypermature cataracts which make the procedure even more difficult and high risk. 

Were you advised of the presence of cataracts by your optometrist? It is always beneficial to follow their advice as to when a referral for the procedure is warranted. 

Additionally, would you be opting for NHS or private as choosing specific lens replacement is not an option with NHS but it is important to discuss at referral or pre op lifestyle so the ophthalmologist is aware. Do also discuss your concerns as local anaesthetic is preferred but general may be used where necessary. 

Undervalued

A close friend of mine with myopia (c. -12) has had successful cataract surgery on both eyes (a year or so apart). Now needs vastly less powerful and "bottle like" glasses!

sassy_one

Thank you to all so far who have replied.

MillerDog, I'm glad yours was successful. Did you go private or via NHS? If you went private, could you possibly let me know who you went with, via PM if you prefer.

When did you exactly have yours carried out? Was it when vision was impacted severely, or earlier?


PterionPterion, yes I was advised following a routine eye test that I have a very very small cataract which is starting to form, but there at that time was no concerns (prior to the covid I was advised).
My vision is only impacted through bright lights, at night, such as headlights where it appears 'scattered' around the edges but I had that even before I was told about the cataract but just put it down to a high myopia prescription. 


Undervalued, thats brilliant to hear!

I am looking at going private, for many reasons, the NHS has already advised me a GP would need to sign off the payment and to do that a very high threshold has to be met, I'm told you have to be virtually blind in the eye before the NHS will operate, madness!


Anyway, the first consultant I contacted, didn't speak direct but to their PA, has deflated me.

Apparently, as I dislike medical / needles and have a phobia, I'd be best suited with the NHS and on that basis alone, and only that small information, that consultant has refused to carry out my cataract surgery?!
That sounds absolutely disgusting that not only without seeing me first to assess how I would be, but also telling me to go to the NHS, when they must know I be waiting years before they'll treat me seems unprofessional and not patient based.


So I will try another consultant now once I get the motivation up, but it took me months to find this one, who has 25 years experience and had really good reviews, so I am very disappointed now 👎

Can anyone maybe suggest some places, pretty much anywhere in the UK.

Undervalued

sassy-one said:

Thank you to all so far who have replied.

MillerDog, I'm glad yours was successful. Did you go private or via NHS? If you went private, could you possibly let me know who you went with, via PM if you prefer.

When did you exactly have yours carried out? Was it when vision was impacted severely, or earlier?


PterionPterion, yes I was advised following a routine eye test that I have a very very small cataract which is starting to form, but there at that time was no concerns (prior to the covid I was advised).
My vision is only impacted through bright lights, at night, such as headlights where it appears 'scattered' around the edges but I had that even before I was told about the cataract but just put it down to a high myopia prescription. 


Undervalued, thats brilliant to hear!

I am looking at going private, for many reasons, the NHS has already advised me a GP would need to sign off the payment and to do that a very high threshold has to be met, I'm told you have to be virtually blind in the eye before the NHS will operate, madness!


Anyway, the first consultant I contacted, didn't speak direct but to their PA, has deflated me.

Apparently, as I dislike medical / needles and have a phobia, I'd be best suited with the NHS and on that basis alone, and only that small information, that consultant has refused to carry out my cataract surgery?!
That sounds absolutely disgusting that not only without seeing me first to assess how I would be, but also telling me to go to the NHS, when they must know I be waiting years before they'll treat me seems unprofessional and not patient based.


So I will try another consultant now once I get the motivation up, but it took me months to find this one, who has 25 years experience and had really good reviews, so I am very disappointed now 👎

Can anyone maybe suggest some places, pretty much anywhere in the UK.

Not total madness because there is a small but real chance of any cataract operation going wrong. Normally very successful but there is a slight risk of making your vision worse than it was before the operation. That is why they are reluctant to do them whist the patient still has some useful vision in the eye.

sassy_one

Undervalued said:

sassy-one said:

Thank you to all so far who have replied.

MillerDog, I'm glad yours was successful. Did you go private or via NHS? If you went private, could you possibly let me know who you went with, via PM if you prefer.

When did you exactly have yours carried out? Was it when vision was impacted severely, or earlier?


PterionPterion, yes I was advised following a routine eye test that I have a very very small cataract which is starting to form, but there at that time was no concerns (prior to the covid I was advised).
My vision is only impacted through bright lights, at night, such as headlights where it appears 'scattered' around the edges but I had that even before I was told about the cataract but just put it down to a high myopia prescription. 


Undervalued, thats brilliant to hear!

I am looking at going private, for many reasons, the NHS has already advised me a GP would need to sign off the payment and to do that a very high threshold has to be met, I'm told you have to be virtually blind in the eye before the NHS will operate, madness!


Anyway, the first consultant I contacted, didn't speak direct but to their PA, has deflated me.

Apparently, as I dislike medical / needles and have a phobia, I'd be best suited with the NHS and on that basis alone, and only that small information, that consultant has refused to carry out my cataract surgery?!
That sounds absolutely disgusting that not only without seeing me first to assess how I would be, but also telling me to go to the NHS, when they must know I be waiting years before they'll treat me seems unprofessional and not patient based.


So I will try another consultant now once I get the motivation up, but it took me months to find this one, who has 25 years experience and had really good reviews, so I am very disappointed now 👎

Can anyone maybe suggest some places, pretty much anywhere in the UK.

Not total madness because there is a small but real chance of any cataract operation going wrong. Normally very successful but there is a slight risk of making your vision worse than it was before the operation. That is why they are reluctant to do them whist the patient still has some useful vision in the eye.

When would you say to move forward with surgery, in your opinion?

I note you said not to leave it until it's very matured.

I agree, I know there is risks involved, I just find it crazy how the consultant has refused on the only basis that I have a phobia, which seems crazy.
They haven't even seen me to make such assessment.

Does a cataract *always* get worse or can it stay the same for a long periods, say a decade or two, then worsen when you get much older?

I ask because I read some people who've had them say while 40 waited but waited until they were in their 70s before having it done when it became worse.

fred246

It is the CCGs who insist that your vision has to be poor before they will operate. That's to save money. Some of them say that drivers can have them done earlier.

Undervalued

sassy-one said:

Undervalued said:

sassy-one said:

Thank you to all so far who have replied.

MillerDog, I'm glad yours was successful. Did you go private or via NHS? If you went private, could you possibly let me know who you went with, via PM if you prefer.

When did you exactly have yours carried out? Was it when vision was impacted severely, or earlier?


PterionPterion, yes I was advised following a routine eye test that I have a very very small cataract which is starting to form, but there at that time was no concerns (prior to the covid I was advised).
My vision is only impacted through bright lights, at night, such as headlights where it appears 'scattered' around the edges but I had that even before I was told about the cataract but just put it down to a high myopia prescription. 


Undervalued, thats brilliant to hear!

I am looking at going private, for many reasons, the NHS has already advised me a GP would need to sign off the payment and to do that a very high threshold has to be met, I'm told you have to be virtually blind in the eye before the NHS will operate, madness!


Anyway, the first consultant I contacted, didn't speak direct but to their PA, has deflated me.

Apparently, as I dislike medical / needles and have a phobia, I'd be best suited with the NHS and on that basis alone, and only that small information, that consultant has refused to carry out my cataract surgery?!
That sounds absolutely disgusting that not only without seeing me first to assess how I would be, but also telling me to go to the NHS, when they must know I be waiting years before they'll treat me seems unprofessional and not patient based.


So I will try another consultant now once I get the motivation up, but it took me months to find this one, who has 25 years experience and had really good reviews, so I am very disappointed now 👎

Can anyone maybe suggest some places, pretty much anywhere in the UK.

Not total madness because there is a small but real chance of any cataract operation going wrong. Normally very successful but there is a slight risk of making your vision worse than it was before the operation. That is why they are reluctant to do them whist the patient still has some useful vision in the eye.

When would you say to move forward with surgery, in your opinion?

I note you said not to leave it until it's very matured.

I agree, I know there is risks involved, I just find it crazy how the consultant has refused on the only basis that I have a phobia, which seems crazy.
They haven't even seen me to make such assessment.

Does a cataract *always* get worse or can it stay the same for a long periods, say a decade or two, then worsen when you get much older?

I ask because I read some people who've had them say while 40 waited but waited until they were in their 70s before having it done when it became worse.

Not me, that was another poster!

They may be right but I have no expert knowledge on the medical aspects of this I'm afraid. I only know what I have read and what I have been told by friends who have had the operation.

PterionPterion

This is going to be a long post but some misinformation regarding cataracts and the NHS often from hearsay or media needs to be clarified.

Very few of the practitioners I have worked with would turn down a cataract op based on funding. There are several guidelines upon which the decision to operate is based on. The main is the level of vision. 6/6 on the vision chart is considered normal vision or 20/20 as the americans say. Approximately 6/12 in the eye with the cataract is where many optometrists/GPs would refer and ophthalmologists would operate. This is akin to the driving standards. NOTE: this is referring to the affected eye only. It does not mean they only operate when you can no longer drive as with both eyes you would be well within driving standards- it is just an arbitrary measure. This is nowhere near blindness. 

The second guideline is based on the affect on quality of life. So for example even if your vision is better than 6/12 but you have significant difficulty with glare, haloes, depth perception, risk of falls, compromised work or sporting ability etc then this is a valid reason for the procedure. The cases where you hear people have been denied surgery is usually because there are other underlying issues which would make the risks of the op outweigh the benefits. 

Your optometrist is best placed to recommend when the surgery would be appropriate and they can initiate the referral. GPs are notoriously poor in dealing with eye related issues so see your optician. Depending on where you are based in the country some schemes allow for you to choose where you would like to go for the op (some cities have private providers who perform procedures on behalf of the NHS, again the availability of these options should be discussed with your optician. 

Regarding, the private consultant turning you down it is usually because general anaesthetic/sedation is a higher risk for them than the actual cataract op itself. Furthermore they may not have provisions to actually offer the service given the current climate and would require additional medical practitioners to be present in an adverse event (sedation) related. 

Mature dense cataracts are when you have little useful vision left in the eye. Again the NHS/CCG/consultants DO NOT want to wait this long. It is a far more costly and risky and so usually it is done much earlier (the optician is the best judge of this). Yes some people may have to wait longer but again that's because in their case the risks may outweigh the benefits. 

The progression of cataracts is different in each patient. Some with health conditions like diabetes, UV exposure, genetics, family history may see rapid decline in 12-24 months whereas others can go decades with no significant change. 

Finally, my personal opinion is the private route is a waste of money for something as straightforward as a cataract op that is readily available on the NHS (unless there are significant other factors involved. 

Ibrahim5

Sedation is like drinking alcohol. If you have 20 pints they would probably do a good operation because you would be totally unconscious. A general anaesthetic is safer than 20 pints. If you have 5 pints it would be difficult to do complex surgery on your eye because you wouldn't keep still. That level of sedation is not good for eye surgery. Better to have no pints. If you insisted on sedation they might give you half a pint. Sedation and eye surgery don't generally mix.