Cataracts

1. Pre-operative Assessment:

• The eye is carefully examined to determine the best type of IOL for your needs. This includes measuring the shape of your cornea, the size of your eye, and your overall eye health.  Your needs are discussed and matched to the type of IOL that will give you as close to what you want as is possible.

2. Surgical Procedure:

• The natural lens is broken up (phacoemulsification) and gently removed from the eye.some text
  • The IOL, which has been selected based on your specific vision needs, is then implanted in the eye.
  • The surgery itself usually takes around 15 to 30 minutes per eye. The procedure is performed under local anesthestic drops, and we routinely DO NOT USE needles when administering your anaesthetic. This type of anaesthetic ensures your comfort during the surgery and also ensures a smother more rapid recovery with fewer risks. We have a dedicated ophthalmic technician holding your hand throughout the procedure for your communication and comfort.  Because we are a specialised team, all the nurses you meet in our assessment clinic are the same nurses who will get you ready for surgery, be in the operating theatre with you and discuss your postoperative care with you in our recovery room afterwards.
• Feedback from our patients tells us that this makes the day of surgery quite relaxing and takes away much of the stress involved with having eye surgery. ‍

3. Recovery:

• Recovery is generally quick, with most patients experiencing improved vision within a few days to a week. You will need 2 weeks of reduced activity as your eye needs time to heal, and you will use eyedrops for the first 4 weeks after surgery.  We will give you full guidance on what you can and can’t do after surgery and how to care for yourself at your initial assessment, and again after your surgery. Because our team works at The Eye Surgery Hastings only, 5 days a week, we are always available for advice and will happily see you at short notice should you have any concerns.

Cataract surgery involves removing the cloudy lens in the eye and replacing it with a clear artificial lens called an intraocular lens (IOL). Refractive lens exchange involves removing the natural lens before it becomes cloudy. There are several types of IOLs available, each with unique features designed to address specific visual needs.

It's important to recognise that not all lenses suit everyone, and more expensive lenses are not ‘better’ lenses.  

Only extensive imaging of your eyes and a thorough examination by an experienced surgeon can determine the best options for you, with you, based on your eye health, lifestyle, and preferences.

Monofocal IOLs‍‍

Monofocal IOLs are the most commonly used type of lens. They have one focal point meaning they focus at one specific distance only. They provide clear vision at one distance—either near, intermediate, or far—depending on your choice.

Advantages:

• Reliable
• Provide excellent vision at the chosen focal point (e.g., distance or near)
• Lower risk of complications compared to enhanced depth of focus or multifocal lenses
• Typically covered by insurance

Disadvantages:

• Require glasses for reading or distance vision (if the IOL is set for distance vision, or reading vision)
• Limited range of focus

Multifocal IOLs

A multifocal IOL has distinct focal zones (typically two, three, or more concentric rings) that divide the light entering the eye into different focal points. Each ring has a different focal point—one for near vision, one for intermediate vision, and one for distance vision. The lens provides multiple fixed focal points at set distances. The brain learns to select the most appropriate focal point depending on what the patient is looking at.

Advantages:

• Can reduce or eliminate the need for glasses or contact lenses, though this is NEVER guaranteed
• Can avoid the use of glasses after surgery
  

Disadvantages:

• Not suitable for some eyes
• Cause visual disturbances like halos or glare, especially in dark conditions such as night driving
• Cause reduced contrast sensitivity giving poorer vision in dimly lit conditions
• Can takes months to adapt to as the brain needs to learn to select the correct images.   A small proportion of patients are unable to tolerate them and require IOL removal.
• Higher cost and not covered by insurance
• Commercial pilots need to be aware of the likely restrictive implications or even ineligibility to a medical certificate following multifocal IOLs implantation.‍

Enhanced Depth of Focus (EDOF) IOL

An EDOF IOL is designed to extend the depth of focus, creating a continuous range of vision, rather than having distinct focal points. This range of vision is typically greater than a monofocal IOL but smaller than a multifocal IOL. It uses wavefront-shaping technology to enhance visual clarity across a wider range of distances, particularly in the intermediate zone (e.g., for computer use or arm-length tasks).

Advantages:‍

• Can reduce or eliminate the need for glasses or contact lenses, though this is NEVER guaranteed
• Can avoid the use of glasses after surgery especially at intermediate distances (e.g., for computer work, cooking, or using a mobile device) which traditional monofocal IOLs may not provide.
• Glares and halos are less frequent and less troublesome than with multifocal IOL’s
• Very little loss of contrast sensitivity

Disadvantages:

• Some patients may still need reading glasses for fine print or intricate tasks (e.g., threading a needle).

The difference between an Enhanced Depth of Focus (EDOF) IOL and a Multifocal IOL can be difficult to understand. The difference lies in their design and how they focus light, resulting in a different visual experience for the patient. EDOF intraocular lenses can be thought of as a stepping stone between monofocal lenses and multifocal lenses.  They have been designed as a response to bridging the gap between patients wanting a bigger range of focus but less loss of contrast sensitivity and fewer glare and haloes. ‍

Toric IOLs

Toric IOLs are specifically designed for patients with astigmatism, a condition where the cornea is irregularly shaped. These lenses correct the astigmatism, improving both distance vision and clarity. They can be monofocal, EDOF or multifocal.

Advantages:

• Corrects astigmatism and provides clearer vision at all distances
• Reduces the need for glasses or contact lenses after surgery

Disadvantages:

• Requires precise alignment during surgery, so placement is crucial
• Requires meticulous imaging to determine the causes and size of your astigmatism, needing more advanced imaging technology
• Higher cost, and often not covered by insurance

Monovision

Monovision after cataract surgery is a technique where each eye is set at a different focal distance, typically one eye for distance vision and the other for near vision.

Here’s how it works:

1. One eye (usually the dominant eye) is corrected for distance vision (i.e., seeing far away clearly).
2. The other eye is corrected for near vision (i.e., seeing up close, like reading a book or using a phone).
3. The brain then learns to combine the inputs from both eyes to create clear vision at all distances, allowing the person to see both near and far without relying on glasses.
   

Advantages:

• Reduces or eliminates the need for glasses after cataract surgery.
• Uses monofocal lenses and so provides the best quality vision

Disadvantages:

• Some people may experience difficulty with depth perception or find it hard to focus on intermediate distances (like reading a computer screen).
• It can take some time to adjust to the difference in focus between the two eyes.
  

Monovision is a good option for many people who want to minimize their need for glasses after cataract surgery, but it's important to discuss whether it's right for you with your eye surgeon.

Which IOL Is Right for You?

Hopefully it is now clear that not all IOLs suit everyone.

Your pre-operative assessment is aimed at considering the many different factors that influence which IOLs would be best suited to your eyes and your needs for your cataract surgery, including:

• Your overall eye health, shape, size and visual potential
• Your lifestyle and visual needs (e.g., whether you want to read without glasses or focus on distance vision)
• Whether you have other eye conditions, such as astigmatism
• Your ability to tolerate certain types of lenses, especially multifocal or accommodating IOLs
  

Our goal is to help you make the best choice for your cataract surgery by using our expertise and advanced technology to assess your eye's suitability for different types of IOLs.

We'll explain your options in a way that's easy to understand, ensuring you have all the information you need.

We will take the time to discuss your preferences and listen to your concerns, working together to find the IOL that fits your specific needs.

We encourage you to ask any questions you have.

Rest assured, we will never pressure you into choosing a more expensive lens. A higher-priced lens isn’t always the best option for your individual needs, and we are committed to helping you select the lens that is the best fit for you.

Refractive Lens Exchange is also known as lens replacement surgery. It is a highly effective surgical option for people who want to improve their vision, particularly those with significant refractive errors. It provides a long-term solution that can reduce dependence on glasses or contact lenses. The procedure is almost the same as that for cataract surgery. The natural lens is removed, and is replaced with an IOL. The IOL choices after RLE are the same as for cataract surgery- read above for more information on the different IOL options.

Here's how it works:

1. Preparation:

• Just like cataract surgery, the eye is carefully examined to determine the best type of IOL for your needs. This includes measuring the shape of your cornea, the size of your eye, and your overall eye health.

2. Surgical Procedure:

1. The natural lens is broken up (phacoemulsification) and gently removed from the eye.
2. The IOL, which has been selected based on your specific vision needs, is then implanted in the eye.
3. The surgery itself usually takes around 15 to 30 minutes per eye. The procedure is performed under local anesthestic drops, and we routinely DO NOT USE needles when administering your anaesthetic. This type of anaesthetic ensures your comfort during the surgery and also ensures rapid recovery with fewer risks.  We have a dedicated ophthalmic technician holding your hand throughout the procedure for your communication and comfort.  Because we are a specialised team, all the nurses you meet in our assessment clinic are the same nurses who will get you ready for surgery, be in the operating theatre with you and discuss your postoperative care with you in our recovery room afterwards.
4. Feedback from our patients is that this makes the day of surgery quite relaxing and takes away much of the stress involved with having eye surgery.

3. Recovery:

• Recovery from RLE is generally quick, with most patients experiencing improved vision within a few days to a week. You will need 2 weeks of reduced activity as your eye will needs time to heal.  We will give you full guidance on what you can and can’t do at your initial assessment.

Why Choose RLE?

RLE is often considered for people who are experiencing significant refractive errors, such as those who:

• Have high levels of nearsightedness, farsightedness, or astigmatism that cannot be corrected with traditional glasses, contacts, or laser eye surgery (like LASIK).
• Are in their 50s or older and are struggling with presbyopia (difficulty focusing on close-up objects due to aging) and want to reduce or eliminate their dependence on glasses or contact lenses.

RLE is especially popular among people who are no longer good candidates for LASIK or other laser refractive surgeries, either due to age or the severity of their refractive error.

Advantages:

• Improved Vision: RLE can correct a wide range of refractive errors, giving patients clearer vision at multiple distances, potentially reducing or eliminating the need for glasses or contacts.
• Long-Term Solution: Since the natural lens is replaced with an artificial one, RLE is a long-lasting solution for vision correction, unlike LASIK, which can sometimes require enhancement procedures over time.

Disadvantages:

• No IOL on the market provides perfect vision after cataract surgery.  If your vision before surgery is good, you may be frustrated with your vision after surgery.
• As with any surgical procedure, though generally very safe it does carry risks which can include blindness and reduced vision after surgery.  It is impossible to do RLE without these basic risks.

When it comes to eye surgery, the quality of care you receive is crucial to achieving the best possible results. Choosing an experienced ophthalmic surgeon working with their own dedicated team in an operating theatre designed specifically for eye surgery offers several key benefits that contribute to consistently high quality care and outcomes.

Experienced Surgeon

Dr Alex Buller is an experienced ophthalmic surgeon who has undergone extensive training and has years of hands-on experience in performing eye surgeries. This expertise ensures that your surgery is carried out with precision, reducing the risk of complications and improving the likelihood of a successful outcome.

Skilled Team

Dr Alex Buller is supported by a dedicated team of professionals, including specialised nurses and technicians, all of whom are trained in eye care. Working together regularly, our team has developed a deep understanding of the specific needs of eye surgery, ensuring smoother, more efficient procedures.

Specialised Operating Theatre

Our operating theatre is designed specifically for eye surgery and is equipped with the latest technology tailored to the precise needs of ophthalmic procedures. This focused environment helps maintain the highest standards of sterility, safety, and efficiency during surgery.

Minimised Distractions

When a surgical team works exclusively in an eye surgery setting, it allows for a level of focus and familiarity that isn't always possible in a general operating theatre. This leads to better patient care and quicker response times in case of any issues that arise during the procedure.

Consistent Teamwork

Because Dr Alex Buller and his team regularly work together, we have developed a streamlined workflow and effective communication. This consistency helps anticipate the needs of the surgery, reduces delays, and ensures all aspects of your care are managed seamlessly.

Personalised Attention

With a dedicated team, Dr Alex Buller can focus fully on the surgical procedure while the team takes care of everything else, ensuring that your experience is smooth, comfortable, and tailored to your specific needs.

The combination of expert skills, a specialised environment, and a coordinated team leads to consistency in quality, fewer complications, and faster recovery. This ensures that you receive the best possible outcome from your eye surgery. With our focus on precision, safety, and personalised care, you can feel confident that you’re in expert hands.