Out of hours emergency service opening times?

Out of Hours Emergency Service

Mondays to Fridays
7:30-10:30PM at £160 per call out with Diagnostic Investigations

Saturdays and Sundays
6:00AM until 10:30PM @ £190 with Diagnostic Investigations

What tests should I need for Glaucoma screening?

The monitoring of glaucoma in the UK is usually quite limited. Typically patients are seen in an NHS setting where they will have their visual fields carried out, visual disc assessment and pressure testing. Additional tests such as Heidelberg spectralis 4D scanning are not always available under the NHS.

The ideal detection and monitoring plan for anyone at risk of glaucoma, who has glaucoma or wants to find out if they have glaucoma is to have the following battery of tests carried out…

Humphrey C24-2 Visual Fields
Goldmann Applanation pressure measurement
Pachymetry (corneal thickness measurement)
Anterior Chamber analysis (assessment of the front of the eye)
Gonioscopy-analysis of the drainage system of the eye
Heidelberg Spectralis optic disc retinal nerve fibre analysis
Heidelberg Spectralis macular retinal nerve fibre analysis/posterior pole analysis
Heidelberg Multicolour analysis
Optic Nerve/Disc assessment
We recommend this should be carried out at least once a year but preferably every six months.

A full glaucoma assessment which include all of the above tests is £250.

What are the risk factors associated with Glaucoma?

  • short-sightedness
  • poor circulation
  • diabetes
  • high blood pressure
  • migraine sufferers, or of African-Caribbean origin.

Glaucoma is usually manageable using eye drops and early diagnosis can prevent any significant vision loss if diagnosed early. Early detection is the key to a better prognosis.

Are there any cataract procedure risks?

Complications can occur albeit very rare. Less than 5% of patients experience complications. The most common complications can be dealt with and usually don’t affect sight in the long term. Your eye surgeon will discuss the risks with you before you decide to have the surgery.

Serious complications are much rarer and include retinal detachment, macula swelling, a break in the lens capsule, infection or problems with the lens implant. If you experience very painful eye or your vision drops drastically, then contact the eye department as soon as possible.

The most common complication

One of the most common complications is a thickening of the lens capsule which holds the artificial lens in place. This may occur a couple of months or even years after the initial procedure. If this happens, your sight will become cloudy again, as though the cataract has come back. This complication is known as posterior capsule opacification and it is usually quickly dealt with by a small laser procedure.

Can cataracts be prevented?

Age is the largest influence on cataracts which we cannot prevent. Other factors involved in cataract development include life-long exposure to sunlight, smoking and having a poor diet lacking antioxidant vitamins.

How are cataracts treated?

The only effective treatment for cataracts is surgery to remove your cloudy lens and replace it with an artificial lens implant. Consultant eye surgeons will normally remove one cataract at a time.

What are cataract procedures?

It is usually done with a local anaesthetic, which means that you will be awake during the operation but you won’t feel any pain. You will be able to talk to the operating team and ask for any assurance you need. The local anaesthetic may involve drops and an injection or just drops.

During the process, a micro-incision is made into the eye to enable removal of your lens so you don’t need any stitches.

To remove the cataract, the eye surgeon will remove the natural lens in your eye and replace it with an artificial lens implant. The artificial lens implant will have a prescription to give the best vision possible. Some patients do not need distance glasses or glasses at all after cataract surgery. The majority of patients will need reading glasses after cataract surgery though.

Your eye may begin to feel slightly sore once the local anaesthetic starts to wear off. The dressing, which is put on in the hospital, usually needs to stay on your eye overnight, but you should be able to take it off the following morning. Your eye may look red and your eyelids might develop some bruises but these usually improve over a couple of days.

What are common catarct symtoms?

When your cataract starts to develop, you may feel your sight is changing or not as good as it once was. Some people described it as looking through dirty spectacles lenses. You may also notice that colours appear less bright.

What happens after the cataract operation?

Most people have no problems after the surgery and they go about their daily routine the next day.

The hospital will give you eye drops to use for 4 weeks but sometimes can last up to two months. There are usually two drops you can take: one is an antibiotic which stops infection and the other are steroid drops to help reduce any inflammation.

Other than the drops you can usually carry on as normal, although you might need to avoid the following for the first week to ten days:

Rubbing your eye.
Strenuous exercise, contact sports and heavy lifting
swimming (until your ophthalmologist says you can).
Wearing eye make-up until the hospital are happy with your recovery.
Avoid getting soapy water in your eye when washing hair.

What is phakic intraocular lens (PIOL) implantation?

Lenses that are implanted into the eye to correct vision without taking out the natural lens are call Phakic Intraocular Lenses (PIOLs). PIOLs are made of clear synthetic plastic. They sit either just in front of, or just behind, the pupil – a bit like building your contact lenses into your eyes.

PIOL implantation is effective in treating high spectacle prescriptions, and is widely used to treat younger patients who are not suitable for laser eye surgery.

The commonest type of PIOL implanted in the UK and worldwide is the Visian ICL (intraocular collamer lens). This is a soft flexible implant designed to sit just behind the pupil and in front of the natural lens in the eye. You cannot see or feel ICLs after implantation, and you do not need to clean them.

The other main type of PIOL is the Artisan/Verysise PIOL. This PIOL clips onto the iris just in front of the pupil, and is sometimes visible as a glint in the eye. Like ICLs, you cannot feel Artisan/Verysise PIOLs after implantation, and you do not need to clean them.

If you are suitable for PIOL implantation, your surgeon will discuss which type is the best option for you.

What are the benefits?

PIOLs are highly effective at treating both high glasses prescriptions and astigmatism. For most patients, vision after PIOL surgery is similar to vision in contact lenses before surgery without the discomfort and limitations on activity.

Who is suitable for PIOL?

Young patients who are unsuitable for laser vision correction are often offered PIOL implantation. This is because PIOLs can correct a wider range of spectacle prescriptions than laser vision correction, and may be a safer option if you have pre-existing cornea or eye surface problems.

You need to be over 18 years of age and have a stable spectacle prescription. This is normally defined as no change greater than 0.5 units (0.5D) in the last 2 years.

The range of spectacle prescriptions that can be treated effectively is approximately:

Up to -17.00D of myopia or short sight
Up to +10.00D of hyperopia or long sight
Up to ±4.50D of astigmatism
Supplementary laser vision correction can be used to extend this range for suitable patients with very high prescriptions in a combination treatment that is commonly called BIOPTICS.

What is Refractive Lens Exchange?

A cataract is a misting up of the natural lens, which sits just behind the pupil and helps to focus light on the retina. Cataract surgery involves replacing the misty natural lens with a small, clear synthetic implant called an intraocular lens (IOL). The focusing power of the IOL can be chosen to reduce dependence on glasses after surgery.

Refractive Lens Exchange (RLE) is identical to modern cataract surgery. Both operations involve replacing the natural lens with an IOL. The only difference is that cataract surgery is performed mainly to correct blur or light scatter caused by a misty natural lens; whereas RLE is performed to reduce the need for glasses or contact lenses.

IOL implantation is a bit like building your glasses or contact lenses into your eyes

There are two main IOL types:

Monofocal IOLs – monofocal IOLs aim to reduce spectacle dependence for distance (driving) vision

Multifocal IOLs – multifocal IOLs aim to reduce spectacle dependence for a wider range of activities, including intermediate (computer screens) and near (reading) vision
If you are suitable for RLE, your surgeon will discuss which IOL type is the best option for you.

What are the benefits?

About four out of five patients are completely free of glasses after RLE with widely used contemporary multifocal IOLs.

If you do need help from glasses after surgery, it is usually for a specific activity in the near, intermediate or distance range.

Approximately 95% of patients are satisfied with the outcome of surgery, and many describe it as life changing.

Although RLE is often bracketed with cosmetic surgery procedures, the benefits are mainly functional. It is designed to make you less dependent on glasses and contact lenses, helping you to lead an active lifestyle more easily.

RLE eliminates the need for cataract surgery in later life, and it is often preferred to laser vision correction for patients in the retirement age group in whom the early stages of cataract formation are often already present.

In the absence of a new health problem in the eye, vision normally remains good, and your spectacle prescription normally remains stable after RLE. If you do experience any deterioration in vision in the years after surgery, it can often be reversed with a one-off minor laser procedure called YAG capsulotomy.

Who is suitable for RLE?

If you are over 50 years of age and have a glasses prescription higher than the normal range for laser eye surgery, you are likely to be suitable for RLE.

Almost any level of myopia (short sight) or hyperopia (long sight) can be corrected by RLE, and IOLs with built in astigmatism correction are available. Lens implantation techniques can be combined with laser eye surgery in suitable patients to extend the range of astigmatism treatment or ne-tune the focus outcome.

You may not be suitable for multifocal IOL implantation if you have pre-existing problems with your eye health.

When can I get my cataracts removed?

There is no longer a reason to wait until the cataract is ‘ripe’ or ‘mature’before removing it. Any surgical procedures involve some risks so it is usually worth waiting until vision cannot be improved with spectacles.

When will I notice an improvement in my eyesight?

Some people can tell that their sight has improved straight away. Your sight may not be as good as you expect for the first week after the operation, as the eye is still recovering from the surgery and will probably be a little swollen.

On some rare occasions visual improvement may be limited by other eye conditions such as macular degeneration or glaucoma. Cataract surgery is the most successful surgical procedures however on the odd occasions some side effects from the operation can cause the vision to be poorer than expected.

If you experience severe pain or your vision suddenly gets a lot worse, then you should let the hospital know as soon as possible as this may mean they need to see you again.