Secondary lens surgery
What is secondary lens surgery?
Secondary lens surgery is where a new lens is inserted into the eye to correct refractive requirements after previous eye surgery. The lens is usually placed in front of the original intraocular lens and adds near and intermediate vision or corrects astigmatism. Sometimes if it has been impossible to implant a lens in the original surgery, the secondary lens is attached to the iris (the coloured part of the eye) or placed in front of the iris.
Over 350,000 cataract operations are performed in the UK each year. In the vast majority of these cases the operation will have been performed in a NHS facility using a monofocal intraocular lens implanted into the eye. Monofocal intraocular lenses have a single focal point that gives clear vision at a set distance. If distance vision without spectacles is the planned result, reading glasses will be needed after the operation. If there is astigmatism or even if the distance refractive error has not been corrected, spectacles will be needed for near and distance vision. Up to recently there has been little that can be done for this. Some patients have had laser refractive surgery, but that still leaves the need for near vision spectacles.
There is a wide range of secondary lens types (called secondary intraocular lenses or IOLs) that we can implant to enhance your vision. We will help you choose the one that best suits you, your eye, your needs and your lifestyle.
These are designed to give distance intermediate and near vision without spectacles. They work well with people who do not wish to wear spectacles all the time, though for some people glasses will be needed for very difficult visual tasks. Edgbaston Eye Consultants tend to use Extended Depth of Focus (EDOF) intraocular lenses which give a more natural change from distance to near vision, a bit like wearing varifocal spectacles, that is associated with fewer visual side effects after surgery.
These intraocular lenses are designed to correct astigmatism in the eye that will reduce the need to wear spectacles after surgery. They are one of the most effective strategies in reducing spectacle dependence in people with larger degrees of astigmatism, but often spectacles will be needed in certain circumstances. The placement of toric intraocualr lenses in front of the original intraocular lens is advantageous as the position is more stable that if it is implanted at the original surgery.
If you feel that you need more performance from your vision after cataract surgery to suit your lifestyle, you must tell your optician at your eye check. You will be referred to Edgbaston Eye Consultants, or you can contact us and refer yourself for treatment.
The purpose of this appointment at the hospital is to make sure that secondary lens surgery is the best treatment for you. Please bring your current glasses, a list of your medications and any medical record books you may have. If you wear contact lenses these should not be worn for at least 48 hours before your appointment. Several eye tests will be conducted, and you should allow 2 hours for all the tests to be completed and your pupils dilated. When your pupils are dilated, your vision can be blurred temporarily for up to 4 hours and it is important that you don’t drive yourself back after the appointment.
We will examine your eyes thoroughly and perform scans to calculate the power of lens needed during the operation and to make sure that your retina is healthy. This way we can plan the operation that will suit you best and make sure that any factors that might make the operation complex are taken into account. Make sure you ask any questions you have about your surgery with the nurse and/or doctor at your appointment.
We aim to match the surgery that we offer you to your lifestyle. Most of our patients lead active lives; many are still working, most drive, use mobiles/ tablets and enjoy reading. This increases their visual needs for distance, intermediate and near vision. We address these needs at the preoperative clinic appointment and help you make a decision on when to have your operation and what lens to use during the procedure.
You will be asked to sign a consent form once all the pros and cons of the procedure have been explained to you. Cataract surgery is a safe procedure with a very low complication rate, but that does not mean that it is entirely risk-free, and these risks will be explained to you in detail. You should ask as many questions about the procedure as you have, so that you are sure that it is the best thing for you when you sign the consent form. You will be given a leaflet to take home that will allow you to read about the procedure in the comfort of your own home. You will then arrange a date to come for your operation.
Secondary Lens Procedure
This operation usually takes around 10-20 minutes and is performed as a day-case. We aim to have the whole admission completed within 3 hours. We virtually always operate on one eye at a time under local anaesthetic.
A number of checks are made before the operation to make sure that the surgical plan is ready and that the consenting process has been completed properly. Drops are used to dilate the pupil to help with the operation, to numb the eye and to sterilize the eye before the procedure, then the skin above the operative eye is marked with an arrow. That way we do the right operation on the right person using the right lens in the correct eye.
The local anaesthetic process means that you are awake during the operation, but do not feel any of it. We initially use local anaesthetic eye drops are used to numb your eye then infiltrated anaesthetic exactly over the area we operate on, an additional sedative is available to help you relax if necessary. This makes the operation completely painless, though you will feel movements of the surgeon’s hands around the eye as the operation is performed. If there is any question that the anaesthetic is not enough, we use an infiltration around the eye to numb the whole area completely. That way we can perform eye surgery on virtually everybody. The rare cases needing a general anaesthetic are often when there is difficulty positioning and special help with this is provided for all our general anaesthetic cases at the Hospital of St John and St Elizabeth in London.
Once the eye is numbed, the operation is performed under a microscope through a very small opening. The size, shape and location of the incision is expertly planned for each individual patient, allowing a more precise and predictable procedure. You will see a bright light in front of you and should look directly at it, it will not harm your vision. The rolled up intraocular lens is introduced through the incision and it opens in the eye like a flower. Antibiotics are injected into the eye at the end of the procedure to help prevent infection. In the vast majority of cases, the incision is so small that no stitches are needed to close the eye. You may have to wear a pad over your eye afterwards.
After the operation, you will be taken to a room to recover and the surgeon will come to tell you how the procedure went. You will be given your drops to put in the eye for the next 3-4 weeks and an explanation on how to put them in. You will have any questions answered about what you can and can’t do after the procedure a follow-up appointment will be arranged and an emergency number given. You can then go home and enjoy your new vision as it recovers over the next few days.
After surgery, you’ll have a course of steroid drops to help control any swelling and to promote healing. It is important to finish this course of treatment. For most people, this means taking the drops for 3 weeks. Your ophthalmology team will let you know what you need to do.
Most people recover very quickly following cataract surgery and you may feel back to normal the day after your operation. Some people might feel more tired than usual after the surgery, but after a few days you’ll start to feel back to normal. Your eye may look red when you remove the dressing and you may notice some bruising around your eye. This is normal and should improve after a couple of days. Most patients experience improved vision between 1 and 2 days after surgery and this improves with time.
You will be given an appointment at 1-2 weeks to make sure the eye is recovering, and the drops are going in properly. It is possible you will be listed for the other eye to have an operation then. At around 6 weeks, after you have seen your optician, your eye will be checked again, and you are likely to be discharged from clinic, to enjoy your new vision.
Time off work
Normally, you will usually need a week off work after surgery, but this may be longer if work in a visual critical area.
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