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Phaco cataract surgery

Cataract Surgery



~ Legacy ~

~ Mr Walker retired from cataract surgery after 30 years in April 2024 ~

Modern day micro-incision phacoemulsification cataract surgery with replacement lens implant technology is nothing short of miraculous!

Success rates are very high and patients love it. There is a joyous "wow" factor being able to see clearly again, with colours restored all bright and true. The operation itself is found to be an easily tolerated matter ("100 times better than going to a dentist"), and the recovery period is surprising quick too.

I have had the pleasure of performing well over 10,000 procedures in my surgical career. It is hugely gratifying to have mastery of this technical art. I enjoy the demand for high level skill and attention to detail which goes along in a continuous pursuit to achieve absolute patient safety.

Complications are rare but should be the focus in an endeavour to completely avoid. The average nationally quoted risks for two benchmark complications in this operation are posterior capsular rupture 2% and endophthalmitis 0.1%; I am very pleased to say my own rates are ten times better at 0.2% and 0.01%, respectively.

I hold several strong beliefs in this area which I think are key to maintaining and improving on success.

This starts with a pre-operative ward round check at the slit-lamp microscope. The eye should be confirmed as free from potential infection sources and all technical and surgical approach data checked. The patient should be well in themselves. It is not infrequent to find new issues which need addressing and taken into account, or factors which have been overlooked by others.

The patient should be confident they will not feel, see or need to worry about moving the eye. In my view this is best achieved either with a sub-Tenon’s ‘no needles’ local anaesthetic block or general anaesthetic. I don’t use just topical local anaesthetic drops as in my opinion they are insufficient and can lead to a bad experience.

I use the more mainstay monofocal intra-ocular lens implants. These have stood the test of time, having superior and pure optics. I don’t use multifocal or extended range (so called ‘premium’) intraocular lenses: the optics are a compromise and simply not as good; there can be problems with glare, haloes and reduced contrast sensitivity; the aberrations are not always easily adapted to - reflected in the fact that 5% of these lenses end up having to be removed and exchanged. 

I also do not use toric lenses as they are not always rotation stable and many a wise optician will know astigmatism is something best left where it is comfortably adapted.

I do see patients on post-op day 1 to ensure all is as perfect as it should be. The reassurance is invaluable and it is the time to remember best the post-op rules for a full recovery. Over the years and on rare occasion, I have seen issues which demanded early action. I do not favour telephone or delayed review which would miss the opportunity to detect rare complications.

In essence, the precious gift of sight should never be taken for granted. I treat every patient as I would wish to be treated myself; I operate on your eye as if it was my own.

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