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Mark Westcott
 

Private surgery

There are 3 sets of fees involved: hospital fees (room, operating theatre, implant cost and medical supplies, etc.), anaesthetist fees and surgeon’s fees. Surgeon’s fees in London are usually of the order of £900, with anaesthetist fees at around £300-£400. Hospital fees are harder to specify as these vary. Hospital fees in Central London can be anywhere between £2,000-£3,500.

Note: that all these costs are for one operation only – normally each eye is operated on separately, so two operations will be needed.


Will it be covered by my health insurance?

This will vary depending on your policy. Hospital fees are usually fully covered. Some insurers have “capped” the amount they’re willing to pay for the surgeon’s and anaesthetist’s fees, so you may need to pay any extra (known as the shortfall). This is usually less than £200, but will vary depending on your insurer.

Note: some insurers/policies limit your choice of surgeon and you will only be allowed to see one of a small number of surgeons who have agreed to keep their fees low.


Reducing the need for glasses after surgery: What are the options?

Removing the cloudy lens and replacing it with a new one allows us to correct certain aspects of a patient’s vision. In many cases it’s possible to significantly reduce a patient’s dependence on glasses. We’ve outlined a number of options below. However, please don’t worry if it all seems complex – Mark will guide you through the options before the operation, based on his extensive experience and your specific visual needs. For example, an avid golfer would want excellent distance vision, whilst an academic would need good reading vision – although we do find that many people just want to minimise their use of glasses!


“Set for distance”

One of the great benefits of cataract surgery is that we can effectively correct any short-sightedness (myopia) or long-sightedness (hypermetropia). Ophthalmic surgeons normally set the operated eye for distance. This means that you should achieve very good unaided vision, although you may require a weak prescription to get the sharpest vision for driving and long-distance work (e.g. at the cinema). You will, however, need to have reading glasses to get comfortable reading vision of small print.

Many patients like and use varifocals, or bifocals before surgery. You can continue to use these types of glasses after surgery, but the prescription will need to be changed.


Monovision

When patients have cataracts in both eyes. we can set one eye (usually the dominant eye) for distance vision, and the other eye for reading. The focal point for reading is at about arm’s length and the brain automatically switches to the eye with the clearest image. Patients effectively use one eye for distance and their other eye for some near work. This means that you may not require glasses for reading menus in restaurants, or prices in shops. It does not guarantee that you will be independent of glasses, but it will reduce your dependency on reading glasses. You would still require glasses to get the best reading vision, particularly in poor light.

This “Monovision” is usually well tolerated and can work very well. You may already have tried it before surgery, as many opticians do this with contact lenses. If you are interested, it is sometimes worth performing a trial of monovision before surgery, where we simulate it for a day prior to surgery. Most patients (92-98% in recent studies) adapt quickly to this spread of focus. Very rarely, a patient may feel that the eyes are imbalanced, but this can be corrected with contact lenses, glasses or a corrective surgical procedure (LASIK – “laser” surgery). If you choose “monovision” the insurance company will cover this lens implant, as a standard one is used, and there is no need to get both eyes done within a short period of time (unlike multifocals: see below).


Multifocals

It’s also possible to use a multifocal lens implant during cataract surgery. Multifocal lenses reduce dependence on glasses by providing a clear focus at more than one distance. As with monovision, most patients adapt quickly to multifocal lenses. However, some patients are affected by glare and haloes. These side effects are caused by the optical compromise required to create several points of focus in the eye rather than just one.

Most importantly, you need to be aware of the drawbacks and potential complications of these lenses:

  • Glare and haloes in 10% of patients, which can be problematic for driving. Almost all patients will notice multiple images around point sources of light, especially at night (e.g. looking at the stars in the night sky) from the first day after surgery. Most patients will report some visual symptoms of glare or haloes under certain circumstances. These symptoms tend to become less troubling with time.
  • Intolerance of the lens. It is estimated that about 1-5 in every 200 patients simply cannot tolerate the lens once it is implanted, to the extent that they request that it is removed. Whilst Mark would not charge you for surgical fees to remove a lens, you will incur hospital and anaesthetic fees if we have to remove the lens because of intolerance.
  • Even if the lens is successful, and you tolerate it well, it is important to understand that it will not guarantee that you will be free of glasses, but it will reduce your dependence on glasses. You must have realistic expectations. Also multifocal lenses work better in older patients (over 65 years) and are more problematic in younger patients (in their 50s).
  • Both eyes need to be operated within a short time (normally 2 – 3 weeks). It is not possible to have surgery in one eye only, and the assumption is that you will need surgery in both eyes in quick succession.
  • Insurance companies may not pay for the cost of the lens. The cost of the RESTOR lens is about £400 plus VAT.
  • Multifocal implants generally are not advised if you have high astigmatism (Mark would obviously exclude this before surgery).

Astigmatism: What is it, and how does cataract surgery affect it

Astigmatism occurs primarily when the front of the eye (cornea) is shaped like a rugby ball, rather than a football. Your optometrist can correct this with special glasses or contact lenses.

If astigmatism is present before surgery, then you will need to wear glasses or contact lenses for distance and reading (or varifocals). For mild degrees of astigmatism, it is possible to reduce the degree of astigmatism during cataract surgery, in order to reduce the strength of glasses needed after surgery.

Moderate and severe astigmatism can be corrected by using a special astigmatic lens implant during cataract surgery, called a toric lens. This can work well. However insurance companies generally won’t pay for the cost of toric lens implants (the cost of the Acrysof Toric IOL is about £400 plus VAT). You will also need to have an additional measurement of the cornea prior to surgery (topography).


We have put all the cataract information on the next few pages of our website into a pdf document for you to download and print out if you prefer.

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