Cataract surgery firsthand
Optometrist Martin Pratt speaks to OT ’s Emily McCormick about his experience of cataract surgery and how an intraocular lens implant has improved his vision
27 May 2015
In March this year optometrist Martin Pratt had cataract surgery on his left eye, having become troubled with developing lens opacities for some time.
As a practitioner with almost 40 years of experience, Mr Pratt is well versed in observing cataracts and referring patients for surgery when necessary. However, he admitted that when the time came for his own operation, he was a bit apprehensive.
Like most people, when the 59-year-old first noticed a change to his vision, he ignored it, knowing that, as a clinician, he could “manage it.” The slow progression, paired with an initial minor vision correction (-0.75D), meant that Mr Pratt waited three years before biting the bullet and having cataract surgery.
Justifying the waiting period, Mr Pratt explained: “If I’m honest, I knew that in the beginning there was no urgency to have surgery, so I put it off.
“I used the same judgment on myself that I would when a patient presents to me with cataract. I would always ask them, is it impinging on what you do and is it causing you a problem? If it is not, and they meet the vision standards required, such as those for driving, I would let them decide when they were ready.”
Unfortunately, however slow, Mr Pratt’s cataract did progress and he monitored it until earlier this year when he noticed that his vision suddenly deteriorated quite quickly and he took action.
“I can now read most things without spectacles, which I haven’t been able to do for the last 10 years or so."
“I found that reading with my left eye was getting progressively ‘fuzzy’ and although my corrected visual acuity was 6/9, I was struggling to read N8,” he admitted.
Being under 60 years of age, the optometrist noted that he is “very young to have developed cataracts” – now in his right eye also – commenting that his active lifestyle which includes sailing, scuba diving and hill walking could be the reason for this early development.
Reflecting on what finally made him have surgery, Mr Pratt told OT: “Of practical significance in my professional role was the position of the opacities which, now in both eyes, ran diagonally across the centre of the pupils.”
This position meant that Mr Pratt could see his cataracts across a patient’s pupil when he performed retinoscopy, and could therefore become a hindrance to his work.
LENS CHOICE
Despite being a clinician, just as most people would, Mr Pratt researched the lens options which were available to him thoroughly, before deciding that he would have a multifocal intraocular lens (IOL).
Due to this decision, with multifocal IOLs unavailable on the NHS, the optometrist proceeded with surgery privately with local eye clinic ExeterEye.
“I did a lot of research before making the decision,” Mr Pratt said. “I had previously been to a clinical presentation at ExeterEye, I knew they were using a particular multifocal IOL that I was interested in and I had been very impressed,” he added.
Aware that private healthcare is not an option for everyone who requires cataract surgery, Mr Pratt is very clear about why he opted to go private. “I have nothing against the NHS and I think the service offered in Exeter, where I live, is excellent. However, the multifocal IOL which I was thinking of having wasn’t available through that route,” he explained.
Once Mr Pratt made the decision to have surgery, things progressed quickly. “Within an hour of emailing a surgeon I know at ExeterEye, his secretary had called to arrange a consultation,” Mr Pratt revealed, adding: “I emailed on Monday and had my first appointment that Thursday.”
THE SURGERY
Attending the consultation prepared and with a view of the route that he wished to take, advice from his surgeon, Daniel Byles, led Mr Pratt to have an aspheric SV intraocular lens implant with a target refraction of -1.25D.Mr Pratt underwent cataract surgery, which he describes as “like having your eyes open underwater,” last month and has recently had his final post-op refraction.
Although extremely positive about the experience, recounting the surgery, Mr Pratt admitted that there were elements pre- and post-surgery which he was not prepared for.
“I was slightly surprised at the amount of eye drops they put in my eye before the surgery,” Mr Pratt said. “While many patients are most nervous about the injection you have into the corner of your eye, having the drops was certainly more unpleasant than I anticipated,” he said, adding that he did not feel the injection at all.
However, Mr Pratt is nothing but impressed with the results, as he told OT: “I can now read most things without spectacles, which I haven’t been able to do for the last 10 years or so."
“Typically, before the surgery, at work I would be constantly taking my reading spectacles on and off every time I had to use an instrument, and now I don’t have to do that. It’s most beneficial.”
Closing with an honest anecdote, Mr Pratt concluded: “Of course, it’s not an entirely pleasant procedure. I can only liken it to a trip to the dentist; it’s not exactly excruciatingly painful, but it’s something that you have to put up with.”
DIARY OF SURGERY
Martin Pratt shares some of his personal observations of cataract surgery post-opFIVE HOURS POST OP…
The shield is off and the eye drops are in. My double vision has disappeared as the anaesthetic has worn off, but the eye is now very tender and aching. There are beautiful halos around lights, and a double concentric circle with about 100 fine radial spokes, which is a very interesting visual experience.
There was a lot more pre-op preparation than I had expected, with three doses of dilating drops over an hour, and then topical anaesthetic before an injection of full local anaesthetic behind the eyeball. I had not appreciated that this paralyses all of the ocular muscles so that the eye and eyelid loses all movement. It was a very weird sensation being able to see with the eye, but not be able to close it.
I was also surprised that they poured four doses of tropicamide in for the procedure, and, on reflection, I reckon it took a good three days for the pupil activity to return to normal.
The surgery itself was painless and quick, but the double vision afterwards made me feel rather queasy.
There was a lot more pre-op preparation than I had expected, with three doses of dilating drops over an hour, and then topical anaesthetic before an injection of full local anaesthetic behind the eyeball. I had not appreciated that this paralyses all of the ocular muscles so that the eye and eyelid loses all movement. It was a very weird sensation being able to see with the eye, but not be able to close it.
I was also surprised that they poured four doses of tropicamide in for the procedure, and, on reflection, I reckon it took a good three days for the pupil activity to return to normal.
The surgery itself was painless and quick, but the double vision afterwards made me feel rather queasy.
DAY 1
The haloes disappeared today, but the pupil is still fixed and dilated. My eye aches and is a bit tender. Now I know what patients mean when they say colours are much brighter – there is a definite sepia tone when looking through a non-operated eye which still has 6/6 VA.
DAY 2
The star burst halos I experienced yesterday would have looked wonderful on a fireworks photo. They have all gone now though, thankfully. The oblique vertical diplopia was really horrible; I hope I never suffer ocular decompression illness.
I am recuperating at home today and I definitely could not have worked. I am doing music practice and with my operated left eye music [sheet] is perfectly focused at 60cm away, the paper white and the notes black. The only problem is that my single vision ‘music’ spectacles, which have a +1.50D add, are rimless, so I can not remove left lens. So I drilled a 24mm diameter hole through the lens.
Another interesting observation is that I have never really liked the brown MAR coating which I have on my occupational varifocals because white paper looked sepia. However, now through my left, operated eye, white paper looks white and bright via these spectacles. So the coating seems to add to the sepia effect of early cataract. This possibly infers that there is no point in supplying filter coatings to clients with lens opacities, as they have a natural built in filter, which is what I have always advised. Yet, I definitely need a filter post-cataract operation.
I am recuperating at home today and I definitely could not have worked. I am doing music practice and with my operated left eye music [sheet] is perfectly focused at 60cm away, the paper white and the notes black. The only problem is that my single vision ‘music’ spectacles, which have a +1.50D add, are rimless, so I can not remove left lens. So I drilled a 24mm diameter hole through the lens.
Another interesting observation is that I have never really liked the brown MAR coating which I have on my occupational varifocals because white paper looked sepia. However, now through my left, operated eye, white paper looks white and bright via these spectacles. So the coating seems to add to the sepia effect of early cataract. This possibly infers that there is no point in supplying filter coatings to clients with lens opacities, as they have a natural built in filter, which is what I have always advised. Yet, I definitely need a filter post-cataract operation.
DAY 5
The pupil is back to normal and the slight tenderness has gone. There is no redness, and, externally, the eye appears normal.
FIVE WEEKS LATER
A post-op refraction shows my unaided vision to be 6/18 N6. Rx -1.25 / -1.00 x 20 VA 6/4 , with a near add of +2.00 N5.
I admit that I am slightly disappointed by the refraction because my pre-op prescription was -0.50 / -0.75 x 20 and my target prescription was -1.50 mean. However, a slit lamp examination showed slight folds in the peripheral cornea, so it will be interesting to see if the residual cyl reduces over the next six months or so.
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