Factfinder
Questions to ask your doctor
Ophthalmology
Cataract surgery
How long will I have to wait for treatment?
The length of time you have to wait varies from one hospital to another. The government has invested £52m in the cataract care pathway programme - it hopes to reduce waiting times to below three months and significant progress has been made in many NHS. For more information on waiting times, go to our Hospital Guide.
Can I be treated as a day case?
Best practice is to perform this operation as a day case. You get to go home straight after the operation, which patients often find more convenient. However, some hospitals are better than others at managing to do this. Our statistics show that the best hospitals treat all patients as day cases while the worst treat only 45 per cent in this way. The average is 95 per cent, so ask what the day case rate is for your surgeon's hospital.
How many operations have you done?
A number of studies have made an association between the volume of procedures carried out by surgeon or hospital and the outcome, suggesting that practice makes perfect. Cataract surgery is one of the most commonly performed operations in NHS hospitals. Some non-specialist hospital trusts conduct up to 6515 operations a year, while others carry out as few as 18. Find out how experienced your surgeon and hospital is in this procedure.
Do you specialise in cataract surgery?
Check our consultant guide to see whether your doctor has a special interest in cataract surgery. For complex cases, make sure you see someone that specialises in the surgery you are undergoing. In some cases a junior surgeon may assist, but less experienced surgeons should not be performing the operation on their own so find out what kind of supervision there will be.
What is your complication rate?
Cataract surgery has one of the highest success rates and according to the Royal College of Ophthalmologists fewer than 2 per cent of patients have serious, unforeseen complications. One of the most common is a thickening of the lens casing, but this can easily be corrected with laser treatment. Check how the surgeons carrying out your operation compare - there could be three or four members in the surgical team. If some operations they carried out had complications, ask them to explain what they were and why they occurred.
What kind of anaesthetic will be used?
A local anaesthetic is usually used, but a general anaesthetic might be appropriate depending on your circumstances. You should tell your consultant if you don't want a sharp-needle anaesthetic. A sub-Tenon's local anaesthetic is highly effective at pain relief and is much safer. Topical anaesthetic is good in skilled hands, but is associated with more perception of what is going on. If undergoing a general anaesthetic your life is in the anaesthetist's hands even in what is otherwise a routine surgical procedure, so try to find out what qualifications and experience they have and try to meet them before the operation.
What is your accuracy of biometry?
Biometry is the process that uses either laser or ultrasound to predict the correct lens implant power and getting it right is a key part of a successful operation. Consultants should adhere to the guidelines from the Royal College of Ophthalmologists. Laser interferometry allows more accurate adjustments to the lens to be made after it has been implanted. It won't always be available and, although the necessary equipment is becoming more widespread, it is only appropriate in around 75 per cent of cases. Ask whether your hospital audits the accuracy of biometry and find out what kind of results your surgeon has had.
Are you going to try anything on me that is new to you?
New lens technology is being developed that neutralises various aberrations, but you need to consider the possible long-term dangers of something that hasn't got a long track record of success. Although new implants might be shown to be both safe and advantageous over time, some ophthalmologists are still wary about new types of lens and lens materials.
Will you be providing a multifocal lens?
While it's possible that multifocal lenses can improve your vision for distance and for reading so that no further correction is required, in practice this is not always achieved. Contrast is reduced by certain types of multifocals and biometry has to be very accurate to get good results. There is also a period of adjustment required on the part of the patient to a diffraction type of multifocal lens. In a recent survey by the United Kingdom and Ireland Society of Cataract and Refractive Surgeons, only 5% of its members had used multifocal lenses.
What is your attitude to complementary therapies?
One Spanish study shows that lutein - available as a supplement or found in spinach or kale - may improve sight for people with age-related cataracts. If you are interested in complementary treatments, you should assess your consultant's attitude towards them and ask what they suggest in your case.
And finally - is surgery really necessary?
Unnecessary cataract operations could result in a worsening of vision. The first question to ask the surgeon is whether you definitely need surgery. In general, surgery should be considered if your eyesight interferes with your daily life and affects your ability to read or work. If you drive, you must reach the required standard set by the DVLA, so you might need the cataract removed if you want to keep your licence.
Glaucoma
Is surgery necessary and how long will I have to wait?
As most cases of glaucoma do not require surgery, you need to ask exactly why it is appropriate for you. A surgeon might need to perform a trabeculectomy, where a small piece of tissue is removed from the eye to let fluid escape. Check with your hospital to find the likely waiting time in your area.
How long will it take?
Each operation should take no more than 45 minutes and best practice is to perform this operation as a day case. You get to go home straight after the operation and most patients find that more convenient. However, some hospitals are better than others at managing to do this. Ask your hospital what percentage of patients it treats as day cases.
How many operations have you done and what is the success rate?
Some surgeons might have carried out many trabeculectomies, whereas others are relatively inexperienced in the procedure. Up to 5,000 trabeculectomies are carried out at NHS hospitals each year - non-specialist hospital trusts conduct as many as 194 a year while some carry out only one or two, if any. One way of measuring success is to look at how often patients have to return to hospital following surgery. Ask your hospital to provide you with this information.
Do you specialise in glaucoma?
Check our consultant guide to see whether your ophthalmologist has a special interest in glaucoma. For complex cases, make sure you see someone that specialises in the surgery you are undergoing.
What is your complication rate?
According to the National Trabeculectomy Audit, the average success rate for surgery is around 60% - ask how your consultant compares. Glaucoma sub-specialists obtain higher success rates in general, but be aware that certain surgeons take on difficult cases and so might have lower overall success rates. Also note that different surgeons use different criteria for success. Ask your surgeon to explain how and why complications can occur or have occurred and how they are managed. One in four patients will have a little bleeding in the eye and about one in five will experience leakage of the wound. Scarring is another possible complication and the opening made in the eye needs to be prevented from healing. Anti-scarring treatments are available, so ask whether these are suitable for you.
Is laser treatment appropriate?
Laser treatment for glaucoma might be available, but some types of laser therapy have proved less effective for glaucoma when compared to surgery. If your consultant suggests laser therapy, ask them to explain what type of laser therapy is being offered and why it is appropriate.
Are prostaglandin analogues available?
Around 90 per cent of glaucoma cases are treated with eye drops. Prostaglandin analogues are the latest type of antiglaucoma medication to be developed - dosing is required only once daily, they produce few side effects and are the most potent topical agents in reducing eye pressure. Beta-blockers are less favoured because of their side effects but can be useful, as can carbonic anhydrase inhibitors and alpha-agonists. If drops fail to work, surgery might be required.
What is your attitude to complementary therapies?
If you are interested in complementary treatments, you should assess your consultant's attitude towards them and ask what they suggest in your case. Studies have shown that Gingko biloba might help slow visual damage in glaucoma and cannabis (a controversial treatment) has been shown to reduce eye pressure. Vitamins A, C, E, lutein and zeaxanthin are often recommended for eye disease, but there is no evidence to show that they offer protection against glaucoma.
Laser refractive surgery
What types of laser refractive surgery are available and what is best for me?
Conventional LASIK (Laser Assisted In Situ Keratomileusis) can correct short sight, long sight and astigmatism, accounting for around 95 per cent of refractive error. Wavefront LASIK tackles the remaining 5 per cent of defects and many consider that it offers better results. PRK and LASEK are alternatives - the recovery period is longer than for LASIK, but might be safer if your cornea is relatively thin.
Would a clear lens extraction be more suitable?
For the correction of higher refractive errors and for older patients, lens implantation techniques are often preferred. Cataract surgery - called clear lens extraction when the lens is not cloudy - can remove the natural lens and replace it with an artificial one. Ask your consultant which treatment is suitable for you.
How much will it cost?
Laser refractive surgery is generally considered non-essential and therefore not usually available on the NHS. Private treatment usually costs £1000-1500 per eye and is available at some NHS hospitals. Clear lens extraction is usually twice the price. Make sure you get full details of exactly of what is and what isn't included in the quoted fees.
What qualifications do you have?
Guidelines from the Royal College of Ophthalmologists say that only registered surgeons with specialist training should carry out laser surgery. A broad knowledge of ophthalmology is essential to properly assess patients and manage complications. Ideally, surgeons should also belong to a relevant professional organisation that provides continuing professional development too. Check if your ophthalmology consultants has laser refractive surgery as a special interest. This does not mean that other consultants don't have the necessary experience to carry out laser surgery, but for complex cases you should try to see someone that specialises in the surgery you are undergoing.
What experience have you had and how can you demonstrate results?
In general, the more operations a surgeon has carried out the higher the success rate. In some cases, sight without glasses might not be as good as sight with glasses before the operation. The difference is usually minor, but find out what results your surgeon has had. Also check how many patients have had to come in for further treatment to improve on the initial results. Bear in mind that one in three people will still need glasses for some purposes, such as night driving. Laser surgery will not be able to cure age-related presbyopia and the need for reading glasses in your mid 40s and beyond.
What risks are there and what is your complication rate?
Complications occur in less than 5 per cent of cases, but make sure your consultant outlines all the risks. Flap complications with LASIK arise in 0-4 per cent of cases, but can usually be corrected with little or no loss of vision. Some people have a problem with dry eyes in the months after surgery and artificial tear supplements might be needed in the long term. Many patients have experienced glare or halo effects when night driving, particularly just after treatment. This is more likely the higher the correction that has been made, but is rarely severe. In rare cases, excessive thinning of the eye wall can cause the shape of the eye to be unstable after treatment. Severe loss of vision is very unusual, but some patients could require corneal surgery or hard contact lenses to restore vision. You should find out exactly how frequently your surgeon has experienced complications and why.
Can both eyes be done on the same day?
LASIK treatment on both eyes is possible on the same day, but your consultant should outline the risks. In order to reduce the risk of cross contamination should complications arise, each eye should be treated as separate procedure, so check that this is the case for you.
Corneal disease
How do you decide whether surgery is advisable?
Ask your consultant if surgery is necessary in your case. Various types of corneal disease can sometimes be treated with eye drops or tablets, and specialised contact lenses can be used as an alternative if there is minimal scarring present. The path of light to the retina can be distorted so the picture passed to the brain is not clear. In more severe cases, a corneal graft ('keratoplasty' or transplant) is required, where part of your cornea is removed and replaced with a similar piece from a donor eye. The operation can be combined with other procedures such as cataract surgery if required. Graft surgery is usually done to improve the sight of the eye, but might also be necessary for pain or to repair a weak area. Ask your surgeon to explain what level of vision you might realistically be expected to gain if you do have surgery.
How long will I have to wait for treatment?
Our most recent figures show that the average wait for all ophthalmic procedures is 96 days, but can be as long as 167 days or as short as 48 days. Ask your hospital for information on their waiting times for this treatment.
How long will it take?
The operation takes about an hour and patients are usually admitted on the day of the operation and discharged the following day. Ask your hospital to give you their most up to date information.
How many operations have you done?
Some surgeons might have carried out many corneal transplants, whereas others are relatively inexperienced in the procedure. Up to 1700 corneal transplants are carried out in NHS hospital each year and some non-specialist hospital trusts carry out as many as 91 operations a year while some will only do one or two, if any. Find out how experienced your surgeon or hospital is, but with corneal grafts it is often more important that you have access to good aftercare.
Do you specialise in this surgery?
For complex cases, try to see someone that specialises in the surgery you are undergoing.
Who is the anaesthetist and what is their experience?
Either a local or general anaesthetic can be used, depending on your circumstances. Doctors having operations themselves worry as much about the anaesthetist as the surgeon. If undergoing a general anaesthetic your life is in the anaesthetist's hands even in what is a routine surgical procedure. If possible, it's good to meet the anaesthetist before the operation to check you are indeed fit for general anaesthetic.
Are there intensive care facilities?
If things go wrong with a general anaesthetic, you need access to good intensive care. And the unexpected can happen even in apparently routine surgery, so it is important to know whether there is a facility on site or else how far away the nearest one is.
What are the risks and what is your complication rate?
There is a risk that your body rejects the transplanted cornea, but this does not necessarily lead to failure with prompt and appropriate aftercare. Rejection is most likely within the first year, but could occur at any time after the operation. It is more likely in some corneal diseases than others. Your consultant should highlight the danger signs - such as poor vision, redness or pain - so that the eye can be treated immediately and you should be given an emergency contact number. Other complications are quite common. Blurring because of astigmatism (distortion or exaggerated curvature of the graft surface) is common and about one third of grafted eyes need contact lens correction to achieve optimum vision. More serious complications such as infection, glaucoma and cataracts are less common after the operation but can cause severe problems, so follow-up appointments are very important. Ask your surgeon about complications experienced and their causes. Complications can result in emergency readmission to hospital. The average readmission rate following a corneal transplant is 2.5 per cent, so see how your hospital compares.
When can I return to work and what further treatment is necessary?
You should be able to resume normal activity soon after a corneal graft, but this will also depend on your condition and overall vision. Ask about when you can return to work or do sports, especially swimming. Contact sports are not advisable for someone who has had a corneal transplant. For the first few months your vision will fluctuate as the eye heals and prescriptions for glasses or contact lens might not be given for months. You need to have a clear programme of aftercare - you will be given eye drops for six months (possibly indefinitely) and you'll need regular visits to your hospital in the first year or two. Stitches will usually be left in place for one to two years, possibly longer. Stitches can be removed easily in the clinic and are taken out if they are causing astigmatism, or have broken or loosened.
Eye cancer
If the tumour is growing, or causing symptoms it is usually treated with radiotherapy followed by surgery to remove the iris, cornea, muscle or even the whole eye. Ask your doctor which treatment is suitable in your case.
It may be possible to save the eye and keep your sight by using radiotherapy to treat your melanoma. This will depend on where the tumour is as well as how large it is. Ask your doctor about the success rates of each stage of treatment.
Eye surgery will be done under general anaesthetic. Ask your doctor how long you will need to remain in hospital for monitoring.
If you have had your eye removed, you will need to care for and clean your artificial eye and empty eye socket before you leave the hospital. Ask if someone will advise you on how to care for your eye following surgery.
Radiotherapy is an effective treatment for melanomas which are confined to the eye itself and have not spread to the socket. Tiny plates, lined with radioactive material, are stitched into place over the tumour and left in place for up to a week. Ask your doctor about the side effects of this treatment.
While you have the plates in place, you will be in a single room in the hospital. This is because a small amount of radiation will be given off by the plates. Ask your doctor if it is safe for you to receive visitors and if staff will monitor the amount of time visitors can spend in your room.
Las with many other cancers, doctors do not know exactly why melanoma of the eye develops. Ask your doctor if there are measures you can take following treatment to prevent recurrence.
Eye cancer can spread to other parts of the body. Ask your doctor what tests you will need to detect any spread of the cancer.
Refractive error
A refractive error is a mismatch between the power of the eye's optical system and its length. It generally results in either blurred vision, or else symptoms such as eyestrain and headaches. Vision therapy, also referred to as visual training can help correct or improve the condition. Ask your doctor what this treatment involves and what alternatives there are.
It may also be treated by wearing special lenses to re-balance the eyes. Ask your doctor if this is suitable in your case and how long it is likely to be before you see results.
Laser vision correction is a relatively quick surgical procedure to treat refractive errors. A laser is used to precisely reshape the cornea. Ask your doctor if this treatment is available and what the success rates are.
Laser is usually performed under local anaesthetic. Ask your doctor what risks are involved in this treatment and how long the benefits will last.
It usually takes a few days after surgery for the full effects to be felt. Ask your doctor when it will be safe for you to drive again.
Squint
If the squint is caused by one eye being more long-sighted, then wearing glasses or a patch on the weaker eye may do the trick. Ask your doctor if these non-invasive procedures are suitable in your case.
If the squint is severe, then an operation is sometimes performed to correct the squint. Ask your doctor about the risks and success rates of this type of surgery.
Botulinum toxin is a treatment often used for adults who have a squint. The toxin is injected into the muscles of the affected eye, causing a paralysis of the muscle which corrects the squint temporarily. Ask your doctor about the possible side effects of this treatment.
The paralysis lasts for weeks, occasionally months, before wearing off completely. Ask your doctor how often you will need repeat treatment.
Laser surgery may be a treatment option for adult squints. Ask your doctor about the success rates and whether laser surgery is available.
Retinal detachment surgery
If any part of the retina is lifted or pulled from its normal position, it is considered detached and will cause some vision loss. A detached retina is a very serious problem that almost always causes blindness unless it is treated. Ask your doctor what the chances are of regaining your sight.
Retinal detachment can occur at any age, but it is more common in midlife and later. There are a number of conditions that can increase the chance of a retinal detachment. Ask your doctor to explain these conditions and how they can cause retinal detachment.
Retinal tears usually need to be treated with laser surgery or cryotherapy (freezing), to seal the retina to the back wall of the eye again. These treatments cause little or no discomfort and may be performed in your ophthalmologist's office. Ask if this treatment will prevent a retinal detachment and which treatment, if any, is best for you.
There are several ways to fix a detached retina. The decision on which type of surgery and anaesthetic (local or general) to use, depends upon the characteristics of the retinal detachment. Ask your doctor what type of anaesthetic you will need.
There are essentially three types of surgery, and there is usually some discomfort after all of them. Ask your doctor to explain the different types of surgery that are possible and which is most suitable for you.
A retinal detachment must be treated but there are risks associated with surgery. These include infection, bleeding, high pressure inside the eye or cataract. Ask your doctor how likely it is that you will suffer from any of these problems.
Most retinal detachment surgery is successful, although a second operation is sometimes needed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind. Ask what the success rate is at your hospital and whether you are likely to need a second operation.
Your ophthalmologist will prescribe any necessary medications for you. Ask when you will be able to resume your normal activities.
Vision may take many months to improve and in some cases may never fully return. Unfortunately, some patients, particularly those with chronic retinal detachment, do not recover any vision. Ask what the chances are of your vision improving.
Diabetic retinal surgery
Retinopathy (damage to the retina) is a common complication of diabetes. If left untreated, it can get worse and cause some loss of vision, or blindness in severe cases. Good control of blood glucose and blood pressure slows down the progression of retinopathy. Ask what you can do to slow the progression of retinopathy.
Different parts of the retina can be affected. The macula is a small part of the retina which is roughly in the centre at the back of the eye. This is where you focus your vision. So, when you read or look at an object, the light focuses on the macula. The central and most important part of the macula is called the fovea. The outer part of the retina is used for peripheral vision. Ask your doctor which part of the retina is affected and how serious your condition is.
The longer you have diabetes, the more likely it is that retinopathy will develop. Twenty years after the onset of diabetes, some degree of retinopathy will have developed in almost all people with type 1 diabetes, and in about six in 10 people with type 2 diabetes. Even when type 2 diabetes is first diagnosed, some degree of background retinopathy is seen in about one in four people. Ask what stage your condition is at, and what is the most suitable treatment.
Treatment can prevent loss of vision and blindness in most cases. So, if you have diabetes it is vital that you have regular eye checks to detect retinopathy before your vision becomes badly affected. Ask your doctor to test your vision at least once a year.
If you are found to have mild (background) retinopathy, and your vision is not affected, then you are likely just to be monitored and re-checked every few months. The retinopathy may not progress to more serious forms, particularly if your diabetes and blood pressure are well controlled. If more severe changes are detected, ask to be referred to an eye specialist for a detailed eye examination, and treatment if necessary.
Laser treatment is used mainly if you have new vessels growing (proliferative retinopathy), or if any type of retinopathy is affecting the macula. A laser is a very bright light that is very focused so it makes tiny burns on whatever it is focused on. A 'burn' can seal leaks from blood vessels, and stops new vessels from growing further. Ask whether laser treatment is suitable for you, what the process involves and how long it will take.