Cataract surgery | NHS or Private? What are the differences?

Most of us will at some point be faced with worsening vision due to cataract as we age, and the need to consider cataract surgery.

Cataract surgery is often an opportunity to improve your natural level of vision as well as correct short sight, long sight and astigmatism. However, as remarkable as modern cataract surgery is, there are some associated risks to it as with any other surgery.

In the UK, cataract surgery is performed by the NHS and also at private clinics and hospitals.

The NHS does an amazing job of providing cataract surgery to the general population. An ageing population and the fact that most people require cataract surgery as they get older make this type of surgery the most common surgery performed in the UK. This places pressure on NHS trusts and potentially creates long waiting lists. This situation is likely to be exacerbated by the current NHS wide shutdown of services due to the Covid-19 crisis.

The role of the NHS is to widely provide cataract surgery to the population whilst also training the next generation of eye surgeons. In this capacity, the primary aim of surgery is to remove the cataract rather than necessarily provide glasses-free vision, and to this end NHS hospitals only use monofocal lens implants, generally aiming for good distance vision.

Patients will usually require glasses for reading as well as for distance in some cases if they have residual glasses prescription or astigmatism. As the only source of training of junior doctors, NHS cataract surgeries will be performed by different grades of doctors, some of whom are learning surgery.

Overall complication rates in this setting are up to 2% based on the National Cataract Dataset of 57000 cataract surgeries.

Private cataract surgery has several differences from routine NHS surgery

1. Surgery is performed by a consultant surgeon chosen by the patient
   The patient is able to choose the consultant they want and will have their surgery performed by this experienced surgeon. Cataract surgeons at OCL have complication rates lower than 0.5% and an infection rate of 0%. This private setting provides a personalised approach to your care.
2.  All aspects of your treatment are overseen by your consultant
   Results of surgery are optimised at each stage of planning; the lens selection and surgery are by a consultant. Similarly, any post-operative problems are managed directly by the same consultant.
3. Advanced lens technologies now offer the opportunity to achieve your best potential vision
   Sophisticated lenses such as extended depth of focus trifocal lenses achieve glasses independence for near and distance vision in the majority of patients and are only available to private patients. It is not possible to buy these lenses and take them in for your NHS surgery and the NHS don’t allow you to ‘top-up’ and pay the additional cost of these lenses.
4. Astigmatism correction
   Astigmatism correction with toric lenses is also undertaken as standard in private elite clinics like OCL, but are only available in some NHS settings for higher levels of astigmatism.
5. Access to Femto laser cataract surgery
   Elite clinics like OCL offer femtosecond laser cataract surgery for blade-free precision and optimal lens placement
6. Laser refinement of results for glasses-free vision
   Some clinics such as OCL offer the opportunity to refine the outcome of cataract surgery through laser eye surgery if needed. The availability of this second step of refinement is a game-changer in achieving your best vision, particularly if you are considering an advanced lens such as a trifocal and should be a question you ask your surgeon if you are considering a multifocal lens.
7. Surgery when you want it
   Private cataract surgery can be performed at a time that is convenient for you and avoids long waiting lists.
8. Cataract surgery is covered by medical insurance
   All private medical insurers in the UK such as BUPA and AXA will cover cataract surgery and offer cataract care pathways. Some lens implant choices may incur an excess dependent on your level of cover.