Phacoemulsification explained

The standard modern method for cataract removal is called Phacoemulsification. In this procedure, ultrasound energy is used through a very small incision to break up and remove the cataract. It’s a highly advanced, but simple process that can be broken down into the following steps:

1 - Your surgeon will make a small incision at the edge of the cornea once the area has been cleaned and your eye is fully numbed. The incision is usually 2-3 millimetres long, and its placement is carefully planned to make sure your surgeon has the best and safest access to the lens.

2 - Next, your surgeon will make a small and precise opening on the front surface of the capsular bag. This is a thin, transparent membrane that your natural lens sits in. The goal of the opening, also known as a capsulotomy, is to be able to cleanly access the cloudy material in your natural lens, but preserve the capsular bag. This will be used to support your new artificial lens later. 

3 - Now the ultrasound energy comes into play. Through the corneal incision, a very fine ultrasonic probe will be inserted. This precision tool is able to break up the hardened cataract into very small fragments. These fragments are then very gently removed from your eye by a suction mechanism. 

The combination of these two elements is what makes it possible to remove an eye lens without the need for any large or invasive incisions. 

With the natural lens material removed, it’s now time to place the new artificial lens into the empty capsular bag that was preserved earlier. Most modern artificial lenses are flexible, which means they’re folded and precisely placed in the natural capsular bag.

Because the incision is so small and designed to be self-sealing, stitches aren’t usually required. Your eye’s natural pressure helps the wound close at the end of the procedure.

Phacoemulsification has been refined over several decades and is now the routine method used for the vast majority of cataract operations across the UK. At OCL Vision, detailed pre-operative measurements and personalised lens planning are integrated with this established technique to support accurate and carefully planned visual outcomes.

Laser-assisted vs traditional cataract surgery

Some clinics, including OCL Vision, offer laser-assisted cataract surgery using a femtosecond laser. This technology is designed to automate certain early steps of the procedure.

The femtosecond laser can be used to create small corneal incisions and the capsulotomy that would be performed manually by your surgeon during a phacoemulsification procedure. It’s also used to soften or segment the cataract, which might reduce how much ultrasound energy is required. 

Both approaches aim to safely remove the cloudy lens and carefully place the new intraocular lens. The advantage of the femtosecond laser procedure is in the precise programming and reproducibility of the early cataract removal steps. 

OCL Vision was one of the first clinics in the UK to offer femtosecond laser cataract surgery. Several of our consultant ophthalmologists specialise in this treatment, including Ms Masara Laginaf and Ms Laura de Benito-Llopis.

Anaesthesia options

Cataract surgery is usually performed under local anaesthetic using eye drops. These drops are applied shortly before the procedure and numb the eye, so you shouldn't feel pain during surgery. In some cases, an additional local anaesthetic injection around the eye may be used to improve comfort and reduce eye movement. This depends on clinical needs and isn’t always a requirement. 

Typically,  you’ll remain awake during the operation so you can follow simple instructions, such as looking towards a light. This helps the surgeon maintain accurate positioning throughout the procedure. While this can sound a little unsettling beforehand, most patients find the experience calm and controlled once surgery begins.

You shouldn’t feel any pain during cataract surgery. You might experience sensations like pressure, the feeling of cool fluid on the surface of the eye, or bright light from the operating microscope. It’s also common to see shifting colours or shadows during the procedure, but you won’t be able to see the instruments clearly.

You might be given a light sedative if you’re feeling unsettled about the procedure. This can help to ease anxiety and make the experience feel less overwhelming.  It’s worth noting that the sedative does not put you to sleep, and the surgery is still performed under local anaesthetic.

It’s quite rare that general anaesthesia (where you are completely asleep) is required. Situations where this might be considered include severe anxiety, certain neurological conditions, or scenarios where remaining still would be difficult.

How long does cataract surgery take?

The cataract surgery procedure itself usually takes between 15 and 30 minutes per eye.  You can expect to be at the clinic for around 3 hours in total on the day, which includes arrival and check-in, preparation, and a short recovery period. 

The preparation time before the operation is vital, with pupil dilating drops administered alongside other final checks and theatre preparation. After surgery, you’ll rest for a short period while our staff ensure you are comfortable and stable.

It’s important to remember that you’ll need someone to accompany you on the day, as you won’t be able to drive immediately after the operation. If you’ve travelled by public transport to the clinic, it’s still advisable to have someone with you, as your judgment and balance will still be stabilising. 

Can both eyes be treated on the same day?

If you’ve chosen to have private treatment, it’s often possible to have cataract surgery in both eyes on the same day.

This is known as bilateral surgery, and is an option if your surgeon believes you’re suitable following an assessment.

Bilateral surgery is a popular choice as it avoids having to wait for your second treatment. At OCL Vision, around 50% of patients with cataracts in both eyes choose same-day cataract surgery.

Whilst the procedures take place on the same day, they are treated as strictly distinct treatments with separate instruments and preparation.

The assessment to understand if you're suitable includes assessing how similar your cataracts are, along with eye health and any other conditions that would make staggered surgery a safer option. Practical considerations, like travel and support at home, will also be taken into consideration.

For some patients, the idea of having all procedures done on the same day appeals, as it limits the disruption and overall recovery window. Others might prefer to have one procedure and wait to see how that settles before going ahead with the next operation. Both approaches are safe and well-established, so the choice between bilateral and staggered surgery can be tailored to your preferences and clinical needs.

Considering cataract surgery

Cataract surgery is a carefully planned and very common procedure designed to restore clearer vision. 

Modern surgical techniques, such as phacoemulsification and femtosecond laser surgery, use small incisions and refined instruments to perform precise, safe procedures. 

Cataract operations typically only take 15-30 minutes per eye, and in total, you can expect to be at the clinic for around 3 hours. It’s a brief routine procedure, and means that you can return home on the same day to recover and relax. Knowing what happens before, during and after surgery often makes the decision to have treatment feel less daunting.

For some, the main concern is being awake. For others, it’s whether the outcome will meet their daily visual needs. These questions are all entirely valid, and it’s normal to feel a little anxious or have specific concerns about what will happen on the day. 

At OCL Vision, cataract treatment is consultant-led from the initial assessment through to follow-up. Our expert team is on hand to guide you through each step, from initial assessment to follow-up appointments in recovery, ensuring you feel informed and reassured along the way. 

If you’d like to understand how recovery typically progresses, you can read more about recovery after cataract surgery. To explore the different intraocular lenses available, including premium options, visit lens options for cataract surgery.

For personalised advice, you can book a cataract consultation to discuss your vision goals and receive a tailored treatment plan.