The ultimate guide to the best treatment for your sight problem
Until a couple of decades ago, the most common way to correct a person’s sight problem was for them to wear spectacles or contact lenses.
Now, however, sophisticated corrective eye surgery techniques can reduce or entirely eliminate the need for glasses. But which should you choose?
We speaks to the experts who outline the different procedures available – and identify which is best for you...
Eye spy: Although LASIK eye surgery is a common solution to eye problems, it is not always the optimum choice
WHAT IS IT?
A cataract is a clouding of the lens, the part
of the eye that helps focus light on to the retina to form an image. As the lens ages, it can turn yellow and cloudy so that light is unable to pass through to the retina. The result is that vision becomes blurred.
Lens replacement surgery. HOW IT WORKS
Most cataract surgery is performed under local anaesthetic and the procedure takes about 30 minutes. ‘The old lens is usually removed using a technique called phacoemulsification,’ says Mr Niall Patton, consultant ophthalmologist, cataract and vitreoretinal surgeon at Manchester Eye Hospital. This involves making a small incision in the cornea – the surface at the front of the eye – with a blade before the cataract is broken up using high-frequency ultrasound. Some clinics now use a state-of-the-art laser to create a more accurate incision. The fragments are then removed through a fine tube before an artificial lens is inserted which unfolds once it is in place inside the eye.
‘Lenses are fixed on the NHS for just one level of vision, usually distance,’ says Mr Patton. ‘Patients are then left needing glasses for reading and close-up work. Premium lenses, such as multifocal lenses – for distance and near vision – are only available privately.’
20/20 vision: Nicole Kidman has had LASIK surgery to correct her blurred vision
‘Patients are usually advised to take a week off work,’ says Mr Patton. ‘And they’ll need to use eye drops to aid healing and prevent infection for approximately four weeks.’
Monofocal lenses are available in NHS hospitals, but for £2,000 to £2,500 privately. Multifocal lenses are £3,000 to £3,500.
WHAT IS IT?
Short-sightedness or myopia usually occurs because the eyeball is too long or the cornea is too curved. The cornea is responsible for focusing light on to the lens and, in turn, the retina. In a myopic eye, light doesn’t reach the retina, resulting in blurred distance vision.
LASEK surgery, which involves using a laser to reshape the cornea, without an incision.
HOW IT WORKS
Laser eye surgery works by removing tissue from the cornea to change its shape. Although LASIK surgery (see the LONG-SIGHTEDNESS panel below) is the most commonly used type of laser eye surgery, LASEK surgery can be used when a patient’s cornea is too thin for LASIK. ‘It’s also used if you participate in active sports and are at risk of being hit in the eye,’ says Prof David Gartry, consultant ophthalmic surgeon at London’s Moorfields Eye Hospital.
The procedure, under local anaesthetic, involves alcohol applied to the eye to soften the protective layer so it can be pushed to one side. Once tissue is exposed, the cornea can be reshaped. It takes ten minutes per eye
One week off work is advised because vision may be hazy for up to ten days.
£2,500 to £3,500 for both.
WHAT IS IT?
Long-sightedness, or hypermetropia, is caused by the eyeball being too short or the cornea being too flat. Both defects cause the light to focus beyond the retina, making it difficult to see nearby objects. Distance vision is usually normal.
LASIK or IntraLASIK surgery, involves cutting into the eye in order to reshape the cornea.
‘Laser surgery is more limited when treating long-sightedness,’ says Prof Gartry. ‘That’s because it’s easier to flatten the surface of the cornea – as we do with short-sight – than it is to make it more curved, which is what we need to do to correct this problem. Patients are left with a greater chance of needing glasses afterwards, albeit with a weaker prescription.’
How it is done: Laser eye surgery works by removing tissue from the cornea to change its shape
HOW IT WORKS
‘After applying anaesthetic drops, a small flap is made on the surface of the cornea,’ says Prof Gartry. ‘IntraLASIK uses a laser and LASIK uses a small, hand-held device.’ Another laser is used to remove some corneal tissue, thereby reshaping it before the flap is replaced. The procedure takes around ten minutes per eye. Nicole Kidman had Lasik surgery to correct her blurred vision. She says: ‘Now I have 20/20 vision and I notice if people are watching me, but I also smile back if someone waves.’
‘We also have new Wavefront technology to guide and customise the IntraLASIK procedure,’ says Prof Gartry. ‘It measures the eye’s prescription at initial consultation, meaning the treatment is more accurate.
Patients are usually back at work after two days.
£3,000 to £4,000 for both eyes with the Wavefront technology.
WHAT IS IT?
Presbyopia is the medical term used to describe age-related long-sightedness that develops from the mid-40s onwards. As the eye ages, the natural lens loses its flexibility and ability to focus, due to weakening muscles. This means that close-up objects become more difficult to see and the sufferer needs the help of reading glasses.
WHAT TO ASK YOUR SURGEON
It is important to ask your surgeon the following questions before you decide to undergo a procedure.
Do you have the Certificate of Competence from the Royal College of Ophthalmic Surgeons?
How many procedures do you perform a year?
What is your success rate?
What is the complication rate for your clinic?
How much formal training do you have in laser eye surgery?
Are you accredited and do you hold a specialist NHS post?
Professor Gartry also warns: ‘Beware any clinics offering “two eyes for one” deals and discounts if you book by a certain date. A patient’s decision to have a surgical procedure shouldn’t be based on an offer with a deadline.
'And, of course, ensure you’ve seen the surgeon performing your operation ahead of the procedure to fully discuss your options.’
Lens replacement surgery or Laser Blended Vision (LBV).
HOW IT WORKS
‘The lens replacement procedure is the same as for cataract surgery,’ says Mr Patton.
‘Multifocal lenses are generally implanted to replace the ageing lens rather than monofocals.’
LBV works by making one eye see better at distance and the other better close-up.
‘With LBV, both eyes see at distance and near, but one performs slightly better at distance, while the other is slightly better close-up,’ says Professor Dan Reinstein of the London Vision Clinic.
‘The brain merges the images from both eyes naturally and 97 per cent of people can adapt to this slight difference.’
LBV tends to be performed using the LASIK method.
‘It’s a much less invasive alternative to lens replacement for presbyopia,’ says Prof Reinstein.
Vision can settle within just three hours.
From £4,800 for both eyes.
WHAT IS IT?
Astigmatism is a condition that causes blurred vision due to the cornea being unevenly curved. The irregular shape results in two focal points rather than one.
ReLEX smile, a new ‘keyhole’ version of LASIK surgery. It can also correct short-sightedness and presbyopia. It is so new it is only available at the London Vision Clinic.
HOW IT WORKS
Under local anaesthetic a laser cuts out a small disc of tissue in the front of the cornea, without the need for a flap.
‘The laser passes through the surface of the cornea to outline the tissue to be removed,’ says Prof Reinstein.
‘It then creates a 2mm incision, through which the surgeon removes the lens or tissue with a super-fine pair of tweezers. It’s much less invasive, so surgeons can treat far higher prescriptions compared to LASIK and LASEK.’
Heals within hours. Patients are back to work the next day.
From £4,800 for both eyes.
Patients with wet age-related macular degeneration need regular injections into the eye to preserve their sight.
Sheila Rossan, 75, a management consultant from London, was one of the first to undergo a new procedure that reduces the need for the painful jabs.
'It was terrifying because I knew AMD can cause the loss of central vision,' said Sheila Rossan
Glancing at my tiled kitchen floor four years ago, I was shocked to find that instead of running in straight lines, the grout between the tiles seemed to be doing a hula dance: it wiggled and waved all over the place.
Then when I picked up my crossword, the two final columns seemed to be falling away.
My sister, Mitzi had developed the same symptoms a few months earlier and been diagnosed with a degenerative eye condition, age-related macular degeneration (AMD), so I knew I needed urgent treatment.
I called my GP and she referred me to Moorfields Eye Hospital in London as an emergency the next day.
You can do a self-test for AMD using an Amsler grid, made up of horizontal and vertical lines, so I printed one off the internet.
When I focused on the central dot with my left eye, the straight lines curved and there was a dark shape at the centre.
It was terrifying because I knew AMD can cause the loss of central vision, which you need for looking straight ahead.
At Moorfields the next morning the consultant injected dye into a vein in my arm which travelled up to the eye to highlight the blood vessels.
He confirmed I had wet AMD in the left eye — abnormal blood vessels were clustered under the macula, which is the central part of the retina at the back of the eye.
'You can do a self-test for AMD using an Amsler grid, made up of horizontal and vertical lines, so I printed one off the internet,' said Sheila. When these blood vessels leak, they can cause inflammation and scarring, damaging eyesight. My right eye was clear. I then had Lucentis injected into the side of my eyeball — this drug stops the chemicals that make these blood vessels grow and leak and can even reverse the disease. Though I had local anaesthetic drops, the needle hurt horribly. The doctors warned that the condition could return and I met people who’d had 30 injections, which sounded dreadful. That day my eye felt so uncomfortable I just wanted my bed. Though it looked normal, the eye felt gritty and I had to take antibiotics for five days and couldn’t swim or wear eye make-up. Every four to six weeks, I’d go back for checks and more Lucentis, if needed. Though the idea of an injection was repulsive, I knew it could save my sight from deteriorating. Over two years, I had around 14 injections. Once my eye was terribly painful for a couple of days and another time the doctor broke blood vessels. On one visit I refused an injection because I just couldn’t bear it.
'Over two years, I had around 14 injections,' said Sheila
I checked my sight weekly, and the black shape in the centre of the Amsler grid turned grey, then disappeared after a couple of injections, showing an improvement.
Then my husband, Alfred, read about Oraya’s IRay device, a new treatment being tested where a low-voltage X-ray beam is aimed at the abnormal blood vessels to stop them growing, and reduce inflammation and scarring.
Moorfields referred me to the consultant doing the trial, Tim Jackson at King’s College Hospital in London.
I had the treatment in April 2011 — it involved looking down a microscope while beams were fired into my eye. I didn’t feel a thing and 20 minutes later I went home.
Afterwards I had tests every month, which showed my left eye was fine.
In the year after the IRay treatment I needed only one more injection (because the blood vessels were starting to grow back), and by last year, I was down to six-monthly check-ups.
By then AMD was starting to develop in my right eye, so I’ve had two Lucentis injections in it. I’m keen to have Oraya but because the trial is over I’ll have to pay for it. But it’s better than going blind.
Now the devastating deterioration has stopped, I can enjoy crosswords and go swimming and skiing, too — without needing more painful injections.
Tim Jackson is a consultant ophthalmic surgeon at King’s College Hospital, London. He says:
Age-related macular degeneration, a condition where cells in the macula slowly die off, affects 510,000 Britons and causes more blindness than all other eye diseases put together.
Around half have wet AMD, the most damaging kind, causing vision loss often within a few weeks or months.
The leaking fluid makes the macula thicken.
It’s like looking through a convex mirror — straight lines are distorted.
Age-related macular degeneration affects 510,000 Briton
Each year 40,000 Britons are diagnosed with wet AMD.
Doctors don’t fully understand its causes, but it usually affects the over-50s and smoking and genetics are also risk factors.
Eating lots of green leafy vegetables is advised because they provide critical nutrients and protect against harmful chemicals generated by light and oxygen combining at the back of the eye.
Older people should visit their optician every year or two and without delay if they notice blurred central vision.
NHS patients have been offered Lucentis since 2008.
Most start with three injections over three months, then return to hospital every four to six weeks and have further injections if the disease has reactivated.
Most patients need four to eight injections a year for life. While some tolerate these well, others dislike them intensely.
Most maintain their vision over the initial few years of treatment and about a third improve, however sight can decline in the longer term.
Each Lucentis injection costs the NHS £1,000.
Radiotherapy has been tried as a treatment for wet AMD as far back as 1993 — but the Oraya IRay is a significant refinement of the technique and aims to reduce or even eliminate the injections.
Cells that are still growing — such as with new blood vessels — absorb more radiation than mature, healthy ones.
Because the IRay is precisely focused, we can target the abnormal vessels and reduce damage to the neighbouring healthy retina.
A trial at King’s College Hospital and other European sites found patients needed around a third fewer Lucentis injections following treatment.
For those with the most active disease, injections were reduced by over half and vision was significantly better than for those on Lucentis alone.
A third of this group needed no further injections over a year.
The treatment is not suitable for everyone with wet AMD, such as where the macula is severely scarred.
And while most patients get some benefit, about a quarter still require at least four injections a year.
Treatment takes around ten to 20 minutes. Anaesthetic eye drops are put into the patient’s eye, then they put their chin in a chin rest.
A contact lens, which is fixed to a bar, is placed over the eye to stop it moving, then the machine fires the three beams at the macula from three different angles.
If the patient moves, the IRay’s tracking device interrupts treatment until the eye is back in position. Afterwards the patient cannot drive home and returns for monitoring a month later.