Cataract

Age-related cataract is one of the commonest reasons for referral to ophthalmology services and approximately 330,000 cataract operations are currently carried out in England and Wales per year.

Surgical removal of the cataract is the only effective treatment for the condition, and is normally recommended when the symptoms of cataract (blurring of vision, glare) or reduced visual acuity become significant – for example where the ability to meet the legal visual standard for driving is under threat. The primary aim of cataract surgery is the restoration of clear vision which, particularly in the elderly, is important for maintaining independence and reducing the risk of falls.

Cataract surgery is normally carried out using the technique of phacoemulsification (fragmentation of the nucleus of the lens using ultrasound) through an incision of about 3mm or less. The capsule of the natural lens is retained and is used to support an artificial lens made of a flexible polymer which is injected through the same incision. The great majority of cataract operations are carried out under local anaesthesia as day case procedures.  The procedure is normally very well tolerated by patients and it is usually possible to resume most activities within a few days.

The fact that cataract surgery is fairly quick to perform and has a high rate of success tends to create a false impression that it is a minor procedure. In fact, it is a technically exacting procedure to perform and requires a very high level of manual dexterity. The specialty training curriculum for ophthalmology places considerable emphasis on training in cataract surgery and surgeons in training are expected to have performed at least 350 cataract operations by the time they complete the training programme. Surgeons in training are also expected to complete a minimum of 50 cataract operations per year from the third year of training onwards and there is evidence that this frequency of exposure to surgery is important to acquire the necessary skills. Whether a similar minimum frequency of exposure to cataract surgery is necessary for cataract surgeons to maintain their skills after completion of training is less clear, but there is evidence that surgical complication rates tend to be lower in surgeons who undertake larger numbers of cataract operations.