You can either be referred by your optometrist or your general practitioner to Mr Agarwal. Please request your optometrist or GP to arrange an appointment with Mr Pankaj Agarwal at a clinic convenient to you. Mr Agarwal provides cataract surgery in both Spire Shawfair Park and The Edinburgh. His name must be mentioned in the referral letter. Alternatively, you, your GP or optometrist can make an appointment via the enquiry or referral forms.
Yes, you can. Click here to make a direct appointment.
For Spire Shawfair Park hospital to see Dr Agarwal or if you want to be seen in The Edinburgh clinic, you can phone the clinic and request an appointment with him.
- Make sure you don't drive yourself to the clinic. Most likely, your pupils will be dilated to look at the cataract and back of the eye. This will make your eyesight blurry and is not recommended to drive immediately following this. If you have no option, and need to drive, you may have to wait for 2-3 hours before your eyesight returns to normal.
- Always bring your glasses with you as Mr Agarwal will check your eyesight with the glasses on.
- Please let Mr Agarwal know about all the medications you take. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.
- It is always useful to have a rough idea of your availability for surgery and dates for any planned holidays.
- In the clinic, you will have a thorough eye examination. Please let Dr Agarwal know if you had any previous eye problem, surgery or lasers.
- Prior to the cataract surgery, you will have a pre-assessment. During this, the eyes will be thoroughly examined and measured. The shape of the front eye and the eye's length helps Mr Agarwal decide which lens to implant in your eye.
- An OCT scan will be done to check the condition of the back of the eye.
- Any other health conditions will also be checked.
- If you decide to go ahead with surgery, you will be given information leaflet to advise on how to clean your eyelashes.
Your eyesight will improve.
Sometimes new glasses may temporarily improve the eyesight to an extent. But if the cataract is too advanced, glasses may not help. The only treatment for cataract is an operation.
A cataract usually gets slowly worse. Leaving a cataract untreated does not threaten your eye health generally, but it can be visually disabling.
In certain eye conditions, early surgery is recommended, and Mr Agarwal will discuss this with you.
During the pre-assessment in the clinic, you will have a test performed to decide the power of the implant needed for your eye. There are different options which Mr Agarwal will discuss with you. The most common intraocular lenses used in the UK are monofocal or standard lenses to correct you for distance, and you will need glasses for reading and fine-tuning your distance vision.
You can also opt for monovision which means you will use one eye for reading and the other one for distance. You should only go for this option if you have tried using your eyes in this way in the past with glasses or contact lenses.
Then there is an option of multifocal lenses. These lenses claim to correct for both distance and near. There are potential problems and risks with these lenses - including difficulty seeing at a near or close distance, problems with night vision, haloes and glare. Mr Agarwal will be able to discuss this with you in detail in the clinic.
In this surgery, the natural lens is removed and is replaced by an artificial lens implant. The cloudy lens with a cataract is replaced with a clear lens and the vision becomes clear again.
Most of the cataract surgeries performed in the UK are done by phacoemulsification method, which is a way of removing the cataract using an instrument that makes use of sound waves for breaking up the eye lens.
In this method of surgery, a small cut is made at the edge of the cornea, which is the clear dome at the front of your eye covering the iris and pupil. The cataract is then broken into small pieces using ultrasound (sound waves) and then removed from your eye through the cut.
Mr Argarwal will place the lens implant behind the iris in the same natural bag (or capsule) that held the natural lens in place.
The surgery is done as a day case, and you will be staying in the hospital for 3-4 hours. You will be given further information about what time to arrive in the hospital.
You will be called nearly an hour before the actual time of surgery to prepare you for surgery. The nurses will check your records and then insert drops in the eye to be operated to dilate the pupil.
Mr Agarwal will then meet you and check whether you have any questions about the surgery and make sure you are happy with the discussions and understand the risks and benefits of the surgery. He will then make sure that the consent form is signed and your eye is marked.
The operation is usually performed under a local anaesthetic given as eye drops or occasionally an injection in front of the eye with a blunt cannula.
Sometimes a general anaesthetic is used if you are very anxious. Alternatively, Mr Agarwal will be able to offer you sedation. Mr Agarwal will discuss the options with you. The operation usually takes about 20 minutes.
If the operation is performed under a local anaesthetic, you will need to lie still and flat during the procedure. If you cannot lie still and flat, let Mr Agarwal know. The theatre nurses can provide support so that you are comfortable, and they can adjust the operating table.
Your face will be covered with a cloth to allow Mr Agarwal to work on a clean surface. Air will be blown gently towards your nose. If you are claustrophobic, let Mr Agarwal know.
Once the eye becomes numb, and the pupil becomes large, Mr Agarwal will start the surgery. You will likely see some movements or change in lights or shadows, but the details are not seen properly.
Mr Agarwal makes a few tiny cuts through the cornea, the clear front part of the eye. This cut makes a passage through the dilated pupil to reach the lens.
There are various layers present in the lens of the eye. The outermost layer is called the lens capsule (a natural bag that holds your lens). During the surgery, Mr Agarwal cuts open the front of the lens capsule to reach the lens inside. Using the same instrument, Mr Agarwal reaches the lens and breaks it into smaller pieces to remove it using suction. The lens capsule remains in the eye so that the artificial lens implant can be placed inside it. The new lens is then unfolded within the eye and settles in place within the lens capsule.
After the operation, the eye is covered by a dressing to prevent any foreign particles from entering the eye and keeping it clean. After the surgery, you will be taken to the ward, and you can relax and have tea or coffee. The nurses will then explain to you about the drops you will need to use and supply you with these. They will also discuss with you the dos, don'ts, and aftercare. You can then go home.
If you go home on the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency.
If you are worried about anything, in the hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications.
Once the effect of the local anaesthetic fades, the eye may feel sore. The most straightforward remedy is to take painkillers, such as paracetamol. It is advised to keep the dressing on at least overnight so that the eye is protected. The dressing can be removed the very next day following the surgery. You can keep your eyes open during the day, but you need to cover them during the night for a week only using a plastic eye shield so that you don't accidentally rub while sleeping.
A reddish appearance along with some bruising is expected, which will disappear after a few days.
The after-effects of the surgery are different for different people. Some might feel comfortable and normal the very next day of the surgery. At the same time, some may recover to their normal condition after a few days. Generally, after surgery, the patient needs to follow the course of two eye drops. One is antibiotics, which helps to prevent infection. The other is steroid drops, which will prevent swelling and assist in recovery. It is vital to start the eye drop course at the specified time and finish it. The antibiotic is for one week, and steroid is usually for four weeks unless advised otherwise. The nurse in the ward will let you know for how long it has to be.
As soon as you take off the dressing, the vision will become brighter and clearer than it was before the surgery. You may notice the improvement in vision immediately after taking off the dressing or it may take a few days for the vision to improve. This will vary between individuals. Generally, it takes two to five days to feel completely normal and any cloudiness to disappear completely.
The lens that is implanted in the eye is generally aimed to provide you with clear distance vision without glasses. Most of the time, reading glasses will be needed.
If both the eyes are undergoing cataract surgery, Mr Agarwal will recommend waiting for at least four to six weeks after your second surgery before trying to buy a new pair of reading glasses. It may be noted that the aim of cataract surgery is to make your vision clearer and not to reduce the need for glasses. Therefore some patients may still need both distance and up-close glasses afterwards. You can consult Mr Agarwal for estimating the possible outcome of the cataract surgery.
Cataract surgery is a relatively safe and successful surgery. The possibilities of side effects and complications are very low. The chance of having a complication which would affect your vision in the long term is even lower. In general terms, the success rate of cataract surgery is as high as 98%, which means that the level of your vision will certainly increase after the cataract surgery.
Any numbers which relate to risk are from studies of people who have had this operation. Mr Agarwal may be able to tell you if the risk of a complication is higher or lower for you. Some complications can be serious. You should ask Mr Agarwal if there is anything you do not understand.
One of the most likely problems which may occur after the surgery is known as posterior Capsule Opacification (PCO). When this occurs, the lens capsule bag which holds the artificial lens becomes thick and cloudy. This problem may not happen immediately after the surgery, and typically occurs after a few weeks, months or even years after surgery. This will certainly affect the vision, but it can be corrected by a simple laser procedure which makes the vision clear again.
A few other complications that might occur with a cataract surgery (which are very rare) are:
- Pain, which is usually only mild and easily controlled with simple painkillers such as paracetamol. You may feel pressure or mild discomfort. If you are in severe pain, let Mr Agarwal know as this is unusual.
- Bleeding during or after the operation. Usually, there is little bleeding, and your eye may be slightly red. If it is very red and painful, let Mr Agarwal know as this is unusual.
- Infection may cause blurred vision or even permanent loss of vision (risk: 1 in 1,000). Most infections happen after 2 to 7 days. If your eye becomes red and painful, and your vision becomes blurred, let Mr Agarwal know straightaway. You may need other procedures to control the infection.
- Tear in the bag which holds the lens in place (risk: 1 in 50). A tear may result in some of the jelly that sits within the back of your eye coming forward. Mr Agarwal will need to remove the jelly at the front of your eye during the operation. You may need another operation. A tear may also result in some fragments of the natural lens falling to the back of your eye, which could cause inflammation. You may need another operation to remove the fragments.
- Heavy bleeding inside your eye during surgery may cause permanent loss of vision (risk: 2 in 10,000).
- Clouding of the bag which holds the artificial lens in place (risk: 1 in 10). You might notice a gradual worsening in your vision or blurred vision a few months or years later. A simple laser procedure called YAG capsulotomy can be performed to correct it.
- Retinal detachment, which is the lifting off of one of the layers at the back of your eye (risk: 1 in 300 after seven years). The risk is higher if there has been a loss of some of the jelly within your eye during surgery. If you notice that you suddenly get a lot of 'floaters' or flashing lights, or you think you have a shadow in your vision, let Mr Agarwal know.
- Inflammation in your other eye (sympathetic ophthalmia) (risk: less than 1 in 1 million). This is a potentially serious complication which may be treatable. If you develop pain or blurred vision in your other eye, let Mr Agarwal know.
- Cornea abrasion, where the surface of your eye gets scratched during the operation (risk: 1 in 10). This is easily treated with antibiotic eye drops.
- Cystoid macular oedema, which is a swelling of the area of the retina responsible for visual sharpness (risk: less than 2 in 100). This causes blurred vision and can happen up to 6 weeks after the operation. The swelling usually settles, but you may need anti-inflammatory eye drops or a steroid injection into your eye. Rarely, blurred vision may be permanent.
Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination.
If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours.
Please ask Mr Agarwal when you can return to normal activities. Most people resume normal activities soon after the operation. It is important to look after your eye as you are told, to reduce the risk of complications.
Do not drive until you are confident controlling your vehicle, are meeting the driving standards and always check your insurance policy and with your doctor.
While care has been taken to compile accurate information and to keep it up to date, Mr Agarwal cannot guarantee its correctness and completeness. The information provided in this information sheet is designed to support care and is not a substitute for professional healthcare advice, by a qualified doctor or other healthcare professional, which will be tailored to a patient’s individual circumstances.