Clinical Review

Recent advances in customising cataract surgery

  1. Malcolm Woodcock, ophthalmology specialist registrar1,
  2. Sunil Shah, consultant (,
  3. Ronald J Smith, associate professor2
  1. 1Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH
  2. 2Jules Stein Eye Institute, 100 Stein Plaza, University of California Los Angeles, CA 90095-7000, USA
  1. Correspondence to: S Shah

    Cataract surgery has advanced a lot over the years. This review describes the latest techniques and how they are used to customise the surgery to the needs of the individual patient


    Cataract is an important cause of visual impairment worldwide. In the United Kingdom, 30% of people aged over 65 have visually impairing cataract (that is, Snellen visual acuity of less than 6/12 attributable to a lens opacity) in one eye or both eyes.1 (See table A on for risk factors.) A visual acuity of 6/12 is below the legal vision requirement to drive in the United Kingdom, which approximates to a visual acuity of 6/10, and evidence indicates that cataract surgery may even decrease the incidence of road traffic crashes among people over 65.2 The NHS does approximately 200 000 cataract operations annually, making this one of the most common surgical procedures in the country.3 Despite this, 88% of people with treatable visual impairment from cataract are not in contact with any eye healthcare services, which represents a very large potential healthcare need.1

    The fundamental aim of cataract surgery, the removal of the opacified natural lens to improve vision, has remained the same for hundreds of years. However, the way in which this is achieved and the expectations of the people having the surgery have altered drastically (table 1). Here we give an overview of some of the advances that allow cataract surgery to be customised for each patient. We discuss the process that patients go through from their first meeting with an ophthalmologist, through the preoperative assessment, to the actual surgery itself and beyond to the appraisal of the results of that surgery. The visual potential of the patient can be realised in many different ways, and when looked at in this context …

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