A cataract is the clouding of your natural crystalline lens inside your eye. This transformation happens over a lifetime. Without you realising, your appreciation of colours gradually changes with the world developing a sepia tone. As they progress, cataracts cause increasingly blurred vision. You may also notice that your night vision deteriorates with glare, halos, and starbursts around lights.

A cataract doesn't ripen - this is a construct developed to delay and rationalise the need for surgery. As a cataract develops, it speeds changes in your glasses prescription, meaning you will likely need to change your glasses more frequently.

We all have different occupations, interests and visual needs. Ultimately, the time for surgery is when the cataract impairs your quality of life.

Cataract surgery is one of the most common and safest procedures performed. Millions are performed each year. No surgery is without risk, but the risk of causing you to lose your eyesight is less than 1 in 10,000.

In the UK, we are very fortunate that cataract surgery is integral to an ophthalmologist's training. However, similar to any profession, a range of abilities exist. A good guide is asking about the number of procedures the surgeon performs per annum and their complication rates. Ideally, choose a surgeon where this is their bread and butter, performing routine, higher volume cataract procedures (>~500 per annum).

If you wish to reduce your dependence on contact lenses or glasses following the procedure, choose a Refractive trained surgeon. Refractive surgery is not included in UK training and requires further years of specialist training. Choose a surgeon who has undertaken this additional training and has CertLRS qualification. For further information on lens choices click.

Other tools to decide on your surgeon include online reviews, speaking to colleagues and friends, and discussing with your GP or Optometrist. Additionally, all UK surgeons working in the NHS have their NHS safety data published; https://nodaudit.org.uk

Ultimately you want somebody with whom you can trust and build a rapport.

We describe cataracts by their appearance, splitting them into;

Nuclear - when the centre of the lens is affected - these changes are slow and develop over decades.

Cortical - these changes are at the edge of the lens and typically cause spokes similar to the wheel of a bike. The spoke changes usually start at the outside, moving in with time. They affect the vision increasingly as they move more centrally.

Posterior sub-capsular - when the back of the lens is affected. These grow more quickly and may occur at a younger age. This type affects the vision more profoundly and usually needs surgery more quickly. These can develop following trauma or after using certain medications, such as steroids.

It is common to have more than one of these at a time.

The type of cataract influences how it affects your vision and its development speed but does not make a difference surgically. There are many different techniques used to remove cataracts. The surgeon must have sufficient experience to adapt during each procedure, optimising the technique for your eye.

Denser, more advanced cataracts typically require more ultrasound energy to remove. This can delay healing and make the surgery more technically challenging if very mature. Mr Darcy has years of experience with thousands of cataract procedures. Other surgeons often refer him the technically more complex cases.

We are all fortunate to have the NHS. During times of emergency, the NHS typically provides a quality of care paralleled by the best healthcare systems in the world.

The volume of work can place increased challenges on elective outpatients and surgery, with varying waiting times.

All private providers are also not equal, and doing homework is essential.

In general terms, the differences you should expect from private cataract surgery are;

1. Ability to choose your surgeon.

2. Consultant surgeon

3. Greater convenience with shorter waiting times

4. Full range of intraocular lenses - NHS trusts carry single mono-focal lens banks as a one-type must fit all patients model.

5. Opportunity to achieve greater spectacle independence

6. Astigmatism correction - a limited number of NHS trusts offer toric intraocular lenses, which are only allowable above pre-determined levels. Privately astigmatism should be corrected as standard. We would strongly suggest checking this with your chosen private provider.

7. Premium cataract surgery - the ability to reduce or eliminate your need for glasses at all distances using specialist intraocular lenses.

This is a common question asked and something unique to the UK. The simple answer is no. Alleviating pressure from the NHS frees money and finite resources for the NHS to concentrate on the emergency and cancer care we all occasionally need. This sense of guilt is something unique to the UK and the NHS. Other countries around the world incentivise or even penalise people via increased taxation to reduce the burden on their public healthcare systems.