Steven

vitrectomy surgery

Steven, 55, is no stranger to issues with his eyesight. As a child he suffered from a lazy right eye, which left him totally dependent on his left eye for vision. He wore glasses routinely, but in his early 50s began to notice that this same eye was becoming cloudy. He was subsequently diagnosed with cataracts and had an operation to remove them and implant a corrective lens. For about eight months everything was fine until, quite suddenly, his corrected eye took a dramatic turn for the worse.

Quite literally, my life has been changed. I can read. I can do my hobbies. I can do all the things I was beginning to think I’d never be able to do again.

“It literally happened overnight,” he recalls. “I remember bending over over at one point the day before and getting a slight pain in the back of my eye. But I just thought it was a migraine or something like that. So I went to bed that night as normal, got up the next morning, opened my eye and – bang – it was full of ‘objects’. There was a matchstick-sized one right across the eye and a spider web of patches over the rest of the eye. I couldn’t read or anything. It was horrendous.”

In A&E, the doctors diagnosed Steven with posterior vitreous detachment (PVD for short), a condition where the vitreous jelly in the eye separates from the retina. Although PVD is common – and in most cases painless and harmless – it can be a red flag for retinal detachment, a much more serious, sight-threatening condition that requires immediate treatment.

With or without retinal issues, however, PVD can cause tiny opacities to appear in a person’s field of vision. These are known as floaters. They vary in kind from small dots and rings to general cloudiness or a cobweb effect. They are also more common in patients who, like Steven, have previously had a cataract operation.

Over the next few months, Steven sought advice from a number of specialists. The general feeling was that he would need to sit tight and wait for his brain to become accustomed to the changes – in effect, to get used to it. Understandably, this didn’t feel like the news he had been hoping for.

“I just thought, I’m not having this,” he laughs drily. “And after three months, nothing had changed whatsoever. So I started to do my own research.

“One of the specialists mentioned a possible operation called a vitrectomy, but said it wasn’t really recommended unless there was underlying damage to the retina. He also said it could be invasive and would require a general anaesthetic.”

In his research, however, Steven came across Andrew Luff’s work at Sapphire Eye Care. Mr Luff is a specialist in vitrectomy surgery for floaters and performs over 100 such operations every year. Encouraged by what he read, Steven plucked up the courage to make contact.

“I booked an appointment to see him, though it was with a bit of trepidation! But the whole thing turned out to be so enlightening. He listened to all my problems and concerns. He took detailed scans of my eyes. And then he used a model of an eye to talk me through the operation and the possible risks. He also said we could do the surgery under local anaesthetic, and that no stitches would be needed in my eye. So I came away very reassured.”

In a vitrectomy for floaters, the surgeon makes three tiny incisions in the eye, removes the vitreous jelly that has become clouded with floaters, and replaces it with a transparent saline solution. If he also discovers evidence of retinal tears or weakness (which could predispose a patient to future retinal tears) while carrying out the surgery, he can then treat these areas with a laser to prevent subsequent retinal detachment.

A few weeks after the appointment, Steven came back in for his operation. He was nervous, but says the team were able to make him feel at home. “All the staff were superb, which really eased the day and any nerves I had,” he explains.

“When you get to the hospital, they describe exactly what will happen and what the anaesthetist will do. You have a couple of jabs around the outside of the eye to anaesthetise it, which I didn’t even feel. You can also have a sedative to help you relax.* That’s optional, but I decided to have it; it’s just a small jab on the back of the hand. From that point you’re aware of everything that’s going on, but you don’t feel anything.

“I think the operation took about 40 minutes, and in my case there was no damage to the retina so I didn’t need to have the gas treatment. They put a patch over my eye to protect it and I left hospital about an hour later. There was a small amount of bruising under the white of the eye and a slight amount of discomfort for the first couple of days, but you just take a little paracetamol for that.”

When Steven removed the patch the next morning, the change was already obvious. “Immediately I took it off, I could see the floaters were completely gone. It was quite incredible. My distance vision was a bit affected by the drops that you take for the first month, but once I stopped those it came back perfectly.”

Three months on, Steven feels the decision to go ahead with the vitrectomy has been justified, to put it mildly.

“I’m absolutely delighted,” he says. “I’m staggered by the clarity of vision and the beautiful, vivid and bright colours – much better than before my PVD. As well as removing the floaters, it has also removed all the opaque jelly.

“If you have floaters and have been told you need to get used to it, there is a solution,” he adds. “I can now read again. I can do all my hobbies again. The difference has been incredible. I have no hesitation whatsoever in recommending it, or Mr Luff and his team.”

* Sapphire Eye Care offers intravenous sedation to all patients, delivered by a consultant anaesthetist.

John

cataract surgery

Since cataracts usually develop slowly, the problems they cause have a habit of creeping up on us – that is, until they become too frustrating to ignore.

This was exactly what brought John, a retired accountant from Hampshire, to Sapphire Eye Care in early 2019.

“I noticed I was having difficulties with my vision at night,” he explains, when we catch up for a chat about his experience.

“I might be walking along and the headlights from a passing car would feel incredibly bright – so bright that it almost hurt to look at them. I’d find myself having to glance away or look down at the ground.

“I realised something similar was happening when I watched television in the evenings. The picture on the TV set just felt too bright for my eyes.”

When John, 75, went to see his local optician, Howie & Tickner in New Milton, the consultant confirmed that he had developed early-stage cataracts.

Glare from bright lights – particularly at night – is a common symptom of cataracts. The lens of our eye is naturally clear, allowing light to pass to the retina unobstructed. When the lens becomes clouded by cataracts, however, light gets scattered around the eye. This interferes with retinal image contrast and makes our eyes more sensitive to brightness. Other red flags include ‘halos’ around light sources, blurred vision when looking at distant objects, and colours appearing faded or washed out.

To make matters worse John was also experiencing headaches when reading. Though he has worn glasses for short-sightedness since his teens, the pain was a relatively recent development.

“I couldn’t do more than an hour or so at a computer. I’d get a headache and wouldn’t be able to get rid of it until I’d taken some paracetamol. It wasn’t at the migraine level, but it wasn’t comfortable either.”

Since Sapphire founding consultant Andrew Luff had treated John’s wife for cataracts in 2008, John’s cataract diagnosis didn’t come as a total bolt from the blue to him. All the same, he adds, it was still a bit perturbing to hear the optician recommend surgery.

“I remember swallowing hard and thinking, ‘OK… hold your nose and go for it,’” he laughs. “Because it’s all very well to have somebody else’s story of surgery, but this would be me going through the procedure.

“But I was reassured by what the optician said. He told me all would be well and that I’d be amazed by the results. So I had no fright about what was going to happen.

“Of course, I knew I could wait before having the surgery. But it felt like the sensible thing would be to go for it now – not to hang around, but to have the procedure and benefit from the good vision afterwards. So that’s what I did.”

When John visited the clinic at Highcliffe Medical Centre, Mr Luff examined his eyes and talked through the options for surgery. Though toric lenses are sometimes recommended for astigmatism during cataract procedures, Mr Luff felt John would be able to achieve good visual correction with standard cataract lenses. (A toric lens has different powers for a vertical line compared with a horizontal line, whereas a regular lens has just one power.) So he booked in for surgery and returned for the treatment a few weeks later.

“To be honest, I was a little bit apprehensive on the day,” John admits. “When you go into hospital, they initially measure your eyes again. Then Jane [King, Sapphire’s Ophthalmic Nurse Specialist] talked through everything again, so I knew exactly what was going to happen. But when my blood pressure was taken it had gone up to about 170, which is about the highest I’ve ever known it! So I was obviously feeling a bit nervous.

It was all very comfortable. Nothing hurts…

“After that, though, you meet the anaesthetist and he’s able to offer you some sedation if you want it.* So I was given some and from that point on I felt thoroughly relaxed throughout the whole process. It was all very comfortable. Nothing hurts. In fact I found myself actually looking forward to the second operation [on the other eye], because the whole thing was so smooth and interesting.

“After the operation you’re taken back to your room. I had something to eat, and they measured my blood pressure again. And then I was free to go home. You’re given eye drops to take with you, and each one is clearly labelled, with a matrix for when you need to take them over the coming weeks.”

Because John’s first procedure was on his dominant reading eye, he wasn’t able to appreciate the full vision changes until the second procedure had been completed 10 days later. But from that point on, he explains, the difference was profound.

“It was absolutely sensational. Not long afterwards, I went up to the clifftops at Barton on Sea and I remember looking out to the Purbeck Hills [25 miles away] –  I could see them with perfect vision.

“Driving and reading are fantastic now, too. I have some inexpensive glasses for reading, just 1.5 and 2 dioptres, just to see how it all settles down. But I haven’t been rushing off for the paracetamol. I read the papers, watch the TV… there’s been a real transformation.”

Having been through the process, John is happy to recommend it to others.

“Mr Luff was brilliant,” he says. “He’s very good with patient contact. He takes the time to explain things, or to explain them differently if necessary, which I know from my professional experience is very important.

“We met several people who were going in for subsequent tests after cataracts, and everybody was saying how remarkable it is. To be honest, it leaves you feeling slightly euphoric.”

* Sapphire Eye Care offers intravenous sedation to all patients, delivered by a consultant anaesthetist.

Adrian

cataract surgery

Most people know that cataracts get worse over time, but when exactly is the right time to have them removed?

That was a question that Adrian, 71, faced when his cataract-induced eyestrain went from manageable to intolerable within the space of a few short months.

“I’m a business coach and mentor, so I do a lot of work online,” he explains. “But in recent months I’d noticed my eyes were becoming extremely strained when I looked at my laptop screen.

When I stared at the computer screen, it almost hurt.

“It wasn’t as though I was completely unaware that I had cataracts. I’d had a routine eye test about a year before. The optician said my eyes were starting to show the first signs, but that surgery might still be a long way off. As it turned out, however, they got a lot worse over the next few months.

“I guess you’d say it was a bit like having a partially-frosted sheet of glass in front of your face. I couldn’t see all the words clearly when I was reading. When I stared at the computer screen it almost hurt. I don’t want to exaggerate the problem but it got to the stage where it was very, very uncomfortable.

“So at that point I thought to myself, ‘This is so uncomfortable that I’m going to look into having surgery privately.’ I’m fortunate enough to have a health insurance policy, and when I got in touch with the company they told me I would be covered for cataract surgery.”

On a recommendation from his optician, Adrian made an appointment with Sapphire consultant Andrew Luff. Mr Luff examined Adrian’s eyes and then talked him through the ins and outs of cataract removal.

Cataract surgery involves removing the eye’s cloudy lens and replacing it with a clear, artificial implant. This new lens can provide visual correction for long- or short-sightedness: either with a single point of focus (monofocal), or a multifocal lens that offers a degree of freedom from spectacles for many everyday tasks. (For more detail, read our cataract briefing; see especially “Which implant lens should I have?” in the FAQ section)

Having worn glasses routinely for over 50 years, Adrian says it felt quite strange to contemplate the idea of being able to dispense with them in any capacity.

“I’ve worn spectacles for short-sightedness since I was about 18, and in the end of course, you just get used to it. It was just a question of having regular eye tests to make sure the prescription was accurate. So that’s what I had been doing ever since.

“I really didn’t know much about cataract surgery, to be honest. But what I liked about Mr Luff was his confidence. Sometimes you meet professionals who know their job inside out, where you can tell, intuitively, that you’re in safe hands. That’s how he came across. And I found that very reassuring. After that initial consultation I knew I’d made the right choice of surgeon, because he gave me lots of confidence.”

As it happened, the operation was able to go ahead more quickly than he had imagined. “I had one eye done on the Monday, followed by the other one on the Thursday of the same week! Normally you’d have longer between the two operations [the NHS estimates an average of six to 12 weeks between procedures], but Sapphire were able to be flexible around my diary.

“I didn’t really feel any nerves on the day. When I got to the hospital – the Nuffield Wessex, near Eastleigh – they were very efficient. I was really impressed with the staff. When I got into the operating theatre everything was lined up and ready to go. The operation itself lasted about 20 minutes from beginning to end, and Mr Luff explained everything as he went along, step by step. There was no pain involved whatsoever.”

Post-op, Adrian found the vision change was fairly dramatic. “The impact was almost immediate,” he recalls. “If I looked about four feet in front of me, I could see everything more clearly without my spectacles than I could with them on. My short to long range vision was brilliant.

“Mr Luff and the nurses had advised me that I would need some reading glasses for very close-up work, so after the operation I went out and bought a couple of pairs of inexpensive reading spectacles. In the first few weeks after surgery you need to give your eyesight a bit of time to settle down, so you can assess what prescription you need for clear and near vision.

“When I went back to the same opticians, they did another eye test and recommended a glasses prescription that would allow me to see very clearly in the very short range. And I’m very happy with that. I’m now cataract-free, but I no longer have to wear spectacles all the time either. I just pop a pair on now and again when I’m working.”

Eyestrain, too, is now a thing of the past. Putting it all together, Adrian says he would recommend the procedure for anyone who might be in a similar position.

“The whole process was very swift and trouble-free – and frankly, in a world that is so often chaotic and stressful, that’s a big relief. You don’t get many things in life that are more important than your eyesight; to have it resolved so quickly and so efficiently was very pleasing indeed.”

Julie

cataract surgery

Severe short-sightedness had been part of Julie’s daily experience for as long as she could remember. Until recently, she had a prescription of -22 and needed to wear specialist glasses or contact lenses throughout the waking day. But when an optician diagnosed her with early-stage cataracts, Julie – a 56-year-old editor by trade – began to contemplate having surgery for her vision for the first time. A year on, her eyesight has been completely transformed. We asked her to tell us her story…

“Extreme short-sightedness was something I had learned to live with over many years. It had never stopped me from undertaking anything, but I certainly had to adapt the way I approached various activities – hobbies like swimming, scuba diving and horse riding, for example, which I love.

“In a way, I had always been quite fortunate; I had the capacity to wear both corrective glasses and contact lenses, despite my extreme myopia. But the glasses were very heavy by virtue of their prescription, and as any contact lens wearer will know, eye contact with non-saline water should be avoided. This meant both diving and riding had to be adapted. And, as an editor, reading had also been a key capacity to maintain for my job.

I walked into the operating room a bundle of nerves but came out totally transfixed by the whole experience. It was nothing like I had imagined. None of the anticipated horrors had materialised

“I first discovered that I had the very initial stages of cataracts at a routine eye appointment. My optician explained that, although no one could be sure, the cataracts might take some time to form. I had imagined it would be quite some time before I needed to consider surgery – as it turned out, just six months later I was told that a referral would now be sensible. That was a huge shock.

“The eyesight I had become so adapted to may have required extreme correction over the years, but it was all I knew. Any suggestion that I needed surgery for something better, with all the known incumbent risks attached, caused me a considerable amount of worry. But the changes in my sight had been relatively fast, and changes to my long-distance sight could quite soon mean I would lose the capacity to drive. To leave my eyesight as it was, was no longer an option.

“When I was referred to Mr Andrew Luff at Sapphire Eye Care, he recommended surgery to remove the cataracts, replacing my natural lenses with corrective implants. However, the preparation needed for these operations was something I had not anticipated and it required some organisation around daily needs. Because I had been a contact lens wearer for over three decades, I would be required to cease all contact lens wear for two weeks before the initial consultation. This was to allow the eye to return to its default shape so that the measurements taken would be from the natural eye shape. Since I drove with a combination of contact lenses and top-up glasses, this meant I could not drive for two weeks before the consultation, so arrangements had to be made to allow for this too.

“My decision to go forward with the operations was a difficult one, albeit a foregone conclusion because of the imminent changes occurring in my eyes. There was a huge sense of the unknown, together with the anxiety that went with it. I was very scared indeed. Scared of the surgery and the actual procedure, and scared of the outcome. In hindsight, it was all a very anxious mix of emotion that I was struggling to keep under reasonable control – and only just managing to do so.

“On the day of the first operation, I fretted that I may react badly to someone operating on my eye, even though I knew I would feel no pain. And I was also worried that my asthma, which had been around all winter and probably been made worse by the anxiety, would result in me coughing under sedation just when the operation on my eye was underway such that I would not be able to do anything to stop it. I could not imagine a worse scenario.

“But here is the thing… on the day I walked into the operating room a bundle of nerves, but came out totally transfixed by the whole experience. It was something amazingly interesting and nothing like I had imagined. None of the anticipated horrors had materialised, indeed for some reason from that first day onwards, my asthma subsided completely!

“The reality was that during the operation, although I was sedated but conscious, I saw just a single light in the ‘distance’ surrounded by dark, and had absolutely no sensation of the surgeon working on my eye at all. I did not register any people or equipment in the surrounding area either. I heard a little water being used but there was no feeling of this; in fact my eye did not register any movement or pain whatsoever. My concentration was focused on the light in the distance, and that was where I seemed to be, too – in the distance.

“I remember at the end of the surgery feeling totally amazed at the experience and captivated by the extraordinary nature of the op. And most of all, as I stood up, that I could see out of my eye, even just after the surgery. This was my long-distance eye, and I could see down the corridor and everyone walking towards me for the first time ever in my life with no visual aids.

“Ten days later, I returned for the second eye operation on my near-distance eye and this was a totally different anticipation. I could not wait to get on with the operation; I had a complete 360-degree turnaround in confidence. But this time, when I stood up after the op, I could see out of both eyes – with no visual aids.

“The recovery time for both eyes was almost faultless and there was minimal discomfort throughout the month following each op. I kept to the eye drops schedule without any deviation, and kept each eye covered with a hard patch for four nights after the op, just to try and with no possible risk of infection. And of course, with the eye covered at night, I knew I could not rub my eyes in my sleep – and the whole recovery was made that much easier.

“The change in eyesight was immediate. The original plan had been to adjust the sight for long distance and have low-strength top-up glasses for reading and close-up work. But to my astonishment, when I had my first eyesight check-up, it was found that I could not only see long distance (and driving), but I could also read the smallest reading print size. This was more than I could ever have hoped for and imagined possible. Now I wake up in the morning and I do not have to put on glasses. I walk out to the car and drive with no glasses. I can go swimming and see without visual aids. And contact lenses are no more.

“There was a certain period of elation that has never quite subsided. I still have to pinch myself and old habits die hard – I often still think I should remove my contact lenses before I turn in at night – only to then remember I do not have any lenses anymore and I can just see properly!

“The decision to go ahead with the ops was the right one. I am eternally grateful to Sapphire Eye Care – to Andrew Luff and his amazing and attentive team – and for the opportunity to have such incredible surgery. Just 20-odd minutes in reality, yet so very important in the way it can improve lives.

“I would urge anyone with extreme myopia to pursue the possibility of lens replacement surgery if they are offered it: it can be utterly life changing and I can thoroughly recommend it.”

Grace

Vitrectomy surgery

As an award winning blogger with an eye for a good story, Grace doesn’t pull any punches when it comes to her vision issues.

“Blind as a bat!” is how she describes her pre-operation eyesight.

“I was totally dependent on my contact lenses and pebble-thick specs – without them I had only a very blurry, ethereal view of the world,” says the writer, whose day job involves running a popular online magazine for older women called Annabel & Grace.

“Wearing glasses with such thick lenses was not my idea of fun. They weren’t very flattering, to say the least. And my wearing time for contacts had been gradually reducing, too. My eyes were getting drier more quickly during the day.

“To make matters worse, I had also started suffering from floaters. Floaters are tiny opacities in the vitreous of the eye. They feel a bit like having translucent grey worms swimming in your field of vision. They had crept up on me over the last few years, but I’d simply put up with them because I was told it was tricky to remove them. My right eye was particularly bad.”

Despite the obvious frustrations, Grace had more or less resigned herself to living with her vision issues. But that changed when she went for a routine optician appointment and was told that her eyes were also developing cataracts – which was a bit of a shock, to put it mildly.

“I had absolutely no inkling at all,” she explains. “I thought a cataract was an opaque membrane over an eyeball, and I knew I didn’t have that.

After 50 years of viewing the world as an indistinct, blurry mess, it was pretty much a miracle…

“When I got the diagnosis, my mother said, ‘Oh you don’t need to worry. They can take years to develop and they need to be ripe before you can have them operated on.’ But my optician told me that the technology is so good these days that you can have cataracts sorted out as soon as they appear.

“She recommended Mr Luff of Sapphire Eye Care, who had operated on her own torn retina. Another two friends knew of him, too, and said he was especially known for vitrectomies.”

When Mr Luff examined Grace’s eyes, he confirmed that she had both early-stage cataracts and a “spectacular number of floaters” – but that he could treat both conditions with a combined cataract and vitrectomy procedure. The same operation would also be able to correct her short-sightedness.

“When I found out that the operation also meant I wouldn’t have to wear contacts or glasses anymore, it was a no-brainer,” she admits.

Understandably, Grace says she was quite nervous about the first operation on her right eye (eye surgery of this kind is commonly carried out on one eye first, before the other eye is operated on a week or two later). On the day, however, she was given a light sedative to help her relax.

“A tiny intravenous cannula was put into the back of my hand,” she explains, in the article she later penned for her website.

“I did not feel a thing except that, in a millisecond, the sedative hit home and I was very woozy and happily chatting (or was it mumbling?!) to the surgeon. Any anxiety I had completely disappeared… I could not see or feel anything during the operation.

“It took about 45 minutes to replace my lens and remove my floaters (vitrectomy). It felt more like 30 seconds. The next thing I was aware of was sitting in an armchair drinking a delicious cup of tea and feeling pleasantly groggy.”

After being given a protective patch to wear over her eye, Grace went home to recuperate. She was asked to take a course of eye drops for the next four weeks, and told to keep the patch on overnight. Peeling it off the next morning was, she admits, a slightly nerve-wracking experience! But the change was immediately apparent.

“I could see. And see clearly,” she recalls on her blog. “My eye was pretty bloodshot but there was no discomfort. After 50 years of viewing the world as an indistinct, blurry mess until I popped in my contact lenses each morning, this was pretty much a miracle as far as I was concerned.”

Returning for the second operation, Grace had none of the anxiety she’d felt first time round. The procedure on her left eye took only 10 minutes, and she was able to see perfectly afterwards.

Three months on, she says she still appreciates the freedom of being able to wake up in the morning and see clearly, without having to reach for the lenses. Happily, she has even been able to dispense with the reading specs – good news for someone who spends so much of her time reading and writing.

“I was told originally that I’d need to keep using reading glasses, which I didn’t mind. However, after my two (painless) ops, I don’t even need reading glasses.”

Having taken the plunge on treatment for her vision issues, Grace is very happy to recommend the service to others.

“I was impressed by the set-up and by the professionalism and kindness of the staff,” she says of her experience. “I felt I was in very good hands.”

Annabel & Grace is an online magazine, predominantly aimed at women in their mid- 30s and up. It covers everything from recipes and age-appropriate fashion to travel, cultural reviews and product recommendations. You can read more of Grace’s stories on, www.countrywives.co.uk. (Please note that Sapphire Eye Care is not responsible for the content of external websites.)