Requirements
- Stop wearing contact lenses at least 3 days before.
- Continue your usual treatments.
- No eye make-up.
- Arrive fasting.
Home / Surgery / Cataract
Cataract surgery
Seeing clearly again
With the development of cataract surgery and the modernisation of surgical equipment, operating techniques and lens implants, millions of people each year can stop wearing glasses or contact lenses, entirely or in part. It is now the most frequently performed operation in the world.
More than 97% of operations go ahead without complication, and in most cases functional vision returns the next day. I choose the technique and the implant after the examination, not before: every eye is different. And I take the time to explain each step, before, during and after.
Understanding
What is a cataract?
A natural lens that loses its transparency. Nothing more, and that is why we know how to treat it.
Behind the pupil sits a small transparent lens, the crystalline lens. It focuses light so that images reach the retina sharply, like the lens of a camera.
A cataract is the clouding of this lens. Over time, the proteins in the lens clump together and it becomes cloudy, like a misted-up window.
The anterior segment: what the surgery passes through
A clear lens, a clouded lens
The lens is clear. Light passes through it without being scattered and the image forms sharply on the retina.
The lens becomes cloudy with age. Some of the light is blocked and the rest is scattered: the image loses contrast, colours turn yellow and halos appear around lights.
Incoming rays Focal point Scattered light Clouded lens
Surgical principles
Replacing the clouded lens with an implant.
A quick operation, 10 to 20 minutes, following a well-established protocol, carried out in the operating theatre at Clinique Les Martinets.
The six stages of the operation, illustrated →
What if the lens is still clear?
The same procedure can correct presbyopia when the lens is still clear, or when its clouding does not yet affect vision: this is PreLex. The lens is replaced so that you can see close up again without glasses. It is then no longer cataract surgery but refractive surgery, which is not reimbursed, and I generally reserve it for patients over 55. PreLex in detail
Lens implants
The choice that determines your vision after the operation.
The implant is an artificial lens placed behind the iris, in place of the clouded lens. The implant, and the calculation of its power, determine how precise your vision will be.
- Why is an implant used?
- With the right power, it replaces the natural lens and restores visual acuity.
- Are implants permanent?
- Yes. Once in place, they last a lifetime.
- Can the implant be seen after the operation?
- No. It sits behind the iris and cannot be seen.
- Can you feel the implant?
- No. It is painless and cannot be felt.
Technical features
Materials
Hydrophilic or hydrophobic acrylic, biocompatible.
Filters
Against UV and blue light, to protect the retina, particularly in AMD (age-related macular degeneration).
Asphericity
Most modern implants are aspheric: they reduce optical aberrations and improve night vision.
Spherical or toric
Spherical implants correct myopia (short-sightedness) or hyperopia (long-sightedness). Toric implants have their power aligned along a precise axis to compensate for astigmatism: a monofocal, EDOF or multifocal lens can come in a toric version.
Four types of lens, four ranges of vision
-
Monofocal lens
Monofocal
Distance vision
-
Monofocal Plus
Monofocal Plus
Distance and the start of intermediate
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EDOF lens
EDOF
Distance and intermediate
-
Multifocal lens
Multifocal
Distance, intermediate and near
Range of clear vision by type of implant
Indicative diagram. The result depends on your anatomy and on the biometric calculation.
Expected results
The most frequently performed operation in the world.
Nearly 900,000 operations a year in France, more than twenty million worldwide. It is also one of the oldest and best-documented.
Recovery
- Useful vision from the next day in most cases
- Gradual improvement over a few days
- Very quick return to usual activities
- Final glasses prescribed at one month
Comfort
- Local anaesthesia with eye drops, usually without an injection
- Painless operation
- 10 to 20 minutes in theatre
- Home the same day
What improves
- Sharpness and contrast restored
- Brighter colours: many patients rediscover blues
- Easier night vision and night driving
- Halos and glare markedly reduced
In addition
- Myopia or hyperopia can be corrected at the same time
- Astigmatism corrected with a toric lens
- Presbyopia corrected with a multifocal or EDOF lens
- The cataract cannot come back
What the figures say
The success rate is above 97%. Complications, usually minor and temporary, occur in 1 to 2% of operations: out of a hundred people operated on, ninety-eight to ninety-nine have none.
These figures are not guarantees, since no surgical procedure can offer one, and your own case is assessed at the pre-operative assessment. But they give a fair measure of a risk that a list of complications tends to overstate.
That is why the timing of the operation is your decision. Surgery is not done at a set stage, but when the cataract genuinely gets in the way of daily life.
The pre-operative assessment
The step that sets how precise your vision will be.
It determines the safety of the operation and, above all, your result. It is also what tells us whether a premium implant (EDOF or multifocal) suits your eyes.
Visual acuity and cornea
- Measurement of visual acuity and refractive error
- Examination of the pupil
- Corneal topography
- Corneal pachymetry (thickness)
- Corneal specular microscopy if needed
Eye health and implant calculation
- Eye examination with the pupil dilated
- Dry eye test if needed
- OCT, optical coherence tomography
- Biometry personalised calculation of the implant, essential
General health and expectations
- Age, medical history, current medication
- Motivation and realistic expectations in some situations, occasional glasses cannot be avoided
- Information and informed consent: risks and benefits are discussed
On the day
What happens at Clinique Les Martinets.
As a day case, under local anaesthesia. One eye at a time, two weeks apart.
Preparation
- Admission paperwork.
- Additional eye tests.
- Changing into a sterile gown in the day-surgery unit.
- Dilation of the pupil begins.
Positioning
- You lie comfortably on the operating table.
- Local anaesthesia.
- An eyelid speculum is put in place.
The six surgical stages
- Micro-incisions.
- Capsulorhexis.
- Ultrasound fragmentation, then aspiration.
- Injection and unfolding of the implant.
- Antibiotic injection, self-sealing incisions, eye protection.
Immediately after surgery
- Rest in your room and a light snack.
- Instructions and check-up dates explained again.
- Home with someone if possible, by car or taxi.
- Treatment starts the same evening.
The six stages of the operation: front view, then cross-section of the anterior segment
Antiseptic cleaning of the eye surface, anaesthetic eye drops, then placement of an eyelid speculum.
One main incision at the limbus and one or two side-port incisions (paracenteses), with no stitches.
Continuous circular opening of the capsule, which is kept to hold the implant.
The lens is broken up by ultrasound and then aspirated, while the capsule is preserved.
The implant, folded inside an injector, is injected and then unfolds inside the capsular bag.
Antibiotic injection, check that the incisions are sealed, protection of the eye.
Structure involved Clouded lens Implant Preserved capsule
I have been operating on cataracts since 2013, in the operating theatre at Clinique Les Martinets, with an Alcon Centurion phacoemulsification system. Background and surgical facilities
Risks and monitoring
The details, for those who want to know everything.
These complications are rare: one or two operations in a hundred, most of them minor and temporary. They are listed here because you have the right to know about them before giving your consent, not because they are likely. Skip this section if reading it worries you: we will go through it together at the consultation.
How to read what follows
The frequency is given for each complication. “0.03%” means three operations in ten thousand. The most serious are the rarest; the most common (dry eye, corneal oedema, raised eye pressure) are temporary and treated with eye drops.
See the complications and their frequency in detail
Intraoperative complications, during the operation
These incidents happen during the surgical procedure. They are often due to an anatomical fragility (high myopia, for example) or to the density of the cataract.
| Complication | Frequency | Severity and impact |
|---|---|---|
| Posterior capsule rupture | 0.5% to 2% | Moderate to severe. May lead to vitreous loss or require a change in the type of implant. |
| Dislocation of lens fragments | 0.1% to 0.2% | Severe. Pieces of the lens fall to the back of the eye and require a second operation, a vitrectomy. |
| Expulsive haemorrhage | < 0.05% | Very severe. An absolute emergency, with a risk of losing the use of the eye. Extremely rare today. |
| Injury to the iris or pupil | 1% | Mild. Minor bleeding or a misshapen pupil, with no major consequence for vision. |
Swipe to see more →
Major post-operative complications
| Complication | Frequency | Average onset | Details |
|---|---|---|---|
| Endophthalmitis (infection) | 0.03% to 0.1% | 2 to 7 days | The most serious. Requires hospital admission and urgent antibiotics. |
| Retinal detachment | 0.1% to 1% | Months to years | More common in people with high myopia, or if the capsule ruptured during the operation. |
| Macular oedema (Irvine-Gass) | 1% to 2% | 4 to 12 weeks | Inflammation of the centre of the retina. Usually treated with eye drops. |
Swipe to see more →
Minor or common post-operative complications
| Complication | Frequency | Details |
|---|---|---|
| Secondary cataract (posterior capsule opacification) | 20% to 30% | Clouding of the membrane behind the implant. Treated very simply with a YAG laser, at the practice. |
| Raised eye pressure (ocular hypertension) | 2% to 5% | Often due to the viscous substances used. Temporary, treated with eye drops. |
| Corneal oedema | 1% to 3% | Blurred vision the next day. Clears within a few days with the post-operative treatment. |
| Dry eye and discomfort | Very common | A gritty or foreign-body sensation, caused by the incisions and the eye drops. |
Swipe to see more →
The four signs that should make you seek medical advice
Recovery is usually straightforward, and these situations are exceptional. Knowing them simply allows you to react quickly if needed: if so, contact your surgeon or an ophthalmic emergency department without delay.
- Severe painStrong pain that does not ease with paracetamol, or a feeling of pressure behind the eye.
- Sudden loss of visionIf your vision, after being clear, suddenly becomes very blurred or dark, or a black curtain appears.
- Increasing rednessThe eye becomes redder and redder, instead of clearing a little more each day.
- Flashes or fixed spotsSudden onset of repeated flashes of light or a dense shower of black floaters.
Practical information
Insurance cover, scheduling and follow-up.
Unlike refractive surgery, cataract surgery is covered by French national health insurance (Assurance Maladie).
Insurance cover
The operation is reimbursed by national health insurance. Depending on the implant chosen and the fees, some out-of-pocket cost may remain: you are given a quote at the pre-operative assessment, to pass on to your top-up health insurance (mutuelle). Payment is made on the day of the first post-operative check-up, with an invoice for your mutuelle.
Scheduling the operation
The operation is booked through the secretariat of the Rueil Ma Vision practice. Surgery takes place on Tuesdays and every other Wednesday, within a few weeks. A consultation with the anaesthetist is required before the operation. The two eyes are operated on two weeks apart.
Post-operative follow-up
A check-up at two days, then another at one month. Further appointments are possible if needed, and at your request.
Contact us
By phone on +33 1 47 51 10 83, by email at contact@rueilmavision.fr, or book an appointment directly on Doctolib.
Getting to the practice
Consultations and assessment
- Rueil Ma Vision practice
- 96 avenue Albert 1er, 92500 Rueil-Malmaison
- +33 1 47 51 10 83
Where the operation takes place
- Clinique Les Martinets
- 97 avenue Albert 1er, 92500 Rueil-Malmaison
- +33 1 47 14 64 40
- Directions →
Public transport
- RER A, Rueil-Malmaison station
- Bus 241, Rueil-Malmaison RER stop
Public car parks
- 81 avenue Victor Hugo
- 7 avenue Alsace-Lorraine
- 47 avenue Albert 1er
Cataract surgery fees
€400in additional fees above the national tariff, per eye
The operation is covered by national health insurance (Assurance Maladie), with a reimbursement base of €271.70 per eye. A monofocal lens involves no extra cost; a toric, extended depth of focus (EDOF) or multifocal lens adds €90 to €450 per eye, which national health insurance does not cover but your mutuelle may, depending on your policy. You are given a written quote before the operation. Full fee information
SFO information leaflets (in French)
These leaflets are published by the French Society of Ophthalmology (Société Française d'Ophtalmologie, SFO) and the French national union of ophthalmologists (Syndicat National des Ophtalmologistes de France). They describe the operation, its results, its risks and the consequences of declining treatment. They form the basis of informed consent, but do not replace the consultation.
Getting here
Coming for a consultation, wherever you live.
The practice is in Rueil-Malmaison, five minutes' walk from the RER A (the regional express train line), where the Hauts-de-Seine and Yvelines départements meet. It is easy to reach from Paris, La Défense and the whole of western Paris. I see patients from Rueil and the neighbouring towns, and people who come from further afield.
For refractive surgery, some patients also come from elsewhere in France or from abroad: the pre-operative assessment and the operation can be arranged on two consecutive days, and part of the follow-up can be done with your usual ophthalmologist. Let us talk about it before you travel.
Hauts-de-Seine (92)
- Rueil-Malmaison
- Nanterre
- Suresnes
- Puteaux
- La Défense
- Courbevoie
- La Garenne-Colombes
- Colombes
- Bois-Colombes
- Asnières-sur-Seine
- Levallois-Perret
- Neuilly-sur-Seine
- Saint-Cloud
- Garches
- Vaucresson
- Marnes-la-Coquette
- Ville-d'Avray
- Sèvres
- Boulogne-Billancourt
Yvelines (78)
- Bougival
- Chatou
- Croissy-sur-Seine
- Le Vésinet
- Le Pecq
- Louveciennes
- La Celle-Saint-Cloud
- Marly-le-Roi
- Le Port-Marly
- Montesson
- Carrières-sur-Seine
- Houilles
- Sartrouville
- Maisons-Laffitte
- Saint-Germain-en-Laye
- Le Chesnay-Rocquencourt
- Versailles
- Bailly
- Noisy-le-Roi
Val-d'Oise (95) and Paris
- Argenteuil
- Bezons
- Cormeilles-en-Parisis
- Paris 8th
- Paris 11th
- Paris 15th
- Paris 16th
- Paris 17th
RER ARueil-Malmaison station, five minutes' walk. Direct trains from La Défense, Nanterre, Chatou, Le Vésinet, Saint-Germain-en-Laye or Paris.
By carVia the A86 and the N13. Three public car parks close by: avenue Victor Hugo, avenue Alsace-Lorraine and avenue Albert 1er.
Where operations take placeCataract surgery, ICL phakic lenses and PreLex at Clinique Les Martinets, in Rueil-Malmaison. Refractive laser surgery at Institut Voltaire, Paris 11th.
You are the one who decides when the time is right.
A cataract is not operated on at a set stage, but when it starts to cause real difficulty: driving at night, reading, faces you recognise less easily. There is no rush, and nothing gets worse by waiting a few months. The consultation is first of all a chance to talk it over.
Dr Emmanuel Halimi
Ophthalmic surgeon · RPPS 10100555084 · Medical Council of Hauts-de-Seine no. 92/23003
Page written and approved by the surgeon.
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