Cataract Surgery Checklist: What You Really Need to Know After Referral
- Posted
- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: October 23, 2026
- Last Updated: October 23, 2026
TL;DR: If you have been referred for cataract surgery, two decisions deserve particular attention: the lens that goes into your eye and the surgeon who puts it there. On the NHS, you will usually be offered a standard monofocal lens set for distance or near, and you may not be able to choose your surgeon. The surgery is of a high standard. But if you want a wider choice of lens, a named surgeon, or astigmatism correction your local service does not fund, you need to know that before your date arrives, not after.
You have been told you need cataract surgery. Perhaps your optician spotted it, or your GP referred you after your driving vision became a worry. Either way, you are now on a pathway, and most patients only learn how that pathway works as they move through it.
This checklist is what I would want a member of my own family to know on the day they were referred.
I began my career in ophthalmology in 2003, trained for six and a half years at Moorfields Eye Hospital, and spent five years as an NHS consultant at the Western Eye Hospital. I have worked on both sides of this decision.
If you have already decided to go private and want the questions to ask a private surgeon, use our companion Private Cataract Surgery Checklist.
Two Important Decisions: Your Lens and Your Surgeon
Cataract surgery removes the cloudy natural lens and replaces it with an artificial intraocular lens (IOL). The operation itself is broadly the same wherever you have it. What differs is:
- The lens. It helps determine your range of focus after surgery: distance, near, or across a range. Once it is in, changing it is a second operation.
- The surgeon. Who operates, whether they are in training, and whether you met them before the day.
Your own eye matters just as much. Other conditions, such as macular degeneration, glaucoma or diabetic eye disease, can limit the result whichever lens or surgeon you choose.¹ So ask early whether anything other than cataract is likely to limit your vision after surgery.
1. Your Lens: What You Will Be Offered on the NHS
NHS patients are offered a monofocal lens. National Institute for Health and Care Excellence (NICE) guidance for adult cataract surgery advises against offering multifocal lenses, which provide focus at more than one distance, and the standard commissioned lens is a monofocal.² You will not usually be given a choice of manufacturer.
A monofocal lens focuses at one distance. You choose, or are guided towards, one of two targets:
- Distance focus. The default. Good for driving and television; you will need reading glasses.
- Near focus. You see well up close without glasses but need glasses for distance.
Near focus is typically only offered to people who are short-sighted (myopic). They have lived their whole lives taking their glasses off to read, so they know exactly what they are asking for.
In my practice, if you have never been short-sighted, I rarely recommend near focus, because it can feel disorientating. What matters is an informed target based on your habits and visual priorities, not a default.
Monovision: My Professional View
Monovision sets one eye for distance and the other for near, usually with the dominant eye, the eye your brain tends to favour, set for distance. It is an option, and for the right patient it works very well.³
NICE recommends offering monovision to people who already have it, or who have a difference in prescription between their eyes, and want to keep it.² My own practice follows the same principle.
I will offer monovision if you have worn it in contact lenses for years and know which is your distance eye. We can measure eye dominance in clinic, but most long-standing monovision wearers already know, because they have lived with it.
Without that history, I am cautious. “My next-door neighbour has monovision and never wears glasses” is not a reason to have it. Good for them, but you might not tolerate it, and I would rather not take that risk with your eyes.
A contact lens trial does not settle the question either: when a cataract is significant, a trial cannot show you what monovision will feel like after surgery.
Checklist questions:
- Will my lens be set for distance or for near, and why?
- If I am short-sighted, have we discussed keeping my near vision?
- Have I worn monovision before? If not, why is it being suggested?
2. Astigmatism: Will It Be Corrected?
If your cornea, the clear front surface of your eye, is shaped more like a rugby ball than a football, you have astigmatism. A toric lens has astigmatism correction built in, and randomised trials show it gives better unaided distance vision than a standard lens in eyes with meaningful astigmatism.⁴
Whether you are offered one on the NHS depends on where you live. Funding is decided locally, and some areas do not routinely fund toric lenses.⁵ In my experience, hospitals that do offer them most often set the threshold at around 2 dioptres of corneal astigmatism, but this is not universal. Dioptres are the units used to measure the amount of optical correction needed.
Where toric lenses are not offered, NICE suggests placing the main incision on the steepest axis, the direction in which the cornea curves most steeply, or making small relaxing incisions in the cornea to reduce astigmatism.² These have a smaller effect than a toric lens.⁴
Two technical points matter:
- Corneal topography should be performed. It maps the shape of the cornea and shows the pattern and regularity of your astigmatism, which decides whether a toric lens is suitable.² Regular astigmatism follows a consistent pattern of curvature.
- Irregular astigmatism needs specialist assessment. This means the corneal curvature is less uniform. It may make a toric lens unsuitable, although some eyes with a sufficiently regular central component can still benefit.⁶
What about digital alignment? A toric lens only works if it sits on the right axis, meaning its corrective power is aligned with the direction of your astigmatism. Some centres use digital, image-guided systems to mark that axis during surgery.
They are not commonly available on the NHS, and I want to be open that Blue Fin Vision® does not use one; in my experience, many private providers do not either.
Digital image-guided systems can improve alignment accuracy. However, a recent meta-analysis, a study combining the results of several studies, found no statistically significant difference in distance visual acuity, meaning the sharpness of distance vision, between digital and manual marking, despite better alignment with digital systems.⁷
We use manual marking with the patient sitting upright, followed by an intraoperative axis check, meaning we check the lens alignment during surgery.
My professional view is that digital alignment alone is not a reason to leave the NHS and go private.
Checklist questions:
- How much astigmatism do I have, and is it regular?
- Has corneal topography been done?
- Does my hospital offer toric lenses, at what threshold, and how are they aligned?
- If not, what will my vision be like without correction?
3. Your Surgeon: Who Will Actually Operate?
NHS hospitals are training hospitals, and that is how the next generation of surgeons is trained. Doctors in surgical training are qualified doctors at different stages of experience, operating under supervision. You are entitled to know who is involved in your care and what their role is, and you can decline to take part in training.⁸
Ask who will operate and how they will be supervised. If you would prefer a doctor in training not to operate, say so at the consultation and confirm it on the day. The hospital may not be able to promise a named consultant, but your preference should be heard.
They remain your eyes. Lying down to have eye surgery is an act of trust, and surgeons should treat it as the privilege it is.
What else to expect on the NHS pathway:
- Clinics are pooled. The surgeon you meet in clinic may not be on the team that operates on you.
- Your first appointment may be in the community and may be with an optometrist or another allied health professional rather than a surgeon.
- Your follow-up may also be in the community, often with a local optometrist.
- Choosing your surgeon is very difficult. In England you have a legal right to choose your provider and a consultant-led team at the point of referral,⁹ but that is not the same as choosing who holds the instrument.
I want to be fair here: NHS cataract surgery is of a high standard. Cases are matched to a trainee’s experience, operations are supervised, and many units submit their outcomes to national audit.¹⁰ Where your choice of surgeon matters most is in complex eyes, and in whether you feel you have been heard.
The purpose of these questions is not to undermine confidence in NHS care. It is to help you understand who will operate, how the team works and what applies to your own case.
Checklist questions:
- Who will perform my surgery, and will I meet them beforehand?
- Will a doctor in training carry out any part of my surgery, and what are the arrangements if I would prefer they did not?
- Where will my pre-operative assessment and follow-up take place, and with whom?
- Who do I contact if something goes wrong after surgery?
4. Deciding Whether to Go Private
A proper consultation, NHS or private, should set out all reasonable options relevant to your eyes and priorities, including suitable options that are not offered at that hospital or by that surgeon. If the only lenses you hear about are the ones on that clinic’s shelf, you have not had the full conversation.
A credible assessment must also be capable of saying no, including “you do not need to go private”.
In my experience, these are the main reasons patients choose private cataract surgery. None is automatic: each is something to verify with the provider, which is what our private checklist (linked below) is for.
- A named surgeon who consults, operates and follows you up.
- A wider choice of lens, including extended depth-of-focus lenses, which extend the range of clear vision, particularly from distance to arm’s length; trifocal lenses, which provide focus at distance, intermediate and near; and toric lenses, which correct astigmatism.
- Astigmatism correction your local NHS service may not fund.
- Timing, including having both eyes done on the same day where suitable.
- Continuity, with complications managed by the same team rather than handed on.
A wider choice is not an automatic upgrade. Not every lens suits every eye, some carry optical side effects such as glare and haloes at night,¹¹ and you may still need glasses for some tasks.
I have written about this in more detail:
- Is It Worth Going Private for Cataract Surgery?
- Is Private Cataract Surgery Better Than NHS?
- Private vs NHS Eye Surgery: How the Pathways Differ
- Private Cataract Surgery Checklist: the questions to ask a private surgeon
Checklist questions:
- Have I been told about all reasonable lens options for my eyes, including those not offered here?
- Do I want a named surgeon from consultation to follow-up?
- Does my local NHS service fund the lens or correction I need?
Your Printable Cataract Surgery Checklist
Download the one-page printable version (PDF), or save this list on your phone, and take it to your appointment.
Your Eye
- Is anything other than cataract likely to limit my vision after surgery?
Your Lens
- Will my lens be set for distance or near, and why?
- Am I short-sighted, and would near focus suit me?
- Have I worn monovision in contact lenses before, and do I know my distance eye?
- Are there other lens options suitable for my eyes that are not offered here?
Your Astigmatism
- How much astigmatism do I have, and is it regular?
- Has corneal topography been done?
- Will it be corrected with a toric lens? If not, why not? If so, how will it be aligned?
Your Surgeon
- Who will operate, and will I meet them first?
- Will a doctor in training carry out any part of my surgery, and what are the arrangements if I would prefer they did not?
- Where will my follow-up be, and who do I call if there is a problem?
Your Choices
- Have all reasonable options for my eyes been explained, including suitable ones not available here?
- Does a named surgeon, wider lens choice or astigmatism correction matter enough to me to consider going private?
Frequently Asked Questions
What lens will I get with NHS cataract surgery?
A standard monofocal lens, usually set for distance vision. You will normally need reading glasses afterwards. A near-focus target (the same lens, set for reading) mainly suits short-sighted patients who prefer to read without glasses. Your team should discuss the intended focus and which glasses you will need afterwards.
Can I choose my surgeon on the NHS?
In England you can choose your provider and a consultant-led team when you are referred.⁹ In practice, clinics are pooled and it is very difficult to guarantee which surgeon operates on you.
Will a trainee operate on me?
Possibly, under supervision. You are entitled to know who is involved and their role, and you can decline to take part in training.⁸ Tell your surgeon your preference at the consultation and confirm it on the day; the hospital may not be able to guarantee a named consultant.
Is monovision a good idea after cataract surgery?
NICE recommends it for people who already have monovision or a difference in prescription between their eyes and want to keep it.² In my practice, I offer it to people who have already worn monovision contact lenses for years and know which eye they use for distance. Without that experience, I am cautious, because you may not tolerate it.
Will the NHS correct my astigmatism?
It depends where you live. Funding is decided locally, some areas do not routinely fund toric lenses,⁵ and where they are offered the threshold varies.
Is NHS cataract surgery safe?
Yes. NHS cataract surgery is of a high standard. The main differences in private care are choice of surgeon, choice of lens and continuity of care, not the basic safety of the operation.
References
- Day AC, Donachie PHJ, Sparrow JM, Johnston RL. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye (Lond). 2015;29(4):552–560. doi:10.1038/eye.2015.3
- National Institute for Health and Care Excellence. Cataracts in adults: management. NICE guideline NG77. London: NICE; 2017.
- Finkelman YM, Ng J, Barrett GD. Patient satisfaction and visual function after pseudophakic monovision. J Cataract Refract Surg. 2009;35(6):998–1002. doi:10.1016/j.jcrs.2009.01.035
- Kessel L, Andresen J, Tendal B, Erngaard D, Flesner P, Hjortdal J. Toric intraocular lenses in the correction of astigmatism during cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2016;123(2):275–286.
- NHS Essex Integrated Care Board. Toric intraocular lens implants. Effective 1 April 2026. Available from: essex.icb.nhs.uk
- Chen X, Jiang Y, Gao N, Gao Y, Yang J, Bu S, Tian F. Effectiveness of toric intraocular lens implantation for correcting irregular corneal astigmatism in cataract eyes. Sci Rep. 2024;14(1):8868. doi:10.1038/s41598-024-59303-0
- Yu JG, Ye T, Xiang Y. Digital marking versus manual marking technique for toric intraocular lens alignment: a meta-analysis. BMC Ophthalmol. 2025;25(1):499. doi:10.1186/s12886-025-04329-9
- General Medical Council. Decision making and consent. London: GMC; 2020.
- Department of Health and Social Care. The NHS Choice Framework: what choices are available to me in the NHS? Available from: gov.uk
- Royal College of Ophthalmologists. National Ophthalmology Database Audit: Eighth Annual Report. London: RCOphth; 2025.
- de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12(12):CD003169.
ABOUT THE AUTHOR
Mr Mfazo Hove
MBChB MD FRCOphth CertLRS
Consultant Ophthalmic Surgeon | Founder and Medical Director, Blue Fin Vision®
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with more than two decades of experience across NHS and private practice and more than 57,000 ophthalmic procedures performed. He trained for six and a half years at Moorfields Eye Hospital and served for five years as an NHS consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust.
He specialises in cataract surgery, refractive lens replacement, laser vision correction and implantable Collamer lenses (ICL). He is the founder and Medical Director of Blue Fin Vision®, a private ophthalmology group providing consultant-delivered care across London, Hertfordshire and Essex. His cataract surgery outcomes are publicly reported through the National Ophthalmology Database.
A ZEISS Key Opinion Leader and international speaker, Mr Hove is a contributing author to The Ophthalmologist and Ophthalmology Times. His writing examines how clinical governance and the organisation of ophthalmic services shape patients’ experiences and outcomes, with a focus on transparent outcome reporting, surgical training and long-term accountability for patient care.
Book a Consultation With Blue Fin Vision®
If you have been referred for cataract surgery and want to understand the options suitable for your eyes, Blue Fin Vision® provides consultant-delivered care across London, Hertfordshire and Essex.
Book a paid cataract consultation to discuss your individual needs, suitable lens options and Mr Hove’s documented surgical outcomes.
