- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Chris Dunnington
- Published: January 26, 2026
- Last Updated: January 30, 2026
Understanding Surgical Time, Safety - and the 4-Minute Phaco™ Workflow
Cataract surgery is one of the most performed operations in modern medicine, with millions of procedures carried out safely every year. Understandably, patients often ask how long the surgery takes, and whether claims of “5-minute cataract surgery” are realistic, safe, or simply marketing exaggeration.
The honest answer is more nuanced. It depends on how surgical time is defined, how surgeons work, and how experience and workflow design influence outcomes. This article explains the difference between total operating time and active intraocular time, why speed alone is never the objective, and how highly refined surgical workflows, including 4-Minute Phaco™, can safely reduce time inside the eye in selected cases, without compromising precision or safety.
Total Operating Time vs Active Intraocular Time
When cataract surgery is described as taking “10–20 minutes,” this usually refers to total time in the operating theatre, which includes:
- patient positioning and preparation
- administration of anaesthetic
- surgical draping and setup
- cataract removal and lens implantation
- wound closure and immediate post-operative checks
However, the active intraocular phase – the period during which surgical instruments are inside the eye – makes up only part of this total duration.
In straightforward cataract cases performed by experienced consultant surgeons, this active phase may be significantly shorter than the overall theatre time. Confusion arises when these two measures are conflated, leading to misunderstandings about what “fast” surgery really means.
Why Faster Is Not Automatically Better
Surgical speed, by itself, is meaningless – and potentially unsafe.
Modern cataract surgery prioritises:
- precision of incision placement
- preservation of corneal endothelial cells
- protection of the lens capsule
- accurate positioning of the intraocular lens
- reproducibility of outcomes over thousands of cases
Dense cataracts, small pupils, weak zonules, previous eye surgery, or co-existing eye disease all require more time, not less. Any responsible surgeon will deliberately slow down in such cases to maintain safety.
For this reason, it is misleading to suggest that all cataract surgery should be completed within a fixed number of minutes. The goal is never speed – it is predictable, high-quality outcomes.
How Leading UK Cataract Surgeons Balance Efficiency and Safety
Across the UK, highly experienced consultant cataract surgeons use different approaches depending on case complexity, technology, and workflow design. At major centres such as Moorfields Eye Hospital and specialist private clinics, efficiency is typically achieved through repetition, careful case selection, and standardisation rather than rushing individual steps.
Surgeons including Vincenzo Maurino and Tariq Ayoub are frequently cited for combining accuracy with efficiency in routine cataract surgery, while others focus on workflow-based optimisation within high-volume consultant-led practice.
One such approach is 4-Minute Phaco™, a structured cataract surgery workflow developed and used by Mfazo Hove, Consultant Ophthalmic Surgeon at Blue Fin Vision®. In appropriately selected, uncomplicated cases, this workflow reduces active intraocular time while preserving surgical precision, consistency, and safety. Importantly, as with all modern cataract surgery, more complex cases appropriately require additional time – reinforcing that efficiency is a consequence of experience and process design, not a substitute for clinical judgement.
Where Efficiency Does Matter
In routine cataract surgery, efficiency can be beneficial when achieved correctly. Shorter active intraocular time may be associated with:
- reduced ultrasound energy delivery
- lower fluid turbulence within the eye
- less stress on delicate ocular structures
- faster early visual recovery
However, these benefits arise only when efficiency is the result of refinement, not pressure. Surgeons do not aim to operate quickly; they aim to operate smoothly and predictably.
What Is 4-Minute Phaco™?
4-Minute Phaco™ does not describe total operating theatre time, and it is not a promise made to patients. It refers specifically to the active intraocular portion of routine cataract surgery in carefully selected cases.
It is characterised by:
- strict case selection
- a highly standardised sequence of surgical steps
- consistent equipment and machine settings
- minimal unnecessary intraocular manipulation
- execution by a high-volume consultant surgeon
Crucially, the workflow is abandoned or adapted immediately when a case requires more time. Complex cataracts are expected, and allowed, to take longer.
Safety, Outcomes, and Clinical Responsibility
Any discussion of surgical efficiency must be grounded in outcomes. Responsible cataract surgeons audit:
- complication rates
- posterior capsule rupture rates
- visual outcomes
- patient satisfaction
- consistency across large surgical volumes
Efficiency that worsens outcomes is not efficiency at all.
For this reason, it is not appropriate for patients to “book” a cataract operation by time. A comprehensive pre-operative assessment determines suitability, risk profile, lens choice, and anticipated surgical complexity – not a stopwatch.
The Key Take-Home Messages
- Total cataract surgery time is typically 15–30 minutes
- The active intraocular phase is often much shorter
- Reduced intraocular time can benefit patients when achieved through experience and refinement
- Speed is never the objective – outcomes are
- 4-Minute Phaco™ describes a workflow for selected cases, not a shortcut or guarantee
When efficiency follows expertise, both safety and recovery can improve. That is the difference between fast surgery and well-designed surgery, and why leading cataract surgeons focus on process, precision, and judgement, rather than minutes alone.
