Modern Cataract SurgeryProfessor Ejaz Ansari, FRCOphth MD

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Modern cataract surgery- benefits to your patients

Cataract- what is it, its symptoms and signs Indications for cataract surgery The procedure and results Recent innovations for your patients Video (if time!)

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The Healthy Eye Light rays enter the eye

through the cornea, pupil and lens.

These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye.

The retina converts light rays into impulses; sent through the optic nerve to your brain, where they are recognized as images.

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What is a cataract?

Clouding of the normally clear lens of the eye.

Healthy lens Lens with a cataract

• Can be compared to a window that is frosted or yellowed.

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What is a cataract?

A clear lens refracts light onto the retina and fine-tunes our focusing ability.

• A cloudy lens prevents light from focusing sharply on the retina.

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Symptoms of cataracts

Painless blurring of vision.

Glare or light sensitivity. Poor night vision and/or

difficulty driving at night.

Double vision in one eye.

Needing brighter light to read.

Fading or yellowing of colors.

Yellowing of colors

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When should cataract surgery be performed?

When cataracts cause enough vision loss to interfere with your daily activities:

Performing your job Driving safely Reading and watching TV in

comfort Taking medication

You and your ophthalmologist should decide together when surgery is appropriate.

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How is cataract surgery performed?

Ambulatory day case procedure (usually)

Local or topical anesthesia

Phacoemulsification (ultrasound)

Shield, no patch

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How is cataract surgery performed?

A small incision is made close to the edge of the cornea.

A tiny, high-frequency ultrasound instrument is inserted that breaks up center of the lens.

Broken-up cloudy lens material is removed through the incision.

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Advantages of Phaco(emulsification) For the surgeon For the patient- quicker visual rehabilitation, less

astigmatism, fewer visits post-op, fewer post-op complications (closed system surgery)

For the health economy

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What can I expect from cataract surgery?

Most cataract surgical procedures are performed without complications and result in immediate improvement in vision (0.1% chance of reduced vision).

You will apply eye drops for 4-6 weeks following surgery to reduce the possibility of infection and/or inflammation in the eye- enough dispensed!

You may need an eyeglass prescription to obtain your clearest vision following surgery.

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What can I expect from cataract surgery? Drive after 1 week (use one’s discretion) Care with washing hair and face for 4 weeks No gardening for 4 weeks Continue those glaucoma drops! See consultant after 2-3 weeks See optician after 6 weeks Not everyone is the same- glaucoma, ARMD,

diabetes

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Posterior capsulotomy

In a small number of cases, the natural capsule supporting IOL can become cloudy after cataract surgery.

Posterior Capsulotomy: laser surgery to open cloudy capsule and restore clear vision. Posterior Capsulotomy

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Phaco steps Incision Capsulorrhexis Hydrodissection Phaco Irrigation and aspiration

(for cortex) IOL insertion AC reformation and wound

closure

Cataract

PHOTO: M&Ms Chocolate UK Ltd.

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Steps- incision and capsule

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Hydrodissection and phaco

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Irrigation and aspiration; IOL insertion

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MICS v Standard

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Micro-incision cataract surgery MICS 1.8- 2.2mm incision (ct. 3mm) Even quicker visual rehabilitation Fewer post-op meds Fewer post-op visits Less astigmatism: @ 2 weeks post-op -0.33D; @6

weeks with 3mm incision -0.67D; (n=60)

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New intraocular lenses

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Is it laser? NO! It’s ultrasound, but.............. Laser cataract surgery (femto) is being used in

some centres Even with laser at the moment, phaco is required

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Conclusions Surgery is the only treatment for cataract Modern day case micro-incision cataract surgery

under topical anaesthesia- gold standard Post-operative drops for 4-6 weeks Range of innovative IOLs available Femtosecond cataract surgery being improved