Modern Cataract Surgery Professor Ejaz Ansari, FRCOphth MD

v 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!)

v 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.

v 4 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.

v 5 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.

v 6 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

v 7 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.

v 8 How is cataract surgery performed?  Ambulatory day case procedure (usually)  Local or topical anesthesia  Phacoemulsification (ultrasound)  Shield, no patch

v 9 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.

v 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

v 11 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.

v 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

v 13 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

v 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.

v Steps- incision and capsule

v Hydrodissection and phaco

v Irrigation and aspiration; IOL insertion

v MICS v Standard

v Micro-incision cataract surgery  MICS  mm incision (ct. 3mm)  Even quicker visual rehabilitation  Fewer post-op meds  Fewer post-op visits  Less 2 weeks post-op weeks with 3mm incision -0.67D; (n=60)

v New intraocular lenses

v 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

v 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