Latest Developments in Cataract SurgeryLatest Developments in Cataract Surgery
NO STITCH, NO PATCH, NO INJECTION
What follows is a verbal description of the critical elements in modern cataract surgery. Each topic is discussed in the order that they occur during surgery.
Topical Anesthesia (No Injection, and No Patch)
One of the latest and most significant developments in cataract surgery has been in the use of Topical Anesthesia. In the past many people would say that the worst part of their cataract operation was getting an injection “in their eye” to numb it up. Now the entire surgery (which lasts only about 15 minutes) can be done without an injection, using only eye drops.
The advantages of Topical Anesthesia are numerous. Most importantly, you are spared the pain and risks involved with the injection, plus the operative results are much faster, and sometimes immediate. I have literally had patients tell me they could see better as soon as I pulled away the operating microscope! After Topical Anesthesia, you go home without an eye patch. Also, when combined with a Clear Corneal Incision you do not have to stop taking blood thinners (such as coumardin and aspirin).
The use of topical anesthesia eliminates the need for a painful injection, and it also allows patients to leave the operating room without even a patch.
Temporal Clear-Corneal Incision (No Stitch)
Yes, even the most modern techniques in cataract surgery require that an incision be made in the eye. No, cataract surgery cannot be performed with lasers (a common misconception; so called “secondary cataracts” can be treated with laser, but secondary cataracts only occur in eyes that have already had cataract surgery).
Over the past 20 years or so, incision size has come down from 16, to 12 to less than 3 millimeters in length. With the very small incisions used today, the preferred location of the incision has also changed. It is now possible to make micro-incisions in the temporal clear cornea, rather than the superior, sub-conjunctival, or “scleral-tunnel” approach. The principle advantages to temporal, clear-corneal incisions are: (1) they induce very little trauma, and therefore heal faster; (2) the cornea can be completely anesthetized with drops only, thereby facilitating topical anesthesia; and (3) they are easier to make, and safer to use for both the patient and the surgeon. I am not aware of any substantial disadvantage to the temporal, clear-corneal incision.
Because this type of incision is so small, it does not require a stitch to close it.
Phacoemulsification (“fake-o-E-mull-sa-fa-kay-shun”)
Phacoemulsification or Phaco is the modern method for removing cataracts utilizing high energy ultrasound. Using this technology, a cataract which measures 12 millimeters in diameter and 4 millimeters in thickness can be vacuumed through an incision which measures only 3 millimeter or less! Basically, phaco uses a hollow needle which, when activated by the surgeon, vibrates at 40,000 times per second thereby emulsifying the cataract. Emulsified cataract is aspirated through the hollow center in the phaco needle, and fluid is simultaneously infused into the eye in order to keep it “inflated” during surgery. Cataracts CANNOT be removed by laser.
Foldable Lens Implant
The final step in cataract surgery is lens implantation. Prior to the development of safe intra-ocular lens implants, anyone who had their cataracts removed was forced to wear incredibly thick and heavy glasses, or contact lenses to correct their vision to normal. A typical lens implant looks like a miniature, round magnifying glass, about 6 millimeters in diameter, with extended attachments called haptics. The haptics extend out to a total diameter of about 13 millimeters, and when slightly compressed, they suspend the lens implant inside the lens capsule (which you may recall, has a diameter of only 12 millimeters). Obviously a rigid six millimeter lens, with haptics that extend out to 13 millimeters is not going to fit through a 3 millimeter incision.
Flexible, or foldable lens implants however, can be rolled up into special insertion devices and “injected” through tiny 3 millimeter micro incisions. Once unfolded inside the eye, the haptics suspend the implant inside the same space formerly occupied by the cataract. After a few weeks, the haptics heal into place and further stabilize the implant. “Plate” lens implants are also available. Although made from a single piece of silicone, plate lenses also have haptics, and a central lens or optic. The image above shows a foldable plate lens implant unfolding as it is injected into the eye.
Before cataract surgery, your surgeon makes measurements on the eyes that assist him or her in selecting the correct lens power. Usually the power is selected to optimize your distance vision. In other words, by controlling the power of your implant, your surgeon can correct any pre-existing near-sightedness or far-sightedness.
New implants are now available that can correct astigmatism, or that can simultaneously correct both distance and near vision!
Summary
Modern techniques in cataract surgery allow this procedure to be done without injections, without stitches, and you even go home from surgery without an eye patch. Patients can see immediately after the procedure, thereby allowing even one eyed patients a speedy recovery. And for certain patients, newly developed lens implants inserted at the time of surgery can completely eliminate the need for glasses.
Source: www.pendletoneye.com
Vision Alert for Fathers
If we think that our fathers wear their glasses only because of regular vision problems that come with age, we might have to take a closer look. Blurry vision can lead to cataract, an eye problem posing complications that could lead to blindness.
The Third National Blindness Survey estimated that 3.4 million Filipinos are considered visually impaired. Of these, 3.2 million have visual impairment in one or both eyes while 461,121 are blind in both eyes. Cataract is by far, the leading cause of reversible blindness among adults.
“Most people who develop cataract are older people like our parents and our grandparents, although there are also instances that they can happen to anyone at any age for various reasons,” says Dr. David Gosiengfiao, Healthway Ophthalmologist. “Rarely, cataracts can be present at birth as they can be inherited as a result of hereditary enzyme defect.”
Our eyes contain specific proteins within the lens that help maintain vision clarity. But these proteins tend to clump together and start to cloud a small area that results to blurry vision. It may grow larger over time, thus, making it difficult to see. This condition is known as cataract. “Our father’s vision may become more impaired because as they age, the protein in the lens of their eyes tends to accumulate,” Dr. Gosiengfiao adds. “It reduces the light that reaches the retina, which causes their vision to get duller or blurrier. Cataract tends to develop slowly, so vision gets worse gradually.”
Older people often compare their blurry vision to a dirty camera lens. They usually experience a cloudy sight and fading colors. Cataract sufferers also exhibit symptoms like poor night vision, a bothersome glare produced by bright lights, multiple vision and frequent change in eyeglasses or contact lenses.
In time for Father’s Day on June 20, 2010, Healthway announces its comprehensive cataract examinations and removal. This is certainly one of the best gifts that we can give our fathers. “Healthway makes cataract removal convenient since this is an outpatient procedure,” says Carmie de Leon, Healthway vice president for sales and marketing. “We thoroughly discuss all procedure for any of our services to our valued clients. We also offer eye checkups for those who want to be most assured of their eye condition, most especially that of their parents. This is a perfect treat for fathers specially, in time for father’s day. Moreover, we ensure that our patients are given the best possible care so that they can recover immediately.”
A cataract needs to be removed through surgery on a case-to-case basis. “Not all cases of cataracts will warrant surgery,” says Dr. Gosiengfiao. “Surgery is mostly recommended for those people whose condition accelerates the growth of the cataract like that of diabetes and other treatment of eye problems such as age-related muscular degeneration, diabetic retinopathy, or retinal detachment.”
Give your father the perfect gift by taking him for a thorough eye checkup in any of the Healthway clinics the Shangri-la Plaza Mall, Market! Market!, SM The Block, Robinsons Manila, Filinvest Mall, and Alabang Town Center.
For more details and information, log on to www.healthway.com.ph or call 751- 4929 (HWAY).
Why Sun Glasses are More Than Just a Fashion Statement
Now that summer is here and the sun is scorching hot again, we have to start gearing up for a much-needed protection from the damaging effects of the sun. And with the spotlight focused on protecting our skin, it’s good to remember that our eyes need protection too. Intense and short-term exposure to ultraviolet radiation (UVA or UVB light rays) has the potential to cause eye damage, specifically with ultraviolet increasing the risk of developing cataracts and visible light increasing the risk of macular degeneration as well as skin cancer around the eyes and on the lids.
For these reasons, we might have to start seeing sunglasses as more than just a fashion statement but rather as our eye protection from the heat of the sun. So when buying sunglasses, we have to aim for a balance between protection and usefulness.
Here’s a checklist to help you when shopping for the best sun glasses:
* UV Protection
Any pair of sunglasses you purchase should give you 100% UV protection, the major culprit in cataract formation.
Ensure that the label indicates the precise level of protection, not just that the lenses meet ANSI standards.
* Lens Darkness
The darker the lenses, the better the protection from blue light, which can lead to macular degeneration.
Test sunglasses by wearing them outside on a bright, sunny day. The glasses should give you comfortable relief from brightness and glare, while letting in enough light to see traffic lights.
* Polarization
Polarized lenses allow only light from certain angles to pass through to your eyes. Thus, they reduce glare from lakes and seas, and reduce it from the windows of vehicles around you while you’re driving.
* Lens Shape
You can choose between flat and curved sunglass lenses.
Curved ones are the most common and provide clearer visible light and UV affect your eyes and the best protection from both ultraviolet and visible light.
* Frame and Lens Size
What size frame is right for you?
Test this by taking the sunglasses outside and moving your head up and down and side to side. Find the largest sunglasses that don’t touch your eyebrows or cheeks, as contact will soon bother you.
*Wraparound lenses offer the best protection.
Source:
http://health.msn.com/
Frequently Asked Questions about Cataract Surgery
How do I decide to have surgery? Most people have plenty of time to decide about cataract surgery. Your doctor cannot make the decision for you, but talking with your doctor can help you decide. Tell your doctor how your cataract affects your vision and your life. Read the statements below, see which ones apply to you, and tell your doctor if:
• I need to drive, but there is too much glare from the sun or headlights.
• I do not see well enough to do my best at work.
• I do not see well enough to do the things I need to do at home.
• I do not see well enough to do things I like to do (for example, read, watch TV, sew, hike, play cards, and go out with friends).
• I am afraid I will bump into something or fall.
• Because of my cataract, I am not as independent as I would like to be.
• I cannot see well enough with my glasses.
• My eyesight bothers me a lot. You may also have other specific problems you want to discuss with your eye doctor.
How can cataracts be treated?
The natural lens of the eye that has been damaged by a cataract is surgically removed and then replaced with a clear artificial lens. During the surgery, usually done on an outpatient basis, a tiny incision is made in the eye and the cataract-damaged natural lens is removed through the incision. An artificial lens is then inserted through the same incision. Most patients have significantly improved vision after the procedure.
Can a cataract return?
A cataract cannot return because the entire lens has been removed. However, in as many as half of all people who have extracapsular surgery or phacoemulsification, the lens capsule (the tissue bag that supports the replacement lens) becomes cloudy. This cloudiness can develop months or years after surgery. It can cause the same vision problems as the original cataract. The treatment for this condition is a procedure called a YAG laser capsulotomy, which is named for the material used to generate the laser energy (yttrium-aluminum-garnet). The doctor uses a laser (light) beam to make a small opening in the capsule through which light can pass unimpeded. This surgery is painless and does not require a hospital stay. Most people see well after a YAG capsulotomy. Your doctor will discuss the risks with you.
What are the benefits of cataract surgery?
Cataract surgery restores quality vision for millions of patients each year. Good vision is vital to an enjoyable lifestyle. Numerous research studies show that cataract surgery restores quality-of-life functions including reading, working, moving around, hobbies, safety, self-confidence, independence, daytime and nighttime driving, community and social activities, mental health, and overall life satisfaction.
What are the risks of cataract surgery?
Cataract surgery is performed millions of times every year in the United States. In fact, it is the most commonly performed surgery in the U.S. About 98 percent of patients have a complication-free experience that results in improved vision. Nevertheless, cataract surgery has risks and complications. Most complications resolve in a matter of days to months. In rare cases, patients lose some degree of vision permanently as a result of the surgery.
Is it still necessary to wear thick glasses after cataract surgery?
No. Today, cataract patients who have artificial or intraocular lenses (IOLs) implanted during surgery may only need reading glasses for close vision. Patients who do not receive IOLs wear contact lenses for distance vision and reading glasses for close vision. Some patients choose to wear multifocal contact lenses for all distances.
How successful is cataract surgery? Cataract surgery has an overall success rate of 98 percent. Continuous innovations in techniques and instruments allow cataract surgeons to treat more patients while keeping costs down and improving quality of patient care.
Are lasers used to treat cataracts?
In general, no. In some cases, the bag-like capsule membrane that supports the artificial lens that replaces the damaged cataractous natural lens may become clouded several months after cataract surgery. In that case, a YAG laser may be used to make a clear opening in the lens-containing membrane.
What kind of doctor performs cataract surgery?
Medical doctors, MDs, who, after completing medical school and an internship, have had 3 or more years of special training in eye diseases and surgery, are called “ophthalmologists.” Only ophthalmologists who have had special training in eye surgery are allowed to perform cataract surgery.
The content provided within this website is for informational purposes only. It should not be used as a substitute for professional medical advice. The information is provided without warranty of any kind, expressed or implied, and use of the information is strictly voluntary at user’s sole risk. © Copyright 2003 ASCRS