Mr Imran Rahman Consultant Ophthalmologist Special interests:

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Cataracts Truth and Myths

• Mr Imran RahmanConsultant OphthalmologistSpecia
  l interests
• Cataract, Corneal Transplantation and Glaucoma

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What is a cataract?

• Latin word for waterfall

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What is a cataract?
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What is a cataract?
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The History of Cataract Surgery

• Reports of cataract surgery date back 300BC
• ConstantinusAfricanus (AD 1018)
• Cataract
• Couching 600BC in India
• Aphakic correction
• Remained popular until 19th century

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Scale of the problem

• 18 million people blind with cataracts
• 2 million procedures in the US
• Over 300000 in the UK last year
• Over last 20 years, number of procedures
  quadrupled

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Age and risk factors

• 42 between 52-64,
• 60 between 65-74
• 91 between 75-85
• UV exposure 3 xs more prevalent in pilots
• Diabetes
• Trauma
• Genetics
• Medicines

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Prevention

• UV glasses more delay onset
• Vitamin A,C and E
• N-acetylcarnosine can treat cataracts??
• Realistically no true prevention

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Symptoms of cataract

• Individual
• Second sight
• Blurring
• Loss of sight
• Glare
• Daily tasks difficult
• Falls and secondary injuries

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Glare and clarity
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What we do about cataracts?

• Remove only when vision affected or retinal
  problems
• Removal and replacement of cataract lens has been
  mastered
• Results exceptional
• But expectations increased

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Cataracts

• Removal and replacement of vision has been
  mastered
• Results exceptional
• But expectations increased

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Intracapsular and extracapsular surgery

• Intracapsular surgery with Cryoprobe
• Aphakic
• AC lens
• Extracapsular surgery started 1753
• Jacques Daviel long corneal incision
• Von Graefe 1865 small scleral incision
• Intracaps favoured

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Phacoemulsification

• Charles Kelman 1967
• 4 hours and 41 minutes of ultrasound
• Endophthalmitis
• Phacoemulsification took off some 20 years later
• Average time for surgery is 15 mins
• Incision size decreased from 12mm to 3mm and now
  possible through 1.8mm

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Introduction of the IOL

• Operating microscope 1948
• Intraocular lens 1948
• Harold Ridley 1906-2001
• Perspex
• Opposition
• ECCE became favoured procedure

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Current IOL outcomes

• 80 within /- 1 D of desired outcome
• Monofocals
• Why?

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Limitations of current IOL measurements

• No matter how good the system, people will still
  make mistakes. Some reasons include
• people in a hurry
• lack of training or accessible guidelines
• reliance on others
• technical failure (rarely)
• human error (often).
• Some common mistakes (collected from the UK and
  overseas departments)
• wrong A-constant selected
• wrong formula used
• wrong K-readings entered by hand (90 degrees out)
  
• biometry print-out stuck in wrong patients notes
  
• incorrectly labelled IOL
• wrong patient in theatre
• reversed IOL optic
• wrong IOL implanted (25.5 D implanted instead of
  22.5 D or 30 D instead of 3.0 D).
• Some errors of omission include
• no biometry at all

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Complications

• Unusual
• Infection
• Bleeding
• Irritation
• Retinal detachment
• Sight loss

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Presbyopia

• Holy Grail
• An unwelcome reminder of advancing age
• Mechanism unknown

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Signs of Presbyopia

• Loss of ability to read up close
• Difficulty reading in bright light
• Difficulty viewing a computer screen
• Need reading glasses or bifocals
• Holding objects further away to read

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Prelex and Premium lenses

• The hope of premium lenses
• Choosing the right lens for the right patient
• Hypermetropes are desperate to revert to
  spectacle independence

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Prelex and Premium lenses

• The hope of premium lenses
• Choosing the right lens for the right patient
• Hypermetropes are desperate to revert to
  spectacle independence

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AcriLisa

• Acrilisa stated as 90 spectacle Independence
• Only 1 year old
• Yet to be proven

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Crystalens AO
International Registry Always Sometimes Never
Distance 6 13 81
Near 6 34 59
Never for distance or near - - 47
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Restor and Tecnis

• 80 of patients no longer needed glasses or
  contact lenses to see clearly at all distances

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Limitations

• Studies look at spectacle independence
• Image quality limited
• Sharpness reduced
• Haloes and glare
• Decrease vision in dim light

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Light Adjustable Lens

• Only lens adjustable after implantation
• Perfect guaranteed vision can be achieved
• Stable
• Corrects presbyopia and cataract
• This is the next big innovation in Lens surgery
• The Future of Intraocular lenses

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Customisation
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The next Members Health Seminar is on-

• Wednesday 8th September 2010
• 10.30 11.30am
• Education Centre Lecture Theatre
• VISION Mr Phil Graham