Cataracts and Cataract Cataracts and Cataract SurgerySurgery
Surendra Basti, MDSurendra Basti, MD
LASIK, Cataract & Cornea SurgeonLASIK, Cataract & Cornea Surgeon Associate Professor of OphthalmologyAssociate Professor of Ophthalmology
Northwestern University Feinberg School of Northwestern University Feinberg School of Medicine, Chicago, ILMedicine, Chicago, IL
Email: [email protected]: [email protected]
What is a Cataract ?What is a Cataract ?
Definition:Definition: Degradation of the Degradation of the optical quality of the optical quality of the crystalline lens through loss crystalline lens through loss of clarity or change in color of clarity or change in color
Discoloration or opacification Discoloration or opacification of the human lensof the human lens
The LensThe Lens
All light going into the eye needs All light going into the eye needs to pass through lensto pass through lens
Important role in focusing of light. Important role in focusing of light.
Change in color or clarity of lens Change in color or clarity of lens changes light focusing and hence changes light focusing and hence affects vision clarityaffects vision clarity
Cataract – Age of Cataract – Age of OnsetOnset
Age related (senile)Age related (senile) – most common – most common
Cataracts in young adultsCataracts in young adults – inherited, – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery
Cataracts in childrenCataracts in children – metabolic, – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited
Age Related Cataract – Age Related Cataract – Causative FactorsCausative Factors
AgeAge
DiabetesDiabetes
Environmental: UV-B light, Environmental: UV-B light, smokingsmoking
Cataract – Age of Cataract – Age of OnsetOnset
Age related (senile) – most commonAge related (senile) – most common
Cataracts in childrenCataracts in children – metabolic, – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited
Cataracts in young adults – inherited, Cataracts in young adults – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery
Uveitic CataractUveitic Cataract Photos of chelationPhotos of chelation
Cataract in Juvenile Rheumatoid Arthritis
Cataract – Age of Cataract – Age of OnsetOnset
Age related (senile) – most commonAge related (senile) – most common
Cataracts in children – metabolic, Cataracts in children – metabolic, anatomic abnormalities, inheritedanatomic abnormalities, inherited
Cataracts in young adultsCataracts in young adults – inherited, – inherited, secondary to trauma, electric shock, secondary to trauma, electric shock, radiation, diabetes, medication-radiation, diabetes, medication-related, myopia, chronic eye disease related, myopia, chronic eye disease or surgeryor surgery
Cataract – Causative Cataract – Causative FactorsFactors
Medication relatedMedication related: inhaled or : inhaled or oral oral
steroid intake, phenothiazinessteroid intake, phenothiazines
Cataract – Causative Cataract – Causative FactorsFactors
Systemic disease –Systemic disease –myotonic myotonic dystrophy, dystrophy, WilsonWilson’’s disease, s disease, Atopic dermatitis, Atopic dermatitis, diabetes, diabetes, neurofibromatosineurofibromatosiss
Cataract and DiabetesCataract and Diabetes
Two patterns of cataract formationTwo patterns of cataract formation
Most common is cataract formation Most common is cataract formation that is of insidious onset (late 50s)that is of insidious onset (late 50s)
Less frequently, uncontrolled Less frequently, uncontrolled diabetes causes acute onset of diabetes causes acute onset of cataractcataract
Cataract – Can it be Cataract – Can it be Prevented or Slowed ?Prevented or Slowed ?
No definitive proof that intake of No definitive proof that intake of vitamins or nutrients or vitamins or nutrients or ‘‘catalinacatalina’’ eyedrops decrease incidence of eyedrops decrease incidence of cataractcataract
Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications
Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications
Nuclear Cataract - Nuclear Cataract -
Posterior Subcapsular CataractPosterior Subcapsular Cataract
CorticalCortical
Anatomic Types of Anatomic Types of CataractCataract
Nuclear Cataract - Nuclear Cataract -
Posterior Subcapsular CataractPosterior Subcapsular Cataract
CorticalCortical
Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications
Nuclear CataractNuclear Cataract - -
Change in vision clarity andChange in vision clarity and
eyeglass prescription for distanceeyeglass prescription for distance
Anatomic Types of Anatomic Types of CataractCataract
Nuclear CataractNuclear Cataract
Posterior Subcapsular CataractPosterior Subcapsular Cataract
CorticalCortical
Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications
Posterior Subcapsular CataractPosterior Subcapsular Cataract
Decreased vision especially in Decreased vision especially in
Bright light, glareBright light, glare
Anatomic Types of Anatomic Types of CataractCataract
Nuclear Cataract - Nuclear Cataract -
Posterior Subcapsular CataractPosterior Subcapsular Cataract
CorticalCortical
Anatomic Types of Anatomic Types of Cataract & Their Visual Cataract & Their Visual ImplicationsImplications
Cortical CataractCortical Cataract – –
minimally affects clarity minimally affects clarity
of vision unless advanced.of vision unless advanced.
Common symptom is Common symptom is
glareglare
Treatment StrategiesTreatment Strategies
When cataract mild, a change in When cataract mild, a change in eyeglasses helps visioneyeglasses helps vision
In patients with more advanced In patients with more advanced cataracts or in patients with cataracts or in patients with glare, surgical treatment is glare, surgical treatment is indicatedindicated
Cataract SurgeryCataract Surgery
Most commonly performed eye surgeryMost commonly performed eye surgery
Among most successful surgeries that Among most successful surgeries that can be performed on the human body. can be performed on the human body. Not a procedure without risk.Not a procedure without risk.
Topical Anesthesia, out-patient Topical Anesthesia, out-patient procedureprocedure
Cataract SurgeryCataract Surgery
Steps – remove cataract and place Steps – remove cataract and place an artificial lens in place of it. an artificial lens in place of it.
Cataract SurgeryCataract Surgery
Steps – remove cataract and place Steps – remove cataract and place an artificial lens in place of it. an artificial lens in place of it.
Cataract Surgery – Cataract Surgery – Postop. PeriodPostop. Period
Topical steroid eyedrops for 4 weeksTopical steroid eyedrops for 4 weeks
Topical antibiotic for a weekTopical antibiotic for a week
Eyeglass check in 4 weeksEyeglass check in 4 weeks
Thereafter, yearly follow-upThereafter, yearly follow-up
Recent Advances in Recent Advances in Cataract SurgeryCataract Surgery Cataract Surgery may be looked upon Cataract Surgery may be looked upon
as an opportunity to give patients as an opportunity to give patients freedom from eyeglassesfreedom from eyeglasses
This is possible with the use of newer This is possible with the use of newer IOLs that focus light at most distancesIOLs that focus light at most distances
(these lenses are (these lenses are multifocalmultifocal as as opposed to previous lenses which are opposed to previous lenses which are monofocalmonofocal))
Recent Advances in Recent Advances in Cataract SurgeryCataract Surgery New IOLs have an out-of-pocket cost New IOLs have an out-of-pocket cost
similar to LASIK surgerysimilar to LASIK surgery
Considerable freedom from eyeglasses Considerable freedom from eyeglasses possible with these IOLspossible with these IOLs
Some surgeons/patients extend the Some surgeons/patients extend the above to patients who donabove to patients who don’’t have a t have a cataract but want freedom from reading cataract but want freedom from reading glasses (Refractive Lens Exchange)glasses (Refractive Lens Exchange)
Cataract Surgery and Cataract Surgery and AlphablockersAlphablockers
Alpha blockers cause pupil to behave Alpha blockers cause pupil to behave unpredictably (does not dilate, floppy unpredictably (does not dilate, floppy iris) during surgeryiris) during surgery
Selective blockers (tamulosin, Rapaflo)Selective blockers (tamulosin, Rapaflo) have a more profound effecthave a more profound effect
5 alpha reductase inhibitors (avodart, 5 alpha reductase inhibitors (avodart, proscar) do not affect the pupilproscar) do not affect the pupil
Cataract Surgery and Cataract Surgery and AlphablockersAlphablockers
Instruct patients to intimate their Instruct patients to intimate their eye doctor if they are having eye doctor if they are having cataract surgerycataract surgery
Stopping alphablockers prior to Stopping alphablockers prior to surgery does not prevent IFISsurgery does not prevent IFIS
Dose or duration of use do not Dose or duration of use do not have a significant effect of IFIShave a significant effect of IFIS
Cataract - SummaryCataract - Summary
Cataract is a major cause for Cataract is a major cause for treatable vision deficittreatable vision deficit
Acute onset of cataract usually Acute onset of cataract usually not age related – diabetes, not age related – diabetes, trauma possible causestrauma possible causes
Cataract - SummaryCataract - Summary
Cataract Surgery only when Cataract Surgery only when patient bothered by existing patient bothered by existing visionvision
Cataract surgery among most Cataract surgery among most successful surgical procedures successful surgical procedures but is not without riskbut is not without risk
Cataract - SummaryCataract - Summary
Cataract surgery is an outpatient Cataract surgery is an outpatient procedure done using local procedure done using local anesthesia and involves removal anesthesia and involves removal of cataract with Ultrasound and of cataract with Ultrasound and placement of IOLplacement of IOL
For patients desiring freedom For patients desiring freedom from eyeglasses, options of new from eyeglasses, options of new IOLs availableIOLs available
FREQUENCYFREQUENCYFREQUENCYFREQUENCY
Frequency
WHAT IS IT?•How fast the phaco needle moves back and forth
WHAT IS THE FREQUENCY RANGE?•The frequency of ultrasonic handpieces is between 27,000 and 60,000 times per second
ASPIRATION FLOW RATEASPIRATION FLOW RATEASPIRATION FLOW RATEASPIRATION FLOW RATE
It is the primary force that attracts It is the primary force that attracts material to the phaco tipmaterial to the phaco tip
• It determines how fast material is drawn to the phaco tip
High Flow
Low Flow