spectacle independence after cataract surgery

Dr. Mazhry

Spectacle independence Spectacle independence after Cataract Surgeryafter Cataract Surgery

Dr. Zia-Ul-MazhryFCPS(Pak), FRCS(Edin), FRCS(Glasgow), CIC Ophth- (UK)

Discussion Plan

Dr. Mazhry

Objectives:

Upon successful completion of the activity, participants will be able to: Understand the magnitude of reversible

blindness caused by cataract and ideal time for surgical intervention.

Review the basics of phaco cataract and IOL surgery

Apply information, while advising their peers and family about the latest aphakic visual rehabilitation and spectacle independence after phaco cataract IOL surgery

Dr. Mazhry

THE BASICSPart-1

The Blindness Burden

In Pakistan, according to the Pakistan National Blindness and Impairment survey, the leading causeof blindness in adults more

than 30 years of age is cataract (Table 4). While globally 39.1% of all blindness is

attributable to cataract, in Pakistan the burden of blindness due to cataract is significantly larger at 51.5%. 85.4% of blindness is avoidable in Pakistan.

www.themegallery.com

When Should an Individual Have Cataract Surgery?

Need to get rid of old concept of “A cataract does not have to become "ripe" before it can

be removed” It is time to consider cataract surgery

if an individual has a cataract and resultant blurred vision that makes it difficult to do anything he or she wants and needs to do,.

A cataract should not be removed simply because: it is present. Many people have cataracts that do not

cause blurred vision, interfere with activities of daily living.

Dr. Mazhry

Eye as an optical system

Focusing Lenses Cornea

• Fixed power 43D Lens

• Variable power 10-20D

Axial Length Fixed 22-24mm

The image formation

The image Processing


The Lens and Cataract


Presbyopia

The Astigmatism


THE STORIESPart-2

Dr. Mazhry FRCS, FCPS

21st century IOLs

Cataract Story1500 years BC to 21st Century & Beyond


21st century IOLs

The Story of IOL

Sir Harold Ridley performed first IOL implantation on November 29, 1949.

– long-standing dogma that one "should never put a foreign body into the delicate tissues of the eye“

The Phaco story

Phacoemulsification was first introduced in 1967 1969 “Charlie has produced an

operation which will take all the fun out of cataract surgery.”

1974 “The use of the phaco machine for the removal of a cataractous lens is analogous to the shooting of game birds with guided missiles.”

Evolution of Phaco

The 1960s – The Beginning

The 1970s – Moving Back

The 1980s – The Capsulorrhexis Era

From 1985 to 1995- a “dramatic phaco revolution” The less than 10% of

surgeons using phaco in the early 1980s rocketed to 95% by 1995.

The 2000s – An Era of Alternative Energies and Further Reduction of

Ultrasound EnergyCataract & Refractive Surgery Today

Story of foldable IOLs

.

OCULAR SURGERY NEWS 6/1/2007

Erin L. Boyle

“I longed for a method of IOL insertion

that would not require me to

enlarge the [phaco] wound.”

Thomas R Mosacco MD

The AcrySof Story

علم توحیدی میں ھاتھوں دل لبریز سے عشققدم تھے چومے کے بڑھ نے ہسپانیہ ساحلگئی ہو خلافت قائم آ2خرش میں قرطبہگئی ہو روشن بھی میں یورپ 2سلام ِع: شمتھا معمور قرطبہ سے تہذیب 2ور علمکا نور منب: 2یک لئے کے یورپ تاریکتیرگی چھائی پہ یورپ تھی 2ند2م بر لرزہروشنی گل گئی ہو ہاتھوں کے ہی پاسبانوں

سرور و رقص و نغمہ رباب و طاؤس و چنگفتور کا آ2پس 2ور دوری سے حکموں کے 2للہگو کلمہ سب گئے 2ٹھ سے و2دیوں کی ہسپانیہہو 2للہ صد2ئے آ2ئی پھر نہ تک صدیوں کتنیسو2 کے 2للہ 2یک نہیں غالب بھی کوئیبجا جا کندہ تحریر ہے پہ 2لحمر2ء دیو2رگلہ سے قدرت تیری یا کروں سے ضعیفی 2پنیکا تثلیث کدہ ظلمت میں وسط کے حرم تیرےسجود و جڈب کا 2قبال بہت آ2یا تو یاددرود ویسا ٰووۃ صل ویسی ہو بھی میں قسمت میریجلے دل کا مظہری پہ بربادیوں تیری 2ندلس

ملے موسی و طارق کو ساحdلوں تیرے نہ پھر

2ندلس د2ستان

CHOOSING AN IOL (INTRA OCULAR LENS)

Part-3

Choosing an IOL

Surgeon’ View The Lens

• Material• Design• Cost

The Procedure• Wound Size• Easy, Safe, Quick,

Insertion Post Op

• Visual Outcome• Inflammation• PCO• Dysphotopsia

Patient Factors Motivation Life Style Different Models

and Makes? Cost Cost Cost

Cataract Surgery


Monfocal Lenses


The Ideal Foldable IOL

Smaller Incisions Surgeon friendly implantation

Durable and flexible Compatible delivery system

Centration & Fixation in Capsular Bag Excellent visual out come No Inflammatory response No PCO Spectacle Independence

Foldable IOL Materials

Silicone Acrylic

Hydrophylic(Hydrogel) Hydrophobic

Collamer

Choosing an IOL?

Choosing an IOL-The Material

Silicone Acrylic

Hydrophylic(Hydrogel) Hydrophobic

Collamer

Choosing an IOL-The Insertion Systems

ForcepsInjection SystemsInjection Systems


21st century IOLs

Choosing an IOL-The Insertion Systems

SPECTACLE INDEPENDENCE AFTER CATARACT SURGERY

Part-5

Multifocal Lenses


Lenses WITH CORRECTIONS


WHAT WE DO AT WTHC EYE DEPARTMENT

Part-4

Why to talk and explain the technology to the patients?

It is important because the decision is going to affect the rest of the life of the patent.


Guidelines for Ocular Implants and disposables


The patients are admitted one day before the surgery. The power of the lens is calculated through biometric

measurements. A briefing is already given to the patient about

availability and non reimbursable nature of lens Implants.

Standard Intraocular lens combining quality with economy in accordance with the approximate amount, (patient happily and easily agrees to spend) is prescribed mentioning power model and make.


However no patient is refused surgery or lens implant on the basis that he or she cannot afford to purchase. Such patients are provided implant from mutual Zakat Fund from the staff.

The patients are advised to purchase the implant on their own. They are guided about the nearby places for purchasing according to their choice and convenience.

The patients are advised to arrange required medicine and material. They get it checked by the staff and the patients keep it in their own custody till the time of their surgery.

The patient brings the implant and disposables with him or her to OT on operation day. After surgery and implantation the lens stickers are pasted in the patient record and the lens card with details and sticker pasted on it is also handed over to the patient.

Phacoemulsification Procedure


AcrySof Restore IOL Implantation

What’s Ahead

Preloaded Lenses Multi-focal Lenses Thin Lenses Phakic Lenses Adjustable Lenses Accommodating Lenses Injectable IOLs Toric Lenses Custom Lenses

21st century IOLs

Light Adjustable IOLs

OVERVIEW AND SUMMARYPart-5

Dr. Mazhry

The Whole The Whole PackagePackage

Rapid, Safe, Smooth Two Handed Surgery with time tested lens implant aiming at true

spectacle independence

Dr. Mazhry

Lay sans bhi ahista keh nazuk hai buht kamAfaq ki is kargah – e -shisha gari ka

spectacle independence after cataract surgery

Health & Medicine