A patient education lecture explaining modern catract surgery solutions. Cataract surgery these days not only removes your glasses but can correct other preexisting errors as well. Toric and multifocal IOLs have opened new windows for visual rehabilitation after cataract surgery.

1. Dr. Mazhry
Spectacle independenceSpectacle independence
after Cataract Surgeryafter Cataract Surgery
Dr. Zia-Ul-Mazhry
FCPS(Pak), FRCS(Edin), FRCS(Glasgow), CIC Ophth- (UK)

2. Discussion Plan
Dr. Mazhry

3. 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

4. THE BASICS
Part-1

5. 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.
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6. 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

7. Eye as an optical system
 Focusing Lenses
 Cornea
• Fixed power 43D
 Lens
• Variable power 10-20D
 Axial Length
 Fixed 22-24mm

8. The image formation

9. The image Processing
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10. The Lens and Cataract
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11. Presbyopia

12. The Astigmatism
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13. www.themegallery.com

14. THE STORIES
Part-2

15. Dr. Mazhry
21st
century IOLs
Cataract Story
1500 years BC to 21st
Century & Beyond

16. Dr. Mazhry
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“

17. 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.”

18. 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 Energy Cataract & Refractive Surgery Today

19. 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

20. The AcrySof Story

21. ‫علم‬ ‫توحیدی‬ ‫میں‬ ‫ھاتھوں‬ ‫دل‬ ‫لبریز‬ ‫سے‬ ‫عشق‬
‫قدم‬ ‫تھے‬ ‫چومے‬ ‫کے‬ ‫بڑھ‬ ‫نے‬ ‫ہسپانیہ‬ ‫ساحل‬
‫گئی‬ ‫ہو‬ ‫خلفت‬ ‫قائم‬ ‫آخرش‬ ‫میں‬ ‫قرطبہ‬
‫گئی‬ ‫ہو‬ ‫روشن‬ ‫بھی‬ ‫میں‬ ‫یورپ‬ ‫اسلم‬ ‫ع‬ِ ‫شم‬
‫تھا‬ ‫معمور‬ ‫قرطبہ‬ ‫سے‬ ‫تہذیب‬ ‫اور‬ ‫علم‬
‫کا‬ ‫نور‬ ‫منبع‬ ‫ایک‬ ‫لئے‬ ‫کے‬ ‫یورپ‬ ‫تاریک‬
‫تیرگی‬ ‫چھائی‬ ‫پہ‬ ‫یورپ‬ ‫تھی‬ ‫اندام‬ ‫بر‬ ‫لرزہ‬
‫روشنی‬ ‫گل‬ ‫گئی‬ ‫ہو‬ ‫ہاتھوں‬ ‫کے‬ ‫ہی‬ ‫پاسبانوں‬
‫سرور‬ ‫و‬ ‫رقص‬ ‫و‬ ‫نغمہ‬ ‫رباب‬ ‫و‬ ‫طاؤس‬ ‫و‬ ‫چنگ‬
‫فتور‬ ‫کا‬ ‫آپس‬ ‫اور‬ ‫دوری‬ ‫سے‬ ‫حکموں‬ ‫کے‬ ‫اللہ‬
‫گو‬ ‫کلمہ‬ ‫سب‬ ‫گئے‬ ‫اٹھ‬ ‫سے‬ ‫وادیوں‬ ‫کی‬ ‫ہسپانیہ‬
‫ہو‬ ‫اللہ‬ ‫صدائے‬ ‫آئی‬ ‫پھر‬ ‫نہ‬ ‫تک‬ ‫صدیوں‬ ‫کتنی‬
‫سوا‬ ‫کے‬ ‫اللہ‬ ‫ایک‬ ‫نہیں‬ ‫غالب‬ ‫بھی‬ ‫کوئی‬
‫بجا‬ ‫جا‬ ‫کندہ‬ ‫تحریر‬ ‫ہے‬ ‫پہ‬ ‫الحمراء‬ ‫دیوار‬
‫گلہ‬ ‫سے‬ ‫قدرت‬ ‫تیری‬ ‫یا‬ ‫کروں‬ ‫سے‬ ‫ضعیفی‬ ‫اپنی‬
‫کا‬ ‫تثلیث‬ ‫کدہ‬ ‫ظلمت‬ ‫میں‬ ‫وسط‬ ‫کے‬ ‫حرم‬ ‫تیرے‬
‫سجود‬ ‫و‬ ‫جڈب‬ ‫کا‬ ‫اقبال‬ ‫بہت‬ ‫آیا‬ ‫تو‬ ‫یاد‬
‫درود‬ ‫ویسا‬ ‫وۃ‬ٰ ‫صل‬ ‫ویسی‬ ‫ہو‬ ‫بھی‬ ‫میں‬ ‫قسمت‬ ‫میری‬
‫جلے‬ ‫دل‬ ‫کا‬ ‫مظہری‬ ‫پہ‬ ‫بربادیوں‬ ‫تیری‬ ‫اندلس‬
‫ملے‬ ‫موسی‬ ‫و‬ ‫طارق‬ ‫کو‬ ‫ساحلوں‬ ‫تیرے‬ ‫نہ‬ ‫پھر‬
‫اندلس‬ ‫داستان‬

22. CHOOSING AN IOL
(INTRA OCULAR LENS)
Part-3

23. 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

24. Cataract Surgery
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25. Monfocal Lenses
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26. 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

27. Foldable IOL Materials
 Silicone
 Acrylic
 Hydrophylic(Hydrogel)
 Hydrophobic
 Collamer

28. Choosing an IOL?

29. Choosing an IOL-The Material
 Silicone
 Acrylic
 Hydrophylic(Hydrogel)
 Hydrophobic
 Collamer

30. Choosing an IOL-
The Insertion Systems
 Forceps
Injection SystemsInjection Systems

31. Dr. Mazhry
21st
century IOLs
Choosing an IOL-
The Insertion Systems

32. SPECTACLE INDEPENDENCE
AFTER CATARACT SURGERY
Part-5

33. Multifocal Lenses
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34. Lenses WITH CORRECTIONS
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35. WHAT WE DO AT WTHC EYE
DEPARTMENT
Part-4

36. 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.
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37. Guidelines for Ocular Implants
and disposables
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• 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.

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• 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.

39. Phacoemulsification Procedure
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40. AcrySof Restore IOL
Implantation

41. What’s Ahead
 Preloaded Lenses
 Multi-focal Lenses
 Thin Lenses
 Phakic Lenses
 Adjustable Lenses
 Accommodating Lenses
 Injectable IOLs
 Toric Lenses
 Custom Lenses

42. 21st
century IOLs
Light Adjustable IOLs

43. OVERVIEW AND SUMMARY
Part-5

44. Dr. Mazhry
The Whole PackageThe Whole Package
Rapid, Safe, Smooth Two Handed Surgery
with time tested lens implant aiming at true
spectacle independence

46. Dr. Mazhry
Lay sans bhi ahista keh nazuk hai buht kam
Afaq ki is kargah – e -shisha gari ka